Charting Pediatrics

As a continuation of our discussion of congenital heart disease from Season 2, Episode 21, we are going to look at the primary care provider's ongoing role caring for these patients; signs and symptoms of undiagnosed patients and how to support adolescent patients transitioning to adult care.

Today's guest is Joe Kay, MD. Dr. Kay is Program Director of the joint Adult Congenital Heart Disease Program at the University of Colorado Hospital and Children's Hospital Colorado, and Associate Professor of both Pediatrics and Medicine at University of Colorado School of Medicine.

We love hearing from our listeners! Reach out and tell us what you would like to hear in a future episode.

How many concussions are too many for a young athlete? When should sport retirement be considered?

In today's episode we are going to look at the case of a high school athlete as the basis for exploring these questions with Julie Wilson, MD. Dr. Wilson is Co-Director of the Concussion Program at Children's Hospital Colorado and Assistant Professor at the University of Colorado School of Medicine.

Tell us what you thought about today's episode.

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The practice of pediatric pain management has developed significantly in the last decade with the use and validation of pain assessment tools specific to pediatric patients, yielding evidence-based pain management guidelines in children of all ages.

Still, pharmacological intervention options coupled with practicing safe prescribing can be overwhelming in the primary care setting. In today's episode we are joined by Tom Majcher, DO, to discuss a practical approach to outpatient pain management in pediatrics and the prevalence of conditions associated with acute and chronic pain.

Dr. Majcher is Chair of Anesthesiology at Children's Hospital Colorado and Professor of Anesthesiology at the University of Colorado School of Medicine.

A real public health problem has snuck up on us as pediatricians - vaping and e-cigarettes use. On today's episode, we will unpack the facts about e-cigarettes and vaping, provide you with practical tools to counsel your patients and families and talk about upcoming advocacy and policy work pertaining to e-cigarettes. Our guests today are Jennifer Woods, MD, Medical Director of the Adolescent Medicine Clinic at Children's Hospital Colorado and associate professor of pediatrics at the University of Colorado School of Medicine; and Heather Hoch, MD pediatric pulmonologist at Children's Hospital Colorado and assistant professor the CU School of Medicine.

From today's episode:

• The 2018 NIH Monitoring the Future Survey Results were released last month. The survey found that 37% of 12th graders and 18% of 8th graders have vaped in the last year and the number of kids who used vaping products in the last month jumped from 11 to 21% in 12th graders and from 9 to 16% in 10th graders — those changes are the biggest jumps in adolescent substance use that has been seen in the 4 decades of conducting the Monitoring the Future Survey.
• From the AAP: 5 Facts to talk to Teens about Vaping
• The FDA held a public hearing on January 18, 2019 to discuss efforts to eliminate youth e-cigarette use, with a focus on the potential role of drug therapies to support cessation and the issues impacting the development of such therapies. If this is a topic you are passionate about, we encourage our listeners to visit the FDA website to submit a public comment, those public comment submissions will be available through February 1, 2019 https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/ucm456610.htm)
• Pediatricians Push for Laws to Prevent Teen Vaping
• Colorado Bill Introduced to Combat Skyrocketing Youth E-Cigarette Use, Clean Indoor Air Act, House Bill 19-1076

Feedback on this episode or suggestions for a future topic? Write to us at [email protected] - we love hearing from our listeners!

Integrative health care describes the blending of complementary and conventional therapies by practitioners to include all appropriate therapies in a patient-centered and evidence-based fashion.

Today we will offer up some practical tips about how you can incorporate an integrative approach to your care of kids and adolescents with Rachel Workman, MD. Dr. Workman runs the Integrative Medicine Clinic at Children's Hospital Colorado and is Assistant Professor of Pediatrics at the University of Colorado School of Medicine.

Resources mentioned in this episode:

• Nourish Your Tribe by Nicole Magryta, MBA, RDN
• Finally Focused by James Greenblatt, MD
• FoundMyFitness Podcast with Rhonda Patrick, PhD
• The Tim Ferriss Show
• Health for the Whole Child: An Integrative Approach CME Conference, October 30, 2019 in Aurora, CO (CME Credit)

In this episode we discuss how to respond to abnormal results of the newborn Critical Congenital Heart Disease (CCHD) screening with Chris Rausch, MD. Dr. Rausch is the Director of the Cardiopulmonary Exercise Laboratory at Children's Hospital Colorado and Associate Professor of Pediatric Cardiology at the University of Colorado School of Medicine.

In this Episode:

• Why Critical Congenital Heart Disease (CCHD) requires attention from pediatric provider
• Reasons why CCHD can be missed in prenatal screenings
• CCHD screening protocols and toolkits for nurseries
• The recommended screening window for newborns
• How to ensure that newborns get the appropriate evaluations
• Understanding the effect of elevation on CCHD screening results
• The false-positive rate of CCHD screenings
• Improvement in outcome rates for newborns with CCHD
• Occurrences when screenings will be performed by the primary care physician

Today we discuss pediatric trigger thumb (also know as Trigger Finger, Flexor Tenosynovitis, or Stenosing Tenosynovitis) with Sarah Sibbel, MD. Dr. Sibbel is the Director of the Pediatric Hand and Upper Extremity Program and Surgical Director of the Brachial Plexus Center at Children's Hospital Colorado and Assistant Professor of Orthopedics at the University of Colorado School of Medicine.

In this episode:

• Defining pediatric trigger thumb and the path of physiology
• Hypothesis of why trigger thumb occurs in children and adults
• Diagnosing trigger thumb in primary care
• Helpful imaging to obtain
• Operative and non-operative treatment plans and their associated risks
• The success rate of surgery as a treatment
• Time optimal period between observation and surgery for trigger thumb
• How trigger thumb impacts a child's day-to-day life
• Role for non-steroidal anti-inflammatory agents in trigger thumb treatment
• Follow-up plans for the outpatient setting

Happy holidays to you, our Charting Pediatrics listeners. Whether the snow is falling where you are, or your palm trees are wrapped in lights, we hope you will be enjoying these next couple of weeks with family and friends. In this season of celebration and reflection, we wanted to say thank you to you, our Charting Pediatrics listeners. Each week we get the opportunity to interview our pediatric colleagues to bring you meaningful educational content, and we have the best time doing this. Indeed, when we do each of these podcasts, it's the very best part of our day. It's truly humbling to know that there are more than 10,000 of you tuning in each month as part of our amazing Charting Pediatrics community. Like you, we will be taking the next couple of weeks off for friends and family. But don't worry! The show will return on January 8th with new and exciting content that you won't want to miss. Thank you for sharing a piece of your week with us. So until next time, keep on keeping kids safe out there and Happy Holidays!

On this episode we discuss the diagnosis and management of ovarian cysts and torsion risk with Patricia Huguelet, MD. Dr. Huguelet is the Section Chief of Pediatric and Adolescent Gynecology at Children's Hospital Colorado and Associate Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine.

In this episode:

• Most common presentations/symptoms of ovarian cysts reported to a primary care provider.
• Why many ovarian cysts can be asymptomatic.
• Differentiating between other abdominal pain versus ovarian cyst pain.
• Determining whether ovarian cysts are benign or malignant.
• The differences in symptoms and pain in benign versus malignant cysts.
• Three mechanisms of ovarian pain: ischemia from torsion, acute rupture and hemorrhage, rapid capsular stretch.
• The optimal modality for ovarian cyst imaging diagnosis.
• Symptoms and pain that would lead more towards ovarian torsion diagnosis.
• When ovarian torsion might occur without the presence of a cyst or mass.
• Why it is always better to preserve the ovary after torsion; resilience of function.
• The fertility outlook for women who have had ovarian torsion.
• Best treatment course for a hemorrhagic cyst; preserving fertility.
• Laboratory tests to consider when diagnosing ovarian cysts/torsion.
• Outpatient followup care for patients after treatment/diagnosis for ovarian cysts or torsion.
• Likelihood of recurrence of ovarian cysts and risk for torsion.
• The role of non-steroidal use in ovarian cyst pain control.

In this episode, we discuss abnormal pediatric head growth, shape and treatment options with Todd Hankinson, MD. Dr. Hankinson is a Pediatric Neurosurgeon at Children's Hospital Colorado and Associate Professor of Neurosurgery at the University of Colorado School of Medicine.