Pediatric Meltdown

https://302.buzz/PM-WhatAreYourThoughts

Dr. Cullinan is back to finish up this 4-part series on ADHD. There is an enormous amount of practical information and parenting tips in these 4 episodes. If you haven’t yet, be sure to pull up parts 1, 2 and 3.  Here is some data from ADDA (American Deficit Disorder Association 

WHAT IS ADHD?

  Attention deficit hyperactivity disorder (ADHD) is a Neurodevelopmental disorder. It is one of the most common disorders of this kind diagnosed in children. ADHD often carries over into adulthood.

ADHD is a highly genetic, brain-based syndrome that has to do with the regulation of a particular set of brain functions and related behaviors.

These brain operations are collectively referred to as “executive functioning skills” and include important functions such as attention, concentration, memory, motivation and effort, learning from mistakes, impulsivity, hyperactivity, organization, and social skills. There are various contributing factors that play a role in these challenges including chemical and structural differences in the brain as well as genetics.

[00:33 -10:10] Finding an Effective Consequences

• Logical Consequences Connected to Behavior
• Explaining why an emotional lecture is ineffective 
• Kids and Manipulation
• The complexity and sophistication of manipulation

[10:11-16:55] The role of parents in developmental milestones 

• Effectiveness of “Emotion Coaching” on Child Development
• Necessary techniques/ practices for emotion coaching & emotion labeling 
• Definition of TLC (Task Limit Consequences)
• Developmentally Matched Way to Communicate with Child

[16:56 - 30:40]  Benefits of Reward Systems for Families

• Improved Behavior & Increased Self-Discipline
• Enhanced Motivation & Productivity Levels 
• Strengthened Parent/Child Relationship
• Implementing the Raffle ticket strategy

[30:41-41:50]  Leveraging strengths instead of consequence-based discipline strategies 

• Offering Choice and Freedom in Learning Processes
• Acknowledging We Are a Team Working Toward Same Goals
• Building People Up to Improve Executive Functioning Skills
• Activities such as puzzles, art projects, reading can motivate kids to want to work on executive functioning skills 

[41:51 - 46:53]  Closing segment Takeaways

You can reach Dr. Colleen C. Cullinan

Twitter:  @ColleenCullinan

Links to resources mentioned on the show

 Dr. Ross Green                                                                                                                                                    Dr. Ross Greene (drrossgreene.com) 

Other episodes you may like:

**Episode #88

ADHD: Strategies for Boosting Executive Function Pt I

https://302.buzz/PM-WhatAreYourThoughts

Dr. Colleen Cullinan is back for part III, diving deeper into Executive Function. This series not only takes a look at the condition from the child’s point of view, but also the parents. Dr. Gaggino asks the questions that many have thought but few have asked.  If you’re a parent of a child with ADHD, this is especially for you. Dr. Cullinan knows you. She hears you. And she gives a voice to those that have been on the sidelines. Pro Tip: listen to this with a pen and paper nearby. You’ll want to refer back to your notes often on this one.  

[00:33 -12:42] Opening Segment

• We’re introduced to Dr. Colleen Cullinan and continue with part 3 (of a 4 part) series
• Picking up where we left off in episode 109 on “Executive Function”  
• How adults and children differ in terms of Executive Function
• The definition of “Working Memory”
• Driving a car in terms of Executive Functions
• Data on ADHD and car accidents

[12:46- 19:54]  Hindsight, Foresight and ADHD  

• Hindsight: working memory and time
• Foresight: Anticipating potential outcomes in the future
• Running through scenarios and consequences 
• Internal dialogue as a tool to insights and behavior

[19:55 -23:57]  How to Find What’s Motivating For Kids

• Communicating with the ADHD kid on their level, both developmentally and morally
• Motivations are centered around “winning” or “losing”   
• Understanding right versus wrong
• How to deal with temper tantrums in this stage 

[23:58-46:13]  Understanding the Stages of Developmental Empathy in Kids 

• Stage One – Lack of Empathy or Egocentrism
• Stage Two – Beginning Stages of Understanding Others’ Perspectives
• Stage Three – Moral Reasoning & Perspective Taking (capable of true empathy
• Understanding that kids are capable of true empathy, they just need time and experience with it 

[46:14 - 51:33]  Closing segment Takeaways

You can reach Dr. Colleen C. Cullinan

Twitter:  @ColleenCullinan

Links to resources mentioned on the show

Other episodes in the series:

Episode #88 

ADHD: Strategies for Boosting Executive Function Pt I

https://302.buzz/88ADHD-Boosting Executive Function

Episode #109 

ADHD: Executive Functions Pt II

https://302.buzz/109ADHDpt2

Key quotes for Twitter:

“Kids who meet criteria for ADHD tend to be about 2-3 years delayed compared to their same age peers. And I think this is particularly true with working memory and working memory is really a tricky executive function”..  Colleen Cullinan

“There is a lot of data that suggests that folks who meet criteria for ADHD are in more car accidents and have more moving violations and tickets… colleen Cullinan

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed as a Top 20 Pediatric...

https://302.buzz/PM-WhatAreYourThoughts

Dr. Lia Gaggino talks to Dr. Herschel Lessin on how physicians can  juggle their ADHD patients, parents, practice. 

 Here are some facts on ADHD (Attention deficit hyperactivity disorder):

-There's more than one type of ADHD

-ADHD is genetic.

-There is no cure for ADHD, but medication and therapy can control symptoms

-ADHD often persists into adulthood

-People with ADHD may be protected by the Americans with Disabilities Act

 “ADHD is a chronic condition of the brain that makes it difficult for children to control their behavior. 

According to national data, AKHD affects about 9.4% of U.S. children ages 2-17 including 2.4% of children ages 2-5 and 4%-12% of school-aged children…”  American Academy of Pediatrics ADHD | All AAP | AAP

[00:33 -8:20] Opening Segment

• Dr. Gaggino introduces us to Dr. Herschel Lessin
• What drives Dr. Lessin’s passion to be a pediatrician?  
• How his personal experience inspired him to learn more about ADHD
• If managed properly, ADHD has to potential of being a “Superpower”

[8:21- 16:21]  Current Pharmaceutical Development for ADHD Treatment  

• Issues with current drug availability
• Potential solutions moving forward
• Problem Regarding Pediatricians Comfort with Treating ADHD
• Barriers to Treating ADHD

[16:22 -32:47]  The economics behind drug pricing and formulary change

• How this affects health care providers and patients
• Challenges posed by mid-year formulary changes 
• Disruption to patient treatment plans
• Difficulty in switching between medications
• National Shortages of Short Acting Medication

[32:48 -59:32] Making a List from the ADHD Toolkit

• Learning How to Code for all Service
• Documenting Your Thinking 
• How to Set Up a Practice for ADHD Kid
•  The importance of documentation and avoiding being audited

[59:33 - 1:07:23]  Closing segment Takeaway

 Links to resources mentioned on the show

 AAP

ADHD toolkit - 

https://302.buzz/AAP-ADHDToolKit

ADHD Clinical Practice Guideline -

https://302.buzz/ClinicalPracticeGuideline

AAP publication “Congrats You’re Having a Teen!” 

https://shop.aap.org/congrats-youre-having-a-teen-paperback/

REACH Institute - 

https://thereachinstitute.org/Ma

Massachusetts General Child and Adolescent Psychopharmacology 2023 course - 

https://302.buzz/mgcaPsycPharma

AACAP - ADHD Facts for Families - 

https://302.buzz/AACAP-ADHD

NEI Global -

https://302.buzz/PM-WhatAreYourThoughts

Dr. Susan Walley was born to work with kids. She was hooked from the beginning. Recognizing that repertory issues are the #1 cause of hospitalization and realizing that parents don’t realize the impact on their own kids, gave her the inspiration to dive into the work of tobacco/nicotine/vaping addiction. Dr. Lia Gaggino asks the questions that you’ve been wondering about. But first, let’s look at some stats:

Results from the Annual National Youth Tobacco Survey (22 findings)

Almost 1 Million Youths use 2 or more tobacco products

E-Cigarettes are the most commonly used tobacco products

About 1 Million youths use any combustible tobacco products

• 11.3% (3.08 million) middle & high school students reported current use (past 30 days) of any tobacco product 
• Approximately 3.7% (1.00 million) of all students reported currently smoking any combustible tobacco product
• 3.5% (960,000) reported current use of multiple (≥2) tobacco products 

[00:32 -14:38] Opening Segment

• Dr. Gaggino introduces us to Dr. Susan Chu Walley
• Dr. Walley was born to take care of kids
• Just how dangerous is second-hand smoke?
• Vaping is a Youth epidemic
• The tobacco companies are taking advantage of a loop hole in the law in order to market to kids 

[14:39 - 27:07]  The Teen brain is more sensitive to nicotine   

• Tobacco/Nicotine can cause irreversible brain cell damage and long term behavioral damage.  
• Usually, the gateway to future drug use
• Data is still developing regarding vaping because it’s only been around for a fairly short time
• There are currently around 15,000 vape flavorings 

[27:08 -50:54] Messaging:  What Works? 

• It’s difficult for clinicians to give their recommendations without sounding judgmental
• Motivational interviewing and offering help in quitting is shown to be accepted
• The money is being spent in advertising vs education of the dangers of tobacco/nicotine/E-cigarettes

[50:55 - 58:11]  Closing segment Takeaway

You can reach Dr. Susan Walley

Linkedin:  Susan Walley, MD, MHCM, NCTTP, FAAP | LinkedIn

Resources:

Other episodes you may like:

Episode #20 Talking to Teens about Sex, Drugs & Rock n Roll

https://302.buzz/E20-Teen

Episode #5 Substance Use Disorders and Childhood Exposures

https://302.buzz/E05-SubstanceUseDisorders

Mentioned in the Episode

EVALI stands for E-cigarette or Vaping use-Associated Lung Injury

ACT stands for  Ask / Council / Treat

Resources:

1. MMWR Tobacco Product Use in US Middle and High School Students 11.11.2022.

https://302.buzz/PM-WhatAreYourThoughts

Who will heal the healers? Managing physician burnout is a tall order. And yet when both Dr. Tyra Fainstad and Dr. Adrienne Mann found themselves going through difficult life-chapters, they saw a need in the system that had not been addressed.  Their program, Better Together, is for the medical community that may feel isolated or may feel like there’s no outlet. Even though there are definite differences between a Coach and a Physician, when listening to the doctors speak about their program,  it seems so logical that the two would work hand in hand with one another. If you’re dealing with burnout or know someone who is, you’ll want to take a listen. 

[00:30 -23:04] Opening Segment

• Dr. Gaggino introduces us to  Dr.Tyra Fainstad and Dr. Adrienne Mann
• We learn about their journey into medicine and being a life coach.
• They found that burnout was their common thread.
• The difference between Coaching and Therapy

 [23:05 - 30:54]  How a “Cute Little Study” grew into the “Better Together” program? 

• Web based program with 3 ways of participation; (Zoom, write in on the website and weekly modules)
• When they first started, 100 people signed up and that told them how much it was needed.
• Although many didn’t do the work, they actually listened and benefited from the recorded Zooms 

[30:55 -56:28] The 3 “Better Together” factors

• Emotional Exhaustion, Depersonalization, Personal Ethikasy (Accomplishment) 
• Burnout is 2-10 times higher in women vs men
• Should a program like this be required for interns?

[56:29 59:35] What would you tell your “Intern-self”

• If you knew then what you know now… would you have even been ready to hear it? 
• Are you grateful for your anxiety?
• “There’s No Right Way”

[59:36 - 1:04:08]  Closing segment Takeaway

 You can reach Dr. Tyra Fainstad

Facebook:  Tyra Fainstad | Facebook

Instagram: @tyraindenver

Twitter:  @TyraFainstadMD

You can reach Dr. Adrienne Mann

Instagram: @amw1983

Twitter:  @AMannimalMD

Resources:

Better Together website

www.bettertogetherphysiciancoaching.com

Life Coach School

https://www.lifecoachschool.com

Book mentioned:

“Lessons in Chemistry” by Betty Garmus

Amazon.com : lessons in chemistry

Other episodes you may like:

Episode #108 Physician Moral Injury; Healing the Healer 

https://302.buzz/PM-WhatAreYourThoughts

Eating the right foods, getting enough rest, participating in some activity... We’ve all heard that so many times, we can’t even count. However, when Dr. Lenz says it… he backs it up with evidence. Listen in while Dr. Michael Lenz makes the connection of what’s really going on in a patient that is suffering from chronic pain.  It all sounds so logical when Dr. Lenz talks about the Food-Mind-Body connection. Dr. Gaggino and Dr. Lenz talk about how the brain processes pain and offer some answers that you may not have thought about.  If you suffer from chronic pain, fibromyalgia, etc., you’ll want to listen with a pen and pad nearby.

 [00:33 -16:29] Opening Segment

• We hear about Dr. Lenz journey into the medical profession
• How his love of sports relates to his chronic pain practice
• When all those around them are in disbelief, just validating a patient's pain is half the battle
• Are “Growing Pains” real??? Maybe it’s something else… Dr. Lenz digs deeper to find the actual answer

[16:30- 29:20]  The Pain Continuum   

• How the brain processes pain
• Some physicians are not connecting the symptoms; don’t ask the right questions
• 40% of children that have Crohn's disease also have IBS 
• The importance of Food-Mind-Body relationship

[29:21 -39:32]  Connecting the dots

• Offering validation, hope, and trust….however, maybe medication is not your first “go-to” 
• The hypervigilant brain
• Dr. Lenz’s evidence based approach
• People who are on the Central Pain Spectrum need regularity more than originally thought

[39:33 -27:05]  But what about Medication?

• Opioids may make chronic pain worse
• Having patients keep track with a Diary, record the schedule and history, 
• You can have an impact early on in a patient’s life so they don’t end up “just like grandma”

[57:06 - 1:02:26]  Closing segment Takeaway

Links to resources mentioned on the show

The Podcast:  Conquering Your Fibromyalgia

     Apple: Conquering Your Fibromyalgia Podcast on Apple Podcasts

     Spotify:  https://cutt.ly/ConqueringFibromyalgia

Dr. Lenz's Book

https://cutt.ly/ConqueringYourFibromyalgia

Key quotes for Twitter:

“I got kicked off of Facebook.  I said boy, a lot of people here. It seems like they're talking about this like it's a stage four metastatic cancer and we're just doing palliative care. Like nobody's ever going to get better. And I said, my patients get better” ...Dr. Michael Lenz

"Right now, there is no specialist that's really the expert. There may be people in a GI dept and one of them has an interest in this area, but they are not psychiatrists. There might be a psychiatrist who's interested in things, but they're not the neurologist and vice versa"..  Dr. Michael Lenz

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed...

https://302.buzz/PM-WhatAreYourThoughts

You should know that we’re talking about very hard things today. However, death is part of life, and (just like adults), children are not excluded. But logic doesn’t ease the blow when a child passes. Keith was only 6 months old. He left behind 2 loving parents who have now dedicated their lives to creating special programs, support groups and educating medical professionals on best practices when faced with a family going through this kind of a life altering chapter. Dr. Gaggino talks with Rachel and Aaron Lewis about their journey with their son Keith. They’re also joined by Dr. Lisa Humphrey, Director of the Division of Hospice and Palliative Medicine at Nationwide Children’s Hospital.  Together, they’ll tell you about the effect that Keith’s life and death have had on the practice of children in palliative and end of life care. Oh, by the way……Grab your tissues, this will be a tough one.          

 [00:33 -20:16] Opening Segment

• We’re introduced to Dr. Lisa Humphrey and we hear about how her passion for palliative care was born
• We meet Rachel and Aaron Lewis who talk about their son Keith’s journey  
• The myths about palliative care
• The difference between Palliative Care and Hospice
• Being Decisionally Agnostic is a key factor in Palliative Care

[20:17- 35:48]  Hope for the Best, Prepare for the Worst  

• The importance of respecting the decisions of the family
• There is active communication between team members to “keep themselves in check”
• Is it okay to talk about death with the parents and how do we do that in a helpful way?  
• Reading the room is a valuable skill set

[35:49 -48:43]  Preconceived Notion

• Important to have the families in the room (if they want to be there)
• Parents actually watching the team work to save their child with dignity, intellect and intent can be helpful for the bereavement process  
• The magic of the first breath and the last breath

[48:44 1:05:05]  Get out of your comfort zone 

• Biggest fear is that the child’s name will be forgotten
• Encourage the family sitting out in the waiting room to be a part of the care
• For team members: show your validation of the child by showing up, being there saying the child's name, push your humanity forth. 

[1:06:06 - 1:11:25]  Closing segment Takeaway

You can reach Rachel Lewis

Facebook: Rachel Houser Lewis | Facebook

Instagram: @rachel_lewis21.12

You can reach Aaron Lewis

Facebook: Aaron Lewis | Facebook

 Links to resources mentioned on the show

 You can learn more about Keith’s story at

https://302.buzz/PM-WhatAreYourThoughts

Advocacy can take many forms, from speaking out publicly to organizing groups to writing letters to elected officials. Whatever the form, advocacy is an important way to bring attention to issues and make change. And although anyone can be an advocate, there’s definitely an art to being an “Effective Advocate”. Today, Dr. Gaggino talks with Dr. Pam Shaw who has perfected the art of advocacy. Among the many hats that Dr. Pam Shaw wears, (i.e., Professor of Pediatrics, Assistant Dean for Clinical Sciences, Associate Vice Chancellor for Student Services, President of the Kansas Chapter of the AAP– just to name a few), her passion to make things better for all children has no boundaries.  Listen in to not only Dr. Shaw’s personal journey, but also about her work in Washington, D.C. on behalf of all children everywhere. 

[00:33 -12:46] Opening Segment

• Dr. Gaggino introduces us to Dr. Pam Shaw
• What drives Dr. Shaw’s passion to be an AAP Advocate on the national level?  
• What does an AAP Advocate actually do?
• For children's issues, you need lots of organizations working together

[12:47- 25:03]  Bipartisan Concerns  

• Good opportunity to start with AAP
• Politics are affecting the doctor/patient relationship
• Learning opportunities are created when local chapters share successes as well failures with each other
• In order to make an impact, VOTE!!

[25:04 -41:20]  Emphasis On Pediatrician’s Needs

• Safety
• Training
• Vaccine Funding
• Mental Health parity
• Payment for Services
• Coding review

[41:21 -45:13] How Can Pediatricians Up Their Game?

• Join your local chapter of AAP
• Sign up to be a key contact for AAP
• VOTE! (And encourage family and friends to vote as well)

[45:14 - 50:40]  Closing segment Takeaway

Facebook: Pam Shaw | Facebook

Instagram:  @pkshaw

Twitter: @Pkshaw1

Links to resources mentioned on the show

HRSA (Health Resources and Services Administration)

Apply for a Grant | HRSA

COSGA (Committee for State Government Affairs)

Committee on State Government Affairs (COSGA) (aap.org)

American Association of Pediatrics

https://www.aap.org/

“67​,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults”

Get a non-partisan Vote-ER badge and sign-up families to vote - 

TRIGGER WARNING: Please note that this episode contains a discussion of suicide, self-injurious behavior, depression and/or reference of other mental health disorders that may act as triggers.

https://302.buzz/PM-WhatAreYourThoughts

No one expected it. How could you? I mean, he was doing so well. Taking the meds, socially engaged. Everything seemed fine….. But one day in February something went wrong. Dr. Colleen Kraft makes a second appearance on the podcast, but this time, she walks us through her very personal journey of how schizophrenia has affected her family as well as her, as a mother. It’s difficult to hear, but it’s something that will stay with you for a very long time. Dr. Elise Falluco, one of the foremost leading pediatric psychiatrists, helps shed light on this mental illness that 24 million people deal with every day. Our host, Dr. Lia Gaggino gets the hard truth to some hard questions.  Listen in as 3 of the most accomplished medical professionals in the United States discuss this often-stigmatized mental illness, schizophrenia. 

Schizophrenia:

Noun  PSYCHIATRY

1. a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.

• (in general use) a mentality or approach characterized by inconsistent or contradictory elements.
• "Gibraltar's schizophrenia continues to be fed by colonial pride"

[00:30 -15:37] Opening Segment

• The back story on Dr. Falluco and Dr Kraft and what led them to wanting to work with children
• Dr. Falluco talks about (her son), Tim’s schizophrenia diagnosis 
• 33% diagnosed schizophrenics are treatment resistant  
• If 33% of cancer patients were treatment resistant, we would be demanding new and better treatment

[15:38 - 24:46] What are the early signs to look out for?

• No longer cares about appearance, gets tired, sleep disrupted, apathy, stops bathing, etc.
• Psychosis sometimes masquerades as depression 
• The difference between the child who has an “imaginary friend” and a child that is not developmentally typical 
• Most common scenario: parents bring their child to the doctor because the child was found talking to themselves.

[24:47 - 34:16]  How to Ask the hard questions

• The question that will determine “True Psychosis” vs “Psychotic Like Experiences”
• Why headphones might be a red flag?
• How to get past the stigma 

[34:17 - 59:13]  What causes Schizophrenia?  

• Medications and treatments currently being researched
• How much do genetics factor into diagnosing schizophrenia  
• Making the distinction between bipolar and psychosis
• We need to change the language that is associated with schizophrenia (i.e. “Psychotic Killer”, Schizophrenic Criminal”)

[59:14 - 1:08:56]  Closing segment Takeaway

You can reach Dr. Colleen Kraft

Instagram: @docmom3460

Linkedin: Colleen Kraft | LinkedIn

You can reach Dr. Elise Falluco

Linkedin:

https://302.buzz/PM-WhatAreYourThoughts

Why is the U.S. falling behind in healthcare and what can we do to change the narrative?  In this episode, Dr. Gaggino talks to the author of “Who Shall We Let Die”, Dr. Koye Oyerinde. As a Public Health/Global Health Expert, Dr. Oyerinde has had a major role in strengthening health systems for the delivery of Reproductive, Maternal, Newborn, Child and Adolescent Health services in low and middle-income countries. Listen in as Dr. Gaggino and Dr. Oyerinde have a frank discussion about the current state of healthcare in the U.S.

According to the World Health Statistics 2022:

"The Billion target will not be reached by 2023, and progress is less than 1/4 of that required to reach the Sustainable Development Goals by 2030"

[00:33 -10:42] Opening Segment

• Dr. Gaggino introduces us to Dr. Koye Oyerinde
• It was inevitable that Dr. Oyerinde would become a doctor since he spent so much time in hospitals when he was a child.
• What is a “Go Fund Me Health System”?

[10:43- 25:29]  Human Rights Abuse  

• Top Executive compensations are in competition with our healthcare..
• Too many programs without coordination between any of them 
• Do the American Indians, the UK and Canada have a healthcare system that the US should duplicate? 
• The mindset of today’s healthcare stems from a long held tradition

[25:30 -30:53] Global Health section of the AAP

• AAP is able to influence other countries by sending US based experts to initiate better practices
• The US can be proud of the work we do well, but we need to be humble about the work we don’t do well. 
• If members of the AAP are interested in Global Health, there are opportunities to join the Global Health section 

[30:54 - 36:20]  Closing segment Takeaway

You can reach Dr. Koye Oyerinde

Website:  www.drkoyeoyerinde.com

Twitter: @DrKoyeOyerinde

Linkedin: linkedin.com/in/koyeoyerinde

Dr. Oyerinde’s Book

“Who Shall We Let Die”

Amazon: https://cutt.ly/WhoShallWeLetDie

Discounted copies are also available upon request at www.drkoyeoyerinde.com (contact tab) 

 American Association of Pediatrics

https://www.aap.org/

“67​,000 pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults”

For current Data and Stats

Check out the World Health Organization

World Health Organization (WHO)

Other episodes you may like:

Episode #46 

Moral Dilemmas: Where Medicine and Ethics Meet