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Transitioning from pediatric to adult health care: post 5 Pediatrician perspective

In this post on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.

As an adolescent medicine specialist, I feel comfortable talking with teens about many different topics. Our conversations range from gender identity to managing homework. Almost nothing takes me by surprise at this point in my career, but there’s one topic that I always find challenging to approach: transitioning my patients to a provider who manages adult concerns. Pediatricians develop long-term relationships with the families they care for. We watch children grow into young adults, support parents in raising their families, and get to know the intimate details of our patient’s lives. As teens emerge into adulthood, we often find it challenging to transition their health care out of our hands.
Transition sounds like a straightforward concept. As we enter adulthood, we stop seeing the health care provider who knew us as a child and move onto to someone who cares for adults. Read full post »

Intuitive Eating

Guest post: Holly Anderson, MS Nutrition student at University of Washington and

Leadership Education in Adolescent Health (LEAH) Fellow in Adolescent Medicine at Seattle Children’s Hospital

 

Today, the social and environmental influences surrounding food and body image make it increasingly difficult for anyone to have a normal relationship with food. Take those pressures and add to them the many variables of adolescence: confusion related to the physical changes that come with puberty, insecurities with body image and/or self, bullying, body comparisons, messages from friends/family, etc. Suddenly, it’s no wonder adolescents may feel inclined to make misguided or unhealthy changes to their eating patterns in hopes of changing their bodies. Such changes can result in disordered eating patterns, preoccupation with food, distorted body image, and/or concerning weight loss/gain.

As a future nutrition professional with an aspiration of working with adolescents, this is a topic I think about every day. How can we debunk nutrition myths and negative societal influences and instead encourage body kindness and food freedom? The best answer I’ve found is an extremely fundamental but important concept known as intuitive eating. Intuitive eating, developed and made popular by two registered dietitians, is a gentle approach to nutrition, which encourages attainment of a healthy relationship with food through learning to respond to our bodies natural hunger and fullness cues. Young children are actually the best models of intuitive eating; however, as they grow up and are increasingly exposed to diet culture, societal messaging about an unrealistic body ideal in our country, and the other influences during adolescence mentioned above, those intuitive eating tendencies can be easily lost in the shuffle. Read full post »

Important conversations to have with your teen about intimacy

Parents often ask me for advice regarding sex and reproductive health. Many times this involves speaking with me separately from their teen and informing me they found a condom in a pocket or their teen has been in a long term relationship and they think they may be sexually active. Most parents are worried about pregnancy, some are concerned about sexually transmitted infections. For all, I also bring up some topics that aren’t always as obvious, but are just as important. In this post, we’ll discuss important conversations to have with teens about sex and relationships in addition preventing pregnancy and STD’s.

With the #metoo movement that is sweeping social media and the convictions of sexual assault by prominent men in Hollywood, the medical community, and other areas, people who have experienced sexual harassment and assault are beginning to have a voice. Unwanted sexual contact by anyone (regardless of gender) is criminal. Unfortunately, our culture is full of examples where (mainly) female bodies are objectified as sexual objects in movies, commercials, music lyrics, and music videos. The message this sends to youth (and adults) is that the body of whomever we’re attracted to is there for our pleasure. It also sends a message that those who experience harassment and/or assault are at fault or should keep quiet. This needs to change!

I counsel all teens on the importance of consent and mutual respect in any relationship in addition to pregnancy and STD prevention. As more and more parents are pulling me aside to ask for advice, I’m adjusting my counseling to them as well.

Read full post »

Screenagers and the impact of digital devices on the family

I have 2 small children, but already the number of screens in my household outnumber the people! Though there are benefits to digital hand held devices (we use them for reading, counting, learning Spanish, looking up recipes, etc), my view is that nothing can replace the impact of face-to-face time interacting with other human beings. Maybe I’m old fashioned? I’m from the unique generation that grew up with computers, but also remembers a time before the internet.

There is growing body of research describing potential impacts on child development when exposed to media. This includes problematic internet usage, virtual violence, depression and mental health, and attention.

In the documentary Screenagers, Dr. Delaney Ruston explores screens and today’s teens. This documentary was engaging, at times scary, and very real.

Here are the tips I took from the film:

Social media impacts the brain –  dopamine release and pleasure is a normal function of the brain when seeking information and finding it. This is constantly occurring when we check our phone to look for texts, instant messages, and alerts on social media. It’s no wonder we can’t put our phones away.

No one can actually multitask – you can shift attention rapidly, but the cost is poor performance in what you are trying to accomplish. Read full post »

Staying safe using ride share applications

Ride sharing applications have increased in popularity over the past few years. Some of the benefits for the passenger include being able to hail a ride using an app rather than looking up a phone number (for a Taxi), no cash exchange (the apps charge your credit card directly), and viewing a picture of your driver and their car before they pick you up. For the drivers, they have the opportunity to see a passenger profile before they pick up a stranger, there’s no cash exchange (less likely to be robbed), and it is an opportunity to earn extra money on a flexible schedule. However, getting a ride from (or with) a person you don’t know can have dangers. In this post, a provider with expertise in sexual assault shares tips for passenger safety when using ride hailing apps.

Guest post: Julia Mitzel, ARNP

Some tips to keep you and your friends and family safe:

  1. Ask for the name of the driver when they pick you up. Although we have seen some cases where legitimate drivers have committed assault, there are also some perpetrators who borrow a car with a Lyft or Uber sticker or simply hang around places where there are likely people waiting for a car. If they are not legit, they will not match the name of the driver you are waiting for (or the make of the car).
  2. The driver should know your name. Do not provide it until they ask for the right name from you.
  3. Do not drink anything provided by the driver. I have seen a case where the woman was apparently drugged via the water bottle provided by the driver.
  4. Be assertive. Ask the driver questions. Make them think you have someone specifically waiting for you to arrive where you have asked to be dropped off. This is harder if you have been drinking, but certainly try to be alert.
  5. If something looks odd about the door locks, DO NOT get in the vehicle. Are they obviously broken, taped over, etc?
  6. Whenever possible, ride in pairs or groups.
  7. Take a photo of the license plate prior to entering the car. If the driver doesn’t like it, take another vehicle. You can also ask to take the driver’s photo. You can explain why you are doing it. If they say no, get a different driver.
  8. Text the license plate number and/or photo of the driver to a friend before leaving. These may serve as important evidence in an assault case where a phone may be lost or stolen

Time stamps, texts, calls, photos, etc. from smart phones have been instrumental in putting together timelines and assisting with prosecution.

Please be safe out there. Share this information.

Transitioning from pediatric to adult health care: post 4

In this series on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.

A young man with chronic lung disease

In this guest post, a parent shares their experiences both frustrating and enlightening, about being the parent of a youth with the chronic illness, asthma. Though this illness is well known, it is still complicated.

My son is now 20. He’s been followed by medical specialists since he was three weeks old, for asthma and also for treatment of the numerous bone fractures that he was susceptible to because of his medications.

People – even doctors – often think of asthma as something you’ll outgrow. But asthma is a tricky disease. In my son’s case, it didn’t seem to follow a clear path and we dealt with lots of misunderstandings and heartaches over the years, trying to figure out causes and treatments. On occasion, when he was extremely ill, we were referred for additional testing – but all that was ever identified was severe asthma. Read full post »

Loneliness among teens

Loneliness. Is this the future of a generation?

In the past 5 years, I’ve noticed a trend in my conversations with teens and amongst friends, family, and acquaintances. As I raise my children and they ask for more time on the tablet or request to send texts to family, I worry about the trend taking hold of my kids. The trend is feeling alone.

I attended a speaking event by researcher Dr. Niobe Way a few years ago and left with tears in my eyes. She described the transition of boys from connecting, emotion expressing, playful little beings to young men who have ‘buddies’ but no confidants; are comfortable showing anger or pride, but not fear or sadness. Our culture may have shifted the definition of ‘masculine’ to be one that encompasses independence at the cost of connection. An article I read recently described this shift. In it, the author describes higher rates of unemployment, divorce, suicide, and violence among adult males. The key points in the article lead me to consider the increased number of mass shootings in the US. Men have carried all these out. I cannot assume that loneliness, shifts in cultural norms, or changes in how emotions are expressed cause people to kill. I do not know the motivations of the murderers and in no way am I excusing the horrific atrocities they carried out; but I have to hope that we can prevent a massacre from happening again. While many factors need to be considered and intervened upon, changing how we treat each other is a step in tackling the loneliness and despair a person may feel if they are so desperate they want to kill.

Loneliness and social isolation are also becoming routine in my conversations with patients (regardless of gender). We are more “connected” than ever before; nearly every US household has access to the internet or owns a smartphone. Teens spend hours on social media and text hundreds of times per day with friends. Social media brings many benefits: access to online education, remaining in touch with friends and family who are not local, and allowing an outlet to express emotion in an anonymous way. Yet, suicide is the 2nd leading cause of death among teens (second to motor vehicles). Is there a correlation between depression and online use? Read full post »

Transitioning from pediatric to adult health care: post 3

In this series on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.

Transitioning to adult care: the story of one cancer patient and his family

In this guest blog post a family shares their story of working towards young adult self-management.

Patients who are cancer survivors, even if their cancer is cured, often need specialized medical care for the rest of their lives due to their past illness and the treatments they’ve undergone. The mother of a former Hem-Onc patient – 20 years old now – feels grateful to the Seattle Children’s Hospital Heart Center for helping launch their transition process. “They did a one-day conference, and half of it was about transition to adult care. We all went – me, my husband and my son. It was very useful, even if not everything applied to us because my son’s heart condition is not congenital.”

Due to the drugs he’d been exposed to during cancer treatment, this young man is at risk for a number of side effects that might only show up later in life, as well as for a recurrence of cancer. His long-term follow-up care as an adult needs to include awareness of this health history and specific monitoring for certain health conditions. This creates a steep learning curve for him – even more so, given that his treatment also created some difficulties with short-term memory. His mother sees careful note-taking as one skill he needs to develop, as he moves towards full independence in his healthcare management. Read full post »

Managing anxiety at the start of school

Summer is in full swing, but Fall is just around the corner. As children and teens wrap up summer events and get ready for the start of school, anxiety might come up. For parents, it can be challenging to know how to support a teen who is feeling anxious about going back to school. Perhaps your teen struggled last year with missed days due to anxiety, or your teen is going to start high school and is feeling anxious because their friends are all going to different schools. No matter what the reason for feeling anxious, there are some things parents can do to help kids get ready for the return to school. Read full post »

Transitioning from pediatric to adult health care: post 2 Parent Perspective

In this series on transition to adult medical care, we’ll discuss tips and strategies from parents, providers, and family advocates for those who are starting to navigate the complex process of transitioning out of pediatric care and into adult health care. Thank you to Dr Raina Voss and Joy Gehner for their help in organizing the series.

Guest post by: Joy Gehner
Parent perspective on transitioning to adult care

When you have a child with special needs or complex medical issues, it takes a long time to learn about the care they need, and put together their team of doctors and other providers. After my daughter got her multiple diagnoses, between ages two and three, it was years before I felt like we had her full team of experts in place. It was really hard work, where I had so much to learn about what my daughter needed – and so did her care team.

We’ve been developing our relationships with these providers over the many years since then. We’re comfortable with each other. I trust them to know and understand my daughter and our family. When we talk about her care, we have a shared understanding of our experience, a shared history of knowing what works for us and what doesn’t. On an even more basic level, I’m familiar with the processes for making appointments, and how billing works. I know where to park and how to navigate the buildings to the clinics we need. I even have the phone numbers of her most frequent providers memorized, simply from having dialed them so often! Read full post »