Photo by Sue Pizarro.

Happy 4th of July, U.S. readers. Some holiday links along with the usual health ones for you. Enjoy! I’m off to a barbecue.

Chicago Tribune: How Fireworks Work
20-minutes of fireworks = 50 hours’ programming with music and 3+ days to wire the shells to the computer.
Plus, video clips of each type of firework, including the chrysanthemum and the willow.

The History Channel’s “Did You Know?” for Independence Day
Facts and trivia about fireworks and food for the Fourth.

George Washington’s Boyhood Home Found
From the New York Times,

“What we see at this site is the best available window into the setting that nurtured the father of our country,” Philip Levy, an archaeologist and associate professor of history at the University of South Florida, said in an announcement of the discovery.

Plus, a slideshow of the dig, some of the artifacts, and the foundation of the house.

Video: U.S. Honor Guard
From Arlington National Cemetery, his job is to honor the fallen.

Time Magazine: 10 Good Things About $4 Gas
This one’s been making the rounds everywhere. How higher fuel prices are slowly reshaping American habits.

HIV Treatment Increases Asthma Risk in Kids
It makes sense if you think about it a minute, since highly active antiretroviral therapy (HAART) powers up HIV patients’ embattled immune systems. Now place that concept in the larger asthma picture:

[Dr. William T.] Shearer said a study that evaluates the lung function of children with HIV on anti-viral therapy would help explain how an increase in the immune system affects the risk of asthma.

“This AIDS model of asthma might help understand at a molecular level what is causing the current epidemic of asthma among children more generally,” he said.

Surprise Link Between Crohn’s and Asthma
Apparently, the ORMDL3 gene discovered as a risk factor for asthma last year is also associated with Crohn’s.

11 Best, Easy-to-Find Foods You Should Eat
Well’s Tara Parker-Pope got these from nutritionist Jonny Bowden, who wrote The 150 Healthiest Foods on Earth. Check out #9. Turmeric’s been on the radar recently for anti-inflammatory and anti-cancer action, so guess what chronic lung condition it may help? I wrote an article about turmeric and asthma that I’ll have to dig up and repost here.

Filed under: Asthma News & Research, Children's Asthma, Children's Health, Friday Links, Holidays | Talk to me »

I wish I had time to do this one more justice, but I’ve been trying to a finish a couple of projects before I leave for vacation on Sunday. If you haven’t yet read the newest chapter in the story of the EPA, the Clean Air Act, and the White House, check it out. I’ll break it down for you list-style, in typical Asthma Mom fashion:

If We Don’t Admit It, We Don’t Have to Fix It

1. Up until last year, the EPA did not address greenhouse gas emissions like carbon dioxide under the Clean Air Act.

2. Last April, the Supreme Court decided carbon dioxide fits the definition of a pollutant under the Clean Air act.

3. That meant the EPA can regulate CO2 like other pollutants–and, in fact, should–but the Supreme Court stopped short of forcing the EPA to regulate it in a 5-4 decision. As the New York Times notes,

The 5-to-4 decision was a strong rebuke to the Bush administration, which has maintained that it does not have the right to regulate carbon dioxide and other heat-trapping gases under the Clean Air Act, and that even if it did, it would not use the authority. The ruling does not force the environmental agency to regulate auto emissions, but it would almost certainly face further legal action if it failed to do so.

4. And that means the EPA emailed the White House a draft for emissions limits under the Clean Air act, based on their danger to public health and compelled by the ruling. Or, the EPA tried to email it, to be more accurate.

5. Because someone in the White House or the OMB–no one knows who, so far–called then-EPA Associate Deputy Administrator Jason Burnett not to send the message.

6. Since Burnett had already sent it, this unidentified person ordered Burnett to un-email the message.

7. Burnett refused,

8. Much like the way my 6 year-old pretends she doesn’t notice when she drops toys or books in order to avoid picking them up, the White House then just refused to open the email.

9. And it’s still unopened.

10. Meanwhile, Burnett has resigned, saying the Bush administration is dumping emissions regulation on the lap of the next president.

11. Instead of that original email that’s still sitting in limbo, the EPA has been getting ready to release a much weaker version. (Does this sound familiar? New, not-quite-strict-enough smog limits, anyone?)

12. On June 25, the Times indicated just how weak.

Over the past five days, the officials said, the White House successfully put pressure on the E.P.A. to eliminate large sections of the original analysis that supported regulation, including a finding that tough regulation of motor vehicle emissions could produce $500 billion to $2 trillion in economic benefits over the next 32 years. The officials spoke on condition of anonymity because they were not authorized to discuss the matter.

13. As Grist reported,

But White House officials have asked that the EPA delete references to greenhouse-gas emissions endangering public welfare (which would legally allow them to be regulated); how they could be regulated (the document suggests a cap-and-trade system similar to those in place for acid rain and mercury); and the cost of such regulation (according to the document, “The net benefit to society could be in excess of $2 trillion.”). In effect, says one source, White House officials want the document to instead demonstrate that “the Clean Air Act is broken and can’t be used to regulate emissions.”

More on this:

Dot Earth’s Andrew C. Revkin explains how this fits the pattern.
Grist talks to Jason Burnett.
Marty Kaplan considers further innovations of the hands-over-eyes,ears variety at the Huffington Post.

Filed under: Air Quality, Asthma Causes/Risk Factors, Asthma Triggers, Children's Asthma, Children's Health, Environment, Politics | 2 people talking »

Here’s a delicious radioactive candy bar to rejuvenate you:

From this gallery of other radium-enhanced products, from the good old days when a little radiation was good for you.

Five Medical Revolutions, According to the UK’s National Health Service
Know what’s most amazing about these advances in medicine from the past 60 years? That they’re common enough to seem un-amazing in 2008.

If I write about the patient empowerment/doctor-patient relationship/parent advocate issue to an exhaustive degree on this blog, it’s only because I have the luxury to live in a place with access to all this medical technology, and I’m supremely grateful for that.

Don’t Eat These Carnival Foods If You’re Trying to Be Healthy
Most unhealthy choices at the fair, according to Newsweek. You can guess the worst culprits, I’m sure, but this gallery begs the question: isn’t “most” kind of redundant here? When you go to the fair, do you eat healthy food?

No. You go for the funnel cakes.

Filed under: Weird Health Wednesdays | 4 people talking »

It’s pretty clear what most of us what in our medical care:

Reasonable wait times. Open and respectful doctor-patient communications. Doctors who listen. High-quality treatment.

What do doctors say about us, though, especially when they can remain anonymous? Reader’s Digest talked to 24 doctors and therapists about “medical secrets,” and some even used their real names.

You’re going to love some of these. Check out all 41 in the article, but here are my favorites:

The Good

One of the things that bug me is people who leave their cell phones on. I’m running on a very tight schedule, and I want to spend as much time with patients as I possibly can. Use that time to get the information and the process you need. Please don’t answer the cell.
–James Dillard, MD, pain specialist, New York City

*I want to spend as much time with patients as I possibly can.*

I can just hope my family’s doctors feel this way, too. If they don’t, they hide it well.

If a sick patient comes to me with a really sad story and asks for a discount, I take care of him or her for no charge.
–Surgeon, Dallas/Fort Worth

Notice how this doctor chose to stay anonymous instead of getting the free advertising for charitable work? Classy.

Though we don’t cry in front of you, we sometimes do cry about your situation at home.
–Pediatrician, Chicago

Clearly, I never want my kids’ health to provoke weeping by the pediatrician, but it’s comforting to know she might.

The Thought-Provoking

In many hospitals, the length of the white coat is related to the length of training. Medical students wear the shortest coats.
–Pediatrician, Baltimore

Good tip, right? I know I’ll remember it.

In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don’t know anybody who can live that way.
–James Dillard, MD

We’re never going to reach the point where, after a botched surgery, a patient’s family or the patient himself says, “Oh, it’s okay. The doctor’s just human, after all.” Errors mean more in the medical field than almost anywhere else. Overhauling the system to reduce patient loads on doctors, though, does seem like it would at least minimize the chances for mistakes. But I’m no expert, and I’m not even what such a change would entail or if it’s even possible.

Chances don’t look great when you read this next quote:

Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered.
–Vance Harris, MD

That’s flat-out scary, considering how often asthma gets under-diagnosed or misdiagnosed in kids. Problems like asthma are already hard to find sometimes. What happens if diagnostic ability suffers?

The Really Horrifying

I was told in school to put a patient in a gown when he isn’t listening or cooperating. It casts him in a position of subservience.
–Chiropractor, Atlanta

Wow.

I used to have my secretary page me after I had spent five minutes in the room with a difficult or overly chatty patient. Then I’d run out, saying, “Oh, I have an emergency.”
–Oncologist, Santa Cruz, California

An oncologist said this. Every job has its challenges, but should you really get into cancer treatment if you don’t want to see patients on an uneven keel? I’m lucky never to have needed an oncologist or even to have sat in on a visit for a family member, but I’m guessing I’d be a less than ideal patient, if by *difficult* this doctor means *completely freaked out and scared.* And overly chatty? Yeah, if I’m nervous I’ll go there, too.

I know that Reader’s Digest recommends bringing in a complete list of all your symptoms, but every time you do, it only reinforces my desire to quit this profession.
–Douglas Farrago, MD

So….what? We should bring in half the list? Pick our favorite two or three? Make you play charades to guess the rest?

At least a third of what doctors decide is fairly arbitrary.
–Heart surgeon, New York City

And that’s exactly why I’ll keep bringing in symptom lists, giving my own informed input, and advocating for my kid’s health.

Filed under: Children's Asthma, Children's Health, Doctor-patient relationships, Healthcare, Practical Tips | 7 people talking »

Want to Understand How Humidity Levels Affect Asthma?
One of the clearest and most comprehensive explanations I’ve read yet. With links, too, courtesy of the RT Cave, a respiratory therapist blog.

Just What Oil Companies Need: More Dough, Less Accountability
The Supreme Court cut ExxonMobil’s damages from the 1989 Valdez spill in Prince William Sound from the appeals ruling of $2.5 billion to $500 million. (The original ruling awarded $5 billion.) To put this reduction in perspective:

The Exxon Valdez spill was the worst in American history, damaging 1,300 miles of shoreline, disrupting the lives and livelihoods of people in the region and killing hundreds of thousands of birds and marine animals. It occurred after the ship’s captain, Joseph J. Hazelwood, left the bridge at a crucial moment. Mr. Hazelwood, an alcoholic, had downed five double vodkas on the night of the disaster, according to witnesses.

Exxon paid more than $3.4 billion in fines, cleanup expenses and other costs. The spill still affects Alaska’s fisheries today. - NY Times (link above)

If You’re Headed to California, Check the Air Quality First
Smoke from the wildfires is still hanging around, and apparently North California (and Nevada) are under smoke advisory.

Ladies, Feel Like Paying Extra for Health Insurance?
Healthcare and the U.S. Presidential race again, but the word *universal* appears nowhere. It’s all about the need for gender neutral health insurance, and why one candidate’s plan won’t make that happen.

Eat Your Salmon and Anchovies
Even more research linking omega-3s from fish asthma help. This particular bit opens up the exploration into the fatty acids as inflammation therapy. Who knows? Maybe we’re headed back to the days of cod liver oil doses in the morning.

Oops. Edited 10:35 AM for one more, entirely off-topic:

Got a Wii? Super Smash Bros. Brawl is Amazon’s Gold Box Deal Today
Passing on the discount love this morning–$25.99 and free shipping for one of the most popular (with good reason) Wii titles out there.

Filed under: Air Quality, Asthma News & Research, Asthma Triggers, Children's Asthma, Children's Health, Environment, Friday Links, Healthcare | 3 people talking »

I’ve written a couple of times before that I wouldn’t turn this blog into a comprehensive asthma source. For one, the Internet isn’t hurting for good asthma pages–like here, here, and here.

And also?

Asthma Mom morphed into a blog also about air quality and pollution, children’s health, and of course a weekly collection of strange medical links and media.

So maybe you understand my reluctance. Despite it, though, I find myself writing about my kid, her history, my ruminations on breathing problems and healthcare, asthma research, and every other week or so I think, *Ooh, well. There’s that one thing about asthma that’s important to remember, so I’ll just post about it real quick.*

Enough weeks pass, and behold: I appear to be creeping up onto a somewhat comprehensive asthma site. I guess too much information isn’t a bad thing, right? It is, however, forcing me to rethink some of this site’s navigation, as I ran out of tabs for the static pages above months ago. This list from my days as the BellaOnline.com asthma editor will end up on a page and not just a post as soon as I fix that.

When I was first learning, the more I read about symptoms and early warning flare signs in young asthmatics, the more I started noticing some of them in AG’s behavior and remembering how she acted as a sick toddler, right before she flared.

The very early signs are incredibly easy to miss, but if you can recognize them then you have a better chance of heading off a flare right when it starts. Lots of times, what seems like bad or cranky behavior in a very young asthmatic can alert you to an attack. Even now, if my daughter acts unusually tired but she hasn’t been unusually active, I know breathing problems will (usually) follow.

Here are subtle, early signs of an asthma flare, followed by regular and emergency symptoms:

Early/Subtle Symptoms

1. Mood swings
2. Crankiness
3. Fatigue
4. Watering eyes
5. Dark circles under the eyes
6. Cold symptoms - coughing, sneezing, and runny nose
7. Trouble sleeping
8. Restlessness
9. Low exercise tolerance
10.Any changes in breathing
11.Any changes in peak flow readings
12.Anxiety

Flare Symptoms

1. Coughing fits
2. Wheezing
3. Shortness of breath
4. Tightness in the chest
5. Peak flow numbers in the yellow zone

Emergency Symptoms

1. Cyanosis - blue-tinted skin, starting around the mouth and resulting from lack of oxygen in the blood
2. Posturing - hunched-over shoulders while breathing
3. Retractions - drawing in of the abdomen under the ribcage while inhaling
4. Peak flow readings in the red zone
5. Major problems breathing
6. Severe coughing or wheezing that doesn’t improve with emergency meds
7. Severe tightness in the chest that doesn’t improve with emergency meds

Want to read more symptom information?

Filed under: Asthma Girl, Children's Asthma, Children's Health, Practical Tips | 5 people talking »

Yes, you read that correctly. And it’s not just a sing along, either. You get an awareness campaign for testicular cancer self-exams, a bluegrass parody, and a rundown of anatomical slang, all in one funny package. (pun totally intended) Even better? It originally comes from the awareness site Carpe Testes.

Get it?

It’s pretty innocent, but if you work in a very conservative office, it’s probably NSFW.

Here’s another one about checking the family jewels, still funny but not nearly as good as the first one:

Filed under: Weird Health Wednesdays | Talk to me »

You’ve heard of mystery shoppers, I’m sure. They conduct business transactions or pretend to browse/window shop in certain stores in order to evaluate, in secret, the customer service skills of employees.

As Well’s Tara Parker-Pope explains, the American Medical Association was considering whether to support fake undercover patients in waiting rooms as a way to ensure good customer service from hospital and doctor’s office staff. It’s put the plan on hold for now, but apparently some hospitals already use “secret shoppers,” as reported by the Boston Globe a year ago.

These reviewers don’t have access to the actual doctor’s care. They basically sit in the waiting room and watch how the front desk staff treats patients, how long wait times are, and how they handle phone calls.

Sounds good, right?

Medical care is a service we pay for, and we should expect courteousness and prompt service just like in any other industry. By *prompt* I mean *as prompt as possible,* of course. One big difference between this industry and most others is the high potential for unexpected emergencies, and I think most patients–though not all–understand the occasional, unavoidable 30-minute wait.

Some doctors don’t really like this idea, though, and made that opinion perfectly clear at a recent AMA meeting. The Chicago Tribune says,

But AMA members told the panel that they did not trust the secret shopper concept, saying such patients could get in the way of needed medical care for real patients. In addition, doctors say, information gathered could be used to cut payments to doctors or used by trial lawyers as a way to damage physicians in court.

“It is grossly unethical,” said Dr. Howard Chodash, an associate professor of gastroenterology at Southern Illinois University Medical School and an AMA delegate representing the Illinois State Medical Society.

Um. What?

Maybe I’m missing something here. How would quiet, unobtrusive note-taking in the waiting room hinder care for actual patients? If the reviewers practice observation only, then they’re not interacting with the hospital or office staff at all, and their presence should be no more disruptive than the plastic ficus tree in the corner. Unless–I dunno–maybe there’s a case for a particularly busy office needing that extra chair.

As far as the data’s potential in court or against the doctor’s bottom line goes, I can’t see how any medical institution or office that practices respectful patient service would have to worry about either.

Plus, the service can address some serious problems with front office care. Consider this scenario from the earlier Boston Globe story:

In a January report, a mystery shopper described what happened when a man in a wheelchair asked whether his prescription was ready. The receptionist in an outpatient waiting room asked for his Social Security number, the shopper wrote, then “halfway through she interrupted him and asked him to repeat it louder,” which he did. A patient on the other side of the room heard the exchange and commented, “There goes patient privacy.”

Patients tend to be worried, scared, and nervous when they visit a doctor for all but the most routine visits. Add in patient loyalty to a specific doctor and the times when appointments are either impossible to reschedule or it’s medically necessary not to reschedule them, and what you’ve got is a waiting room full of people at the mercy of the staff. I’d argue the medical industry needs secret shoppers more than any other business because of the emotional factor.

And on a positive note, the undercover patients point out excellent service, too, and that can result in bonuses and other compensation for employees.

Way, way down at the bottom of that Boston Globe article is a larger point:

“Is it a little devious, a little misleading to staff, and how would they react?” said Dr. Michael Gustafson, vice president for clinical excellence. He also pointed out that shoppers don’t capture what happens once the patient gets “behind the office door, and that’s the most important part of the experience.”

Well, sure.

I’d love to see some kind of review process for the doctor-patient relationship, one that evaluates whether the physician talks down to the patient, rushes through the appointment, seems willing to listen to patient ideas, and answers questions thoroughly. And using undercover patients for that sort of review really does seem unethical, although I don’t see why offices couldn’t stock comment cards for doctor performance, and patients could later mail them in anonymously.

But I don’t agree with Dr. Gustafson. The crucial aspect of the actual doctor consultation doesn’t negate the need for a positive waiting room experience, since the wait itself can set the tone for the entire visit.

I like this quote from a recent interview with Dr. Rex Greene of the AMA Council on Ethical and Judicial Affairs:

We are running a service business, and we are not as focused on that as we should be.

Filed under: Healthcare | 6 people talking »

C-Sections Increase Childhood Asthma Risk by 50%
Research has suggested the connection between Caesarean birth and asthma before, but this is the clearest link yet. The Norwegian study looked at 1.7 million births over 30 or so years, and emergency C-sections upped the risk even further. And asthma risk during vaginal birth increased with vacuum or forceps use. There are two main theories bouncing around right now, but neither explains why higher emergency C-section risk.

I sure hope this finding doesn’t bring out the small but vocal minority that likes to play the blame game and point fingers at parents over their children’s health issues, but I also hope it’s taken seriously in light of the recent years’ upswing in voluntary C-sections for non-essential, non-medical reasons.

Sputum and Nitric Oxide Breath Tests for Kids Cut Oral Steroid Courses by 29%
If you’ve experienced the joy of a little kid on prednisone–and since you’re reading this, you probably have–then I don’t need to explain the implications here. This research is aimed at severe asthmatic children, but any progress in better diagnostic measures for asthma are generally okay in my book.

Remember to Say “Thanks” for Good Asthma Care
Severe asthmatic Steve, who’s been in the ICU more than anyone I’ve ever known, tells you why.

Second Lawsuit Over the Lame Smog Restriction
Thirteen states are suing the EPA this time, hoping to overturn it. Check it out:

“The EPA is charged with protecting the environment, yet the Bush administration has repeatedly used it as a tool for facilitating pollution instead of combating it,” New York Attorney General Andrew Cuomo said in a release.

Read about the other lawsuit, too.

Man Beat Advanced Cancer After Injections Of Own Immune Cells
UK doctors used immunotherapy, or the process of cloning a patient’s defense cells that fight cancer and then injecting them back into the patient, on a man with skin cancer that had already spread to his lymph nodes and a lung. In just eight weeks, the tumors disappeared and he’s still cancer-free two years later.

The next step is more trials for the treatment and there’s the question of financial feasibility, but still. Science can be a wonderful thing, can’t it?

Teaching Young Girls How to Shop. For Self-Confidence
I am not even kidding, but I wish I were. Via Jezebel, a Kentucky shopping center runs one-day “fashion camps” for girls aged 6 to 12, in which they visit stores to learn how to create outfits and accessorize. There’s so, so much that horrifies me, so let’s just wade right in:

1. The camps start at age six? SIX!?! Does your six year-old need fashion camp?

2. So the camp coordinator/leader says these shopping camps can instill “personal development” and “self-confidence,” but if you read further you’ll discover the sessions are really the brainchild of Becky Norton, property manager of the center. According to the article, she “wanted to do something special for customers.”

3. They’re called fashion camps but apparently also teach organization, finding information, and etiquette in stores like Office Depot and Barnes & Noble.

4. At the retail clothing stores like Limited Too, the girls learn “fashion terminology” and then learn public speaking by talking about the clothes in this stores. Anyone think this age group will practice public speaking beyond this?

“This is pretty. I like this skirt because it sparkles, and I like sparkly things. And purple’s cool. I like purple.”

5. This “something special for customers” costs $60 a day. For that price, the girls get a goody bag with a $40 gift certificate to the center, and of course they’ve basically just spent the entire day window shopping for the stuff they want to buy.

Look, I don’t have a problem with fashion, and I recognize it’s a genuine interest for some children. I mean, I’d be shocked if my own 9 year-old didn’t end up in some kind of theatre/fashion/costume design situation when she gets older. I do, however, want to throw up a little bit at the thought of packaging *consumerism* as *education.* And then marketing it directly to kids under the age of 12.

This quote (I saved the best one for last) doesn’t inspire confidence in the worth of the “camps,” either:

“This is something different,” Ross said. “Not everybody can be a cheerleader or football player, so this is something for someone with different interests … the most important thing I tell the girls is to have fun.”

So that’s it, I guess. Cheerleading, football, or–um–shopping. That’s it? How about art class? Science camp? Soccer? Piano lessons?

You get the picture.

The U.S. Mortgage Crisis and Its Benefits for Land Conservation
From my latest Celsias article, pretty much the only positive spin on the story of family foreclosures, mortgage company abuses, and basement-dwelling home values:

The U.S. housing market is in such decline that foreclosures have even reached some of the wealthiest, most exclusive neighborhoods in the country, places that are normally immune to real estate shifts. In a remarkable turn-around, conservation groups suddenly have so much buying power that more U.S. land was protected than developed in 2007.

Here’s how it’s happening. As homeowners try to ride out the burst real estate bubble in their current homes rather than upgrade or move, and scores of Americans become renters after losing their homes in foreclosure, developers are stuck with large, prime tracts of land they can’t build on since no one will buy.
(Read the whole article through the link above.)

Filed under: Air Quality, Asthma Causes/Risk Factors, Asthma Girl, Asthma News & Research, Asthma Triggers, Children's Asthma, Children's Health, Environment, Friday Links | 5 people talking »

Man Survives 2.5 Inch Nail to the Head
Two things about this story:

1. The Kansas City man shot the thing into his own head when his nail gun went off accidentally.

2. You’ll never guess what the doctor used to get the nail out. (Click to find out.)

If You Don’t Like Detailed Medical Photos, Don’t Click This
But if they don’t bother you, check out the clearest-ever video and photos of human ovulation. Their incredible detail has put them in the history books, as this–the time when life starts, basically–is difficult to predict and therefore capture on film. And the photos were captured by accident, by a doctor performing a partial hysterectomy.

A Horse and a Vasectomy Reversal to Save His Species
Since Przewalski horses from China and Magnolia are endangered, the Smithsonian Institute’s National Zoo reversed the vasectomy of *Minnesota,* a Przewalski with a particularly valuable ancestry. Making natural breeding possible again for an endangered animal is significant, of course, but what caught my eye is the May 6 date for surgery success “confirmation” after the fall procedure.

So I’m guessing the confirmation involved a sample/test sort of situation? Think about it for a minute.

Filed under: Weird Health Wednesdays | 4 people talking »