What would happened if mental health problems would be seen equal as medical problems: I think more lives would be saved

My Name is Ilan Shapiro, I was born in a small city, called México City, a father, pediatrician and Medical Director for Health Education and Wellness at AltaMed.

I’m extremely humbled to have a great team Veronica O. and Sandy N. that in synergy we share education and wellness with our community. Also, with #Pantaleon and #LionsGate por abrir una conversación tan difícil con nuestra comunidad por medio de #LasPildorasdeMiNovio

Since the times of my Abuelita, mental health carried a big burden on the person affected and their family. This movie opens that conversation in the community of how none of us can separate our bodies from our minds.

My Abuelita tried to cure a lot of things with vick vapor rub and te de manzanilla (and sometimes a touch of violeta valenciana), but mental health does not respond to that. 

Mental health is not a taboo subject. We must, as a community, come together and have an open conversation about mental health and its impact on a person, on families and our society at-large.

When a patient comes to me has a pulled muscle, and I send them to Physical therapy with the recommendation on certain medications, there is no doubt on what to do.

Why is it so different when there is a chemical imbalance in the brain causing a big shift in mental health and I recommended medication and therapy, why is it so hard to have that conversation?

The stigma against mental illness is real. If you have any doubt, consider there is a median delay of 10 years between the onset of mental health symptoms and receiving healthcare. One reason for this delay is that people try to hide their mental illness due to the fear of being judged.

Each one of us needs to play a role to eliminate the stigma of mental illness. Here are three ways to make an impact. 

1.    Education- In 2017, there were an estimated 46.6 million adults in the United States with mental illness. This number represents about 1 in 5 adults.

2.    Empathy- Refrain from judgement. Suffering from mental illness can become so unbearable that it affects one’s ability to function. One may even experience suicidal thoughts in an effort to escape the suffering.

3.    Advocacy- Be an advocate for raising mental health awareness. Support groups that advocate, educate and care for individuals and families affected by mental illness. 

Putting this in context Almost 18% of the US is Latino, 15% have a diagnosable mental illness, that is 8.9 million people, MORE THAN the population of NY City

 • U.S.-born Hispanics report higher rates for most psychiatric disorders than Hispanic immigrants.

• Studies have shown that older Hispanic adults and Hispanic youth are especially vulnerable to psychological stresses associated with immigration and acculturation

• Approximately 1 in 10 Hispanics with a mental disorder use mental health services from a primary care physician, while only 1 in 20 receive such services from a mental health specialist.

Several studies have found that bilingual patients are evaluated differently when interviewed in English as opposed to Spanish and that Hispanics are more frequently undertreated.

At AltaMed Health Services is the nation’s largest federally qualified community health centers in the nation. We have 52 sites across Los Angeles and Orange counties serving more than 300,000.

Understanding the need, nearly a decade ago, AltaMed began integrating behavioral health services into the primary care, because we recognized that mental health affects every aspect of a person’s well-being. This type of model in vulnerable communities can help start the healing process, and we’ve had the opportunity to provide services to thousands of underserved patients in the past years under the leadership of Dr. Sandra Pisano.

We all can miss the symptoms that are happening to our loved ones or even to us; some of these mental health challenges do not present as an obvious rash, a fever or a cough. We do not have a straightforward blood lab test for a diagnosis– but we do have a lot of people who can help identify the symptoms. It starts with you– we can all make a difference. We can help ourselves and help our loved ones by letting them know we care and there’s access to help. 

We are amazingly well versed in chisme language; let’s spread the word that is ok to feel different, the same way that people have migraines, people can be depressed, have adhd/add or anxiety. Do be afraid to ask if someone is acting differently, maybe, just maybe, because you showed that you cared, you are saving a life.

Bariatric Surgery Recommendations for Pediatric Patients: new guidelines from the American Academy of Pediatrics

Podcast link: https://lnns.co/LvTMJKx8sHD

This Morning at Buenos Dias America had a great conversation with Andreina Garnica about the new guidelines for weight management surgery in Pediatric Patients. Also, would like to share some links from the American Academy of Pediatrics if you are looking for more information.

El Dia de Hoy en Buenos Dias America tuve una gran conversación con Andreina Garnica sobre los nuevos lineamientos del manejo de peso por medio de cirugía en Pacientes Pediátricos. Ademas, me gustaría compartir la liga de la Academia Americana de Pediatría por si necesita usted más información del tema.

You can find the policy statement, “Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices” here: https://pediatrics.aappublications.org/content/early/2019/10/24/peds.2019-3223

An AAP News article by lead author Dr. Sarah Armstrong is here: https://www.aappublications.org/news/2019/10/27/bariatricsurgery102719

Summary of week 8: Vaccines and vaccines…

For all parents: when it gets time to start the vaccines of your baby, it’s always harder for the parents for than the baby… Nobody can disagree that vaccines has been one of medicines top 3 inventions that has saved and prevented horrible diseases for human kind.

Our daughter for the first time (actually, the second time, the first was the hepatitis b vaccine at birth) got her 2 month old vaccines, and of course, we were happy to get to the milestone. I have said a couple of hundred times (at least) the short list of common side effects that the baby can have, it is my version of the “Miranda rights” that cops know by heart, but this time was a little bit different, knowing that my flesh and blood was going to be immunized (and my wife is not a fan of any needles!). She did perfectly great on her weight, height, meeting all her developmental millstones; waiting for the big moment finally, we were prepared. It’s amazing how important it is to have calm parents at the moment of vaccination, even a small infant can tell if mammy and daddy are nervous. Everything was done in seconds, and with a smile at the exit of the pediatrician’s office.

There is always a small probability that the patient (aka: daughter), can have fever, crying spells, sleeping more than usual, redness on the site and even a bump, everything controllable with general comfort measures. But, my daughter read with me all the side effects, choosing to have on that evening fever and sleepiness. You can imagine the 7 missed calls that I had in my cell phone before I left the office. If you have in your mind the question “you knew the side effects”, the quick answer is: YES, YES and YES! You needed to see this infant, bundled up, having her first fever smiling at her parents: I’m fine; it’s just a little fever. I tried 3 different thermometers, having the same answer: your daughter DOES have a fever. She continued to eat, laugh and play, having extended periods of sleep during the day, but by morning, thank G-d she was back to her old self: laughing, moving and doing her own tummy time. Every day, I learn something new, to be humble and reaffirming that when a parent tells me the fears and myths  that have heard about vaccines, I will share my personal story and the peer review information regarding why it’s important, side effects and the probability of having a severe bad reaction the vaccines, my conclusion always is: I’M HERE TO HELP YOU UNDERSTAND THE INFORMATION, I can’t guarantee 100% that everything will be perfect, but for sure this is a great choice (PLEASE PLEASE go to http://www.vaccines.com/why-vaccinate-fact-01.cfm).

Now to other matters… I can spend a lot of time watching my daughter, amazed on how they  start exploring the world, finding their hands, grabbing things, smiling… No she is moving her legs, trialing objects and cooing, our “sleep, eat, move and poop machine” is actually converting into a “little person”, communicating her needs and fears.  I can’t extend how important it is for any parent to be on top of this, you are the one that knows your baby best.

 

What I’ve learned this week for THE UNOFFICIAL MANUAL ON HOW A PEDIATRICIAN BECOMES A FATHER:

1)    Vaccines are more painful to watch when you are a parent

2)    Having a great time learning from my best teacher… MY DAUGHTER!

Thumb vs Pacifier

When we are babies, none of us were asked if we wanted to “suck our thumb or use a Pacifier (I LOVE THE NAME!), wondering right now about that decision for my daughter. Many lactation consultants and pediatricians believe that there could be a “nipple” confusion if a newborn is exposed to bottles/pacifiers in the first 3 weeks, for sure it’s a nice a idea but I have not yet seen (until now) some one that has not “exposed” their babies to them. In our debate, someone told us, “you can accidentally loose the paci, but you can’t cut out the thumb”… That got us thinking, we waited 3 weeks, limiting her contact to artificial nipples and we started to have a couple of questions in our heads:

1)    Having no choice, but for sure influence in the decision, I would encourage the pacifier for my baby instead of the thumb. The entire concept was commodity, easy handling, decrease risk of Sudden Infant Death Syndrome (AKA: SIDS; could be a topic for another day) thinking that one day in the future “Mr Paci” will go on a trip an never come back…

2)    Choice two: “The Organic Thumb”, you never lose it, they know where it is, but it needs some behavioral interventions (as the pacifier) to finish with it, plus having a finger on the mouth after the child has teeth starts to push  certain areas creating good business for orthodontics.

And for every one… What was your feeling? Did you choose a method? Any tips? Was it hard to “take” it out?

Summary of week 7: Google: your best friend or worst enemy? Child Development, vaccines and translating medical information

I love the secret smiles of some of the parent’s patients when they ask if I have a son/daughter and my answer is: YES, I do have a daughter! It’s possible to even hear the music in the background mixed with empathy. Now as part of my training, I have continued medical education at home, with my Beautiful wife and daughter.

This week I fought against a friend called GOOGLE. For sure you have typed so many things in to that white space in order to get “the best possible answer” in the top 10 results, that most of them are “pushed” to the front due to relevance, hits (how many people actually went to that website) and an equation of Money; having all of  this information in milliseconds. I came home, hanging my imaginary white coat outside of my home to embrace my family. I was bombarded with health questions, doubts and fears from the information acquired thru the internet. After a couple of minutes of hearing the case, we had a nice conversation translating the raw medical information to easy to understand facts, at the end of the conversation, all the doubts and fears became security and peace. It’s really easy to find medical information on the internet, probably in million results and in almost all languages, but reading does not mean understanding the big picture. When you get the results of the question you are searching, please have a couple of things in mind (http://safetynet.aap.org/internet.pdf), anybody can create a website with information, instead, go to known sources (American Academy of Pediatrics, Healthychildren.org, CDC.gov, etc) in order to get peer reviewed information. But the process doesn’t end there, if you have questions, doubts or comments (I have read a couple of vaccine related web sites, with old information, that creates fear and doubt…) JUST ASK YOUR MEDICAL PROVIDER; information is one of the biggest tools that we can use, AND I LOVE when parents come with questions/comments about things that they have read or heard because it actually moves the conversation to a higher level, we’ll review the information, do fact checks and after having all the information, we can take action talking about “the white elephant in the room” (I will completely recommend using: aap.org, healthychildren.org, cdc.gov and when in doubt, you can leave me a comment regarding a website, and I’ll look into it).

Now, moving to other “growing” things… When you go to your pediatrician, it’s imperative to talk about the developmental milestones of your kids, this way the parents and the pediatrician can talk about the motor (physical movements), language and social things that are appropriate for your children. This week, we noticed her different reactions to our voices, her face changes and she knows how to communicate, in an interesting way, about hunger and change of diaper. She is tracking objects, reacts to sounds and facial features, having a smile that warms my heart. My pediatric brain (usually turned off when I’m at home) measures all this little things, monitoring the growth of all areas of my daughter. It’s important if you have other children to know that every kid grows at a different pace, and could achieve the developmental milestones faster or slower that other siblings, my point with this is: IF YOU ARE WORRIED,  ASK YOUR PEDIATRICIAN.

Vaccines are coming our way… My wife hates needles but loves vaccines. In the following week we will have the moment of truth: “the first round of vaccines”. I have been preparing my wife (and my heart too…) for this moment. I will keep you posted… Parents are an essential part of the equation; kids can smell, see and hear fear… Before you step in the room for vaccines, take a deep breath, smile, think about the protection and security that you are giving your kid… Never lie to them, SHOTS hurt, if we say: “it doesn’t hurt”, we are laying to them, then they will be even more scared in the future, not only at the pediatrician office, but every part of your relationship with your child.

What I’ve learned this week for THE UNOFFICIAL MANUAL ON HOW A PEDIATRICIAN BECOMES A FATHER:

1)    Internet is a great tool, but sometimes you need a human to translate and filter information from it.

2)    Follow your instincts, if you are worried about something from your kid, talk to your medical provider.

3)    It is worth it to take a couple of minutes and have a print out of what developmental milestones to expect from your child, that way you know what to expect and monitor his growth.

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