Podcasts about boston children's hospital

This episode features John Brownstein, Chief Innovation Officer at Boston Children's Hospital. Here, he discusses his role as Chief Innovation Officer, his pride in Boston Children's Hospital, and more.

Dr. Timothy Yu is Attending Physician, Division of Genetics and Genomics, and head of the Yu lab at Boston Children's Hospital. He is also Associate Professor of Pediatrics at Harvard Medical School. He walks us through his experience running the first "N of 1" drug trial for a young patient with a devastating genetic mutation.

While the COVID-19 virus has been most harmful to the adult population, its indirect impact on children is taking its toll with behavioral health and other related issues on the rise. Listen to this podcast to hear Roddy Young, Chief Marketing and Communications office at BCH, discuss the impact on children and how the country's leading Children's Hospital is addressing the issue.

Techstination, your destination for gadgets and gear.   I’m Fred Fishkin.   What is being called a Digital Wellness Lab has been created at Boston Children’s Hopsital…to research and work with innovative companies in examining the effects of digital technology on our brains, bodies and behaviors.   Harvard...

Techstination interview: Digital Wellness Lab created at Boston Children's Hospital: Founder Dr. Michael Rich

Thank you for all the love and support! I'm buzzing for the London 2021 Marathon on October 3rd - stay tuned for LOADS more content! Support my fundraising efforts for Boston Children's Hospital: https://secure.childrenshospital.org/site/TR/ActiveEvents/ActiveEvents?px=2051217&pg=personal&fr_id=2076 LAUNCH of my website: www.resiliencyinrunning.com My Merch/Products (all proceeds go to Boston Children's Hospital!): www.resiliencyinrunning.com/merch Podcast Instagram: @resiliencyinrunning Podcast Links: linktr.ee/resliencyinrunning --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/resiliencyinrunning/message Support this podcast: https://anchor.fm/resiliencyinrunning/support

After doctors at Boston Children's Hospital saved Georgia Bowen's life, her mom Kate started to make hospital gowns for children and was able to donate a million dollars to the hospital that gave her daughter a second chance at life.

In the latest episode of Her Story, we sat down with Sandra L. Fenwick, CEO of Boston Children’s Hospital. We discussed Sandi's trailblazing, forty-year career and her path to becoming an exemplar, healthcare administrator, and advocate for children's health.

“Nothing crosses borders in our polarized world like a willingness to care for critically ill children,” says Dr. Jeffrey Burns, a former medical liaison for the US State Department. In addition to leading critical care at Boston Children's Hospital and teaching at Harvard Medical School, Dr. Burns is also the founder and co-program director at OPENPediatrics, an innovative, open-access online community where healthcare professionals from around the world share resources and best practices. Join us for a treat as Dr. Burns talks with Osmosis Chief Medical Officer Dr. Rishi Desai, a former student of his, about the OPENPediatrics platform's international COVID-19 discussion group and how this collaboration brought about the discovery of the potentially fatal MIS-C inflammatory syndrome. In this episode, Dr. Burns not only shares critical information about MIS-C, but also reflects on his career and work with the CDC, addresses public mistrust of vaccines, and encourages others to join the healthcare field.

Any of your patients leery of steroid side effects? Fortunately, we have an expert to share some additional options. Listen in as Peter Lio, MD addresses the history of steroid usage for AD, its alternatives, and how to discuss these alternatives with your patients. Each Thursday, join Dr. Raja and Dr. Hadar, board certified dermatologists, as they share the latest evidence based research in integrative dermatology. To learn more about AD, register for the FREE Understanding Moderate to Severe Atopic Dermatitis in Current Times webinar and CME series.   Dr. Peter Lio is a Clinical Assistant Professor of Dermatology and Pediatrics at the Northwestern University Feinberg School of Medicine. He received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children's Hospital, and his Dermatology training at Harvard where he served as Chief Resident in Dermatology. Dr. Lio is the founding director of the Chicago Integrative Eczema Center and has spoken nationally and internationally about atopic dermatitis, as well as alternative medicine.

Listen as Dr. Kusum Menon discusses the history and science behind corticosteroids and their use in septic shock. She covers the pathophysiology of adrenal function, identifies potential risks and benefits of empiric corticosteroid treatment, and outlines an approach to corticosteroid use in septic shock in children. Initial publication: June 19, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

In the latest ASCO in Action Podcast, American Society of Clinical Oncology (ASCO) CEO Dr. Clifford A. Hudis is joined by Dr. Jonathan Marron, incoming Chair of ASCO’s Ethics Committee and a lead author of the new Ethics and Resource Scarcity: ASCO Recommendations for the Oncology Community During the COVID-19 Pandemic.  In this episode they discuss ASCO’s recommendations, why ASCO developed this guidance, and what patients, families, and the entire medical community need to know about allocating limited resources during the COVID-19 Pandemic.   Subscribe to the ASCO in Action podcast through iTunes and Google Play.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Welcome to this ASCO in Action podcast, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content that offers enriching insights into the world of cancer care. You can find all of our shows, including this one, at podcast.asco.org. The ASCO in Action podcast is ASCO's podcast series, where we explore the policy and practice issues that impact oncologists, the entire cancer care delivery team, and the individuals we care for, people with cancer. My name is Dr. Clifford Hudis, and I'm the CEO of ASCO. And I'm proud to serve as the host of the ASCO in Action podcast series. Today, I'm very pleased to be joined by Dr. Jonathan Marron, incoming chair of ASCO's Ethics Committee and a lead author of ASCO's recent recommendations for the oncology community on ethically managing scarce resources during the COVID-19 pandemic. Dr. Marron is also a bioethicist at Boston Children's Hospital, a pediatric oncologist at Dana Farber Cancer Institute, and he is on the Center for Bioethics teaching faculty at Harvard Medical School. Today, we're going to talk about those recommendations. And I'll note that they were published just recently as a special article just in early April in the Journal of Clinical Oncology. We'll focus specifically on the reasons that ASCO took this step and what it is that oncologists, patients, families, and the entire cancer care community need to know about this issue. Dr. Marron, thank you so much for joining me today. Thank you so much, Dr. Hudis. It's really a pleasure to be speaking with you, and an honor as well. Before we get started, I do want to just point out that I have no conflicts of interest to disclose. Well, that's great. Now, just to provide some context as we start this discussion, it's the middle of May as we're recording this. In the United States, the COVID-19 public health crisis bubbled up to awareness a little bit in January, became seemingly near threat in February, and seemed in the public's eye, I think, to breach our shores at the beginning to middle of March. So we're about four months, more or less, into this public health crisis. The US has had now about a million and a half confirmed cases of the virus. And I think this week, we crossed the 90,000 number in terms of deaths from the virus. From the very early days, there was-- and we all remember this-- an extraordinarily emotional and widespread concern that medical resources, and especially ventilators, but also medications, as well as space, critical and intensive care beds-- those three things, that they would be stretched, that some communities would be especially hard hit, and that, as a consequence, access to those resources might be limited. And when that arose as a concern, what followed, especially for people who work in this field, and bioethicists in general, as well as everyday clinicians, was the very real possibility that they would be forced to make some painful and difficult choices. And I'll say some of our members wrote about these experiences as well in ASCO Connection and elsewhere. So can you now maybe help our listeners understand why ASCO in particular thought that this situation needed to be addressed and why we decided to provide the very specific guidance that you took part in creating in the form of these recommendations? Absolutely. So you really highlighted a couple of the main questions and concerns that we had that we wanted to do our best to address, in the sense that at the outset of the pandemic, it was really difficult to tell what direction things were going to go and just how bad everything was going to get. Seeing the experience in China and seeing the experience in Italy, there was significant concern that, as you mentioned, our health care system would not be able to support the critical care needs that we would have. There is a long history of people thinking about how to utilize and best utilize resources like this in the setting of scarcity. One of the concerns that comes up whenever you have to make these difficult or realistically impossible choices is how you're going to do so. And so really, that's where we came, as oncologists and as the ASCO community, to try to figure out how we could best represent the oncology community and to ensure that cancer unto itself was not going to keep a given patient from having a fair chance to access these potentially lifesaving resources, even in the setting of a public health crisis like this, even in the setting of scarce resources. So I remember as this was being developed having conversations with, I think, you and other members of the panel. I'm going to push a little bit on at least one of the areas that I think is really a concern but can be misunderstood. And that is this high-level statement you just made that people with-- if I understood correctly-- that people with cancer might find themselves discriminated against in these moments of triage, fundamentally. There's one ventilator. There are three patients at need. And God forbid we're ever in this situation-- how do you decide who gets it. On the one hand, of course, there's a fairness doctrine. But on the other, there is a medical reality. And cancer is not one thing. So could you just talk a little bit about what we mean when we say protecting the cancer patients? And let me be clear. We're not saying that cancer as a diagnosis, stage, prognosis should be ignored exactly, right? Absolutely. And I think what you said there really is one of the most, if not the most, important aspects here, that there are a couple of different ways that you can go about trying to take, as the example that you had of the three patients, and decide which of those three will get the ventilator. If not the perhaps fairest way would be simply to make a choice at random and say each of those three individuals has an equal chance at it, and we'll flip a coin or do some other random way of deciding who will get it. That's certainly fair. But some people would say, you know what? They may not be equal in all ways. And if we're trying to maximize our resources and maximize the potential outcome benefits of these scarce resources, we want to do something more than just do something-- choose randomly. And we've actually learned in the past from work with community groups that people don't love the idea of randomly choosing things like this, in a public health emergency or otherwise. And so then-- the question, then, is OK, so how are you going to make that choice. If we're trying to maximize health care outcomes, and which you usually think about that being survival, we want to use medical information. But then the question is, what is the information that should be used. So one of the concerns is that there could be certain disease processes, cancer or otherwise, that would be seen as exclusion criteria. That's to say, OK, we have these three patients. We have one ventilator. Patient one has cancer, so therefore we're going to not even give them a chance at that ventilator. And that's really where this comes in. That's not the way to do this. Cancer absolutely should come into the consideration. But that patient's specific cancer-- their diagnosis, their prognosis, the medical information-- the best medical information that we have, the best evidence-based medical information that we have about their specific disease so that we can make an informed decision, or at least a maximally informed decision about who is the most likely to survive if they are given access to the ventilator or ICU bed or whatever it might be. Yeah, I think this was one of the areas that you had to read somewhat carefully and be patient to understand the context, because if I understand correctly-- and with no disrespect to our colleagues outside of oncology-- one concern is that in the ER, a patient who once had cancer might just be, in a blanket way, discriminated against. But look, I was a breast cancer doc for 30 years. Most of my patients were, frankly, . cured. And the fact that they had breast cancer in 1996 is of essentially no meaningful relevance to any medical decision, almost. I'm oversimplifying it here, rather. But our concern, I think, was that in the front lines, under duress and pressure, that mistaken judgments might be made, and we wanted to advocate for that. Is that-- I may not have said that so elegantly. But is that-- that was one of the concerns in the other direction, right? Absolutely, yeah. And it's certainly conceivable that somebody, in a very well-intentioned way, would think that OK, this patient currently has cancer or at some point in the past had cancer. And as wonderful as the electronic record is, sometimes it can be difficult to tell if something is a current medical problem or a past one. But either way, simply the diagnosis of cancer is not the be-all, end-all. And there needs to be a thoughtful and ethically rigorous process by which these decisions are made. And that's what we hoped to inform with the paper and with the recommendations. You know, it's interesting. And if I may just think of the sweep of time, I always put things in the ASCO context. So the society was founded in '64. The medical oncology boards were in the mid-70s for the first time. The curative systemic therapies for testes cancer, for the lymphomas were a little before that, obviously, and in that general era. It is quite a testimony, when you think about it, to the advances in oncology that we're now worried that people will, in a sense, make too much in the negative direction about prognosis of a cancer diagnosis. And I'm thinking of the last few years, where suddenly there are tranches of survivors of melanoma and non-small-cell lung cancer and other diseases that historically had a very poor prognosis, and now they may still have, on average, a bad prognosis. But there are survivors and long-term survivors with formerly incurable diseases. They need to be protected, in a sense, from this one-size-fits-all judgment, right? Absolutely, yeah. And as a pediatric oncologist, I run into that every day that people assume that, oh, my gosh, children who are diagnosed with cancer, that they're dying left and right. And people are generally quite surprised to hear that we have an 85% survival rate in children with cancer. So that certainly would be a concern in that population as well, that if there were the setting of resource scarcity that a child could come in and say, OK, well, they have cancer, even if it's active cancer, but they, in many cases, would be expected to have a very good chance of survival. It's interesting you bring that up, because I will say in a distantly related aside, certainly one of the more interesting and repetitively surprising conversations many of us have is the one that involves pediatric oncology with friends and neighbors or whatever who aren't that familiar. They're always surprised at the high success rate in that field. And it just makes the point that we can't let a diagnosis stand as the only interpretable fact. So look, these recommendations establish an important principle. A cancer diagnosis alone should not keep a patient from a fair chance to access potentially life-threatening-- or rather life-saving, sorry, resources, even during a public health crisis. But let's go a step further. One of the other recommendations in there were that decisions regarding allocation of scarce resources should be separated-- separated from bedside decision-making. This one, I struggled with as a reader as well. And I wonder if you could explain to our listeners what the intent or thinking behind this recommendation would be. As I ask that question, in my mind's eye, I picture I'm called to the ER. The ER doc is looking at my patient's dropping O2 sat and is turning to me for advice and guidance and understanding of the disease specificity or the specific disease circumstances in this patient so they can make the triage decision. And I'm struggling to understand what we actually mean by decisions regarding allocation of scarce resources should be separated from the bedside. So ultimately, that piece comes down to the fact that we as humans and decision-makers are imperfect. And it would be unreasonable and probably impossible to expect that any one of us, as a clinician or just as a person, could reasonably weigh all of these different things simultaneously, because there is ultimately a huge conflict of interest in saying that I am the clinician taking care of this patient in front of me, but simultaneously, my job is to steward the resources for my institution or, even more broadly, the resources for the entirety of the country or whatever I might consider to be my patient population. And so what we are trying to-- the message we were trying to send with that piece is not only that it shouldn't be the oncologist who's making that resource allocation decision, but it's actually not the emergency room clinician who should be either, because it's just completely unreasonable to expect someone at the bedside to be weighing those two things at the same time and to be making an unbiased decision. Well, apart from the pandemic and the specific kinds of acute resource shortages that the paper addresses, the truth of the matter is, we've been talking about finite healthcare resources and hard choices for years. And these questions often are raised in the context of oncology. So I want in that way to just ask you about something that you mentioned at the very beginning, but I'm going to push you to a more precise answer, the recommendation that says allocation of scarce resources in a pandemic should be based on maximizing health benefits. And you alluded to that a little bit. So can you just expand a little bit on what it is you mean? You've said overall survival is often taken as one. But of course, there are trade-offs. There's quality-of-life issues. There are a number of people who might benefit modestly, more people, fewer people, benefiting more deeply, whatever it is. So I won't hold you to this exactly, although it's being recorded. But what do you think should be the goal when we talk about maximizing health benefits? What exactly does that mean? So this is really where we get into the weeds with this, as you were sort of alluding to. So certainly, we want to save the most lives. I think there is general agreement from most people out there that that's a reasonable and a fair way to look at this. One of the questions that's been debated most over these past couple of months as we've been thinking about these things, perhaps more than we ever have before, is whether we want to somehow integrate the idea of saving the most life years. So what do I mean there? So the idea that a person who is expected to live five years, do we think about that life differently than a person who's expected to live another 45 years? Intuitively, I think many people would say, oh, well, if we have to make that choice, that awful, impossible, choice, we should save the person who is going to live 45 years over the one who's going to live five years. That's getting at this question of saving the most life years, number of total years of life. And so with that, I'll ask you, is there anything else you think ASCO members or the cancer care community or health care institutions should understand about this work in this moment? Is there anything their families and patients you would want to-- is there anything else you'd want them to know about this that we haven't touched on? I mean, I think one really important but really challenging piece about all this is the role of communication, in every sense of the word, that these are absolutely unprecedented times. And these types of decisions, if and when they have to be made, are luckily things that-- the kind of decisions that we don't typically ever have to make. And so if they have to be made, ensuring that oncologists who have the long-standing relationship with patients and families take on a role of communicating with patients and with their families as much as they can to explain why these decisions are being made, and why they have to be made, to ensure that everybody is on the same page I think is really important. What makes this even more difficult is the fact that most hospitals now have visitor policies such that families and caregivers often, if not most times, are not able to be at the bedside of patients, which makes this only that much harder, but makes communication that much more important. I would want to highlight something you just said, because it resonates, at least for me, and I think for many in our in our community. And that is communication. At root, of all of this is dependent and made easier and smoother by high-quality communications. And I would actually extend what you said by pointing out that it also includes discussions about intentions and desires on the part of patients. And this is something we who take care of cancer patients, I think, do try to spend a lot of time on. This discussion is much easier if a patient who does know about a life-limiting prognosis is clear about what they want. Certainly for the whole team, some of the ethical dilemmas might be minimized that way, right? Yeah, I couldn't say that better. That's one thing we try to highlight in the guidelines as well, that we consider advance-care planning and having goals-of-care discussions to be really at the core of clinical oncology practice. And that continues in the setting of this pandemic. And if anything, it's only more important. Well, I think this is really great. I hope that listeners find this discussion intriguing and go and take a more in-depth look at the actual publication. I want to point out that the recommendations that we've been discussing are just one part of ASCO's longstanding commitment to provide information, guidance, and resources that will support clinicians, the cancer care delivery team, and patients with cancer throughout their journeys, and also during this COVID-19 pandemic. That is, what we're doing here is not unique to this pandemic moment, even if the acuity of the need is heightened. There are some other resources that you should be aware of, including patient care guidance for oncologists who treat patients with cancer during the COVID-19 pandemic. There are guidances available for practices on how to adjust our policies in response to the virus and, just recently, on how to begin to return to more normal styles of work. There are also updates on federal activities that have been aimed at responding to this crisis. And everybody knows that this has been a very fast-paced time of change. We recently launched the ASCO survey on COVID-19 in Oncology Registry or ASCO Registry. And our goal is to collect data and share insights on how the virus has impacted cancer care, but also cancer patient outcomes throughout the COVID-19 pandemic. And we encourage all oncology practices to participate so that we can gain the largest data set possible, and therefore represent the diverse population of patients and practices around the United States. I want to remind listeners, you can find all of these resources and a whole lot more at ASCO.org. There is also patient-focused information available at Cancer.net. And with that, until next time, I want to thank everyone for listening to this ASCO in Action podcast. I want to remind you that if you enjoyed what you heard today, you should take the time to give us a rating or review on Apple Podcasts or wherever you might listen. And while you're there, be sure to subscribe so that you never, ever miss an episode. I want to thank Dr. Marron for joining us today. Thank you, Dr. Hudis. It was an absolute pleasure to join you. And lastly, I want to remind you that the ASCO in Action podcast is just one of ASCO's many podcasts. You can find all of the shows at Podcast.ASCO.org.

This episode is an international collaborative conference call hosted by Dr. Jeffrey Burns of Boston Children's Hospital and Harvard Medical School. Featured speakers are Drs. Daniel Barouch, Trevor Duke, and Robinder Khemani, who outline current vaccine developments, oxygen therapy, and ventilation guidelines (respectively) in the time of COVID-19. Initial publication: May 22, 2020. OPENPediatrics attempts to keep all COVID-19 information as accurate and up to date as possible. However, as recommendations for care and treatment are rapidly changing due to the nature of the pandemic, Boston Children's Hospital does not assume any legal liability or responsibility for the accuracy, completeness or usefulness of any information on OPENPediatrics. We advise users to please pay close attention to the publication date of all COVID-19 content, and always adhere to your institution’s specific policies and guidelines. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

WBZ NewsRadio's Madison Rogers spoke with a pediatric cardiologist at Boston Children's Hospital about a rare coronavirus linked illness that has struck some patients.

WBZ NewsRadio's Madison Rogers spoke with a pediatric cardiologist at Boston Children's Hospital about a rare coronavirus linked illness that has struck some patients.

The topic we’ve been wanting to dive into for so long and it’s finally here because of an amazing opportunity that fell into our laps! By far, one of our most decorated guests to date and one of our most sensitive topics to date. We are beyond excited to have Halle (pronounced hal-lee) Tecco, Founder & CEO of Natalist (pronounced nate-uhl-ist), join us to talk about fertility and how it inspired her to start Natalist, a company that makes fertility and pregnancy products (inspired by beauty and backed by science). Halle provides lots of powerful and impactful tips, advice, and takeaways for women AND men trying to conceive. This woman seriously rocks. If you can spare a minute or two, go Google her. We promise you, it’s worth your time. Here’s a sneak peek into only some of what she’s done…be prepared to have your mind blown: Previously, Halle was a founder at Rock Health, and an Adjunct Professor at Columbia Business School. She started her career working in finance and business development roles at Intel and Apple. She is currently an advisor to the Harvard Medical School Department of Biomedical Informatics and Boston Children's Hospital. Halle's also appeared in The New York Times, The Wall Street Journal, and CNBC. She was named as one of Goldman Sach's Most Intriguing Entrepreneurs and listed on the Forbes 30 Under 30. She received her MBA from Harvard Business School and is currently pursuing her MPH from Johns Hopkins. AMAZING STUFF! We hope you enjoy listening to this episode just as much as we enjoyed recording it with Halle. Resources Natalist.com Natalist on Instagram Natalist on Twitter Connect with Mother Forking Podcast Email Instagram Facebook Twitter --- Support this podcast: https://anchor.fm/motherforking/support

Dr. Anthony Rao, Ph.D. is a clinical psychologist who holds a Ph.D. in psychology from Vanderbilt University. For more than 20 years, Dr. Rao worked in the Department of Psychiatry at Boston Children's Hospital and served as an instructor at Harvard Medical School, where he trained psychologists and physicians in the use of Cognitive Behavior Therapy, or CBT. Dr. Rao has been a featured expert on documentaries and has been interviewed for articles in The New Yorker, The Boston Globe, The Washington Times, The Chicago Tribune, and Parents Magazine, among many others. His editorial letters and opinions have appeared in a wide range of publications including Newsweek, Scientific American, The New York Times, and New York Magazine.Dr. Rao has lectured extensively at universities, including Tufts University, Emerson College, and Boston University. He regularly presents at conferences, parenting groups, and conducts workshops for professionals around the country who work with children and young adults. His first book, The Way of Boys: Promoting the Social and Emotional Development of Young Boys (HarperCollins) is an expose on the current crisis in American boyhood. It urges parents, educators, pediatricians, psychologists, and other developmental experts to reevaluate and radically alter how we raise boys – so boys can be their best, respecting their unique development right from the start.

On this episode we speak with Professor Edward Walsh of Harvard University about a recent work he co-authored on Ebstein's anomaly. Can review of pathological specimens offer some insights into why ablations in this patient group are so challenging? Is there an optimal age or size to perform an ablation in this patient group? Why are these ablations so difficult? Dr. Walsh, Director of the Arrhythmia Service at Boston Children's Hospital, shares his deep insights this week. doi: 10.1016/j.hrthm.2020.01.013

Dr. Karen Choong, Professor of Pediatrics at McMaster University, speaks on how to implement early mobilization in critically ill children. She outlines goals for early mobilization, defines criteria for implementation, and offers tips about how to effectively achieve this in the PICU. Initial publication: April 24, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Listen as Dr. Louise Jakubik discusses mentorship, how it benefits the field of nursing and discusses the development of the Jakubik Mentoring Model. Initial publication: April 17, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this episode, HeHe is joined by Julia Brown, MD to discuss COVID-19 and newborns/infants! Julia is a local pediatrician at one of the top 5 birthing hospitals in Massachusetts and is sharing what parents need to know in these unprecedented times. HeHe is asking about how coronavirus presents in newborns, the recommendations on separation of birthing parent and baby plus what breastfeeding parents need to know about transmission! Julia shares what parents need to know about fevers, symptoms of COVID-19 and how to begin treating it at home while you make a plan with your medical providers. The conversation also addresses what pregnant people need to know about washing their babies and what to changes to expect during labor!    About Julia: Julia Brown MD is a primary care pediatrician at Newton-Wellesley Family Pediatrics, a private practice in Newton, Massachusetts affiliated with Boston Children's Hospital. Dr. Brown completed her medical training at Tufts University School of Medicine and her pediatric residency training at Columbia University-Morgan Stanley Children's Hospital in New York City. After residency she worked for three years at Mount Sinai Hospital in New York in primary care as well as dedicating time to pediatric resident and medical student education. In August, 2019 she returned to her roots in Newton, MA and joined NWFP. Her practices is open to all ages from birth to 21 years of age, and her love for athletics has translated to a particular affinity for sports medicine.   Brought to you by: Primally Pure, Listeners can save 10% with code HEHE10 at checkout!  

In this episode, my guest Sherri Tutkus, RN, BSN, Founder & CEO of Green Nurse Group, came on the podcast to share a powerful and inspiring mother son story that follows the timeline from receiving a diagnosis at birth of her son Nicholas with Branchio-Oculo-Facial Syndrome through current day. Sherri gives one of the most powerful illustrations over the course of the episode, of a mother's love, courage, compassion, resilience and tenacity that I've ever heard, and is a fantastic example of holding onto presumption of competence as a guiding light, against all odds.Sherri Tutkus is the founder and CEO of GreenNurse Group, Nursing Director at Irie Bliss Wellness and host of GreenNurse on the Go Radio Show. Sherri is a cannabis nurse, patient and advocate. She earned her Bachelors in Science and Nursing from Boston College. She is highly skilled Registered Nurse with 30 years’ practical experience in various departments within the hospital and home setting. She is utilizing her expert nursing skills as a medical center specialist, clinical nurse liaison and educator to bridge the gap between patients and the cannabis community. Sherri has been educating and implementing holistic integrative healing modalities within her practice for over 20 years. She educates on the endocannabinoid system and the safe utilization of cannabis at dispensaries, hospitals, clinics, patients homes and she regularly does pop up events, seminars and expos. Sherri is an international speaker and she has contributed to the writing of the first cannabis nursing textbook with her cannabis nurse colleagues that will be available in nursing schools across the country. Sherri is a member of the American Cannabis Nurses Association and founding member of The Cannabis Nurses Network and was nominated as one of two nurses for “Health Professional of the Year” for the 2020 New England Cannabis Convention. Sherri brings passion and purpose to her work teaching bio-psycho-social-spiritual healing using cannabis as a tool. In the first part of this podcast, Sherri discusses her own background and connection to cannabinoid medicine. The tools she learned in her own journey enabled Sherri to cope with frequent and ongoing surgeries, procedures, treatments for her son Nicholas and advocate vociferously on his behalf. "When I'm presenting to people, I use myself as a case study. Because basically, prior to me getting ill, I had a history of migraine headaches, ADHD, and anxiety, that was managed with traditional medicine. I was functioning, I was healthy, single mother of three, child with a disability that we're going to talk about, but knowing that I had migraine headaches and at ADHD symptoms should have been a clear indicator that I had an Endocannabinoid deficiency. So everything that we do or don't do in our lives as far as health and wellness affects this neurotransmitter signaling system called the endocannabinoid system, and that the job of that system is to bring balance."She goes on to explain, "By the end before I discovered cannabis. I was on over 16 pharmaceuticals. So, as I've learned over time, if you're taking more than 10 pharmaceuticals, there's 100% chance of having an adverse drug reaction. Polypharmacy. I fit into that polypharmacy category. I am not anti pharma. However, what is really essential for people to understand when they are being prescribed pharmaceuticals is to ask those critical questions and to look at what side effects there are to look at the blackbox warning Okay, how many people have died? You know, what are the side effects, what are the adverse effects, you need to have knowledge knowledge is power. The other thing that people People don't realize is that a lot of pharmaceuticals have a drug nutrient depletion" She goes on to explain, " I have have a history of Polycystic Ovarian disease which is very interesting. And that yeah, that is considered to be a clinical Endocannabinoid deficiency diagnoses as well. So I had issues with fertility all along. ... And then my third pregnancy... it's interesting, you know I gained all kinds of weight and wasn't happy and I started changing my lifestyle when the babies came. And all of a sudden my reproductive system started to auto regulate. I was using specific supplements and nutrition. I changed my diet, I became vegan, I did a raw diet, and all of a sudden, I'm a fertile Myrtle. And before we know it, I'm pregnant with my third" From here, Sherri goes on to discuss the birth of Nicholas and the immediate realization that he had multiple issues of which she was not aware of up until the moment of his birth. She explained to me in writing prior to the recording of this episode, the following, "All of my births were traumatic experiences however this pregnancy was the best and the easiest. I had an uneventful healthy pregnancy. I broke my water 6 weeks early and when my first boy was born he was not breathing and they had to resuscitate him and over the course of my first postpartum days I learned that my son had a rare genetic disorder called Branchio-Oculo Facial Syndrome."BOFS is inherited in an autosomal dominant manner. Each child of an individual with BOFS has a 50% change of inheriting the variant. Nick’s dad carried the gene and at the time of diagnoses the gene had not been identified.She discusses the realization of impact, "you have these craniofacial anomalies that required over 15 surgeries, but the things that they said about mental retardation was not true. The surgical stuff they were able to do . I engaged upon a journey with him that I would do anything for him. It was kind of like, I just got to do this. And so he became my full time job. "I asked Sherri the question, "How did you do it? How did you handle this huge weight of reality repeatedly?" She explained, "I got back to really the basics of self care and being present and grounded. I had already have a lot of those spiritual tools. My son opened up the door to the unseen worlds for me, which is a whole other show. But literally, I kind of felt like and I know it sounds crazy, but I'm sure other mothers can agree or associate or identify.... that I just felt a really strong connection with him and being able to understand what his needs were even before he could communicate."She goes on to add, "it gets back to what I can and cannot control you know, even if I can't control my emotions, even if I'm out of control, like hysterical or anxiety-ridden or sad, I still can have the ability to control what I'm doing and not doing in my life. And so what I knew to be true was in order for me to be the best version of myself, I needed to do everything that I could to take care of myself. And that included my mental health."She goes on to say, "But he's a true miracle. I gave him every opportunity. And he basically showed me through his own actions and his kindness and compassion and his grit and his ability. The kid had so much resilience and he wanted to heal, you know, he's not mentally retarded, he got set up with the Deaf Services as we found out later, he doesn't have sensory neural hearing loss, he has a bone conduction hearing loss. And so he basically told me one day Mom, I want to smile with the rest of the kids. And I was like, oh, of course you do. How do I make that happen? And boy, that was a scary journey. We literally embarked upon the journey of having my boy get a smile." "The amazing craniofacial team at Boston Children's Hospital did an experimental surgery that is called facial reanimation. And basically they didn't know. They said it would evolve over time, would the nerve take and would it connect and would it work? So here we are... I don't know here we are going. Through 16 hours of surgery 10 days in the hospital, not knowing if this is going to work or not. That was another faith based thing. Honestly, you know, it's all you have, and then literally one morning when I was waking him up for school, all of a sudden he sits up in bed. He smiles. So he's really he's come a long way. He's 14 years old now. When he was in sixth grade, he said, I want to go to public school. Oh my god, how is he going to be able to go to public school? So I was like, Okay, let's try to make it happen. And we embarked on the journey of integrating him into the public system."Bringing us to current day, Sherri explains, "You know, he is thriving. He's finishing up the eighth grade this year. And his freshman year, next year in high school, he will be in the public school. He still has an IEP, he's going to be in all honors and advanced honors classes is number one subject Spanish. And one of the other thing is that, you know, oftentimes as parents, we may feel sorry for our kid and you may feel bad. He doesn't feel sorry for himself. He doesn't feel bad." A final quote, "So what can I control? I try to control other people. And we can't control anyone. We can't. And that's the part that was the biggest lesson that I learned. And he taught me that, he taught me where my power lies and where it doesn't lie and how to choose and pick my battles and what's important and what's not important. And in the grand scheme of life, when you can pull back from that and see, what am I doing to be the best version of myself, so I can help my child thrive?"Sherri's links: Green Nurse Group: https://www.greennursegroup.com/Facebook: https://www.facebook.com/GreenNurseSherriInstagram: https://www.instagram.com/sherri_tutkus/, https://www.instagram.com/greennursegroup/Twitter: https://twitter.com/Green_NursesLinkedIn: https://www.linkedin.com/in/sherri-tutkus-rn-bsn-912b7776/

In this episode, my guest Sherri Tutkus, RN, BSN, Founder & CEO of Green Nurse Group, came on the podcast to share a powerful and inspiring mother son story that follows the timeline from receiving a diagnosis at birth of her son Nicholas with Branchio-Oculo-Facial Syndrome through current day. Sherri gives one of the most powerful illustrations over the course of the episode, of a mother's love, courage, compassion, resilience and tenacity that I've ever heard, and is a fantastic example of holding onto presumption of competence as a guiding light, against all odds. Sherri Tutkus is the founder and CEO of GreenNurse Group, Nursing Director at Irie Bliss Wellness and host of GreenNurse on the Go Radio Show. Sherri is a cannabis nurse, patient and advocate. She earned her Bachelors in Science and Nursing from Boston College. She is highly skilled Registered Nurse with 30 years’ practical experience in various departments within the hospital and home setting. She is utilizing her expert nursing skills as a medical center specialist, clinical nurse liaison and educator to bridge the gap between patients and the cannabis community. Sherri has been educating and implementing holistic integrative healing modalities within her practice for over 20 years. She educates on the endocannabinoid system and the safe utilization of cannabis at dispensaries, hospitals, clinics, patients homes and she regularly does pop up events, seminars and expos. Sherri is an international speaker and she has contributed to the writing of the first cannabis nursing textbook with her cannabis nurse colleagues that will be available in nursing schools across the country. Sherri is a member of the American Cannabis Nurses Association and founding member of The Cannabis Nurses Network and was nominated as one of two nurses for “Health Professional of the Year” for the 2020 New England Cannabis Convention. Sherri brings passion and purpose to her work teaching bio-psycho-social-spiritual healing using cannabis as a tool. In the first part of this podcast, Sherri discusses her own background and connection to cannabinoid medicine. The tools she learned in her own journey enabled Sherri to cope with frequent and ongoing surgeries, procedures, treatments for her son Nicholas and advocate vociferously on his behalf. "When I'm presenting to people, I use myself as a case study. Because basically, prior to me getting ill, I had a history of migraine headaches, ADHD, and anxiety, that was managed with traditional medicine. I was functioning, I was healthy, single mother of three, child with a disability that we're going to talk about, but knowing that I had migraine headaches and at ADHD symptoms should have been a clear indicator that I had an Endocannabinoid deficiency. So everything that we do or don't do in our lives as far as health and wellness affects this neurotransmitter signaling system called the endocannabinoid system, and that the job of that system is to bring balance." She goes on to explain, "By the end before I discovered cannabis. I was on over 16 pharmaceuticals. So, as I've learned over time, if you're taking more than 10 pharmaceuticals, there's 100% chance of having an adverse drug reaction. Polypharmacy. I fit into that polypharmacy category. I am not anti pharma. However, what is really essential for people to understand when they are being prescribed pharmaceuticals is to ask those critical questions and to look at what side effects there are to look at the blackbox warning Okay, how many people have died? You know, what are the side effects, what are the adverse effects, you need to have knowledge knowledge is power. The other thing that people People don't realize is that a lot of pharmaceuticals have a drug nutrient depletion" She goes on to explain, " I have have a history of Polycystic Ovarian disease which is very interesting. And that yeah, that is considered to be a clinical Endocannabinoid deficiency diagnoses as well. So I had issues with fertility all along. ... And then my third pregnancy... it's interesting, you know I gained all kinds of weight and wasn't happy and I started changing my lifestyle when the babies came. And all of a sudden my reproductive system started to auto regulate. I was using specific supplements and nutrition. I changed my diet, I became vegan, I did a raw diet, and all of a sudden, I'm a fertile Myrtle. And before we know it, I'm pregnant with my third" From here, Sherri goes on to discuss the birth of Nicholas and the immediate realization that he had multiple issues of which she was not aware of up until the moment of his birth. She explained to me in writing prior to the recording of this episode, the following, "All of my births were traumatic experiences however this pregnancy was the best and the easiest. I had an uneventful healthy pregnancy. I broke my water 6 weeks early and when my first boy was born he was not breathing and they had to resuscitate him and over the course of my first postpartum days I learned that my son had a rare genetic disorder called Branchio-Oculo Facial Syndrome." BOFS is inherited in an autosomal dominant manner. Each child of an individual with BOFS has a 50% change of inheriting the variant. Nick’s dad carried the gene and at the time of diagnoses the gene had not been identified. She discusses the realization of impact, "you have these craniofacial anomalies that required over 15 surgeries, but the things that they said about mental retardation was not true. The surgical stuff they were able to do . I engaged upon a journey with him that I would do anything for him. It was kind of like, I just got to do this. And so he became my full time job. " I asked Sherri the question, "How did you do it? How did you handle this huge weight of reality repeatedly?" She explained, "I got back to really the basics of self care and being present and grounded. I had already have a lot of those spiritual tools. My son opened up the door to the unseen worlds for me, which is a whole other show. But literally, I kind of felt like and I know it sounds crazy, but I'm sure other mothers can agree or associate or identify.... that I just felt a really strong connection with him and being able to understand what his needs were even before he could communicate." She goes on to add, "it gets back to what I can and cannot control you know, even if I can't control my emotions, even if I'm out of control, like hysterical or anxiety-ridden or sad, I still can have the ability to control what I'm doing and not doing in my life. And so what I knew to be true was in order for me to be the best version of myself, I needed to do everything that I could to take care of myself. And that included my mental health." She goes on to say, "But he's a true miracle. I gave him every opportunity. And he basically showed me through his own actions and his kindness and compassion and his grit and his ability. The kid had so much resilience and he wanted to heal, you know, he's not mentally retarded, he got set up with the Deaf Services as we found out later, he doesn't have sensory neural hearing loss, he has a bone conduction hearing loss. And so he basically told me one day Mom, I want to smile with the rest of the kids. And I was like, oh, of course you do. How do I make that happen? And boy, that was a scary journey. We literally embarked upon the journey of having my boy get a smile." "The amazing craniofacial team at Boston Children's Hospital did an experimental surgery that is called facial reanimation. And basically they didn't know. They said it would evolve over time, would the nerve take and would it connect and would it work? So here we are... I don't know here we are going. Through 16 hours of surgery 10 days in the hospital, not knowing if this is going to work or not. That was another faith based thing. Honestly, you know, it's all you have, and then literally one morning when I was waking him up for school, all of a sudden he sits up in bed. He smiles. So he's really he's come a long way. He's 14 years old now. When he was in sixth grade, he said, I want to go to public school. Oh my god, how is he going to be able to go to public school? So I was like, Okay, let's try to make it happen. And we embarked on the journey of integrating him into the public system." Bringing us to current day, Sherri explains, "You know, he is thriving. He's finishing up the eighth grade this year. And his freshman year, next year in high school, he will be in the public school. He still has an IEP, he's going to be in all honors and advanced honors classes is number one subject Spanish. And one of the other thing is that, you know, oftentimes as parents, we may feel sorry for our kid and you may feel bad. He doesn't feel sorry for himself. He doesn't feel bad." A final quote, "So what can I control? I try to control other people. And we can't control anyone. We can't. And that's the part that was the biggest lesson that I learned. And he taught me that, he taught me where my power lies and where it doesn't lie and how to choose and pick my battles and what's important and what's not important. And in the grand scheme of life, when you can pull back from that and see, what am I doing to be the best version of myself, so I can help my child thrive?" Sherri's links: Green Nurse Group: https://www.greennursegroup.com/ Facebook: https://www.facebook.com/GreenNurseSherri Instagram: https://www.instagram.com/sherri_tutkus/, https://www.instagram.com/greennursegroup/ Twitter: https://twitter.com/Green_Nurses LinkedIn: https://www.linkedin.com/in/sherri-tutkus-rn-bsn-912b7776/

Teddy and I met because we're both participants in a diet study put on by Boston Children's Hospital. You can check it out here: https://www.childrenshospital.org/fb4study/ I figured this would be a nice way to document the times.

Atrium Health doctor Mark Vanderwel answers questions on the minds of many parents these days. We will be adding a transcription later today. Quick turn around on this episode! If you saw the original Facebook live, skip ahead 17 minutes - it dropped out after some audio issues but Stacey & Mark picked it back up again, off of FB. You can watch the full interview here Check out Stacey's new book: The World's Worst Diabetes Mom! Join the Diabetes Connections Facebook Group! Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android Episode Transcription Stacey Simms  0:00 Diabetes Connections is brought to you by one drop created for people with diabetes by people who have diabetes by real good foods real food you feel good about eating by Dexcom take control of your diabetes and live life to the fullest with Dexcom.   Announcer  0:19 This is diabetes connections with Stacey Sims.   Stacey Simms  0:24 Hey everybody, welcome to another episode of the show. So glad to have you here. I hope these episodes are helping. Today we are talking with a pediatric endocrinologist starting off by talking about Covid 19, of course, and things that people with diabetes specifically type one needs to keep in mind but then going down the line of listener questions things that my local Facebook group chimed in with things that the diabetes connections group chimed in with. Because if you're not seeing your endocrinologist for longer than expected, which is the case for a lot of us kids and adults, what should you You'll be doing and that's a lot of what we talked about what to do in between how to make sure that you are taking care of what you need to take care of some things you might not have thought about. And just a great chat with Dr. Mark Vanderwel, this was originally done as a Facebook Live Alright, that's only half the truth. This was originally done as a stream yard which is a an audio and video hosting system hosted Facebook Live, which crapped out halfway through and then mark and I jumped onto zoom and record it that way. So the whole video I kind of stitched it together. The whole video is up on YouTube, on diabetes connections there. It is also on our Facebook page. And here is the audio. That's what we're running is the audio of the initial Facebook Live and then everything that you didn't hear. So if you watch the Facebook Live already, the new stuff is about 17 minutes in from the beginning of the interview. If you want to skip ahead, I'm not coming back at the end of the interview. I do want to say, though, that I appreciate all of the messages I'm getting about, you know, putting out episodes. Look, we're all looking for things to do at our homes. We're all looking for good, reliable information. I am hoping to do more episodes like this more zoom Facebook stuff. So let me know what you'd like to hear. I've also been collecting audio from you from people in the audience. And I'm going to be releasing that episode and kind of figuring out how to use that great audio people just keep me posted on what's happening in their homes and what's on their minds. So I'm not really sticking to a schedule. And I guess what I'm trying to say is, I'm sorry, if you were expecting every episode on Tuesday, and sometimes on Thursdays like we normally do, but I don't know about you. I've already lost all track of days of the week. So we're just gonna put out episodes when they're ready to go. And if you want to still listen on Tuesdays, that's awesome. If you want to let me know that that is or isn't working for you. That's great, too. I just think we all need to be here for each other in these wild times. Thank you so much. All right, so here is my talk with atrium health Dr. Mark Vanderwel, welcome to everybody who is watching. I'm so glad to have you with me for this little bit of an unusual circumstances bear with us. This is the first time I've done something like this. I am Stacey Simms, the host of diabetes connections and with me is Dr. Mark Vanderwel, a pediatric endocrinologist here in the Charlotte, North Carolina area with atrium Health. Dr. Vanderwel. Thanks for joining me,   Dr. Mark Vanderwel  3:26 Stacey. It's an honor as always,   Stacey Simms  3:29 well, we should say before we get going, we do have some disclaimers. But the very first thing in full disclosure that people need to know is that this is my son's endocrinologist and I've known Dr. V, as I've called him many times on the show and in my book for more than 13 years now. So we've never done an interview.   Dr. Mark Vanderwel  3:48 Yeah. At least recorded interview for for diabetes connections. We did some back in your radio days. Oh, that's right.   Stacey Simms  3:56 Yeah, I thought you were implying that I like interviewed you when I All right.   Dr. Mark Vanderwel  4:02 So it has been a long time since we've communicated it never on this platform.   Stacey Simms  4:05 Well, I really appreciate you jumping in because as you know, people have a lot of questions nervous times right now. So the The first thing we need to do is is do some disclaimers, obviously, while Dr. Vanderwel is our pediatric endocrinologist, he is not yours. So please, any comments questions that you may have addressed them to your own physician as well? Nothing I will put words in your mouth here, nothing that Dr. Vanderwel says today should be taken as your own personal medical advice. We're here to get general answers to general questions. And that's really about it. So I'm gonna put you on the spot a little bit, I think. But as you listen and watch at home, just you know, let's use some common sense here.   Dr. Mark Vanderwel  4:43 Yes, I'm not speaking for the pediatric endocrinology community in general. I'm speaking for myself and different physicians have different perspectives on how they take care of kids with diabetes. Different physicians will have different perspectives on Covid 19. And what I am saying is my perspective And it will not even apply universally to all of the patients I take care of because we know you are all different. Similarly, I am not a pediatric infectious disease specialist. I'm not I am not an epidemiologist, and I'm not a fortune teller. And I think we're all worried and we do not know what's going to happen in the future. And a lot of what we're talking about is just predictive, then we don't know.   Stacey Simms  5:21 All right, so good things to keep in mind. Also, this is first being broadcast live on Facebook. If for some reason as you're watching it, just bonks out or something crazy happens. We're recording the audio, this will be rebroadcast as a podcast, it may be broadcast in video in some other forms. If you have questions or comments. We're using technology called stream yard, and I can see your comments on Facebook, but we're not actually on Facebook. So there's a big delay, most likely, so bear with us. And I do have a lot of questions that I took in advance. So if we don't get to your question today, I promise it may not be with Dr. Vanderwel schedules permitting, but we are going to be addressing Senior questions going forward. And you know, we're just here to see what we can do. So we want to just jump right in. Sure. Let's go. All right. So my first question is really just about what you're hearing these days because I'm talking to you at home, you're not in the office offices is closed, but are you still getting close? Okay, so what are people asking?   Dr. Mark Vanderwel  6:16 Yeah, so, you know, I think the the primary things are, will we still have appointments? And the answer is we will eventually have virtual appointments. Although a lot of people will also need to be rescheduled, we don't only take care of kids with diabetes, and there are some conditions that we do need to see face to face. In general though, I think most of our kids with Type One Diabetes will be able to seen by a virtual visit, and we'll talk a little bit about that in just a minute. We do still have nurses answering phone calls in our office, I'm not sure what other offices are doing. So we have nurses answering phone calls. We have a physician that's on call 24 seven for hospital based medicine. And so we will we are creating a schedule. That's why our office is closed. We're working on developing virtual visits. And we've never done this before the platform that atrium uses was originally designed for perhaps five, six pediatricians to use to handle only general pediatric calls. And now this platform is being spread out to be used by pediatric specialists, as well as general pediatricians. And I think more than 100 physicians and, uh, and other providers are going to be on this platform. So we're still learning how to do it. And that's why we canceled appointments for a few weeks, but we will have virtual visits up and running hopefully, by next week, Tuesday,   Stacey Simms  7:34 because we're going to be in that soup, right? Yeah.   Dr. Mark Vanderwel  7:38 Your name on my schedule when I was telling everyone that exactly.   Stacey Simms  7:43 Alright, well, I won't call your office and ask what you're doing with me. I will let them reach out to us. When you're talking about virtual and again, this is kind of specific to your office. I don't even know yet. Do we on the other side have to do anything yet or you'll read? Yeah, we'll watch. No,   Dr. Mark Vanderwel  7:58 we we Will for our type one diabetes patients will likely have a medical assistant call you first maybe on the day of the appointment maybe beforehand to review any changes in medications, any new allergies, the types of things they usually ask you while they were checking you back in. And then in preparation for the phone call with a physician, we are going to ask you to gather diabetes data for us whether it's a pump, download a CGM, download a meter download, and that'll be the main thing that we as physicians will review. So we'll tell you more. We'll try to talk through a little bit more about how to do that. Although hopefully you all know how to do that. The physician will also will hopefully again, this is all new. We'll have all that information online.   Stacey Simms  8:42 If you're watching, you kind of saw me roll my eyes there. Dr. Vanderwel knows this but it's a little embarrassing to admit, I never upload anything in advance. I tell them please don't be mad at me. I think the only time I ever logged into T Connect is to upgrade the pump. So   Dr. Mark Vanderwel  8:57 well you know, I think the thing is, we We'll be able to get that data without, without advanced uploading, I don't want to come that 100%. But I think if your data is there, we should be able to access it. But we're gonna learn that over the next three to five days.   Stacey Simms  9:12 That's what we're all be learning it, I am sure. Um, in terms of questions that people have in between these appointments, you know, one that came to mind this morning was, you know, if I, if I need refills, if I'm worried about supplies, are you here? I know most people just call their physician pharmacies are open, but are you hearing anything about issues, shortages, that sort of thing with supplies   Dr. Mark Vanderwel  9:35 whatsoever, and I hope we don't, um, you know, Covid 19 is going to affect people in every sector. And I hope we don't get to a stage where there's problems with pharmaceutical production at this point, there is no anticipated problem with production of insulin production of test strips production with any other diabetes related spies. And so No, I do not foresee that as a problem. I know there's the temptation to stockpile And that's one of the things that we've seen in the general public, obviously, with toilet paper, hand sanitizer, etc. And there's that desire Should I stockpile my insulin? Well, we can't commit insurance fraud. And so as physicians, I cannot write a prescription to your pharmacy saying suddenly that a child who used to use 20 units of insulin a day is all of a sudden requiring 200 units of insulin per day, so that your insurance will cover additional insulin, I can't do that. That's illegal. And so we will be honest with the pharmacies. I'm not sure how you can get extra insulin just in case that might be something better to work with your pharmacy in terms of what they will cover or what they will allow your insurance to cover. But I do not foresee a deficiency in any diabetes related supplies.   Stacey Simms  10:45 Let's jump in and talk about Covid 19 best that we can. One of the questions that seems to be coming up over and over again is you know, we've all seen in the early days of this at least, the charts that came in from China and Italy saying they're the comorbidities and diabetes Sure, can you do you know what that means? Because one of the questions was, is it all type two is it you know, work?   Dr. Mark Vanderwel  11:06 Right so earlier this morning I saw some data recently published in the New England Journal of Medicine related to the children 10 and under. And the only fatality in the Chinese data that was published was a 10 month old, who had had intussusception, which is basically when your intestines telescope on each other. And so the child was already previously ill because of that, and there were no other fatalities in that population under age 10. I do not have the data for other age groups stratified out but that was what I saw on the New England Journal of Medicine earlier today. When the word diabetes is used, obviously, that is a big word and often refers to both type one and type two diabetes. And so as far as I can tell from all the Chinese data, when it says diabetes is referring to the big group of both and everyone's worried at greater risk, because I have type one diabetes, or let's face it type two diabetes? And the answer is, we do not think that people with type one or type two diabetes are at any greater risk of contracting Covid 19 than the general population. So there's no increased risk of picking up this virus as far as we know. Now data changes every day. That's the caveat here. We are still learning but at this point, there's no reason to think that people with diabetes type one or two are more likely to get Covid 19. Just like any virus, whether it's the flu, whether it's the cold, being sick, when you have diabetes makes taking care of diabetes more difficult, and we see that frequently during flu season, that when people are feeling sick, and they may not be eating or drinking quite as well, they have the predisposition to go into diabetic ketoacidosis. And so my answer to how do people with type one diabetes are people who have children who have type one diabetes, better take care of their children, either if They have been exposed to the virus or if they are already showing symptoms of a viral infection. And the answer is us you're sick. And by Sick Day protocol, I mean check for ketones. Even if your child's blood sugar is 124, you can still get ketones if they are not eating or drinking very well. So remember, ketones are what happened, or what happens when your muscles become desperate for energy. And usually with people with diabetes that happens when you don't have enough insulin in your system to help your body take the sugar out of the bloodstream and get it into the muscle cell to be used for energy. But sometimes ketones can happen if you're just not eating or drinking very well. And so ketones can happen even with a blood sugar 124 if your child has been sick, or if she is vomiting or if he is not eating very well because he feels sick. ketones also can be happening more often in the presence of fever. So although as far as we know right now, nausea and vomiting are not necessarily symptoms of Covid 19 like they are the flu. For example, fever is When you develop fever, that can also cause greater metabolic need, your muscles become more desperate for energy that can lead to the production of ketones and cause an increased risk of diabetic ketoacidosis. So my summary is related to kovat, 19 and diabetes, your child is not at greater risk, their immune system should still work just fine to fight off the virus However, they are at greater risk for developing diabetic ketoacidosis in the context of a viral illness.   Stacey Simms  14:29 A couple of follow up questions on that with keep checking for ketones. Do you recommend a keto blood meter? Are you comfortable with sticks and easily?   Dr. Mark Vanderwel  14:40 Yeah, I mean, most people check urine for ketones a blood ketone meter can give you more up to date information, for example, that tells you what's in your blood sugar level. That's what's in your blood right now. Whereas your urine is often saying, well, we made this urine an hour ago and it's been sitting in the bladder for an hour so it's not as up to date as before. glucometer as a blood ketone meter is, but still I think you can get the information you need from, from urine, ketosis, I don't feel you have to rush out and get a blood ketone checker just because of our current situation. I mean,   Stacey Simms  15:13 I'll be honest with you, and I don't know if this is true confessions time, we've never we've never purchased a blood ketones. This was the time I thought maybe, you know, the back of my head was like, should I get on Amazon? And then I got on Amazon, and there were so many and I thought, oh my god, I'm gonna buy a terrible one. So, um, stick with what we know maybe for me?   Dr. Mark Vanderwel  15:31 Yeah, I mean, there are many other things to worry about. And if you felt comfortable checking your child's urine for ketones, there's no need to suddenly change to use a blood glucose blood ketone meter.   Stacey Simms  15:42 Well, he's 15. So maybe,   Dr. Mark Vanderwel  15:43   Stacey Simms  15:46 I'm sorry, this if you're just joining us, we did have a bunch of disclaimers that this is not medical advice you should be taking personally, but this is my son's pediatric endocrinologist. So I might sneak in some personal questions. We'll see. But the follow up question. fever. And then I'm going to ask you that question about repro fantasy. Before I even get to that one, do you recommend? I've heard that sometimes it's better to let the fever go, you know, not to 104 but to 101, things like that.   Dr. Mark Vanderwel  16:17 That is a great question Stacy and I am no longer a general I should say this. I am board certified in general pediatrics, but I have not practiced general pediatrics for 15 years. However, that all being said, fevers makes you uncomfortable. When your temperature is high, you don't feel good, but many people are excessively afraid of fever as something that can hurt you, either in the short term or the long term and in general fever just makes you uncomfortable. So when we're sick, and we have a fever, we often for other illnesses have taken an antibiotic whether it's acetaminophen, whether it's ibuprofen, and what some, some French suggested Scientists have suggested is that ibuprofen and other anti inflammatories may blunt your immune response as of right now that information what's the exact word I had it pulled up is still up for debate. It is not necessarily something that is. That is a stocking answer that we say you must not use ibuprofen in the case of a fever related to Covid 19 unproven was the word I was looking for unproven so let's let's get the elephant out of the bag. What is killing people with Covid 19 is not fever. What is killing people with Covid 19 is respiratory distress is the inability to get breath in and children with diabetes are at no greater risk for developing that than children who don't have diabetes when it comes terms in terms of managing fever. Yes, ibuprofen is a anti inflammatory, ibuprofen at this point. We don't know if it's safe or not. My recommendation, though, is is to say, you know, we want to make sure you're drinking. We want to make sure you can keep fluids down. And if you are so uncomfortable that you can't drink or keep fluids down because of the high fever, then yes, we probably should treat the fever and at first maybe you treat with IV or with acetaminophen. But if all you have is ibuprofen, and you're you're miserable, at this point, it's still unproven that ibuprofen will make Covid 19 worse or prevent you to impair your ability to fight it off.   Stacey Simms  18:27 Well, and will continue to follow that obviously,   Dr. Mark Vanderwel  18:29 just new information.   Stacey Simms  18:31 It's unproven, but I mean, I can't lie. I still you know, I take ibuprofen here and there I immediately was like, No, because it's it's scary.   Dr. Mark Vanderwel  18:39 Sure. Yeah.   Stacey Simms  18:41 I went and checked everything in the house. How much acetaminophen do we have? What What else? Oh, because acetaminophen isn't so many cold medicines, sir. Let me ask you that people with type one and type two people with diabetes. Let's just say that who use CGM know that with Tylenol acetaminophen come warnings with death. calm. Now my understanding is Dexcom je six you can take 1000 milligrams of Tylenol safely by safely means it's not going to burn out your sensor you can is nothing to do with them anything beyond the sensor we're talking about here is that what you were understanding?   Dr. Mark Vanderwel  19:15 My understanding and just for clarification even in previous versions of Dexcom if you're using g five if you're using g four acetaminophen does not prevent it from working. It just may mean the readings it gives you are not as accurate as they might be without acetaminophen in your system. But that's also my understanding for the for the Dexcom g six,   Dr. Mark Vanderwel  19:35 just think or stick. Agreed?   Dr. Mark Vanderwel  19:37 Yeah, if you feel your ducks comm isn't accurate whether you have acetaminophen on board or whether you don't have acetaminophen on board, poke your finger.   Stacey Simms  19:46 Right? Which means that a lot of people need to make sure that not only do we have a meter and test strips, but that we have the batteries or that our stuff is plugged in because um I know A lot of us are very reliant on CGM. Let's just put it that way. And I'm looking at my phone, not to be rude, but to look at the next few questions. So as you're watching,   Dr. Mark Vanderwel  20:10 I know you go Okay, fair enough.   Stacey Simms  20:15 That was more for these guys. But seriously, um, I'm curious too, with, with not knowing when many of us will see our children's, endo next, or if we're adults are watching. Are there things that we should be doing? To check in between? I mean, I know that I'll give you an example. You always check penny for you know, scar tissue.   Dr. Mark Vanderwel  20:40 Right? Like lipohypertrophy. Exactly. Okay,   Stacey Simms  20:42 so go for it. Tell us what we do. Yeah,   Dr. Mark Vanderwel  20:43 so, so lipohypertrophy is when you will put your infusion side in the same place too often, or you give yourself insulin injections in the same place too often. And the downside of that is not only does it look funny, but it can prevent the insulin that you give yourself from getting into The bloodstream, and then it doesn't get from the bloodstream to the eventual target tissues of liver and muscle. So if you are thinking you're giving yourself a bolus, but you're giving it giving it into an area of life or hypertrophy, then perhaps the insulin isn't doing what it needs to do. And that can obviously be dangerous and increase your risk of decay. So, yes, I do think that parents should be checking your child for life or hypertrophy in the same way that their endocrinologist probably does regularly. And the thing that I would probably say is, the easiest way to do is just make sure it doesn't feel like a tricep, you know, flex your tricep right here. And you can feel a little bit of muscle tissue right there. And light by hypertrophy feels a lot like that. It feels kind of clumpy. It doesn't hurt the child, but it feels it like oh, it seems like there's a big clump of subcutaneous tissue here. You can even see like oh hypertrophy a lot of times and I might wind up doing that when I'm doing virtual visits is just have the kid in the room and say, Show me where you Put your palm but just look to make sure it's not looking clumpy now, I'm not going to do anything. Like make them show me their family or anything like that. But you know, their arms, their belly, that sort of stuff. Yeah, I might do that at the opposite.   Stacey Simms  22:13 That makes a lot of sense, though. You know. And another thing I was looking at my list of questions when we were talking about supplies, one of the interesting things is people seem to be posting quite a bit about not being able to get those little alcohol wipes. Yeah, we haven't used those in a very   religiously for years. Sure, sure. Is that something people need to be concerned about? Should I be getting out the rubbing alcohol and checking to make sure as a pediatric   Dr. Mark Vanderwel  22:36 endocrinologist I should say the standard line Yes, the proper protocol for either giving an insulin injection or putting a new infusion site in or putting a new Dexcom in or poking a finger is to wipe that area with alcohol first. That being said, You are probably not the only family. I take care of Stacy where your child does not use rubbing out Color an alcohol swab every time. So yes, we want clean skin. We know that giving an injection or anything that punctures the skin. without alcohol, there is a slightly increased risk of getting an infected site. There's bacteria everywhere. Obviously there are viruses everywhere. But when we're thinking about using alcohol swabs, we're thinking about killing the bacteria on the skin or removing the bacteria from the skin so that you can give a cleaner injection, or a cleaner infusion site or a cleaning Dexcom or cleaner Dexcom site etc. So if you can't get alcohol swabs, you still need to give your child insulin and you still need to figure out what her blood sugar is. So all in all, what's better to give a shot with alcohol to give a shot without alcohol swabs or to give no shot at all. They go in that order best is with second best is without third best is no insulin at all in that's not best. That's bad news. So   Stacey Simms  24:00 So, you know, another thing, that I have a whole bunch of questions here that I'm trying to get to the right order to go in,   when, when we're talking about these in between visits for a long time, and again, I know that you may be limited as what you can say, because we are talking in official capacity. So some of this is on, you know, I don't say on the record off the record, but you'll understand. So there are a lot of people who are very comfortable adjusting pump settings. Sure. There are a lot of people who aren't, you know, what's your advice for a family? And this was a question that came up in our group. I'll say, Michelle asked this, how do you advise or empower, newer diagnose parents on taking pump settings into their own hands? You know, are there ways to tell when something is a basal issue or a QRP? Sure.   Dr. Mark Vanderwel  24:46 Yeah, so first of all, I'm speaking for myself, I'm not speaking for every pediatric endocrinologist out there. I feel comfortable with my patients adjusting insulin settings without my permission, you do not need my permission to adjust your pump settings or your insulin dose. Is, however other pediatric endocrinologist may feel differently. I'm not speaking for all of us. In general, if your basal rate needs adjustment, that means that your child has been going a long time without eating. And her blood sugar either goes up, or her blood sugar goes down in the absence of all other factors. Best time is overnight. So if your kids waking up with a high blood sugar in the morning or higher than it was when he went to bed, that probably means he needs more basal. If he's waking up with a lower blood sugar than it was when he went to bed in the absence of the correction dose at nighttime, then chances are he needs less basal insulin. And kind of the same thing goes for carb coverage, if you notice every time after a meal, and I'm not talking about just that postprandial spike on a Dexcom because that is related not to the insulin quantity but to the timing of the insulin absorption. But let's say two hours, three hours, three and a half hours after every meal. If your kids blood sugar is going up that means That she needs a stronger carbohydrate factor. And remember, Stacy, I know you've written about this in your book, the factor is the denominator, right. So of insulin to carb ratio of one to 10 is stronger than insulin to carb ratio of one to 15. It's the denominator of the fraction. Similarly, for the instant correction factor, if you're giving a dose of insulin through the pump, or through the sliding scale that you've written down, and your child's blood sugar doesn't come far enough, universally, don't make adjustments based on just one thing, let her wait for a pattern to develop. But if you're noticing that you're that your child's blood sugar never comes down far enough after you give them a correction dose. That means let's make the correction factor stronger. And by that I mean maybe change it from 60 to 50, or from 50 to 40 or from 40 to 35, etc. Vice versa, if you are scared to to give a correction dose because your child's blood sugar because it doesn't come in or comes down too far after for extra dose that make it a little weaker. And by doing that I've seen baby move it from 50 to 60 From 60 to 75, or 75 to 90, etc.   Stacey Simms  27:04 So if you're watching this, and I covered my face and kind of made a joke, the reason is because in the book, I do talk about this, but I have definitely made the mistake of thinking that a smaller number meant less insulin.   Dr. Mark Vanderwel  27:18 So it is confusing. It is it, just think about it in terms of the denominator of the fraction, a half a pizza is bigger than a quarter of a pizza, even though two is smaller than four.   Stacey Simms  27:30 You know, and that brings, I know this, this interview is getting a little bit away from Covid 19. But we've got plenty of time to talk about that. The just a follow up on the calling your physician and you know, there are a lot of wonderful presenters like yourself, who will take a call every day for a month from a nervous mom of a newly diagnosed kid. But there are a lot of parents who worry that they're bothering the doctor for things like that. Obviously, it never bothered me. But all kidding aside, can you assure people that if they're calling for instance adjustments that   Dr. Mark Vanderwel  28:00 it's okay. Yeah, it is absolutely. Okay. Like I said, I want you to feel empowered to do that on your own. But if you need help, we are there to help. And my office still has CDs answering the phone during daytime hours, you can take blood sugars and help make adjustments. The physician on call over the night or weekend can also do that, although it's probably easier to do that during office hours while we have CDs answering the phone because they can pull up the child's chart whereas if you call me on a Saturday afternoon, I'm not going to have your child's chart at my fingertips to make those adjustments. So yes, but please don't feel you are on your own. And please don't feel you are bothering us. Yes, when we take call. We also are seeing patients in the hospital and we are usually seeing patients in the office although now we may be doing more virtual visits. We are doing other things. It's not like all we do is just feel phone calls. We are doing other things and so we appreciate that one. If it's not an emergency, if it can wait until morning. That'd be great to wait until more But there are emergencies. And we also understand that when people have a child with diabetes, they worry at three o'clock in the morning, and if they're worried enough, please call us. Yes, that's what we're there for. But remember, we also are not general pediatricians. And so when it comes to Covid 19, if you are worried that potentially your child may have been 19, that is a better question for your primary care provider rather than us. We are not your general pediatricians. However, if you're feeling like your child was getting sick, and you're having trouble managing their blood sugar's because they're sick. That's a question for us.   Stacey Simms  29:32 Well, and that was what I was just going to ask if someone says, Oh my gosh, I think my child has Covid 19 and they have type one diabetes, what would you advise them to do?   Dr. Mark Vanderwel  29:43 I think we're still learning more and more, you know, testing is not really readily available and everything that I've heard about testing to this point, it's been difficult to get a test now hopefully, that'll change soon. Um, and However, our primary care providers are at the frontline of giving of getting people coded testing. figuring out who needs to be tested? So I would defer that question to your primary care office because they will have the most up to date answers about whether you should simply, well, we should all be quarantined ourselves, right, we should all be practicing social isolation, but especially if you have any suspicion that you or your child has Covid 19 you need to stay in your house. And you do not need to expose any other people to this. So in that situation, though, whether do you bring your kid for a Covid 19 test? Or do you just try to isolate them and pray that they get better and again, they should I mean, kids with type one diabetes are not at greater risk for developing Covid 19 or having the respiratory complications, it just makes them more likely to get ketones. So anyway, um, if your kids healthy enough to just stay at home and continue that quarantine. Right now, that's probably what we're recommending, although things may change anytime,   Stacey Simms  30:57 and I guess you've answered this, but I'm going to ask them Again, just in a different way, to be perfectly clear the evidence as we're speaking right now, would say that if a child comes down with Covid 19 has type one diabetes, there is nothing different   Dr. Mark Vanderwel  31:11 to ground at home. Just Just differently from a diabetes management perspective perspective, make sure they're hydrated check for ketones if they're actually acting sick, even if their blood sugar seems fine. Um, follow your sick day protocol. But yes, nothing different compared to your other children who might not have type one diabetes.   Stacey Simms  31:32 Um, something else I wanted to ask. Gosh, I should have closed the blinds. Whoo. It's getting hot in here. One of the things I meant to ask when you talked about the time in between visits because I had a lot of questions on this in our Facebook group. People are saying like me, Benny's appointment was supposed to be in two weeks, we'll do a virtual visit, but I assume we're not going to get that a one. See that? We usually get quarterly.   Do you? Look we have a CGM so I can see what it probably is. But do you ever recommend a homemade one T tests.   Dr. Mark Vanderwel  32:01 Okay, you and I, about a one says yes, yes. So again, I'm not speaking for every pediatric endocrinologist out there, but people definitely overrate the importance of A1C, and so many people come into my office on pins and needles because they're so nervous about what that number is going to be in. As we've said before, you've heard me say it. And I think that's one of the reasons you and I get along so well is because we have a similar perspective, and everyone has different perspectives. But my perspective is, the ANC is just a number. And it's right now the best number we can get in a six minute turnaround test, tell us to summarize blood sugars, but it's just that it's just a number. And as we have more CGM data available, I think we're going to learn that time and range, maybe an even better predictor of avoidance of long term complications, because that's what we're talking about, right? We're talking about not necessarily trying to get your kids A1C to be less than x. We We are talking about trying to help your child be as healthy as she can be when she is 85 or 90 years old, right? And so it's not about the agency, there are plenty of kids I take care of where I'm worried. This kids having way too many low blood sugars, it's affecting their lifestyle. And I'd be much happier if they're a once you jumped up a half point or a full point if they had fewer low blood sugars. So my perspective on it once you may be different than many of my colleagues, I don't think it's worth it for you to check anyone see in the middle of between office visits, especially if you have the capability of looking at a continuous glucose monitoring system that can tell you time and rich.   Stacey Simms  33:38 Is it homey? Once the test even accurate? I've always wondered about   Dr. Mark Vanderwel  33:41 Yeah, I mean, I think so. I mean, I have not seen I'm sure there are studies out there comparing the home a woman c test to a serum drawn that means coming from your arm type of A1C test versus a finger poke A1C test, which we do in our office. Um, I honestly have not looked at those studies, so I can't answer your question. But my guess is yes, it's probably pretty close. Okay, so   Stacey Simms  34:04 I have another one. You know, all these people in my group know you very well. And the question, I've lost the question, Where did I put it? Ah, here it is. Okay. So it's a two parter. The first part is all about technology. Have you mentioned time and range? You mentioned CGM advice for parents. This is a question who says, Are we overly reliant on technology? Or is that a thing? Does she need to worry about being isolated? If something doesn't work?   Dr. Mark Vanderwel  34:35 Yeah, I mean, you use what you have. I mean, we didn't have dex comes when Benny was first diagnosed. We didn't have insulin pumps, when I was, you know, or there were they were out there, but they were not commonly used when I was a resident. Um, when my senior partner Dr. Parker was doing his medical school, they didn't even have finger stick blood sugars, right. And so diabetes management is changing and we not relying on technology, but the technology has been good. And it's helped make diabetes easier, not a cure, but a little easier unless you become a slave to that technology. And you can definitely overreact to the readings on a Dexcom. I know plenty of people who will not put their phone away because they always want to know what every second what their child's blood sugar is. And that's not healthy either.   Dr. Mark Vanderwel  35:22 I know what you're talking about.   Stacey Simms  35:26 I'm only half kidding. But yeah, nothing really can be a problem. I think the bottom line for that too, is if as you're listening, you think, gosh, I don't even know where our meter is. Or do I have test strips? You know, that's the kind of thing that you'll definitely want   Dr. Mark Vanderwel  35:40 to check but you do need to have a beat. You need to have a meter even when your child wears a Dexcom or a Libra or Medtronic CGM. You will need a backup way to check blood sugar. So yes, please have a meter and strips and lancets that's the finger poker available.   Stacey Simms  35:55 lancets we all have 5000 of those.   Dr. Mark Vanderwel  35:57 Yes.   Dr. Mark Vanderwel  35:59 Last question was Do bow ties help you in your practice?   Stacey Simms  36:03 choice only.   Dr. Mark Vanderwel  36:04 So, my grandfather always wear bow ties, you actually might be able to see him right over here at Grand Prix right over there over my shoulder. Always wear bow ties. Um, and so I got that from him. Um, and someone said, I looked smarter when I bought a bow tie. And I was like, you know, great. I like looking smart, even though I so, but to be honest, yes, um, especially in this age of viral transmission, you're probably not going to see me wear a tie when we do a virtual visit. And you may not see me wear a tie as much in the office in the near future. The reason that many of the pediatricians through Boston Children's Hospital other of the older pediatricians wear bow ties rather than long straight ties is because there's less germs from this than there are from something dangling and so I will for virtual visits, I probably will not I almost certainly will not have a bow tie on and for the for visiting the office, I probably won't either just to have one less thing on mice around me that can collect your   Dr. Mark Vanderwel  37:06 which is your grandfather in the medical field or, you   Dr. Mark Vanderwel  37:09 know, furniture industry.   Stacey Simms  37:13 All right. So before I let you go, because this is the first time I've ever had you on the podcast, hopefully not the last. But you know, it was in the interest of kind of feeling a little strange about, you know, that kind of relationship, my son's endocrinologist and that sort of thing. But now, I this has been great.   I'm curious, you know, you've been in practice for us at 15 years. I finished   Dr. Mark Vanderwel  37:34 my fellowship in 2005. So this is this will be my 15th. year as of July one or the end of my 15th year.   Dr. Mark Vanderwel  37:42 Yeah, we caught you   Dr. Mark Vanderwel  37:44 right at the beginning. Right, exactly. You were one of my may not my very first but one of my first patients now, I shouldn't say that. But yeah,   Stacey Simms  37:51 I mean, in the first couple of years,   Dr. Mark Vanderwel  37:52 right, exactly in the first few years. Exactly. So   Stacey Simms  37:54 I'm curious, you know, it's hard to sum up in just a few minutes, but from then to now. already mentioned the technology have things. It's kind of a pet question. I was gonna say, Have you seen things change, but I really want to know, like, how is it to be a pediatric endocrinologist from then to now? I mean, it's got to be difficult with insurance things and all that sort of stuff. But are you still happy? This is a field you chose?   Dr. Mark Vanderwel  38:20 Yes. I love my job. I love taking care of kids with diabetes. I kids with diabetes are only about 30 to 35% of my patient volume. And so I take care of 60% of other kids that I also love taking care of. It's the dream job. And yeah, I did not grow up thinking I wanted to be a pediatric endocrinology. I didn't know I really wanted to be a doctor. When I was in high school. I mean, there are some people that say they knew it from age two for me, that was not the case. But every step along the way, I've kind of thought yeah, maybe I do want to be a doctor. And then I go to medical school and yeah, maybe I do want to be a pediatrician and then I do my pediatric rescue. See and yeah maybe I do want to become a pediatric specialist etc so each step has kind of led me along the way and it's been a great choice I love taking care of your own as well as the all the other kids that I take care of. It's a dream job except for the paperwork.   Stacey Simms  39:15 Alright, so I'll check in with you again if I can during this time who knows how long we're going to be at home you guys doing? Okay, you can have your own everybody   Dr. Mark Vanderwel  39:22 do everyone's healthy. You know? I mean I I'm worried I mean, not about my kids not necessarily about my health I mean when one of those middle age brackets right but I'm worried about my parents, my grandparents who are still alive, you know, I'm, I am worried about I'm worried about the economy of not only our country, but the world I'm worried about, about the financial well being of my patients, even though I'm you can kind of get the sense I'm not really all that worried about the health of my patients with Covid 19 as long as they Following Sick Day protocols and but that doesn't mean go out and get exposed because obviously we need to contain this virus. I am worried about our world. But I'm not necessarily worried about the children that I take care of related to cope with it and I just don't want them spreading this terms to their grandparents.   Dr. Mark Vanderwel  40:17 I think you're absolutely right on that. Well, we will leave it there. And hopefully we can check back in and I will see you for a virtual visit. I'm sure we'll be hearing from   Dr. Mark Vanderwel  40:28 that.   Stacey Simms  40:31 But I do appreciate it. Thank you so much.   Dr. Mark Vanderwel  40:33 Yes, thanks for getting the word out states you remember, wash your hands stay inside socially distinct yourselves.   Dr. Mark Vanderwel  40:41 But don't forget to call your parents all the people you love.   Dr. Mark Vanderwel  40:50 Diabetes Connections is a production of Stacey Sims media. All Rights Reserved or wrongs avenged   Transcribed by https://otter.ai

Ever gone to the doctor expecting one diagnoses and leaving with something totally different? That's common place at The Female Athlete Program at Boston Children's Hospital where student athletes often come in with stress fractures and leave newly aware of their relative energy deficiency or an eating disorder. Today on the show, for episode 3 of the sports series, Boston Children's Nicole Farnsworth RD, joins host Julia Werth RD to discuss the Female Athlete Program and her work promoting awareness about RED-S. If you have any comments, questions or concerns reach out to Julia at werthyourwhilenutrition@gmail.com. If you enjoyed the show, please leave a rating or review! Article of the day: https://www.psychologytoday.com/us/blog/eating-disorders-the-facts/202003/coronavirus-disease-2019-and-eating-disorders Resources for those struggling during Coronavirus: 1. NEDA Helpline: https://www.nationaleatingdisorders.org/help-support/contact-helpline 2. Eating Recovery Center: https://www.eatingrecoverycenter.com/coronavirus-resources 3. BEAT Eating Disorders: https://www.beateatingdisorders.org.uk/coronavirus

Listen as Drs. Scot Bateman and Stacey Valentine of Umass Memorial Medical Center, discuss current red blood cell (RBC) transfusion practices in critically ill children, outline an approach of creating consensus and guidance of clinical RBC transfusion practice, and present recommendations from the Transfusion and Anemia Expertise Initiative. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

This week we review a recent work from the team at Boston Children's Hospital regarding outcomes for patients with complex congenital heart disease who underwent scoliosis repair. We speak with the first author of this work, 2nd year cardiology fellow at Boston Children's, Dr. Robert Przybylski about the work. How should these patients be optimally assessed prior to and then managed during these complex and often challenging surgeries. Dr. Przybylski provides us with great insights this week. doi: 10.1007/s00246-019-02169-1.

This week on Tales from the Shire, AJ sits down with Dana Gottesfeld, wife of Martin Gottesfeld. Martin Gottesfeld. Martin is serving a 10 year prison sentence in federal prison, for his political activism and efforts to have Justina Pelletier released from Boston Children's Hospital in 2014. More information can be found at freemartyg.com.Support the show! Patreon.com/thinklibertypatrons

Listen as Dr. Nadir Yehya, Assistant Professor of Anesthesiology and Critical Care Medicine at the Children's Hospital of Philadelphia and the University of Pennsylvania, discusses the advantages and disadvantages of biomarkers in critical care research. He covers the specifics of how biomarkers influence endotyping, subphenotyping, and enrichment for critical care trials (with a focus on sepsis and ARDS). He also provides an overview of existing literature in adult and pediatric sepsis and ARDS, as well as the strengths and weaknesses of using biomarkers in research. Initial publication: February 21, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

This week we review a recent work on the prevalence of adverse events when starting sotalol in the pediatric patient with arrhythmias. How commonly were problems encountered? Does initiation always require hospitalization and monitoring in an inpatient setting or are there some patients who might be candidates for an outpatient approach? Is there a level of dysfunction that would preclude its use? Assistant Professor of Pediatrics at Northwestern University, Dr. Stephanie Chandler, provides insights into her work from the group at Boston Children's Hospital. Also featured is a brief discussion with Dr. Jack Rychik of Children's Hospital of Philadelphia regarding the CHOP2020 course and next year's CHOP2021. doi: 10.1016/j.hrthm.2020.01.022

In this chapter of the Rwandan National Neonatal Protocol, Dr. Aicha Uwamahoro explains the etiology, investigation and treatments for anemia, bleeding, and polycythemia in the neonatal context. Initial publication: February 14, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this chapter of the Rwandan National Neonatal Protocol, Dr. Hippolyte Bwiza-Muhire discusses risk factors for hyperbilirubinemia in full term and premature infants, how to assess hyperbilirubinemia on a physical exam and how to initiate laboratory testing to determine, initiate, and manage appropriate treatment for hyperbilirubinemia in the neonate. Initial publication: February 12, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this chapter of the Rwandan National Neonatal Protocol, Dr. Lisine Tuyisenge describes the signs of respiratory distress in the newborn, how to identify common causes of respiratory distress, and how to resond and treat common respiratory conditions appropriately. Initial publication: February 4, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

Listen as Nancy Braudis reviews the anatomy of the heart, and how heart disease presents in newborns. Initial publication: January 28, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

S1 Ep17: In this week's episode, we sit down with Michele Sasso, Director of Clinical Programs and Technology and Rebekah Diamond, Director of Policy and Business Relations for the Department of Accountable Care and Clinical Integration at Boston Children's Hospital. They speak about the challenges and intricacies of the ACO program and how their newly formed department seeks to put patient needs first. Find all of our show podcasts on your favorite podcast platforms. www.healthcarenowradio.com/listen/

Listen as Dr. Vinay Nadkarni, Professor and Endowed Chair in Critical Care Medicine at The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, discusses boot camps, orientation, and the next steps in the training of critical care fellows. He outlines the development of methodology through the years and points to some trends that we can expect for the future of boot camp training programs. Initial publication: January 21, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Aly was first drawn to the medical field because she wanted to be the kind of caregiver that she wished she had - someone who fully understands and listens to patients. As a CRNA, she now has integrated holistic practices with conventional medicine at Boston Children's Hospital. In today's episode, Aly shares: - how she became interested in holistic healing such as reiki and how it's improved her patients' experience - what she practices daily to show up for her clients - her experience teaching meditation to staff members as part of a Harvard University study - what it's like working in a hospital as a psychic empath - her definition of true healing Aly's mentioned CRNA retreats: https://www.painlessce.com/seminars31951135 https://www.mooxli.com/events-1/mooxli-2020 Be Highly Meditated: - via Instagram @highlymeditatedpodcast and @daniheals - Join the private Facebook group https://www.facebook.com/groups/369418077303895/ - via email highlymeditatedpodcast@gmail.com As always, thanks for listening! All 5 star ratings and reviews are welcomed as an impactful way to support the podcast. --- Send in a voice message: https://anchor.fm/highlymeditated/message

Host Jeff Lin is joined by Kevin Pawl and David Gates of Boston Children’s Hospital in part 2 as they continue to discuss the hospital’s journey to going “cashless” and the importance of delivering a convenient and frictionless payment experience for families on part one this special two-part series. Want to stream our station live? Visit www.HealthcareNOWRadio.com. Find all of our show podcasts on your favorite podcast channel and of course on Apple Podcasts in your iTunes store or here: podcasts.apple.com/us/podcast/heal…1301407966?mt=2

Listen as Ms. Jamie Harris explains the principles of distraction free practice, and how she used them to create the “Red Zone At Home” medication safety initiative, which reduces medication errors in the home setting. Initial publication: January 14, 2020. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Laura Moretti Reece, Certified Specialist in Sports Dietetics currently part of the Female Athlete Program and Sports Medicine/ Orthopedics Team at Boston Children's Hospital specializes in sports performance-based nutrition, treating low energy availability, disordered eating, and eating disorders in athletes. She works with Olympic and professional athletes, colleges and universities, professional sport and dance facilities and is consulting dietitian for Boston Ballet Company and US Rowing. Laura is an athlete herself. She is a competitive triathlete and a three-time Boston Marathon qualifier and finisher. We talk carbohydrates, keto, Mary Cain, REDs, Oregon Project, Nutrition. Hear Her Sports is long-form interviews with female athletes & women in sports breaking boundaries, speaking up and living with power & confidence.

"If I do an ultrasound before an LP on an infant, would that increase my success rate?"On the show today, we sit down with Dr. Jeffrey Neal from Boston Children's Hospital to talk about The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Contact at Tama.The@gmail.comWorks cited:Neal JT, Kaplan SL, Woodford AL, Desai K, Zorc JJ, Chen AE. The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Annals of emergency medicine. 2017Kessler D, Pahalyants V, Kriger J, Behr G, Dayan P. Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2018; 25(9):1027-1034. Gorn M, Kunkov S, Crain EF. Prospective Investigation of a Novel Ultrasound-assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017; 24(1):6-12.

In this video, Kathryn Gustafson explains how the Infant Carseat Tolerance Screening is used to provide safe motor vehicle transportation for neonates and provides a demonstration of the screening. Initial publication: December 13, 2019. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

Weight-stigma and eating-disorders researcher Kendrin Sonneville joins us to discuss how diet culture steals our well-being by perpetuating fatphobia, why even seemingly subtle forms of weight stigma can lead to poorer health, the role of science in the paradigm shift toward Health At Every Size®, why weight stigma is more than just a health issue, and so much more. Plus, Christy answers a listener question about intuitive eating and fears around weight loss. Kendrin Sonneville, ScD, RD is an Assistant Professor in the Department of Nutritional Sciences at the University of Michigan School of Public Health. Dr. Sonneville also holds an adjunct appointment at Harvard Medical School and is a Collaborating Mentor for the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED) at Boston Children's Hospital and the Harvard T.H. Chan School of Public Health. Dr. Sonneville is a registered dietitian, behavioral scientist, and public health researcher whose research focuses on the prevention of eating disorders among children, adolescents, and young adults. Dr. Sonneville uses a weight-inclusive framework to study how to promote health and well-being without inadvertently increasing body dissatisfaction, disordered eating, and weight stigma. Find her online at KendrinS.sph.umich.edu. Pre-order Christy's forthcoming book, Anti-Diet, and get some sweet bonuses by submitting your proof of purchase at christyharrison.com/bookbonus! Grab Christy's free guide, 7 simple strategies for finding peace and freedom with food, to get started on the anti-diet path. If you're ready to break free from diet culture once and for all, join Christy's Intuitive Eating Fundamentals online course. Ask your own question about intuitive eating, Health at Every Size, or eating disorder recovery at christyharrison.com/questions. To learn more about Food Psych and get full show notes and a transcript of this episode, go to christyharrison.com/foodpsych.

Host Jeff Lin is joined by Kevin Pawl and David Gates of Boston Children’s Hospital, as they discuss the hospital’s journey to going “cashless” and the importance of delivering a convenient and frictionless payment experience for families on part one this special two-part series. Want to stream our station live? Visit www.HealthcareNOWRadio.com. Find all of our show podcasts on your favorite podcast channel and of course on Apple Podcasts in your iTunes store or here: podcasts.apple.com/us/podcast/heal…1301407966?mt=2

Mild eczema can be adequately controlled with topicals and current practices; however, moderate-to-severe atopic dermatitis requires a more complete and comprehensive approach to care. While guidelines exist, treatment is not prescriptive. So we asked Peter Lio, MD, founder of the Chicago Integrative Eczema Center and Clinical Assistant Professor of Dermatology and Pediatrics at the Northwestern University Feinberg School of Medicine, for his opinion. Each Thursday, join Dr. Raja and Dr. Hadar, board certified dermatologists, as they share the latest evidence-based research in integrative dermatology. To learn more about advanced care for atopic dermatitis or earn CME credits, visit learnskin.com/series/advanced-management-of-atopic-dermatitis. Dr. Peter Lio is a Clinical Assistant Professor of Dermatology and Pediatrics at the Northwestern University Feinberg School of Medicine. He received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children's Hospital, and his Dermatology training at Harvard where he served as Chief Resident in Dermatology. Dr. Lio is the founding director of the Chicago Integrative Eczema Center and has spoken nationally and internationally about atopic dermatitis, as well as alternative medicine.

This week the topic is cardiovascular surgery and we speak with Dr. Ignacio Berra of Buenos Aires Argentina about a recent work he co-authored with the surgical bioengineering team at Boston Children's Hospital regarding a newly developed tool to assess the aortic valve. Can this device safely allow for visualization of the valve under the usual aortic diastolic pressures to aid in anatomical assessment and post-repair assessment? What are the technical hurdles of using this device? Is it ready for use in humans? We discuss these and other questions with Dr. Berra this week. doi: 10.1016/j.jtcvs.2018.07.113

In this video, Dr. Ann Thompson, Vice Dean and Professor of Critical Care Medicine and Pediatrics at the University of Pittsburgh School of Medicine, outlines the history of the PICU and its place in the hospital. From the first polio units in the 1930-50s to modern PICUs today, Dr. Thompson focuses on changing roles, technological advancements, and hopes for growth and expansion in the future. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.

ECMO use in the pediatric cardiac patient can be lifesaving but the long term effects are still not well known. This week we explore the neurodevelopmental outcomes in a cohort of patients from Boston Children's Hospital who underwent ECMO support following cardiac surgery and explore factors associated with their neurodevelopmental outcomes. How do these patients fare in comparison to non-ECMO pediatric cardiac surgical patients? Are there modifiable factors that may improve outcomes? We explore these issues with Dr. Ravi Thiagarajan, Professor of Pediatrics - Harvard University and Director of Cardiac Critical Care at Boston Children's Hospital this week. doi: 10.1007/s00246-019-02115-1

In this World Shared Practice Forum video, Dr. Heidi Dalton maps out the rapid expansion of ECMO use globally, describes challenges that providers face in the field of ECMO, and solutions to overcome these challenges in the future. Initial publication: October 12, 2019. Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.