Keep Your Family Healthy

Advice from the Best Doctors in Hawaii.

With the debate  on health insurance raging, it’s hard not to have healthcare on the brain. But congressional and policy arguments aside, everyone can agree that when it comes to your loved ones, you just want them to be healthy. In search of advice on how to best keep Island families healthy, we turned to some of the physicians who appeared on our most recent list of Hawaii’s Best Doctors (July 2008 issue). For more on why these doctors were selected by Best Doctors in America, visit Best Doctors 2008.

Babies and Children

Pediatricians treat children from birth to age 21,  but they also care for other important patients: Mom and Dad. “You’re creating a family partnership,” explains Dr. Michael Sia, of the Department of Pediatrics at Kapiolani Medical Center for Women and Children (945-9955). 

A classic dilemma is, “How can I tell if my child is sick enough to go to the doctor?” According to Sia, parents should look at the basics: eating, sleeping, elimination and crying. “For infants or toddlers, if something drastically changes, then have a conversation with your doctor,” Sia says. Newer parents tend to come in to his office faster, while “more experienced parents may wait and see, do a little TLC and chicken soup.” TLC and soup are often effective, Sia notes, saying that one of the nice things about his field of medicine is that, “Kids are pretty resilient.”

During office visits, Sia routinely discusses good health habits with children and parents: hygiene, accident prevention (particularly drowning), avoiding obesity and smoking. This fall, many parents are also concerned about the H1N1 flu virus. “You don’t have to wear a mask,” Sia says. “The masks aren’t nearly as important as a good hand-washing.”

In October or early November, he anticipates an offshoot of the normal flu shot that will specifically target the H1N1 virus.  “It’s coming separately, through the Department of Health. It’s two doses with a period of a month in between.”

“I’m really excited about how we’re able to adapt to looking at public health threats,” says Sia. “I think the biggest enhancements in our lives have come from our vaccination program. It’s gotten poor PR from our end of the spectrum, and people can see [vaccines] as doing more harm than good, but we’re seeing things that used to routinely cause death and now don’t.” 
 

Biggest Myth?

According to pediatrician Dr. Michael Sia,  many parents are overly concerned about fevers in their children. They’re worried that “fever will kill you or fry the brain. Fever is only a symptom, not a diagnosis,” he says. “A high number doesn’t mean it’s a bad bug or germ. It doesn’t necessarily mean you need to rush to the emergency room.” So parents, by all means call your pediatrician, but don’t panic based solely on a thermometer number.

Adolescents

Dr. Galen Y.K. Chock is chief of pediatrics  at The Queen’s Medical Center’s Department of Pediatrics and also president of the Hawaii Chapter of the American Academy of Pediatrics, and sees patients from birth through their teen years. (521-6030).

Pediatrician Dr. Galen Chock gave the magazine advice about adolescents. Photo: Rae Huo

Regular checkups are important.

Chock: “Most doctors would prefer to see adolescents once a year. For girls, we worry about scoliosis in particular. They’re going to get a growth spurt as puberty starts—that might be as young as fifth grade, and as late as eighth grade—and if their backs start to get a little bent, we like to diagnose that earlier rather than later. It can occur with boys, but it’s much more common with girls.”
 

Teens need even more exercise than adults.

Chock: “This is an important time to be exercising. They’re growing, and it helps with bone and muscle development and coordination. The recommended physical activity level is 60 minutes, five days a week, moderate intensity. We find that a lot of kids are not getting even close to that. By comparison, the recommended activity level for adults is just 30 minutes, five times a week.”
 

Don’t forget about vaccines.

Chock: “There have been a lot of new vaccines coming out geared to adolescents. There are three we like to give out: A tetanus booster, the meningococcal vaccine and, for girls, the Gardisil vaccine, which is very effective against HPV infection, which can lead to cervical cancer decades down the road.”
 

Having problems? They might not be getting enough sleep.

Chock: “It’s not uncommon to see adolescents getting four to five hours of sleep a night, and thinking that’s normal. The recommended amount for high-schoolers is seven to eight hours a night. But many students are dealing with a lot of homework, so rather than just looking at the total number of hours of sleep, we ask questions like, do you need a nap in the afternoon? Do you fall asleep in class? Are you grumpy? Are you getting headaches? Those can all be signs you’re not getting enough sleep.”
 

Adolescent Psychiatry

Dr. Barry Carlton is a psychiatrist with the University of Hawaii John A. Burns School of Medicine, specializing in adolescent psychiatry (586-2900).

It’s OK to tell your doctor everything.

Carlton: “In the context of treatment, any discussion of sex or drugs is strictly confidential. That being said, the practitioner, if she or he is wise, will try to figure out a way for you to talk with your parents, so you feel safe doing it. But they can’t make you. The exception here is safety. If the practitioner is concerned about suicide or something along those lines, they don’t have to be absolutely confidential.”
 

Keep an eye out for family traits.

Carlton: “Certain psychiatric illnesses have a very strong heritability. ADHD, for example, runs in families, so early recognition and intervention can often prevent the progression and some of the more severe side effects of that particular illness.”
 

Parents, talk with your teenager.

Carlton: If you have any doubts about discussing an issue, just discuss it, whether it’s suicide or drugs or sex. You’re far better off doing that than leaving it alone, because teenagers are going to hear it at some point, from somewhere else. Your children may say, oh, Mom, or, oh, Dad, but it’s much better than them thinking you don’t care. Once you bring something up, it makes it an allowable topic of conversation.”
 

For Women of All Ages

Women make the most healthcare decisions and an ob/gyn is their entry into the healthcare system,” says Dr. Barbara Kitashima, who practices at Kapiolani Medical Center for Women and Children (942-8411). She recommends that adolescent girls and women come to her office at least once a year for a Pap test, STD testing and to discuss contraception options. 

Kitashima and Dr. Shawna Brizzolara, a urogynecologist and assistant professor of obstetrics and gynecology at the John A. Burns School of Medicine at the University of Hawaii at Manoa (203-6586), remark that now, more than ever, women have a variety of birth control options to choose from, such as the pill, a vaginal ring, IUDs, the patch and even birth control injections or subdermal implants.

Although Kitashima and Brizzolara are not currently practicing obstetrics, both suggest that a woman should schedule a doctor’s appointment within two weeks to a month of learning that she’s pregnant. “She should be taking 400 micrograms of folate prior to getting pregnant if possible,” adds Brizzolara.

It’s important for patients who are going through menopause to discuss with their doctor the option of being put on hormone replacements. “It’s not for everyone,” says Brizzolara. “Only if a woman is experiencing [ongoing] symptoms.” She suggests eating a balanced diet, cutting back on alcohol and caffeine, and not smoking. Brizzolara and Kitashima have put their menopausal patients on hormone replacement treatments, but do not recommend using the controversial bioidentical hormones.

Kitashima and Brizzolara will send their patients to fertility specialists if they are having trouble conceiving or a gynecological oncologist for patients who have cancer of the reproductive organs. Not all women like to share their problems, however. Women hide urinary incontinence from her, says Brizzolara. “There are so many good new treatments and minimally invasive procedures for incontinence now that a woman should feel free to ask for help.” Kitashima adds that she has had patients try to hide risky sexual behaviors and even domestic abuse from her, while others are resistant to annual tests such as mammograms and colonoscopies. “Unfortunately, some tests are uncomfortable, but early detection can save a life,” she says. “It’s not for me, it’s for them.”
 

Key Advice for Women

For women between ages 11 and 26, get the three Gardasil shots that protect against certain strains of HPV, which can lead to cervical cancer.

• Perform breast self-exams.
• For women ages 35 to 40—depending on one’s family history of breast cancer—schedule a yearly mammogram.
• Before visiting the doctor, have a prepared list of the medications and vitamins you take, as well as questions and topics to discuss during the visit.

The Middle-Age Male

You’ll be pleased to know  that as far as Dr. David McEwan, who practices at The Queen’s Medical Center (537-2211) is concerned, middle-age begins at age 50, not 35 or 40. “Most of the screenings you would do on people begin at 50,” he explains. “If you’re in your 40s, fit and healthy, you probably don’t need much unless there’s a family history of major diseases.”

How often should a man come in?

McEwan: If a man hits 50 without ever having had a comprehensive physical, it’s time to get one, even if he has have no health complaints. “A complete physical takes 40 to 60 minutes and covers family history, blood pressure, diabetes, the colon, the prostate—all the systems in the body. The history is the most important part of the physical; if doctors are allowed the time to do it, they’ll learn a profound amount about their patient,” says McEwan.
 

What do people hide from you the most?

McEwan: Concerns about their emotional and sexual health. “People aren’t used to talking about these,” says McEwan. “But people in their 50s may have issues in both areas so doctors are trained to ask about these and to listen. The doctor should also ask about alcohol and drug use and should be able to tell from your answers if there is really something more to share. Medical records are private, no one can ask for them without permission and you hurt yourself if you don’t disclose things.”
 

Which screenings should a man get?

McEwan: For men, there is no off-the-shelf schedule for exams or screenings; it all boils down to family history. “Assume that you’re well and turning 50, we need to look into your blood pressure, cholesterol, diabetes, prostate health, cardiac health, update your shots, check your stool for blood,” and so on, says McEwan. A baseline physical at 50 will also include blood work looking at 20 different things, from testosterone levels to thyroid function to lipid levels and even some cancer markers. “The workup will guide the monitoring. Depending on what we find, we may want you to come back every year for a comprehensive physical or other screening, or, if you’re fit and healthy, maybe every three or four years.”
 

Any common myths?

McEwan: “The incredible misconceptions that people have about food. They often think they’re eating well and they’re actually harming themselves immensely. A lot of people need serious guidance for that and the lab tests will direct the physician as to what guidance to give.”
   
For McEwan, the main issue is cholesterol, which is in more foods than people realize. “One of my sadnesses is watching the food industry, which has not been kind to the American public. Why do we think we have morbid obesity? It’s because of what we’re eating and the exercise we aren’t doing.”
   
“We think about heart disease all the time but what we really need to think about is vessel disease, all from cholesterol—in the brain, the neck, the limbs. Controlling it can vastly improve your life.”

Watch your diet, be compliant and take your meds if you’ve been prescribed any, minimize your alcohol intake, avoid all illegal drugs and get serious about exercise—it cures almost everything.” –David Mcewan, M.D.

Geriatric Care

Older people, generally grouped as those age 65 and older,  are much more heterogeneous than any other age group. For example, an 83-year-old woman may still be working actively in a family business and living independently, while another 83-year-old woman is bedridden in a nursing home. As the baby boomers turn 65 in 2011, it is important for everyone to remember, “We all have a certain amount of control over our futures through our lifestyle choices—judicious exercise and dietary approaches,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine (522-4000).
 

Nothing is routine

The general health of geriatric patients will vary a great deal, so talk to your doctor about the recommended number of times to visit and what type of screenings you should be taking.

Johnson notes a few screenings: “I recommend annual mammograms for women, annual bone-density tests for osteoporosis, annual flu vaccines, making sure the pneumonia vaccine is updated every 10 years, screening for colon cancer at least every five years, annual skin assessment for possible skin cancers, and screening for prostate cancer in men.” 

Dr. Marianne Tanabe, of the University of Hawaii John A. Burns School of Medicine Department of Geriatric Medicine and Kuakini Center (523-8461), says that frailty and memory loss are common concerns among patients, but often misunderstood. For those patients who have become frail, Tanabe notes that it is often a common thought that it would be easy to go back to a previous level of health and functional status, but points out that “this may be difficult to achieve with successive medical problems that may occur.”

For all elderly patients it is wrong, however, to believe that “progressive memory loss is inevitable and that frailty is inevitable,” says Johnson. “We know now that there are only minor memory changes associated with normal aging and that the elderly can benefit as much from exercise as any other age group.”

On Your Next Visit

Bring in all of your medications. “One of the most critical parts of geriatrics is monitoring medications for toxicities and interactions. In my experience, most people are over-medicated, especially in the skilled nursing facilities. I usually end up stopping more medications than I start,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine.

• Bring in all of your medications. “One of the most critical parts of geriatrics is monitoring medications for toxicities and interactions. In my experience, most people are over-medicated, especially in the skilled nursing facilities. I usually end up stopping more medications than I start,” says Dr. R. Gary Johnson, of Straub’s Department of Geriatric Medicine.
• Have a list of questions and concerns written down beforehand.
• Bring along a family member or friend. “An extra pair of ears hearing concerns and recommendations is always helpful,” says Johnson. “Many older people minimize symptoms, because, ironically, they don’t want to bother the doctor. I often have to rely upon a third person to get a real picture of the situation.”