RSS Feedhttp:// RSS Feeden{540491AB-9545-40C0-AA08-D69BD352DD79} is Greater Trochanteric Hip Syndrome?<p>Common complaints of those presenting with this problem include tenderness directly above the side of the hip, pain lying on that side and pain worsened by activity. The relative lack of information available about this condition can lead to extensive workups and delay in appropriate treatment. But as understanding of this syndrome increases, so do the possible treatments and answers for patients suffering with chronic <a href="">hip pain</a>.</p> <h3><strong>Traditional Bursitis</strong></h3> <p>A little understanding of the anatomy in this area is very helpful. The bony bump over the side of the hip is called the greater trochanter. A tight band about two inches wide, called the IT band, passes over this bump from the pelvis on its way down the leg. There is a slippery membrane called a bursa, which is sandwiched between the IT band and the greater trochanter to reduce the friction between the two structures.</p> <p>Occasionally the bursa becomes irritated or inflamed (<a href="">bursitis</a>). These symptoms can develop in younger people, particularly runners, but symptoms more commonly appear spontaneously after middle age.</p> <p>Non-surgical treatment including stretching exercises and an occasional anti-inflammatory steroid injection will usually solve the problem, although at times the symptoms persist and can be quite debilitating. In this circumstance, a minimally invasive approach with arthroscopic surgery can be used to release the tension on the IT band and relieve the painful symptoms.</p> <p>Usually in younger individuals, a tight IT band at the level of the hip can also cause a repetitive loud, painful snapping sensation over the side of the hip. Again, if the condition is not relieved by physical rehabilitation, then surgical relaxation of the IT band tightness will predictably remedy the problem.</p> <h3><strong>Hip Abductor Muscle Tears</strong></h3> <p>The large muscles that attach to the greater trochanter on the side of the hip are very important to comfortable strong hip function and are called the hip abductors. As we age, the attachments of these muscles weaken, and an estimated one in four women and one in six men develop tears at the attachment sites of these muscles during or after middle age. Some individuals with abductor tears develop significant activity-limiting pain and weakness. Only in the last decade has this condition been recognized as a significant cause of pain and disability. The problem is most accurately identified with MRI imaging of the hip and shows detachment of the muscles from the greater trochanter.</p> <p>Much like the rotator cuff in the shoulder, the abductor muscle attachments to the greater trochanter have been called the &ldquo;rotator cuff of the hip&rdquo; due to similar anatomy and approach to repair. The repair of these torn attachments back to the bone can be accomplished as an open surgical procedure, but increasingly is accomplished with less invasive arthroscopic techniques. The early reported outcomes during the last several years are promising with high rates of success in relieving painful symptoms and restoring lost hip strength.</p> <p>Until fairly recently, <a href="">hip conditions that did not involve arthritis</a> of the hip have been poorly recognized, leaving both younger and older patients frustrated by an apparent lack of treatment options. The increased awareness of these conditions in the physician community and in the population at large is slowly offering the possibility of improved quality of life to those seeking understanding and treatment for these conditions. To find an orthopedic surgeon near you, we invite you to visit <a href=""></a>.</p>Wed, 18 Dec 2013 00:00:00 -0700{681E7CB9-1358-4E33-8B88-A4EF99119C55} Possibilities of Fiction and Imagination in Children<p class="FreeForm" style="margin-bottom: 13pt;">In any <a href="">essay</a> about the busyness of living in Manhattan, the writer Adam Gopnik described his 3 year-old daughter&rsquo;s imaginary relationship with a man she called Charlie Ravioli. Gopnik&rsquo;s daughter, Olivia, constructed an elaborate myth about Mr. Ravioli, a busy New Yorker who &ldquo;lived in an apartment on Madison and Lexington.&rdquo; She would frequently announce to her parents that she had &ldquo;bumped into Charlie today,&rdquo; and would describe fictional episodes of going out for coffee, grabbing lunch, or racing across town in a taxi. More often than not, however, Olivia would comment on Charlie being too busy to get together, or just missing him when she would attempt to reach him. Olivia&rsquo;s parents were fully aware of the fictional nature of this relationship but were concerned that Olivia&rsquo;s distortions might reflect a psychological problem or trauma. Gopnik consulted his sister, a child psychologist, who reassured him that such imaginary friends were completely normal and healthy. Gopnik wrote that children like his daughter were developing &ldquo;a sense of the serene possibilities of fiction.&rdquo; His sister also turned him onto a then-recently published book by <a href="">Marjorie Taylor</a>, <a href="">Imaginary Companions and the Children Who Create Them.</a></p> <p class="FreeForm" style="margin-bottom: 13pt;">I remember coming across Taylor&rsquo;s work while doing my own <a href=";jsessionid=B85DD353DBE16C365BD67CC3BF368785.d02t03?deniedAccessCustomisedMessage=&amp;userIsAuthenticated=false">research</a> on fantasy proneness and imaginative involvement. Not only are imaginary companions quite common, fantasy-prone children tend to have positive interpersonal, creative, and cognitive capacities. They tend to be more outgoing, better able to focus their attention, and more effective at seeing things from the perspective of others. Much like Olivia, who saw her parents and their friends being caught up in their frenetic city life, children may express their own feelings by attributing them to their imaginary companions.</p> <p class="FreeForm" style="margin-bottom: 13pt;">Children sometimes take their fictions a step further, inventing what some have called a paracosm. A paracosm is a detailed, imaginary universe that may include a cast of characters, unique culture and customs, make-believe geography, and invented languages. First described by the researcher Robert Silvey in the 1970s, the term has since been used by developmental psychologists to describe the often intricate parallel universes that some children will create to orient themselves to reality.</p> <p class="FreeForm" style="margin-bottom: 13pt;"><img width="230" height="196" src="/~/media/Images/Modules/Blog/Posts/2013/12/parcosm.jpg" alt="parcosm" /></p> <p class="FreeForm" style="margin-bottom: 13pt;">Many artists and writers &ndash; including Nietzsche, W. H. Auden, and the Bronte sisters &ndash; developed paracosms as children. According to the <a href="">British Library</a>, the Bronte sisters, along with their brother, created imaginary countries which they called the &ldquo;Glass Town Federation.&rdquo; They were obsessive about their imaginary worlds, drawing maps and formulating personalities for their characters. They thought of themselves as the gods of their world and the stories of Glass Town were reportedly written in tiny micro-script, as if inscribed by miniature toy soldiers. And then there's J.R.R. Tolkien, whose Middle Earth must have had at least some of its genesis in Tolkien&rsquo;s own working out of childhood experiences and conflicts.</p> <p> </p> <p class="FreeForm" style="margin-bottom: 13pt;">Freud has famously (and transgressively) said that we are happiest when we are pursuing childhood dreams and longings. This is one of the reasons that excessive wealth is not associated with increased happiness (the youngest among us don't crave wealth; they want connection and play). The dreams and desires we do have as children create echoes and shadows that preoccupy us for a lifetime. Or, to paraphrase Nabokov, we become the shadow of our wildest imaginations. We should not be surprised by our own paracosms &ndash; whether imagined in Second Life, MMORPGs, or lazy daydreaming. As children, fantasy gives us a sense of the possibilities of fiction.</p> <p>&nbsp;</p>Tue, 17 Dec 2013 00:00:00 -0700{BB78AD3E-031E-43BE-A7FD-D11ED2D7E748} Bio-Identical Hormones for Menopause Safe to Use?<p>As a society, we are constantly bombarded with quick fixes and infomercials that promise the cure to whatever ails us. <a href="">Menopause</a> is one area that women are frequently targeted on. It is uncomfortable to experience, and for some individuals, medical therapy carries significant risk.</p> <p>Bio-identical hormones are often marketed as a &ldquo;natural&rdquo; alternative to hormone replacement therapy. They claim that these hormones are identical to hormones made by the body. The theory is that &ldquo;if it is natural, then it is safer.&rdquo; Not only are they claimed to be safe, but bio-identical hormones apparently help with weight loss, prevent Alzheimer&rsquo;s disease, and provide a more balanced amount of hormone as well. </p> <p>Bio-identical hormones typically are not provided like other prescription medication. Providers of these hormones will often complete testing of your hormone levels by testing the saliva. After the hormone is measured, they can then give you the specific dose you need. The dose then has to be made in a pharmacy through a process called &ldquo;compounding.&rdquo; Pharmacies mix the medication according to a specific order provided by a healthcare provider. The medication not only has the active hormone, but also inactive ingredients to help hold a pill together, or make it into a gel, cream, or lotion.</p> <p>The concern with bio-identical hormones is that they are not FDA approved. This is important because when you get a prescription from your physician, side-effects and adverse reactions are monitored by the FDA. When an adverse reaction occurs, it has to be reported to the FDA. However, adverse reactions caused by herbal and bio-identical medications are not required to be reported. </p> <p>As a result, we don&rsquo;t really know about their reported safety. FDA approved prescription medication, on the other hand, is significantly scrutinized and tested. The FDA will probably give more attention to compounding pharmacies in the future, since our country has recently had a significant number of <a href="">infections associated with steroids from a compounding pharmacy</a>.</p> <p>There may be situations in which bio-identical hormone therapy is appropriate. There is a good review of the current <a href="">known facts of bio-identical hormones that can be found on the FDA&rsquo;s website</a>. However, these medications have very minimal scientific evidence behind them, and the proclaimed benefits of them are based on a limited number of vague studies. </p>Mon, 16 Dec 2013 00:00:00 -0700{CB1B6B2E-83BC-4F28-AF65-A2C0ECFADF40} Our Athletic Trainers Take Care of You<p>Most times when you visit the doctor, a medical assistant (MA) takes you back to the exam room, takes vital signs, asks a few questions, and lets the doctor know you&rsquo;re ready to be seen. In <a href="">Intermountain Sports Medicine Specialty offices</a>, however, you are cared for by an Athletic Trainer (ATC) instead of an MA. </p> <p>For the type of care we provide, ATCs provide a significant advantage to you, the patient, and to the doctors. ATCs have expanded knowledge in sports injuries, prevention, rehab, and return-to-play decisions. They can skillfully apply casts, braces, tape, and other devices needed for your treatment. They can care for simple wounds, remove sutures, teach you how to use crutches, and assist during in-office procedures. They also do more of our &ldquo;office&rdquo; work such as assisting with insurance and financial aid questions, sending prescriptions to pharmacies, and answering phone calls, which saves patients the time of waiting for a doctor to call them back. </p> <p>Most ATCs in our group and offices also cover sporting events of one type or another, including local high school soccer, football, and other sports team competitions; triathlons; running and cycling events; and even professional wakeboarding events! Some of our ATCs even have specialized training and a passion for running, and assist in our <a href="">Running Lab assessments</a>. Basically, ATCs can do just about everything (so they ROCK)! </p> <p>And interestingly, <a href="">a study in the Clinical Journal of Sports Medicine in 2013</a> compared clinic efficiency, volumes, and level of care (based on patient satisfaction) and found that clinics employing ATCs performed much better in every category than clinics using MAs. We definitely have nothing against our MA friends, but we&rsquo;re very grateful for the ATCs who put so much time and effort into their work and who make your visit that much better!</p> <p><em>&ldquo;Comparison of the Effect of Medical Assistants Versus Certified Athletic Trainers on Patient Volumes and Revenue Generation in a Sports Medicine Practice.&rdquo; Clin J Sports Med. Jul 2013; 6:4 p. 337-8.</em></p>Mon, 16 Dec 2013 00:00:00 -0700{D4B2FF49-CF76-4557-BB16-A87D5DE57C99};s Supply Chain Organization Receives Number 4 Ranking by Gartner Inc.<p>Intermountain&rsquo;s Supply Chain Organization (SCO) recently received the #4 ranking in an annual top 25 list of healthcare supply chains ranked by <a href="">Gartner Inc.</a>&rdquo; The ranking measures healthcare organizations&rsquo; achievements in transforming their supply chains to increase value, improve patient outcomes and quality, solve challenges, and increase efficiency. Intermountain&rsquo;s SCO efforts have elevated us in Gartner&rsquo;s rankings from #7 in 2011 to #4 in 2012 &ndash; a significant achievement. </p> <p>&ldquo;This ranking is evidence of the hard work given by a dedicated SCO workforce,&rdquo; says Supply Chain/Shared Services VP Brent Johnson. It&rsquo;s important to note that only two healthcare providers made the top 4 &ndash; Mayo Foundation and Intermountain. The other top 4 recipients are all distributers of healthcare products. </p> <p><img width="560" height="418" src="/~/media/Images/Modules/Blog/Posts/2013/12/sco graphic.png" alt="intermountain-sco-ranking-by-gartner" />&nbsp;</p> <h3 class="NormalParagraphStyle">What is a Supply Chain?</h3> <p>Supply Chain Organization, or SCO for short, is a modern version of what some people in the past may have called a purchasing department. However, a supply chain organization covers far more and becomes a system of organizations including people, activities, information, and resources. &ldquo;We work together to ensure the right items are available at the right time and the right place.&rdquo; says Joe Walsh, AVP of Procurement. We employ over 700 individuals who have oversight into approximately $1.3 billion in non-salary spending. Our coordinated efforts save millions of dollars to achieve both cost savings and cost avoidance. &nbsp;Joe puts it like this: &ldquo;We are a service organization to our many important internal stakeholders. In this role, we can never become the weak link in the value chain between our suppliers and the point of patient care.&rdquo;&nbsp;</p> <h3 class="NormalParagraphStyle">What goes into earning the award?</h3> <p class="NormalParagraphStyle"> </p> <p class="NormalParagraphStyle">A little over a year ago, (SCO) moved to a newly constructed office space and warehouse in Midvale. Our new building and location gave us the platform to improve on existing processes and enabled us to push those processes a step further </p> <h3 class="NormalParagraphStyle">Some of these steps included:</h3> <ol> <li><strong>Value Creation</strong>. Our Strategic Sourcing team identifies over 150 services and products each year where value can be created through improved pricing or even cost elimination. Steve Mikkelsen, Operations Director of Laboratory Services, recently used the SCO to get chemistry equipment. &ldquo;We received a very favorable long term contract for a great price that provided just what was needed,&rdquo; says Mikkelsen. &nbsp;Steve adds, &ldquo;We worked together as a team to ensure we received a quicker test turnaround time, a top quality product, and a cheaper cost per test."</li> <li><strong>Logical Unit of Measure (LUM) shipping</strong>. Hospital and clinic staff place orders for crucial items which are then pulled from stock and placed into over 1000 totes every day for delivery directly to the floors and locations where they will be used. Studies have shown that up to 30% of a nurse&rsquo;s time is spent in non-patient care activities. LUM created efficiencies that now allow clinicians to spend less time in stocking activities, freeing time for patient care. </li> <li><strong>Value Measurement</strong>. &ldquo;A process can only be improved upon if it is measured,&rdquo; says SCO Finance and Information Director Tim Goates. A team of analysts work toward capturing data that helps establish the &ldquo;total cost of ownership&rdquo; (TCO). TCO looks at every angle of the product or service to establish the cost of acquisition, usage, longevity, and how it affects related usage. It also takes into account the complexities of legal and business requirements. &ldquo;When TCO principles are applied, we&rsquo;ll get the most appropriate price for what we&rsquo;re purchasing,&rdquo; says Richard Bagley, Director of Strategic Sourcing.</li> <li><strong>IMAT Warehouse</strong> (Integrated Materials, Ancillary, and Transportation). The IMAT warehouse and distribution center itself brings an incredible amount of capabilities previously unseen. About 6000 critical items are stocked there and the warehouse fulfills 98.6% of orders with 99% accuracy.<br /> Additionally, product shelf life has been extended, there is new ability to take advantage of bulk buys, and product waste has diminished since it is no longer necessary to order in case quantities.These capabilities make Intermountain extremely prepared for an emergency or disaster as well as creating a better experience for our patients by having the supplies necessary. </li> <li><strong>Innovation</strong>. Three years ago, a project called Procurement Transformation was launched to help position the SCO for the future. What Gartner really liked about this innovation was how it uniquely positions the SCO to serve patients, employees, the organization, and suppliers by adding expertise, focus, and governance that will allow us to be nimble and effective regardless of coming changes.</li> </ol> <h3 class="NormalParagraphStyle">What is being said?</h3> <p class="NormalParagraphStyle">Gartner describes Intermountain&rsquo;s Supply Chain like this: &ldquo;The Intermountain team has worked hard to deliver on the investment made in its supply chain by its board. With the $40 million, 357,000-square-foot supply chain center in full operation, Intermountain has become a flagship of professionalism to the suppliers with which it works. Its development of a strategic sourcing team that is specifically challenged to find millions in non-price-related savings has made Intermountain think and act differently. It has continued executive support, and the organization&rsquo;s commitment to enabling low-cost and high-quality patient care throughout its supply chain is strong.&rdquo; </p> <p>The entire piece can be found at <a href=""></a>. </p>Fri, 13 Dec 2013 00:00:00 -0700{7394DAC9-927C-48F8-80BB-20DE3E089E4D} Would Someone Need A Swallowing Specialist?<strong>Why would someone need to see a swallowing specialist?</strong><strong><br /> </strong>There are some common conditions that may cause swallowing problems, such as:<br /> <br /> <ul> <li>Stroke</li> <li>Multiple Sclerosis&nbsp;</li> <li>Alzheimer's Disease/Dementia</li> <li>Parkinson's Disease</li> <li>ALS (Lou Gehrig's Disease)</li> <li>and many more...</li> </ul> <strong>What kinds of problems can someone have in swallowing?</strong><br /> <br /> <ul> <li>Difficulty closing the lips</li> <li>Difficulty moving the tongue to control food during chewing</li> <li>The muscles of the face may be weak and allow food to collect in cheeks</li> <li>Problems with sensation so an individual cannot feel where food is located</li> <li>Problems triggering a swallow response</li> <li>Difficulty coordinating the muscles that close and protect the airway, causing a person to cough or choke</li> <li>Decreased control of muscles that push food through the throat</li> <li>Damage to the muscles of the esophagus so they cannot contract</li> <li>Any one of these problems can occur by itself or in combination with other abnormalities</li> </ul> <strong> Signs of Difficulty Swallowing:</strong><br /> <br /> <ul> <li>Coughing while eating or drinking or soon after eating or drinking</li> <li>"Wet&rdquo; Sounding Voice during or after eating or drinking</li> <li>Obvious Extra Effort or difficulty while chewing or swallowing</li> <li>Taking longer than normal to eat</li> <li>Fatigue or Shortness of Breath while eating</li> <li>Weight Loss associated with poor nutrition</li> <li>Repeated Pneumonia</li> <li>How is a swallowing problem evaluated?</li> </ul> <br /> A Speech-Language Pathologist (SLP) is an expert in assessing swallowing disorders and establishing a treatment plan to improve the swallow.<br /> <br /> Your doctor or the SLP may recommend having a Modified Barium Swallow (MBS) evaluation where your swallow is viewed under x-ray to see how food or liquid is moving. Or they may perform a Fiberoptic Evaluation of Swallowing (FEES) where a fiberoptic tube is placed while you swallow food and liquid that is dyed blue. This allows them to visually see where the problem is and how to best go about treating it.<br /> <br /> <strong>How is a swallowing problem treated?</strong><br /> <br /> No two patients are alike in their swallowing problems. Each patient with swallowing problems should have an individual treatment plan developed by the <a href="">Speech-Language</a> Pathologist (SLP), and it is very important that this plan be followed carefully. Here are some examples of things that may be included in a patient&rsquo;s plan for safer swallowing:<br /> <br /> <ul> <li>Exercising muscles that are not working properly with the SLP</li> <li>Change head or body position</li> <li>Changing kinds of foods or thickening liquids</li> <li>Learning new ways of swallowing</li> </ul> <p>If you are interested in speaking with a speech pathologist visit or <a href="">Speech Pathology</a> site.</p>Fri, 13 Dec 2013 00:00:00 -0700{C2B70709-6388-4B06-82F7-984EE956455C} Healthy During the Holidays: The Good and The Bad of Appetizers<p>Food is more often than not the center of holiday gatherings and parties. It is not a bad thing to enjoy food during the holidays, but these holiday parties happen so often during the month of December that you don&rsquo;t want to break the calorie bank every day. The small appetizer type foods are the ones that can especially add up. For example, you can eat the amount of calories you should eat in one meal from appetizers before you even sit down for dinner! It can add up over a whole month!</p> <p>Below is some info on what is good and bad about appetizer type holiday foods:</p> <p style="margin-top: 12pt; text-align: center; background-color: white;"><strong><span style="text-decoration: underline;">Hummus and Veggies</span></strong></p> <p style="background-color: white;"><strong>The Good:</strong>&nbsp;Hummus is high in protein, fiber, zinc, and magnesium.</p> <p style="background-color: white;"><strong>The Bad:</strong>&nbsp;One tablespoon of hummus has around 25 calories &ndash; so&hellip;portion control!</p> <h3 style="margin-top: 12pt; text-align: center; background-color: white;"><span style="text-decoration: underline;">Nuts</span></h3> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Good:</strong><strong>&nbsp;</strong> Heart-healthy fats, fiber, vitamins, and minerals.</p> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Bad</strong>: Portion control! 1 oz. has 164 calories.</p> <h3 style="margin-top: 12pt; text-align: center; background-color: white;"><span style="text-decoration: underline;">Chips and Dip</span></h3> <h3 style="margin-top: 12pt; background-color: white;">The Good: Not much.<br /> The Bad: High in calories and fat &ndash; the calories add up easy and fast!</h3> <h3 style="margin-top: 12pt; text-align: center; background-color: white;"><span style="text-decoration: underline;">Spinach Dip</span></h3> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Good:</strong><strong>&nbsp;</strong>The spinach&mdash;and that's about it.</p> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Bad:</strong><strong>&nbsp;</strong>The spinach is usually drowning in mayo and cheese, which means its surrounded by calories.</p> <h3 style="margin-top: 12pt; text-align: center; background-color: white;"><span style="text-decoration: underline;">Frozen Goodies</span></h3> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Good:</strong><strong> </strong>They are convenient.</p> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Bad:</strong><strong>&nbsp;</strong>Prepackaged foods, especially baked goods, are especially high in trans and saturated fat, refined sugars along with other preservatives.</p> <p style="margin-top: 12pt; text-align: center; background-color: white;"><strong><span style="text-decoration: underline;">Chocolates</span></strong></p> <p style="margin-top: 12pt; background-color: white;"><strong>The Good:</strong> It is good for your soul.<strong><br /> The Bad: </strong>It is hard to just have one! Lots of calories, sugar and fat for not a lot of volume. </p> <p style="margin-top: 12pt; text-align: center; background-color: white;"><strong><span style="text-decoration: underline;">Cheese and Crackers</span></strong></p> <p style="margin-top: 12pt; background-color: white;"><strong>The Good: </strong>Cheese is a good source of protein and calcium.<br /> <strong>The Bad: </strong>Cheese can be high in saturated fat and calories and it hard to eat just a little. </p> <p style="margin-top: 12pt; text-align: center; background-color: white;"><strong><span style="text-decoration: underline;">Shrimp Cocktail</span></strong></p> <p style="background-color: white;"><strong>The Good:</strong>&nbsp;Good source of Omega-3&rsquo;s and lean protein.</p> <p style="background-color: white;"><strong>The Bad:&nbsp;</strong>Shrimp is high in cholesterol and be weary of high sugar/high sodium cocktail sauce.</p> <h3 style="margin-top: 12pt; text-align: center; background-color: white;"><span style="text-decoration: underline;">Nachos and Cheese</span></h3> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Good:</strong><strong>&nbsp;</strong>Salsa can be low in calories </p> <p style="margin: 0in 0in 0.0001pt; background-color: white;"><strong>The Bad:</strong><strong>&nbsp;</strong>Everything else. Chips and cheese are high in fat and sodium. Portion control is always hard with chips and dip too, it&rsquo;s easy to eat a lot without noticing!</p>Mon, 09 Dec 2013 00:00:00 -0700{C4B08B50-CA3F-4431-83BD-5CB9520E5D93} Your Baby - Preventing Pediatric Constipation<p>Constipation may present itself with large, firm and painful stools. This can be associated with infrequent stooling, abdominal pain, cramping, nausea and decreased appetite. It can be severe enough to cause rectal bleeding, stool retention, and impaction with stool leakage.&nbsp; </p> <p>Acute as well as chronic constipation should be evaluated by the primary care provider to obtain a history, perform a physical exam, and make treatment recommendations, as sometimes there is a need to rule out organic causes of constipation. </p> <p>So what are some organic causes of constipation? The causes are mainly attributed to <strong>lack of fluid and/or fiber intake</strong>. </p> <h3><strong>How much fluid intake should occur?</strong></h3> <p>Adequate amounts of fluids should be provided. Infants derive their fluids solely from breast milk and/or formula for the first 4 to 6 months and should be fed on demand. The <a href="">American Academy of Pediatrics</a> recommends exclusive <a href="">breastfeeding</a> until age 6 months. </p> <p>Once <a href="">solid foods are introduced</a> between 4 to 6 months of age it is important to offer additional water and quickly transition to fiber-rich foods including barley, mixed grains, sweet potatoes, and fruit. </p> <p>The minimum fluid intake per day depends on the child&rsquo;s weight, and ranges from 16 oz for a 5 kg infant and 32 oz for a 10 kg infant. The toddler and older child should have frequent access to water throughout the day, allowing adherence to physiologic thirst mechanisms. </p> <p><strong>How can the family help the child drink more water?</strong></p> <p>Have water be their first choice for quenching their thirst. This helps them to avoid developing habits of thirst quenching with sweetened beverages. Make water more attractive with fun, individual cups or adding a mint leaf or slice of lemon for flavor.</p> <h3><strong>What is fiber?</strong></h3> <p><a href="">Dietary fiber</a> consists of&hellip; </p> <ul> <li>Soluble fiber that attracts water and forms a gel-like texture. Examples of foods with soluble fiber include fruits, oats, barley, and legumes like beans or peas.</li> <li>Insoluble fiber that does not get absorbed. This bulks the stool and works as a broom, sweeping stool particles down and out. Examples of foods with insoluble fiber include wheat bran, rye and other grains.</li> </ul> <p>Dietary fiber, in conjunction with appropriate water intake, will keep stools comfortable, moving and easy to pass. It also contains healthy nutrients and vitamins.</p> <p><strong>How much fiber is recommended?</strong></p> <p>The Consensus conference on dietary fiber in childhood recommends 5 grams of fiber a day under age 2 and 5 to 10 grams plus age in years for older children. For instance, if your child is 10 years old, he should get 15-20 grams of dietary fiber per day. </p> <p>If the child is resistant to natural sources of fiber, various over-the-counter fiber supplements are available.</p> <p><strong>How do I read the nutrition label for fiber?</strong></p> <p>When you look at the Nutrition Facts list, fiber is listed under &ldquo;Total Carbohydrates&rdquo; as &ldquo;Dietary Fiber&rdquo; and is measured in grams. Good sources of fiber have at least 3 grams of fiber per serving. Excellent sources of fiber have at least 5 grams of fiber per serving. </p> <p><strong>How can the family help the child eat more fiber? </strong></p> <p>If you believe your child is not getting enough fiber, it is probably true. Here are some things you can do to ensure he gets more fiber.</p> <ul> <li>Fiber-rich choices and plain water need to be offered early on to allow the child to acquire a taste for it.</li> <li>Offer the child a variety of high fiber foods during the day rather than giving only one or two high fiber foods. Include granola bars, fruit bars and fig cookies. Snack choices like fruit baskets or veggie plates should be out and visible to the child to entice appetite for it. </li> <li>Offer fresh fruit with skin on, like apples, pears, and prunes.</li> <li>Offer raw veggies and tomatoes with a healthy choice of dips (low-fat yogurt, bean, hummus, or cheese dips).</li> <li>Offer unsalted nuts, seeds, and popcorn</li> <li>Mix high fiber cereal with a cereal your child likes or add chunks of fresh or dried fruit, bran, flax seeds, or sesame seeds.</li> <li>Cook mostly whole grain pastas, breads, and cereals.</li> </ul>Mon, 09 Dec 2013 00:00:00 -0700{1009E82D-D82A-4DF4-A58F-902A305F907D} Your Baby - All About Croup<p style="margin: 0in 0in 10pt;">Croup is a type of <a href="">upper respiratory infection</a> that can affect the voice box, vocal cords, and the windpipe. These infections are more serious in infants and small children because these children have smaller airways than adults. </p> <p style="margin: 0in 0in 10pt;"><b>What happens in croup?</b></p> <p style="margin: 0in 0in 10pt;"><b>Children with croup usually have these symptoms:</b></p> <ul> <li>A &ldquo;barky&rdquo; cough which sounds like a dog&rsquo;s or seal&rsquo;s bark, noisy breathing, and sometimes heavy movement of the chest when breathing.</li> <li>The cough may be bad enough to cause gagging or vomiting. </li> <li>They may have a runny nose, <a href="">fever</a>, or both.</li> <li>Some infants are quite fussy, sleepy, and have poor appetites.</li> <li>Croup may begin suddenly and is generally worse at night. The worst part of the illness lasts two to three days, but your child may have a wet cough for a week or two.</li> </ul> <p style="margin: 0in 0in 10pt;"><b>How does a child get croup?</b></p> <p style="margin: 0in 0in 10pt;">Your child can catch <a href="">croup</a> if he comes in contact with another person&rsquo;s mucus (for example a sneeze, used tissues, touching hands if the person has not washed their hands). The illness usually begins two to three days after being exposed to the virus.</p> <p style="margin: 0in 0in 10pt;"><b>How do you treat croup?</b></p> <p style="margin: 0in 0in 10pt;"><a href="">Treatments for croup</a> include:</p> <ul> <li>Humidity and cool air are the most important treatments for croup. Some ways to provide cool air and mist are: <ul> <li>If it is cool outside, wrap your baby in blankets or dress your child in warm clothes and take him outside. Cool or cold air will decrease swelling of the airways. This usually takes at least 15 minutes in cool, night air. </li> <li>Use a cool-mist humidifier in your child&rsquo;s room.</li> <li>Mist up the bathroom with hot shower steam and have your child sit in the bathroom for 10 minutes. You can cuddle your child and read a story to keep him calm.</li> <li>If your child is not in severe distress, offer him popsicles or cold drinks. This will soothe his throat and help reduce swelling. </li> </ul> </li> <li>If your child wants to sit up, do not force him to lie down. Your child will usually sit in a position that makes breathing easy. </li> <li>You can give your child acetaminophen (Tylenol) for a temperature more than 101 degrees Fahrenheit. </li> <li>Do not give your child aspirin. Aspirin can cause brain, liver, and kidney damage and Reye&rsquo;s syndrome in children.</li> <li>If the croup is very bad, your doctor may tell you to take your child to the hospital. In the emergency department (ED) your child will receive treatments to open his airways. He may receive oxygen or IV fluids (fluids given through a tiny tube into a vein) if needed. In the ED, the doctor will decide if your child needs to be admitted to the hospital. The length of time in the hospital depends on how long your child needs oxygen, IV fluids, or other treatments. </li> </ul> <p style="margin: 0in 0in 10pt;"><b>Are there complications from Croup?</b></p> <p style="margin: 0in 0in 10pt;">The most common complications of croup are <a href="">ear infections</a> and <a href="">pneumonia</a>. The most serious complication is complete blockage of breathing. This is rare, but you will need to get help right away if you are worried about your child&rsquo;s breathing. This could be life-threatening.</p> <p style="margin: 0in 0in 10pt;"><b>Call your doctor if&hellip;</b></p> <ul> <li>Your child has a hard time swallowing or is drooling.</li> <li>Your child is having so much difficulty breathing that he is restless and can&rsquo;t sleep.</li> <li>Your child complains of an earache or, in an infant, if he pulls at his ears.</li> <li>Your child has a prolonged fever or his temperature goes above 104 degrees Fahrenheit (40 degrees Celsius) or 102 degrees Fahrenheit in infants.</li> </ul> <p style="margin: 0in 0in 10pt;"><b>Go to the nearest hospital if&hellip;</b></p> <ul> <li>Your child does not have enough energy to eat, talk, or do simple tasks.</li> <li>Your child refuses to swallow or lie down.</li> <li>Your child has a bluish color on his lips or face.</li> <li>Your child&rsquo;s chest severely sucks in with each breath.</li> <li>Your child has noisy breathing at rest. Your child is having trouble breathing.</li> <li><b>If your child is in severe distress or cannot breathe, call 911</b>.</li> </ul> <p style="margin: 0in 0in 10pt;">For a list of trending pathogens around the state of Utah, including croup, check out <a href="">GermWatch</a>.</p>Fri, 06 Dec 2013 00:00:00 -0700{AD486E95-7C61-4528-A75D-3D37EC78741E} Little About PPD – Postpartum Depression<p><strong>Is it normal to feel a little depressed after having a baby? </strong></p> <p><a href="">Baby blues</a> are normal and you might feel a little sad, anxious, or cry for no reason. This <a href="">usually lasts for about 2 weeks</a> and begins to get better as the days go on.<br /> <br /> <strong>What are the symptoms of Postpartum Depression (PPD) and how does it differ from postpartum blues?</strong></p> <p>Symptoms of <a href="">Postpartum Depression</a> include sadness, hopelessness, lack of energy, trouble concentrating, anxiety, feelings of guilt and worthlessness, and not wanting to do things you once enjoyed. The symptoms are similar, but the primary difference between baby blues and PPD is that PPD affects a woman&rsquo;s well-being and keeps her from functioning well for a long period of time. It can happen anytime during the first year. In extreme cases, it can cause a woman to have a desire to hurt herself or her baby. This is a reason to go to the ER.<br /> <br /> <strong>How common is PPD?</strong></p> <p>It affects about 10% of women, but because no one talks about it, you feel guilty or lonely for struggling with it. In fact, one study showed that 80% of women with symptoms still hadn&rsquo;t talked with their doctor about it.<br /> <br /> <strong>What can you do if you struggle with PPD?</strong></p> <p>It is so important to understand that it can happen to anyone, and <a href="">having PPD</a> doesn&rsquo;t mean you&rsquo;re a bad mother or a bad person. <a href="">You don&rsquo;t have to suffer</a> and there is help out there! Treatment includes counseling, medication, and support groups. Get rest, stop putting a lot of pressure on yourself, ask others for help, talk with trusted family and friends, spend time with other people, and if possible, avoid major life changes near the time of the birth of your baby, like moving homes.</p>Wed, 04 Dec 2013 00:00:00 -0700