Back To School Immunizations

As summer is quickly coming to a close for kids, it's that time of year again to think about Back-To-School. In addition to thinking about school supplies and school clothes, something else to ask yourself is this, "Is my child up to date on immunizations?"

There are certain immunizations that are required to attend school in the states of Ohio and Pennsylvania, and the Ohio Department of Health and Pennsylvania Department of Health have great links to let you know which immunizations are required to attend school. The full immunization schedule can be found at the site for the Centers for Disease Control and Prevention

But, in general, the immunizations that my patients and their parents are asking about are the following Back-To-School Immunizations:

  • Before Kindergarten: MMR, Chicken Pox, Polio, Tetanus
  • Before 7th Grade: Tetanus Booster, First Meningitis Shot
  • Before 12th Grade: Second Meningitis Shot

The vaccine against Human Papillomavirus (HPV) is not required to attend school (yet), but I still try to have a discussion with parents about the benefits of this vaccine. And, of course, I do recommend the Flu Shot yearly. 

I also get questions about vaccine exemptions. In the states of Ohio and Pennsylvania (and other states), a child who attends public school can be exempted from taking vaccines in school for medical, religious, and philosophical reasons as long as the parent/guardian provides the school with a written statement along with a waiver form.

This exemption also comes with one caveat: If this school has an outbreak, the school may prevent the child from attending, to protect the health of all students and the faculty.

Of course, I advocate for vaccination, because we have seen the complications of not vaccinating. Remember the 2014 mumps outbreak at Ohio State University? This affected almost 500 people. How about the 2014 measles outbreak at Disneyland in California? I believe these came about because the people affected, for whatever reason, were unvaccinated.

Bottom Line: Vaccines work. Get your children vaccinated. Stay up to date on your (adult) vaccinations. And, finally, visit your Family Doctor to see which vaccines are appropriate for you and your child.

Summer Safety Tips

With the first day of summer a few days ago, summer is now in full swing! I've been getting a lot of questions from parents on the topics of pool safety and fireworks safety. And, I'll focus on those topics in this blog post.

Pool Safety: According to the Centers for Disease Control and Prevention, from 2005-14, there were an average of 3500 fatal unintentional drownings annually, which is about 10 deaths per day. And, approximately one in five of these fatalities were children 14 years old and younger.

Here are three Pool Safety Tips to keep in mind this summer:

  • Never leave a child unattended near water
  • Keep a Life-Saving ring and CPR instructions at poolside
  • Keep a phone at poolside so you can call for help if needed

Fireworks Safety: With July 4th right around the corner, here are a couple of alarming statistics to keep in mind. In a 2014 report by the Consumer Product Safety Commission, 35 percent of people seen in the ER around the time of July 4th were younger than 15 years old. In addition, 28% percent of ER visits were due to sparklers. In case you didn't know, sparklers can reach 1200 degrees F.

Here are three Fireworks Safety Tips to keep in mind:

  • A responsible adult should supervise all firework activities. Never give fireworks to children
  • Always have a bucket of water nearby
  • Never, ever relight a "Dud" firework

I also encourage you to check out the story on the WKBN site called "Tips To Say Safe Around Water, Fireworks as Summer Season Begins." 

'13 Reasons Why' Raises Discussion On Teen Suicide

The Netflix drama "13 Reasons Why" is causing a lot of discussion and controversy on the topic of teen suicide. The show, based on a 2007 young adult novel, tells the story, through the tapes she made, of a high school sophomore who committed suicide. Each tape addresses one of the 13 people the student claims contributed to her death.

Before I go further, I wanted to post the link to the National Suicide Prevention Lifeline and their phone number is 800-273-8255. For those who would rather text, contact the Crisis Text Line by sending "Hello" to 741-741. From a medical standpoint, Family has some useful information to increase awareness about teen depression, cyberbullying, and teen suicide. I also share an NPR audio podcast from May 18, 2017 below, and a video podcast from a Suicide Prevention Social Media community.

Even though that it is powerful storytelling, I would NOT recommend that teenagers watch this show alone. However, I realize a lot of kids watching this on their phones on the bus. So, kids who watch this show need to talk with their parents, or guardians, or school counselors, or other adults where they process what they're seeing and what they're feeling.

No, I do not think this show will cause teens to consider suicide. However, I think that this show is high risk to trigger those teens struggling with mental illness, or those who are/have been affected by bullying/cyberbullying and sexual assault in the past. It is unfortunate that the program did not originally share information about the National Suicide Prevention Hotline or the Crisis Text Line as above. More information was added at the beginning of this month.

To help raise awareness, and to help you, here are my "13 Reasons" to look out for in teens (and adults) as Warning Signs For Suicide:

  • Talking about death and/or suicide in a casual way
  • Saying they wish they hadn't been born
  • Asking about death or how to commit violent acts
  • Talking about leaving or going away
  • Saying they won't need things soon
  • Not wanting to be around people anymore
  • Seeming sad and remote, instead of happy and social
  • Becoming more angry or edgy
  • Losing interest in hobbies or events
  • Having trouble focusing
  • Showing changes in normal routine, such as sleeping, eating, or grooming
  • Acting out in harmful ways like drinking, using drugs, or hurting themselves
  • Getting in trouble with the law

Addendum: I also invite you to check out the WKBN-TV article, "Local doctor discusses Netflix teenage-suicide show '13 Reasons Why'"

Qliance Closes: Is Direct Primary Care Doomed?

Qliance, a shining example of success in the Direct Primary Care movement, closed this week according to The Seattle Times. For those who are not familiar, Direct Primary Care is a newer way to deliver healthcare in which patients pay a monthly fee directly to their doctor, and the doctor's office does not accept insurance plans. There are some exceptions to this, but this his the basic concept.

Over the past 10 years, the Qliance model has been held up as THE model to replicate across the country. Now, it's closed. Over the past 24 hours, there has been a lot of talk on social media about why this happened to Qliance. But, it also begs the question: How does this affect the entire Direct Primary Care movement? Is DPC doomed to fail?

Now, I don't believe that, but it makes a good headline (hehe). Has my friend and DPC advocate, Dr. Ryan Neuhofel said on twitter, "Did the failure of MySpace mean the concept of 'social media' was invalid?" Other people on social media are now saying that at the end, Qliance was not really a Direct Primary Care model.

It will be interesting how the Direct Primary Care community spins the closing of Qliance on social media. What lessons will be learned from the Qliance experience? As far as the movement of Direct Primary Care itself, I'm still inspired by the 2013 words of Dr. Erika Bliss, Qliance CEO, "If Primary Care can't step up right now and own the health care system and change it on behalf of our patients, then we should just go home."

RIP Qliance. Thanks for being a pioneer in the Direct Primary Care Movement....

Why Family Medicine Matters and Previewing #StayWellSoon

Our colleague, Dr. Wanda Filer, Board Chair of the American Academy of Family Physicians, was a guest on the ZDoggMD Facebook Live session yesterday talking about the importance of Family Medicine and the importance of Family Physicians. Why does Family Medicine matter? This brief 20 minute program will tell you why #HealthIsPrimary and

In addition, Dr. Filer and ZDoggMD previewed the #StayWellSoon advocacy and educational campaign that will launch on May 23 at Family As ZDoggMD says, May 23 will be a Call of Action in which there will be "cards" that will be available not only promoting Family Medicine, but encouraging people to get connected with a Family Physician. More information soon at

Distracted Driving Is Very Dangerous

Distracted driving is any activity that diverts attention from driving, including talking or texting on your phone, eating and drinking, talking to people in your vehicle, flddling with the radio, entertainment or navigation system - anything that takes attention away from safe driving.

April is Distracted Driving Awareness Month. I get questions all the time from parents worried about their kids, from kids worried about their parents, and everyone else. Distraction is not only dangerous, but it can also be deadly. Here are some 2015 statistics involving distracted drivers from the National Highway Traffic Safety Administration:

  • 3477 people were killed during distracted driving
  • 391,000 people were injured during distracted driving
  • 660,000 drivers are using cell phones while driving

The National Safety Council lists these Five Myths about Distracted Driving in this informative Infographic below:

  • Myth #1: Drivers Can Multitask -> Reality: You cannot totally focus on talking on the phone and safely driving. Trying to do both slows reaction time
  • Myth #2: Talking on a Cell Phone Is Just Like Speaking to a Passenger -> Reality: People in the car can help alert the driver to traffic problems. Those on a cell phone cannot.
  • Myth #3: Speaking Hands-Free Is Safe To Use While Driving -> Reality: Drivers on cell phones can miss seeing up to 50% of their driving environment including pedestrians and red lights
  • Myth #4: I Only Use My Phone At Stop Lights So It's Ok -> Reality: You're still distracted. In a recent study by AAA, people are distracted 27 seconds after they finish sending a voice text.
  • Myth #5: Voice-To-Text is Safe To Do While Driving -> Reality: Actually it's not. If thinking and sending the text is not distracting enough, the autocorrect (or lack of it) will drive you nuts!

With May's upcoming Graduation and Prom season quickly coming upon us, you need to know the facts about distracted driving. If you want more information, check out the National Highway Traffic Safety Administration, the National Safety Council, and the Distracted Driving Awareness month website.

NEOMED Social Media Talk 2017

I'm honored to be a guest of the medical student organization Physicians for Social Responsibility at the Northeast Ohio Medical University. I'll be giving a talk at the university on March 22, 2017. The slides I'll be using are below. I'll be posting more following the talk. If the embed doesn't work below, then click on my slideshare account right here.

Initial Reaction: ZDoggMD Launches Weekly FB Live Show

Tonight, Zubin Damania, MD, otherwise known to his legions of fans as ZDoggMD, took his popularity, passion, and activism to another level, with the launch of a weekly Facebook Live show called "Against Medical Advice," which is scheduled to air Sunday nights at 7pm Eastern time on his Facebook page.

"This is the show for the rest of us," he begins Episode 001, "The show for front line healthcare providers who, for too long, haven't had a voice." "This is your show," he continues, "We need to transform healthcare. If we don't do it, someone else will do it for us."

This initial 32 minute program is part pep rally, part Saturday Night Live skit, and part ZDogg travelogue. In this first episode, ZDogg visits HIMSS, the largest healthcare IT conference of the year. There's also a skit with "Doc Vader" ranting about current events. The last segment of the program is ZDogg at his best, connecting with his audience by responding to the flurry of FB comments happening during the live show.

If you don't have 32 minutes, the best stuff is in the first 6 minutes where he makes the case of why this show is needed. "This show is about the tribe of healthcare - trying to transform healthcare," his opening monologue starts. ZDogg then outlines the failed Healthcare 1.0 paternalistic and expensive model. "The world of Healthcare 2.0 includes the electronic health record which is a glorified cash register with a little patient stuff tacked on." "For Health 3.0, the frontline healthcare provider needs a voice, and that's what the show is about."

According to ZDogg, Health 3.0 is the return to personalized medicine which including the voice of the frontline healthcare worker, team based care, evidenced based medicine. Sound familiar? How about the ideas being talked about by Family Medicine For America's Health and the Health Is Primary campaign? (see videos below)

At its height, there were over 1,200 live viewers during the program. Right after the show ended, there were 38,000 views with over 1,200 FB 'reactions,' and 488 shares. At the time of this posting, which is about 2 hours after the show, there are over 60,000 views, 1,700 FB 'reactions,' 700 shares, and more than 1,200 FB comments.

This show has huge potential. I'm no expert, but here's what I'd like to see in the show (and maybe there are already plans for this). If the show is about the frontline healthcare worker, I'd love to see interviews with those people, like when ZDogg is on the road. I also hope that he does something similar with his shows, to what he does with his songs - have theme based shows. Would love to see a show, for example, on the opioid epidemic, and a content expert be interviewed on this. Finally, what ZDogg does best is connect with his audience. If/When FB Live allows people to "call in" like skype, would love to see him chat with a front like healthcare worker live during the show, and respond to FB live comments.

I don't care if you're a physician, a patient, a nurse, a social worker, a physical therapist, a pharmacist, or anyone else in the healthcare community. I believe we have to come together to have our voices be heard. And, I think that "Against Medical Advice" by ZDoggMD is a great way to do that.

Getting Ready For Daylight Saving Time

The beginning of March means getting closer to the first day of Spring. One of the things that symbolize this is "Springing Ahead" by turning the clocks one hour ahead for Daylight Saving Time.

Did you know that turning clocks head one hour is actually dangerous? Here are some of the less known consequences of sleep deprivation due to Daylight Saving Time:

  • Heart Attacks: The number of acute myocardial infarctions jumps 24 percent on the Monday after the time change, according to as study from the University of Colorado
  • Workplace Injuries: An examination of mining injuries from 1983 to 2006 revealed that the Monday after the time change, workers sustained more injuries and more severe injuries versus the rest of the year
  • Increased Car Accidents: Sleep deprivation can delay reaction time. Also sleep deprivation sometimes prevents you from making good decisions

Daylight Saving Time doesn't have to be so dangerous. Here are some tips to help you "Spring Forward" into Daylight Saving Time:

  • Gradual Transition Into The Time Change: Especially for those taking care of children, start now by putting your children to bed in 15 minutes early, and working towards one hour.
  • Avoid Bright Lights Before Bed: This includes TV, smartphones, and computers
  • Get Some Exercise During The Day: Aim for at least 30 minutes, most days of the week
  • Get Up If You Can't Sleep: If you've been awake for more than 20 minutes, get up, go to another room, and do something relaxing to help get you drowsy, like read a book

Thanks so much to WKBN-TV for posting the HD videos below. Also check out the article on their site, "Not Ready For Daylight Saving Time? Tips On How To Adjust To The Time Change"

Youngstown Northside Hospital Sold: Who Is Steward Health Care?

Today it was announced that Northside Medical Center in Youngstown, Ohio (the hospital in which I was born) is being sold, along with three other area hospitals to Steward Health Care of Boston from Community Health Systems company (WKBN). A total of eight hospitals in Ohio, Pennsylvania, and Florida are included in this deal.

Who Is Steward Health Care? According to the Boston Globe, Steward Health Care System was founded in 2010 to take over the hospitals formerly run by the Archdiocese of Boston. Steward is a for-profit health care provider and is backed by Cerberus Capital Management.

Why did Steward buy these hospitals? Since entering the market in 2010, Steward has become one of the largest health systems in Massachusetts, according to the Boston Globe. On September 26 2016, the Boston Business Journal reported that "Steward Health Care announces national plan, $1.25 billion investment." Around that same time, Modern Healthcare reported on September 24, 2016, Community Health Systems, "Why one of the largest US hospital chains is dismantling itself." Sounded like the business perfect storm.

What's good about Steward? It seems to be able to turn losses into gains. In fiscal 2011, the first year of running the hospitals, Cerebrus reported a $14.6 million loss (modern healthcare). However, by 2015, the company showed an operating profit of $131 million (boston globe). During this process, Quincy Medical Center was closed in 2014. 

What's bad about Steward? In addition to closing the hospital above, Steward has been fined over $40,000 for failing to submit financial data on time to state agencies in Massachusetts. The Boston Globe states, "The company remains locked in a dispute with state officials over what financial information it must disclose." I'm no bureaucrat, but I would imagine Steward would have to submit financial information to Ohio, Pennsylvania, and Florida where they now own hospitals. Are more fines in the future?

What does this mean for the Youngstown, Ohio hospital market? For those locally here in the area, it is no secret that Northside Hospital has been struggling, even before Community Health Systems purchased them. Meanwhile, its local competitor, Mercy Health, has been expanding its presence in the Valley. In addition, regional competitors Cleveland Clinic and University Hospitals of Cleveland have been trying to come in from the north, and University of Pittsburgh Medical Center (UPMC) has been trying to come up from the south.

So, this area, like other areas in Ohio, is becoming a very competitive hospital market. What will be the fate of Northside Medical Center in Youngstown, Trumbull Memorial Hospital in Warren, Hillside Rehabilitation Hospital in Warren, and Sharon Regional Health System? Looking at the short history of Steward, and, let me tell ya, I'm no economist. But, my guess is that it's likely that one, or more than one of these four hospitals may be closing in the near future. Which one(s)? We'll see...