a drop of whizky

Last monday I was fortunate to have a day off work, being able to watch the live streams of TEDxMaastricht, a very inspiring conference with very interesting, impressive and touching talks on the future of healthcare. Videos of this conference can be found here and here.

Salmaan Sana introduced the charter of Compassion for Care. He started his talk with the story of how he lost his initial enthusiasm for becoming a doctor, and how he lost himself in all kinds of international activities in the course of his medical study. He explained how he rediscovered his dream of becoming a doctor in Compassion for Care. He referred to the Golden Rule, that Karen Armstrong unearthed in her first TED talk as the common ground in every religion "Let's revive the Golden Rule", and the Charter for Compassion that follows through as she defended in her award winning TED talk of 2008. That is a really inspiring monologue:

Salmaan Sana's talk at TEDxMaastricht:

This summer we spent our holiday camping in the Loire valley in France. Every morning we walked to the camp store to get our daily bread. I taught my kids how to order bread in French and after a few days Maarten (4 years old) and Leanne (5 years old) thought they could do it all by themselves. So I gave them money, and several minutes later they returned with the bread. Both of them awfully proud that they had shown to be able to buy bread in a foreign country without help or supervision. I can assure you their parents where just as proud! I don't need to explain that they continued to buy the bread all by themselves every day we stayed in France.

This made me remember an article by Lenore Skenazy in the New York Sun, entitled “Why I Let My 9-Year-Old Ride The Subway Alone”. After which some people called her "the worlds worst mom". Personally I think she is right. Nowadays people tend to overprotect their children and supervise them at all times. Find out how to raise Free-Range kids on her website.

... keeps the doctor away. Well, it does not. Fruit is not as healthy as people think. If you believe the nutrition industry, every week produces some new superfood, often a fruit: blueberries, pomegranates, acai berries.

But fruit just doesn’t provide that much nutrition in the first place. Lets have a look at the content of most fruit: water, and more water, sugar (about 10%), some vitamin C and some potassium. That will be most of it, for most fruits. Hardly fibers, hardly other minerals and vitamins. Actually, there isn't much difference between drinking a smoothie compared to an ordinary glass of Coke.

Antioxidants in pomegranate, cranberry or blueberry juice, which supposedly fight diseases as different as cancer and arthritis, actually only last in the body for about one hour. Wheatgrass, that standby of the trendy juicebar, is said to be rich in detoxifying chlorophyll, but every green vegetable and leaf in the world contains cholorophyll – which is not, in fact, absorbable by our bodies.

Then what food is healthy, one might ask? The foods packed full of micronutrients are grains, seeds and nuts, the peas and beans. And don't forget the vegetables we should eat more often, such as cabbage, spinach and broccoli.

As a junior doctor I was amazed to learn that constipation was a frequent pediatric disorder. When my daughter started having these problems, I learned that even if you give your kids a healthy diet, they still can develop constipation...

Constipation occurs commonly in children, affecting up to 10% at any given time! Still, not more than 3% of parents actually seek advice from a doctor for this condition. Constipation describes the infrequent passage of stools (bowel movements) or the passage of hard stools. Any definition of constipation depends upon comparison to how often the child normally passes stools and to the normal consistency of his or her stools.

One of the things that is frustrating for lots of parents is trying to understand why their child is constipated. Although many parents understand the role that too much cow's milk, a diet low in fiber and not drinking enough fluids have in contributing to constipation, they may have other children with the same diet who aren't constipated...

In addition to your kid's diet, the other important factor that contributes to constipation is having infrequent bowel movements. This often occurs after a child has had a large, hard and painful bowel movement, which can occasionally occur in anyone. After this, because (s)he may associate having a bowel movement with pain, (s)he will try to hold his/her stools. This creates a vicious cycle, where bowel movements are painful, so the child holds them in, causing the stools to be even larger and harder, which causes more pain when it finally does pass. Many parents mistake the behaviors that children develop to hold in stool as straining to have a bowel movement, but they are usually stiffening their muscles or fidgeting as an attempt to hold their stool in and avoid a painful bowel movement.

During the last thousands of years, when cholera and other gastro-intestinal infectious diseases were common and killed many people (especially children), natural selection favored people with slow bowels. I believe that is one of the reasons so many people have problems with their bowels.

Other factors that can contribute to constipation and infrequent stooling are: a bad experience with potty training or avoiding strange toilets (i.e. at school).

Non medical treatments for constipation include the 4 F's: more fluids, more fruit, more fat and more fibers. Of these 4, fluids (preferably water) and fibers (mainly found in vegetables like peas and beans) are most important.

Most children who visit my office get this question somewhere during the consultation: "What do you want to be when you grow up?"

It is interesting to see that most kids aged 3 through 7 will have an answer to that question. However lots of teenagers disappoint me with some variant on "I have no idea". Teenagers live for today. Their brain is different. Somehow everything beyond today is hardly worth any attention. This "old" knowledge has recently been confirmed by f-MRI studies.

But don't parents play a role too? I think that the indecision we see in teenagers regarding their future doesn't improve from "modern parenting". No, don't get me wrong, I certainly don't want to go back to those times where parents determined the trade for their children. Parents should go beyond just saying "I leave it to my children to choose what they want to be when they grow up". I certainly believe parents should coach their kids from young age to think about what different choises there are, what each job implies. Learn them to weigh the up and the down sides of jobs. Teenagers who have an idea about what they want to be are more likely going to attend the correct school and will probably perform better.

Every fortnight, and sometimes every week I take my three kids to the Rotterdam zoo (Blijdorp). I started this habit when Leanne, my eldest, became 2 years old (march 2007). Maarten, my eldest son was only 8 months old at that time. Believe me or not, but even an eight month old baby enjoys a zoo. Especially the aquariums with fish. You could see him looking at the fish and the water and marveling at it. My youngest son, Jesse, is eight months, and I see the same marvel in his eyes when he looks at the large sea-turtles or sharks swimming in Blijdorp's big "oceanium".

Leanne always walked the entire zoo. As soon as Maarten could walk, I encouraged him to leave the trolley and walk. He was only 15 months old, when I decided to leave the trolley at home because he walked most of the time. He would walk 3 or 4 consecutive hours without any problems.

Every time I visit the zoo, I see 3, 4 or even 5 year old kids sitting in trolleys pushed by their parents or grandparents. Why on earth do they do that? Don't they realize that walking is good for kids?

I find the zoo the ultimate place to educate my kids according to the principles of philosophy for children. While walking the zoo with them I find many leads to stimulate their reasoning abilities, inquiry, critical and caring thinking (the creative thinking part is more up my wife's alley).

One day during one of my consulting hours it occurred to me that I often get the same complaint from parents with completely different problems. In both cases the parents tell me their kids eat almost nothing! The first kid was growing on target but the general practitioner was concerned about her light weight. Her weight was indeed a bit more than 2 standard deviations below the expected weight-for-length. According to her mother she hardly ate at all. However, she did drink a lot, especially milk-derivates. I explained that such drinks have a lot of calories. Kids who drink rich drinks sometimes stop eating. If she wanted to get her child to eat better, she would have to give her water, or other drinks without sugars and protein. But as long as her kid was growing well, I wasn't to concerned.

The second child was sent to me because the GP wondered if the kid might suffer from "metabolic syndrome". She was very, very heavy. I don't think I ever saw a heavier child of that age (5 years old). According to her mum she ate almost nothing. She grew fat on the air she was breathing. This happens all the time. Most mothers of obese children tell me seriously that their kids never eat sweets, or snacks, or chocolates, actually they never eat, period. Apparently childhood obesity has something to do with parents who fail to see what is really going on. Often these kids drink to much rich drinks, another similarity with the skinny kids.

I always send such kids on a program to loose weight. Unfortunately I have yet to find a study that shows that such programs have a better outcome. On the long term that is. Lots of studies show short term weight-loss, but when you look at the same kids after 10 or 15 years, they are still obese.

Apparently childhood obesity is a more serious condition than leukemia. Nowadays almost all kids with leukemia are cured after 2 years of intense (evidence-based) chemotherapy. However, there is no evidence based therapy for childhood obesity. There is nothing more the doctor can do for you.

Pediatricians in the Netherlands are seeing a dramatic increase in cases of alcohol-intoxication in teenagers. Past night I had to admit a 14 year old girl to the hospital who had drank half a bottle of Vodka (375 cc). She was quite fuddled and incoherent, but when I told her that I was going to take her to the children's ward she became angry and told me loudly and with a thick tongue that she was almost 15 and definitely NOT a child.

Well, I must admit she didn't look like a child, and I can imagine that the shopkeeper who sold her the Vodka might have thought she was adult. I took my time to talk with the parents, and the father confessed that he had allowed her to drink a cocktail on her 14th birthday.

Experts say that is where it often goes wrong. Children learn to drink alcoholic beverages at home, and then when there is no adult supervision, they drink to much.
The teenager brain is very vulnerable and gets damaged easily by alcohol intoxication. Since the brain continues to grow and develop until the early twenties, progenitor nerve-cells are at risk, which might explain why teenage alcohol abuse leads to serious problems in adult-hood as shown in recent studies.

Dutch hospitals have setup a network of outpatient clinics where teenage alcohol abuse is tackled. However I fear there is one similarity between alcohol abuse in teenagers and severe obesity, both are very serious problems, but health care professionals stand more or less powerless.

A few days a go my 2 year old son had a night terror. Around midnight we heard him crying loudly. Heidi and I were not sleeping yet, so we both run to his room to see what was wrong. We found Maarten was not awake, but crying loudly as if he was very scared and hurting.

Even though I knew that trying to sooth him was useless it was very hard not to do so. Heidi took him to our bed, trying to sooth him. It took several minutes before Maarten woke up, crying uncontrollably, all the time. Once awake he immediately stopped crying, pushed away my wife and run back to his own bed, and within minutes he was sleeping comfortably again. It was a very ungrateful experience for Heidi.

Night terrors are probably quite similar to the sleep walking you may see in elder children. In both cases one should not wake the child but just make sure that it doesn't hurt itself. Soothing, even calling their name may prolong the night terror, so following your instinct achieves the opposite of what you are trying to accomplish.