Tuesday, March 14, 2017

Pediatric Neurology and Gluten-Free Diets.

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    1.     I am now working and studying in the pediatric section of neurology. The good news is that it has basically nothing to do with Alzheimer's, which totally freaks me out. The bad news is that it has everything to do with parents who are trying to milk the system for everything it is worth and to have their offspring diagnosed with all sort of conditions for financial gain or for educational advantages. Usually it's educational advantages the parents seek. 

          One parent brought her eight-year-old child for a neurological evaluation. The exam didn't yield any tremendously informative results. Based both on in-office observations and on questionnaires completed by parents, the classroom teacher, and the after-school daycare provider, it's conceivable that the child might possibly have the most slight of attention deficits, but not enough of one that the attending physician who supervises me would be comfortable prescribing even the smallest dosage of any of the medications typically used to treat attention disorders. Furthermore, my conclusion based on a single day of observing the pediatric neurologist in question is that he's not particularly reluctant to prescribe medication for ADD or ADHD. 

           The pediatric neurologist told the mother that there are doctors who would prescribe attention medication for her child but that he wasn't comfortable doing so because in her child's case, the common side effects would likely outweigh any benefits. The side effects about which he was most worried were weight loss and interaction with the child's allergy medication. which, according to the mother, absolutely needed to be taken. The child was already bordering underweight, and stimulant types of medication used to treat attention deficit disorders frequently result in decreased appetite and subsequent weight loss.

           The mother wasn't as disappointed as I thought she might be at the doctor's refusal to prescribe Ritalin or another of the stimulant medications commonly prescribed for attention deficit disorders. (Non-stimulant medications are on the market but are less effective and present more harmful side effects.) I'm not certain precisely what the mother's actual objectives were in bringing her child to a pediatric neurologist. It surprised me that she didn't argue that point more. 

           As the appointment was winding down and the mother and child were practically out the door of the exam room, the mother mentioned to the doctor that the entire family was sensitive to gluten and that she needed a physician's directive so that the school would be forced to provide gluten-free breakfasts and lunches for her child. The neurologist told the mother that any directive from him ordering a special diet would be questioned and rightly so, as neurology and adverse reactions to gluten were for practical purposes mutually exclusive.

           The mother took exception to this and insisted that any medical doctor could prescribe a gluten-free diet for a child and that the school had no recourse but to adhere to the directive. The pediatric neurologist then told her that it shouldn't be any big deal to ask the doctor who diagnosed the gluten sensitivity to prescribe any special diet that was medically necessary. The mother then said that she herself had diagnosed the gluten sensitivity, to which she referred as Celiac Disease.  She had already done the hard work, she said. She merely needed a doctor to agree with her so that appropriate meals would be provided for her child. 

           In my opinion, the insistence upon  gluten-free products is a silly fad. Celiac Disease obviously exists in some people, as does other forms of gluten sensitivity in a relatively few people,  but not in the sheer numbers of people who claim it. What a person does or does not eat or provide to his or her children to eat is the person's own business as long as the person does not place a burden upon others to humor him or her in regard to adherence to whatever self-imposed diet the person has chosen. Asking a doctor to make a diagnosis out of his or her specialty in order to ask the school to go to extra trouble in accommodating the a child's diet when no evidence that it is medically necessary is placing an undue burden on both the physician and the school, in my opinion. 

           The doctor apparently shares my opinion. The mother pled her case for a full five minutes to no avail. my attending physician finally had to move onto his next patient in the middle of the mother's argument as to why the neurologist needed to prescribe the gluten-free diet. "How rude!" the mother exclaimed as she gathered her belongings and left with her child. As the mother pled her case to the receptionist, which was an exercise in futility as the receptionist had no power to authorize a gluten-free diet or anything else, the kid reached into the mother's oversized bag and pulled out a Hostess Ho Ho box. The child  removed a cellophane twin pack of the Ho Hos, ripped the cellophane with her incisors, and shoved a Ho Ho into her mouth. 

           I was too quick for her, though. I reached for the Ho Ho, pulled it out of the kid's mouth before she could take a bite of it, and exclaimed, "You can't have that! It has tons of gluten in it!"  If looks from either parents or their offspring could kill, i would be six feet under.



      1. I liked it when you said "I was too quick for her, though." Of course you were right, but there are crazy people out there that can make trouble for you. That is a sign that this woman is crazy arguing with the doctor and carrying around a box of Ho Hos.

        There is a saying, "The customer is always right." It is about getting the customer to come back and give you more business. Legally, correct me if I am wrong, the parents have the right to do what you think is wrong with their kids as long as they have not had the kids taken from them. Maybe I am wrong but I am saying this because I care about you and do not want you to have to deal with any extra aggravation. You have enough to deal with already.

        You might have to deal with a situation where you are a doctor and someone needs help. There is no law that says that you can't just watch and do nothing while they die. But there may be laws against you helping them and something going wrong. The Seinfeld series ended with them being in jail for not helping a guy that was being mugged. Of course it is a comedy. I am not a doctor so I cannot give any medical advice. I am not a lawyer so I cannot give any legal advice.

        1. The mother told us her child was highly gluten-sensitive. If she said he had a peanut allergy I'd grab a Snickers out of his hand before the child ate it as well. Reported health concerns trump etiquette in the medical world. I'm not in any trouble.

        2. Good. I feel better knowing that you are not in any trouble. But could you help a poor boy out? I am confused. Why was the mother carrying around in her bag a "Hostess Ho Ho box?" Does she have another child that eats them?

          Also you said "If looks from either parents or their offspring could kill, i would be six feet under." Maybe I am out touch with the customs of California, living in Arizona. But are you saying that if the child were drowning and you jumped in and saved the child's life, they would all give you dirty looks and would wish you were dead?

          I do know about different customs. Here I would say that you have a really great heart since you are so nice and caring. In Asia, they would say that you have a really great liver to imply the above. Also China has over a billion people and they squat, not sit, when they go to the bathroom. Science says that if you sit while going to the bathroom, you are partially closing the tube that the waste comes out of. But all that constipation leads Americans to spend a billion dollars on products to clean them out.

      2. Do Ho Ho's now come in cellophane? Back in my day, they came in foil and in single cakes. Little Debbies came in twin packs of cellophane. I was a big fan of Hostess baked goods in those days. Ho Hos tasted better, but you couldn't peel the chocolate off like you can with Little Debbies.

      3. These were in cellophane, though I don't know for a fact that the mother isn't buying the cheaper Little Debbie's snacks and putting them in a Ho Hos box for her kid. I can see this kid holding out for the pricier stuff and going on a hunger strike.

        1. I bought a package of Ho Hos from a grocery store that carries Hostess products and not Little Debbie's. I don't know if the substance that's used in wrapping them would properly be called cellophane as it's not clear, but feels and sounds just like cellophane; it's what I saw. In any event, they're no longer wrapped in foil, at least on this coast; however, the package I bought has them wrapped individually rather than in twos. I don't know where she might have bought them packaged by two, or if she did indeed put little debbie's products in the box. I wouldn't put anything past the woman. She said her child is an extremely picky eater and only eats junk, but that he will starve if she doesn't let him have junk on demand. I understand that picky eaters will often go hungry if you tell them they must eat what's on the table or not eat at all, but if you give them carte blanche regarding bread, peanut butter, etc., they'll eat what is semi-nutritious and the least abhorrent to them even if they cannot have the likes of Twinkies and Ho Hos. k do wonder who she thinks she's fooling if she thinks medical personnel believe that she's providing him consistently with gluten-free junk food, though lots of candy may be gluten-free.

        2. Dammit. Now I want a Ho Ho.

        3. what i really want is a mallomar. i've never had one. i used to frequent a message board on which people spent a great deal of time arguing about whether pinwheels or Mallomars were better and whether or not they're the same thing. my dad says they're definitely not, and that Mallomars are decidedly better. They're apparently an east coast products, and I want one n the worst way. I need to check out whether or not they can be ordered online. Almost anything can be ordered online these days, and I want a mallomar in the worst way.