Category Archives: Uncategorized

Keeping Things Linear

Random morbid fact: Drowning is the #1 cause of accidental deaths in toddlers. Truth is, I’m not doing my job as a pediatrician if I don’t communicate this to parents at well visits. But it’s not a mic drop as I leave the room. We talk about what that means and how to go about life with a toddler that IS going to be around water from time to time.

Here is the advice I give. When you bring your toddler to an event (lake, pool, birthday party with a pond in the back yard), just ask yourself the question: what will keep my child from wandering into that water without me knowing it. Then we talk strategy. Maybe it’s a locked gate, lifeguard, or a rotating ‘water-watcher’ responsible adult. But if you asked yourself that question, congratulations, you are a water-safety conscientious parent. Enjoy your water-vicinity event!

There’s a parallel here to the advice I’m giving to families about what it means to social distance during the COVID19 pandemic.

Quick disclaimer: I’m not a public health expert. But I did marry one, which is good on me.

Here’s what she, and others public health gurus (here is a great podcast from a friend of mine, Dr. Jim Hamblin MD MPH, now writer for the Atlantic) are saying:

Social distancing is NOT social isolation.

Social distancing is making a conscientious effort to limit the spread of illness.  

As Dr. Hamblin states in his podcast:

“A bad thing is happening and we are going to have losses, people are going to die, and the choices before us are to minimize that damage and help each other out the best we can. We need to balance keeping people healthy and keeping society, our economy, going. We need to be realistic about that. We can’t all just stay inside forever (that would be the safest strategy), and we also can’t be living the way were before.”

To me, this effort is individual and very cumulative.

Here is a graph published by the Journal of American Medical Association (JAMA).

It forecast the virus in the current COVID warzone of Lombardi, Italy. .

Here we see two lines depicting two potential patterns of COVID spread, in terms of the real danger, ICU admissions. Notice they are both increasing. That’s not up for debate.

The take home? We need to keep this thing linear. Viruses want to spread exponentially. They are good at that, and I see this in my clinic every year at the beginning of school. For these two-weeks I’ll see tons of kids with viral illnesses. What happened? A virus went from one snotty kid in school, to another, and they infected two more, and they cumulatively infected 10 more. You get how this spreads right?

That snotty kid is out there folks, and he’s gonna get some of us. But we can keep the spread linear if we make some changes.

Luckily, the government and organizations are taking a lot of our social-activity choices out of our hands. Schools, concerts, sporting events, large public gatherings are cancelled. President Trump took the wise step to declare a state of emergency to free up dollars and loosen restrictions to aid public health efforts (The tacit benefit is a leader showing his country to take this seriously).

So, now we are left with choices to make on an individual level. What are the rules?

Rule #1: forget thinking about rules. My advice is to make conscientious efforts, similar to my pool safety spiel. If you do that, I really think we are doing our part to keep this thing linear.

One example is my daughter’s birthday party. We have been planning a big Minnie Mouse party for Margaret. Should we cancel?

We did not. We made a conscientious effort to change our plan to limit spread and exposure. We invited her two best friends (cousins!) and told the other kids to take a hike. With a little hand sanitizing from time to time we had a great time. Margaret sure did.

We can do this! Yes, we will have some choices and sacrifices to make, and honestly, we all know that not everyone is doing this well (check out the Vegas strip). You can’t control that, so don’t worry about it. But little things matter, and your individual efforts will have an exponential impact.

Dayton and El Paso. A Tale of Two Cities

Being a pediatrician is pretty great. For much of the day, I’m playing and interacting with healthy children, monitoring their development, showing off magic tricks, hi-fiving for good report cards, hi-fiving parents for potty training successes.

But I have bad days too.

I’ve cared for children that died from Cancer.

I’ve cared for children that died from SIDS.

Just last month I lost one of my patients in a car accident.

These deaths are tragic and completely heart breaking.

And for everyone of these deaths we search exhaustingly, asking what could we have done differently to prevent this. Asking, what more can we do.

So we act. And we pour every amount of science, medicine, and technology into saving children from cancer.

We passed LAWS to keep infants and toddlers safe and secured in a highly regulated carseat, and young children buckled up.

We regulate the safety of cribs, mattresses, sleepers and post billboards stating unequivocally this is the safest way to sleep and prevent SIDS. Just last month, they took the rock-n-play sleeper off shelves because they said this piece of elevated bedding is too dangerous.

In each of these tragedies our society devotes every effort, including laws, science, and research towards preventing these deaths. Those deaths from the rock-n-play sleeper, although very rare, were unacceptable. Just one extra death from that device was one too many. One too many to ignore even the smallest possibility of a life saved.

But when children die from bullets, whether accidental deaths, homicide, or suicide, are our actions the same?

Do we act with the same ferocious resolve that one death is too many, that one life saved is worth any effort?

The answer is no.

91% of the children killed by a bullet in the world, are in the united states.

That’s 7 kids dying each day from a bullet, 1300 children a year.

And make no mistake, this is an Indiana problem. Hoosier children are in danger. Indiana has the 7th highest per capita rate of shootings involving children in the US.  

Our older children are especially in danger. According to Indiana Youth Institute’s 2015 Kids Count in Indiana Data, 1 out of 5 Hoosier students contemplated suicide in the past 12 months, and about 1 out of 10 teens attempted it. In fact, Indiana has the highest rate of teens who consider suicide and the second highest rate of teens that attempt suicide. Folks this is why we have red flag laws, and our Senators from Indiana know this!

Listen With > 300,000,000 firearms estimated to be in circulation in the united states, efforts to eliminate guns seem misguided. Rather, we as a health care practitioners believe we can shift the paradigm from efforts to live in a world without guns to ensuring we can live safely in a world with guns.

And we can. Imagine a deadly virus was spreading, killing and more and more children every year. We would declare a state of emergency, band together and focus every effort, every dollar, working continuously to stop its spread.  

Folks Gun violence is a disease, and Our Senators must realize that until we start treating it like a disease and focus every ounce on prevention, from background checks to red flag laws, we will never approach a cure.

El Paso and Dayton. A Tale of Two Cities. Killers with different motivations, from different political spectrums. But of course there are similarities, that is the legal access to a weapon that no one would use to protect their family or hunt. A weapon that is only used by evil people for evil purposes. And of course, the same wasted loss of life.

2018 Resolution: Quit using children as pawns

 

Last week, President Trump made a dubious threat to approximately 800,000 children and young adults currently living lawfully in our country: if my campaign promise to build a Mexico border wall does not move forward, these children and young adults will lose their legal status and potentially face deportation.

So who are these kids?

Under the Deferred Action for Children Arrivals program (DACA), these children, some now young adults (often coined ‘Dreamers’), are undocumented immigrants brought to the United States before age of 16, and have lived in the United States for at least 5 years with no significant criminal history. The program allows them to work in the country under two-year renewable permits, enabling employment opportunities and access to higher education that leads to a snowball effect of positive results in their lives and our community.

As young adults, they have served our country in uniform, graduated from our colleges and universities, and are now investing in our community. In our third congressional district represented by Rep. Jim Banks, there are an estimated 1,000 DACA recipients, and another 1,100 DACA eligible. According to the USC Center for the Study of Immigrant Integration, deporting these DACA protected workers would result in a $53,000,000 loss in GDP..

But aside from this, let’s take a step back to consider that on arrival to our country, before being labeled as undocumented immigrants, they were simply children, and this country is the only meaningful home they have ever known. They were children brought here by their parents, and living out a situation they had no control over. I see these kids often in my Fort Wayne clinic, confiding with me in tears the fear of deportation to a country they have no real connection to

Unfortunately, these fears are real and unless congress acts by March 5, 2018, Dreamers’ legal status will expire, and the negative individual and societal impacts realized. Advocating for DACA protections makes sense and is the right thing to do, but as we learned last week, will first depend on a quid pro-quo from the president’s campaign promise to build a wall between the United States and Mexico.

While both may fit under the umbrella of immigration reform, marrying these issues together is immature. In reality, this is a strategy we’ve seen before: holding a popular idea hostage to achieve more controversial campaign promises. As you should recall, congress has refused to re-authorize the popular and important Children’s Health Insurance Plan (CHIP), an insurance plan for 9 million low-income children, until the GOP tax plan is signed into law.

We should be saddened and disappointed that in both cases, the pawns are children. We can do better. To our Representative Jim Banks and Senators Todd Young and Joe Donnelly, YOU can do better. In 2018, lets resolve to stop this unfortunate chess game with children and do the right thing first. Protecting our DACA recipients by legislating their protections into a law, with or without President Trump’s wall, is a step in the right direction.

Happy New Year!

-IndyPedsDoc

Senator Todd Young           DC: 202-224-5623      IN: 317-226-6700

Senator Joe Donnelly         DC: 202-224-4814       IN: 812-425-5813

Rep Jim Banks                       DC: 202-225-4436

My good-bye letter to the wonderful folks at Hendricks Regional Health

To all my wonderful friends at Hendricks Regional Hospital

            It has been the utmost honor to be your pediatrician, colleague, and friend these past five years. I was pretty nervous coming out of residency, gearing up to start my first real job. I had trained, like, since I was a fetus for this moment. It was hard to believe that I was ready to shove off on my own and practice medicine. Only, I wasn’t really ready. To be honest, I faked it a lot at first, and hoped that everyone wouldn’t realize how nervous I was, or how many times I sprinted downstairs to my office to look stuff up. But I soon realized that I didn’t have to do that quite so much, because everyone around me was constantly looking out for me, and for each other. A lot of people like to ask me, as a doctor, if I am afraid of making mistakes. I’m now comfortable knowing that I am going to make mistakes, because I’m human. But the only way I might hurt someone, is by ignoring the concerns from the team around me. And it really is an amazing team. I like to picture us on a typical day as a bunch of arrows pointing in different directions, which is fine because we all had lots of responsibilities. But then…. Sh#t hits the fan. And like magic, those arrows became compass points and everyone suddenly points in the same direction, towards the same end of helping a sick mom, baby, or child. We worked together really well, especially when hierarchical titles were put on hold, and respect for each other’s talents and capabilities became the priority. Your effort and devotion you put into your work is something I will always admire, and never forget. In fact, I could never quite figure out why there was a ‘doctors’ day. I sometimes feel like we are the most spoiled profession in the world compared to the hardworking hospital staff I observed everyday.

(above: first day on the job 7/16/2012. Note all the hair. This was before kids)

           I get quite a lot of satisfaction from my patient encounters. It’s what motivates me and makes me feel whole at the end of the day. But the most enjoyment by far was being welcomed by such cheerful faces (seriously!) each and every morning. You all let me into your lives, recounting accomplishments by your family, fun stories, and even sometimes your struggles. And it was reciprocated. I’ll never forget having a tough day, walking with my head down, when I passed one of the janitors in the hall. I didn’t even see her, but as I was walking by, she said sweetly, “cheer up!” It totally shook me out of my funk, and gave me a wonderful feeling of connectedness.  These personal connections were so valuable to me, and I felt it all the time. I’ll surely miss this job, but it’s you all that I will really miss the most. 

Thank you all for everything,

Sincerely,

Tony GiaQuinta

 

 

 

 

 

 

 

 

Welcome to IndyPedsDoc!

My name is Tony GiaQuinta, and I love my job.

Tony 2

In 2009 I graduated form IU school of Medicine with a medical degree, and spent the next three years in Nashville at the Vanderbilt Children’s Hospital practicing to become a pediatrician.

I’ve always loved pediatrics. Kids motivate me. They give me energy. I can be having a really lousy day… the barometer is dropping, I have a headache, or a thirty hour pediatric shift ahead of me (of course, not allowed these days), and a be completely recharged by a smiling 6 month old eating his hand and talking non-sense. It’s truly a reciprocol relationship. I make them feel better, they help me feel better.

Don’t get me wrong, I like adults too, and in fact, rely on them to do my job effectively. Specifically, my relationship with parents is a critical bond that helps me communicate, treat, and prevent pediatric illness. But treating kids is my passion, allowing me sleep soundly at night and wake up energized in the morning.

After studying since I was a fetus (or seems like), with 4 years of undergraduate training, 4 years of medical school training, 3 years of residency, 4 certifying examinations (including my Pediatric Boards, still pending the results), and a heap of student debt, I have finally started my venture as a licenced pediatrician, capable of making treatment decisions and dolling out pediatric advice on my own. Liberating! A little frightening… but I have confidence in my training and work ethic that I will be a really great doctor. Not a good one. A great one. Cocky? Mmmm… I don’t think so. Kids are too important to have a mediocre pediatrician. You want a great one, and I worked really hard to be just that. Don’t worry, I promise I am still humble and will always admit when I am in over my head or just plain don’t know. I’m thinking this is ok for a doctor to admit, and that even great doctors don’t know everything.

I accepted my first job with Hendricks Regional Hospital taking care of their sick Pediatric population, newborn nursery, and special care nursery. It’s a fantastic job… interesting, exciting, busy, but still lets me spend time with my families and patients for them to ask questions and get the answers they deserve.

But more importantly, my job does not have me working the 80 hours/week that I have grown accustomed to over the past three years during residency! I have time. With a baby on the way, I am sure, some of this precious resource will be diverted. But, over the last three months, I have really cherished these moments talking with other parents and educating them about the field I love.

I focused these efforts initially using my Twitter account @IndyPedsDoc, and garning a few followers (thanks to my sister and wife for getting my name out). Admittedly, most of the posts are ‘re-tweets’ or quotes from other sources, with me adding my own spin on the title.

But I have more to say! Hence, this blog. We’ll see how this evolves, but for now, I am intending to focus this time on advertising current pediatric trends, research, and knowledge and occasionally mixing in my own thoughts and opinion. I really hope that what I post has relevance specifically towards issues that are confusing, controversial, or unknown to my followers. I am also motivated by Dads (being a male myself), and hope for this to be a resource that they can feel comfortable looking towards…although I think I only have 1-2 male followers on my IndyPedsDoc twitter account. It’s a work in progress.

Most of all, I hope this to be helpful. A few friends (now parents) have already begun texting me pictures of their kids’ rashes etc asking for my advice, and always apologetic to be taking my time.

To this, I always reply, that it is an honor to be entrusted with taking care of your loved one, and as mentioned above, I love my job.

Tony GiaQuinta