Health, Doctors and Common Sense

Young doctors have taken to iPhones – could iPad be next?

Apple’s new creation, the iPad, may be a novelty to many consumers, but hospitals are already starting to abandon paper-and-pen clipboards for hand-held digital tablets.

In Sacramento, Kaiser Permanente is in the midst of experimenting with one brand of computerized tablets – with the hope of freeing nurses and doctors from old-school tools and allowing them more time at a patient’s bedside.

“We want our nurses to have time to actually nurse and support the patient. We want to remove the barriers … to provide seamless technology integration,” said Ann O’Brien, a registered nurse and Kaiser’s national director of clinical informatics.

The trial being conducted in Sacramento is part of a broader program, dubbed “Destination Bedside.” Kaiser expects to choose an electronic tablet by the end of the year for use at its hospitals nationwide.

The idea is to improve care and safety by providing up-to-the minute medical information on the patient that can help prevent mistakes. X-rays, medical charts, prescriptions and notes would be readily available at a tap of a finger.

One tablet, the Motion C5, promoted by its manufacturer as a “mobile clinical assistant,” is about the size of a small bathroom scale. It has handles and is equipped with a pen-like stylus.

“I love it,” said Thomas Whiteford, a registered nurse at Kaiser’s Sacramento Medical Center, who took part in testing the device. “I can sit next to the patient and do my charting.”

The popularity of Apple’s iPhone among doctors could be a natural springboard for the iPad. But O’Brien, the health care giant’s informatics director, said the device isn’t even out yet to assess its potential.

Already, the iPhone has become a favorite tool among young doctors, who use many of the scores of health care-related apps, including encyclopedic information on pharmaceuticals.

Kaiser officials are considering whether the iPhone, now a ubiquitous accessory for hipsters and the tech-savvy, will become standard issue at its hospitals to more intimately bring technology to a patient’s bedside.

Jason Wilk, who authors the technology blog tinycomb.com” target=”_blank”>>tinycomb.com, reported last week that Apple officials had visited a Los Angeles hospital, ostensibly to market their products. He presumed it was the iPad.

“Considering what happened with the iPhone, it seems like it makes a lot of sense that they would be talking with hospitals,” Wilk said, noting the mobile device’s popularity among doctors. “You can do so much more with a larger screen, for medical charts. This is probably the future of computing.”

Perhaps it’s the future of medicine, said Dr. Javeed Siddiqui, associate medical director for the Center for Health and Technology at UC Davis Medical Center.

Nurses, doctors and pharmacists have already been using hand-held tablets, but wide-scale deployment would be expensive. The model that Kaiser is considering and that UC Davis is already using on a limited basis costs more than $2,000 per unit.

Many hospitals now use full-sized computers and monitors mounted on wheeled carts, but these don’t offer the same ease of use and mobility as hand-held tablets.

Laptops would seem an alternative, but aren’t as easy to use as they would seem, particularly in a clinical setting where doctors and nurses are always on the go. And they aren’t durable and can’t easily be swabbed down for disinfection.

The hope among hospital officials is that electronic tablets will further power the technological revolution already under way at hospitals. And it’s an obvious extension of the industrywide push toward paperless electronic medical records.

“Information at your fingertips is what medicine should be all about. It allows you to access information as you walk around or as you talk to the patient,” Siddiqui said.

“The paper chart is an antiquated way of providing health care,” Siddiqui said. “The paper chart is inefficient. It doesn’t allow for rapid dissemination of information and really is no longer, I believe, the standard of care in health care delivery.”

Siddiqui, if not caught up in all the buzz generated by Wednesday’s product announcement of the iPad, is excited about the technological strides the device could spur in the medical industry. “It’s portable and it’s lightweight. It has touch screen, a Web browser – and all those features can be utilized as a way to integrate technology in patient care,” he said.

Tags: Bathroom Scale, Clinical Informatics, Clipboards, Digital Tablets, Health Care Giant, Iphone, Iphones, Kaiser Permanente, Medical Charts, National Director, New Creation, O Brien, Paper And Pen, Registered Nurse, Sacramento Medical Center, School Tools, Technology Integration, Whiteford, X Rays, Young Doctors

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RN Julie Guardalabene checks in on Walter Whitenack on Thursday at Mercy San Juan Medical Center’s new patient-care wing.

The gleaming new tower at Mercy San Juan Medical Center bustles with patients, nurses and doctors. Mercy plans to use its private rooms and airy lobbies as selling points in the competition for patients.

Opened a month ago, Mercy’s tower was cited in a recent report ranking Sacramento as the nation’s fastest growing market for health care jobs. The six-story project added 110 beds and nearly 200 new jobs to the hospital.

Despite some delays in construction projects, and even some layoffs, the health care industry has been a solid anchor for the region in a sea of job losses and sinking fortunes. Indeed, recession-battered workers have sought safe harbor by pursuing careers in high-demand health care specialties, such as radiology technology, physical therapy and nursing.

Already, the health care sector accounts for a fifth of the region’s payroll. About 120,000 people are employed by the industry, which pumped $33.5 billion into the regional economy in 2007, according to the Sacramento Metro Chamber of Commerce.

The region’s major health systems occupy four of the top six spots on the area’s list of biggest employers, with a combined work force of more than 30,000.

“It’s my view that outside of state government, the health care and bioscience industry is probably the most important industry sector to our region’s long-term economic stability,” said Matthew Mahood, chamber president and chief executive officer.

“The road to recovery is going to be a very slow process in this region. … But having an industry that can hold its own is progress,” Mahood said.

The industry’s high salaries buoy the rest of the economy. In 2007, according to the chamber, the average hospital worker earned nearly $68,000 a year, compared with the region’s average annual wage of $42,738.

Aging baby boomers, coupled with the region’s population growth, virtually guarantee that the demand for health services won’t diminish.

Proposed federal health care legislation could also increase the demand for medical care if more uninsured people wind up being covered.

“People will always have a need for a hospital,” said Brian Ivie, president of Mercy San Juan. One area that had seen declines – admissions for elective surgeries – is starting to recover, he said, adding, “People are starting to schedule those things that they were putting off.”

During the 12-month period ending in November 2009, the health and education category was the only sector to add jobs to the Sacramento-area economy, contributing 2,800 new positions – which outpaced the San Francisco Bay Area and accounted for about 14 percent of the state’s total in new health care jobs, according to the Sacramento-based Center for Strategic Economic Research.

“Throughout the recession, the health care sector has been providing jobs when every other sector has been losing jobs,” said center director Ryan Sharp.

With the Sacramento area’s population expected to add a million residents over the next two decades, job growth will be “tremendous,” according to Anette Smith-Dohring, work force development manager for Sutter Health’s Sacramento Sierra Region.

David Cherner, managing partner of Health Workforce Solutions, the San Francisco-based labor analysis firm that ranked Sacramento first for potential growth among 30 metropolitan areas, sees “a definite strengthening” in the region.

“The near-term demand for health care workers in Sacramento improved much more aggressively than in other markets in the country,” Cherner said. “We view this as very positive news for Sacramento moving forward into 2010.”

At Sutter Health, more than 300 jobs need to be filled right now in its capital region facilities. As the economy recovers, thousands more jobs will become available to job seekers, Smith-Dohring said.

Every two weeks, between 50 and 70 new employees are hired by the Sutter health care system. “Now is the time to work on a health care career,” Smith-Dohring said.

Indeed, many people are following her advice.

Los Rios Community College officials say demand exceeds the number of spaces available for nursing and more than a dozen other health care programs.

Combined, the American River and Sacramento City college campuses have 800 students enrolled in health care programs, according to community college officials.

Mark Williamson, 38, went through careers in media production and computer support before deciding five years ago to pursue a career as a radiologic technologist, a job that involves taking X-rays and doing other types of imaging.

The computer industry was already hurting, he said, when he took the leap.

“It sounded promising. It sounded like a secure job for the future,” said Williamson, who completed his program at Yuba Community College’s radiology program in Sacramento a little more than a year ago.

The starting salary for a radiology technologist is $65,000. After five years of experience and training in more advanced technologies, such as magnetic resonance imaging, salaries can quickly escalate to $100,000 and beyond.

The high demand makes the job nearly recession-proof.

“It was good timing for me, for sure,” Williamson said.

His boss, Tony Campos, the operations supervisor for diagnostic imaging at Sutter Medical Center Sacramento, has a staff of nearly 60 and expects to hire an additional 20 over the next two years as Sutter Health completes a major expansion at its medical complex on 28th and L streets in midtown Sacramento.

“Our department is going to need a whole lot of techs to work the rooms we’re putting in,” he said.

Certainly, hospitals haven’t been immune to the faltering economy. With increasing worry over personal finances, fewer people scheduled elective surgery. That meant empty hospital beds and lower revenues. As a result, major projects were delayed, including plans by Sutter Health to build an ambulatory care facility and hospital in Elk Grove.

Because of uncertainty over pensions and other investments, older nurses delayed retirement – resulting in fewer job openings and increased frustration for nursing school graduates.

The tighter job market prompted Julie Guardalabene, 25, a registered nurse, to think hard before deciding to return to California with her fiancé after a few years in Portland, Ore.

To Guardalabene’s surprise, she quickly found a job – at Mercy San Juan’s new tower. But her fiancé, R.J. Cervantes, had to temporarily settle for a job at an area casino while he looks for a post in government or as a political staffer. “It’s been rougher for him,” Guardalabene said.

Robust population growth and healthy competition among the area’s four largest health systems – Kaiser Permanente, Sutter Health, UC Davis Health Systems and Catholic Healthcare West’s Mercy hospitals – have produced a surge of construction projects.

At UC Davis Medical Center, a $450 million surgery and emergency services pavilion, which was to have been completed last year, is expected to be finished in late summer – about nine months behind schedule. More than 300 construction workers are swarming the 143-acre campus.

Last year, Kaiser Permanente opened its Women’s and Children’s Center in Roseville, and it is continuing work to expand its south Sacramento hospital.

Officials at Kaiser, which laid off more than 1,000 employees statewide last year because of falling enrollments, declined to be interviewed.

While few new jobs will be created by Sutter’s expansion of its midtown medical center, a wave of retirements will open up hundreds of positions – amounting to as much as 30 percent of its Sacramento work force when the project is completed by 2012.

Filling those jobs will “be very challenging for us, but we are planning for it,” Smith-Dohring said.

Looking down the road, Sutter sees a need for a new hospital in Elk Grove, but planning has been pushed back, said Nancy Turner, a spokeswoman for the health system.

Sutter also would like to break ground soon on an ambulatory care center in Elk Grove, but there, too, the economy has delayed plans.

“We are still very much committed to this project; unfortunately, we are not able to keep to the original timeline because of the downturn in the economy,” Turner said. “We will continue to move forward so that when the market turns we can be absolutely ready to move forward with construction.”

Mark Williamson, a radiologic technologist at Sutter General Hospital, prepares to X-ray Terrance Randle’s sore ankle. Williamson, 38, changed careers five years ago and says he made the right choice.

Mercy San Juan Medical Center opened a new patient tower in December, adding 110 beds and nearly
200 new jobs, while a recent report ranks Sacramento as the fastest-growing market for health care jobs.

Tags: Aging Baby Boomers, Bustles, Capital Health, Careers In High Demand, Chamber President, Chief Executive Officer, Economic Stability, Health Care Industry, Health Care Sector, Health Care Specialties, Mahood, Mercy San Juan, Mercy San Juan Medical Center, New Jobs, New Tower, Population Growth, Regional Economy, Sacramento Metro Chamber, Sacramento Metro Chamber Of Commerce, Sector Accounts

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Dr. Anthony Retodo has been appointed director of medical services at Kaiser Permanente’s Folsom medical offices.

The Shingle Springs resident has a biochemistry degree from the University of California, Davis. He graduated from the Medical College of Wisconsin and trained in internal medicine at Santa Clara Valley Medical Center in San Jose.

He has been an adult medicine leader at the Folsom site for four years and has been with Kaiser Permanente for six years.

Tags: Adult Medicine, Biochemistry Degree, Clara Valley Medical Center, Dr Anthony, Internal Medicine, Kaiser Medical, Kaiser Permanente, Medical College Of Wisconsin, Medical Offices, Medical Services, Medicine, Medicine Leader, Santa Clara Valley, Santa Clara Valley Medical, Santa Clara Valley Medical Center, Shingle Springs, Six Years, University Of California, University Of California Davis, Valley Medical Center

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Jabril Debrow, who suffers from a rare cancer, gets an autograph from Sacramento King Kevin Martin before Tuesday’s game. One of Jabril’s wishes was to meet Kings players.

Jabril Debrow’s type of kidney cancer is so rare that only 140 cases have been documented, ever.

The fourth-grader from Fairfield was diagnosed in October with renal medullary carcinoma, a malady doctors discovered just 20 years ago. Its cause is a mystery, though researchers have found a linkage to sickle cell traits. Patients usually live five months after diagnosis.

More than four months in, Jabril’s body is struggling – but his mind and spirit are soaring.

In his condition, it is common for charities like the Make-A-Wish Foundation to step in and make something good happen. In November the foundation asked Jabril for his one wish.

For several days he wrestled with the question: A PlayStation 3? A laptop? A flat-screen TV?

In the end, he said, there was one wish his thoughts kept returning to: a meeting with President Barack Obama.

“He’s just awesome,” he said. “Awesome” is Jabril’s highest praise. His usually soft voice turns deep and robotic when he says the word. He’s been obsessed with the president for the past year, because Obama “wants to make the world a better place.”

Make-A-Wish made it happen; Jabril met with Obama in December, then wrote a book about it.

This week he got a bonus wish fulfilled: He attended his first Kings game, sitting courtside and meeting his favorite players.

Jabril is so thin he disappears under his trendy red hoodie and black puffy jacket. Despite his stature he acts like an adult: There’s no fidgeting typical of preteen boys. He’s fond of minimalist, grand statements.

When his mother cries over his cancer, 10-year-old Jabril comforts her. When the nurse takes five blood samples, he looks her in the eye, unfazed.

That mature veneer melted away, however, when Jabril entered the White House.

He said Obama poked his head out of the Oval Office and said, “Hey Jabril, how are you doing?”

“His mouth was hanging open,” said his mother, Jennifer Debrow. “And then Jabril asked him, ‘How do you bowl in the White House?’ “

Obama laughed, Jabril said, and invited him to bowl a few frames if he wanted to. The president then advised Jabril to do well in school, and gave him a yo-yo and some M&Ms.

When they came back, Jabril wrote a book, “Wishes Do Come True,” about his experience with cancer and his trip to the White House.

“I want other kids who get sick to not be scared,” he said.

Jabril’s grave prognosis is due to the cancer’s aggressiveness and rarity. Because so few cases have been diagnosed, it took doctors five months to figure out what he had.

Last May, his mother noticed Jabril was losing weight and there was blood in his urine. In June, his blood pressure started rising. His mother wasn’t worried because he had never been really sick before.

“Blood in the urine is a symptom for a lot of things,” said his doctor Inessa Gofman, a UC Davis fellow in pediatric hematology oncology.

It wasn’t until Jabril had an episode of excruciating abdominal pain that doctors ran a CT scan, revealing the tumor in his kidney. The cancer had already spread to his liver and lungs.

Such a rare cancer is difficult to treat, Gofman said, because there’s no standard of care. The only literature that exists on renal medullary carcinoma treatment are individual case studies.

One of the only things known about renal medullary carcinoma is the majority of patients – Jabril included – also have sickle cell trait. Sickle cell trait means a person carries one of two genes necessary for sickle cell disease, a condition where red blood cells form an abnormal, curved shape.

Gofman said it does not mean sickle cell trait – which afflicts mostly African Americans – in any way causes renal medullary carcinoma.

There are over 300 million people with sickle cell trait, she said.

“It’s really a mystery,” she said.

At Tuesday’s Kings game, Jabril and his family sat courtside, watching the players warm up. One by one, they took a break from shooting hoops to kneel down and introduce themselves to the 4-foot-5 Jabril. Tyreke Evans was teary-eyed after meeting him.

“Mom, I had such a good time I forgot I had cancer,” Jabril said.

Jabril Debrow bowls at the White House bowling alley last month after meeting with President Barack Obama, who also gave him a yo-yo and M&Ms. Jabril wrote a book, “Wishes Do Come True,” about his experience with cancer and his trip to the White House.

Tags: Barack Obama, Blood Samples, Courtside, Flat Screen Tv, Game One, Grand Statements, Highest Praise, Kevin Martin, Kidney Cancer, Kings Game, Malady, Mind And Spirit, Mother Cries, Playstation 3, Preteen Boys, Rare Cancer, Renal Medullary Carcinoma, S Type, Soft Voice, Wish Foundation

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The chief executive officer of the Sutter Health network assumed his post this month as chairman of the California Hospital Association board of trustees, the trade group announced Tuesday.

As chairman, Patrick Fry will help direct an association representing more than 400 hospitals and health systems.

The association handles policy and advocacy concerns on the state and national levels for California’s hospitals.

Fry’s term is for the current year. He became secretary-treasurer of the board in 2008 and was elected chairman a year later, but his term did not start until this month, said association spokeswoman Jan Emerson. Fry joined Sutter Health in 1982 and rose to CEO in 2005.

Tags: Advocacy, Board Of Trustees, California Hospital Association, Ceo, Chief Executive Officer, Emerson, Health Network, Health Systems, Hospitals, Patrick Fry, Rose, Secretary Treasurer, Spokeswoman, Sutter Health, Sutter Hospital, Trade Group

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Patient Joel Thomas, left, of Lincoln discusses his shoulder injury with Dr. Stephen Weber, an orthopedic surgeon. Weber conducted a study using platelet-rich plasma in a group of patients recovering from torn rotator cuffs; he concluded that the treatment didn’t make a difference.

With Tiger Woods and Pittsburgh Steeler Hines Ward providing star-powered proof, demand boomed in recent years for injections of “concentrated” blood rich in platelets to relieve hard-to-heal joint and tendon injuries.

But Dr. Stephen Weber, a Sacramento orthopedic surgeon, was not convinced that the new therapies involving so-called platelet-rich plasma would speed recovery. So he conducted a study.

When he compared the outcomes among patients who used the blood product to help mend torn rotator cuffs and those who didn’t, Weber concluded that it didn’t make a difference and wasn’t worth the extra hundreds of dollars in expense.

“My advice to patients: Be skeptical,” he said.

The country as a whole could use a dose of such skepticism when it comes to expensive new therapies, critics say.

More than $700 billion is spent annually on unproven medicine and procedures, a significant factor in the escalating cost of health care. Patients and doctors rush to adopt the latest and newest medical treatments – often without regard to whether they actually make sense from a cost-benefit standpoint.

Some members of Congress are taking aim at the problem by proposing research centers that could promote less expensive approaches in health care.

Such research centers could serve as libraries of best practices and proven medicine, gathering data that would better inform health care decisions made by physicians and their patients.

The health insurance industry, which blames escalating premiums on the high cost of dispensing medical care, supports the effort – in theory.

“Health plans certainly want this kind of information. Which treatment works best is really crucial information,” said Robert Zirkelbach, spokesman for the group America’s Health Insurance Plans.

In the absence of such scrutiny, he added, “Patients aren’t always getting the best medical treatment.”

Because the proposal for comparative research centers is included in the massive health care bills now before Congress, its fate is uncertain.

If passed, it would build on the $1.1 billion allocated to so-called comparative effectiveness research approved in last year’s economic stimulus package, which will fund programs at existing federal agencies and create a council to provide guidance.

Critics say establishing Comparative Effectiveness Research Centers, as they would be called, could lead to treatment being dictated by nonmedical oversight panels.

They’ve also raised the specter of rationing. Former vice presidential candidate Sarah Palin deepened the controversy last summer by referring to “death panels” that could make life-and-death decisions.

Pharmaceutical companies and medical device companies have been wary of comparative effectiveness panels that, they say, could be automatically dismissive of products deemed too expensive.

Advocates dismiss those concerns, saying the intent is much more benign: Reduce pain and suffering – and wasted expense – by educating doctors and consumers about medical care that is safe and effective.

In some cases, the research centers would weigh in, analyzing data or launching studies of their own.

Supporters say the proposals would in no way undermine the doctor-patient relationship. The House health bill states that it would not “authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”

The idea, rather, is to provide information that health plans, hospitals and doctors could use to decide which treatments make sense. Health care costs have been steadily escalating and are now estimated at $2.3 trillion annually nationwide.

About a third of this money now goes to pay for health care products and services whose value is unproved, according to estimates by the Congressional Budget Office.

More expensive doesn’t always translate to more effective, according to researchers at the Dartmouth Atlas Project, which for the past two decades has been monitoring what it says are “glaring variations in how medical resources are distributed and used in the United States.”

Regions that spend lots of money on health care don’t necessarily get better results than other areas with lower expenditures, according to the researchers.

While some experts blame the high cost of medicine on expensive new technology, that’s only part of the problem. In general, there are few incentives for doctors and patients to keep costs down – particularly when health insurers are picking up most of the tab.

The U.S. Food and Drug Administration approves pharmaceuticals and medical devices for use, but it does little to inform the public about how truly effective a drug or device is – compared with other drugs or other treatments, said Maribeth Shannon, director of the market and policy monitor program for the California HealthCare Foundation.

“It’s a common American phenomenon to jump on the new thing,” she said. “But it may or may not be better than existing therapies.”

That may be the case when it came to treating joint injuries, said Weber, the orthopedic surgeon.

Weber launched his study last year after noticing the increasing use of platelet-rich plasma therapies in repairing joints and torn tendons.

Some doctors believe that platelet-rich blood, when injected or surgically implanted into wounds, helps the body more quickly repair bone and tissue, particularly in hard-to-treat tendon injuries, such as tennis elbow.

Weber’s small study compared two groups that had undergone rotator cuff surgery, 30 patients in each, who volunteered for the research. They showed no noticeable difference in healing and effectiveness whether or not they were treated with platelet-rich plasma material.

Another study on the use of platelet-rich blood in Achilles’ tendon injuries, published in the Jan. 13 issue of the Journal of the American Medical Association, appears to corroborate Weber’s conclusion that the blood therapy may have little value.

But Dr. Alan Hirahara, another Sacramento orthopedic surgeon, stands by the therapy. He offered a study he conducted himself last year showing improvements in recovery for his patients, 139 of whom received surgery with the platelet-rich blood and 39 who did not.

“There was a big difference in my patient outcomes. We’re saving money; we’re saving the system money,” said Hirahara, who opposes comparative effectiveness panels.

“You should always justify why you’re doing things. If it’s not working, you shouldn’t do it because it’s wasting money,” Hirahara said.

Weber doesn’t quibble with that.

“We want to be the guys in the white hats – the good guys. If physicians aren’t responsible, then the government is going to step in,” said Weber.

He said he supports comparative effectiveness research but is wary of the proposed panels because they could take away decision-making authority from patients and their doctors.

“I prefer to do things that are supported by medical literature,” he said. “You want to be in front of the pack, but at the same time you have to be careful.”

The skeptic, he said, would seek out a second opinion.

In Dr. Stephen Weber’s office, a magnetic resonance image shows a patient’s shoulder. Knowing whether the newest therapy is the best one is a health care challenge.

Tags: Blood Product, Care Patients, Dr Stephen, Health Care Decisions, Health Insurance Industry, Hines Ward, Joel Thomas, Medical Debate, Medical Treatments, Members Of Congress, Orthopedic Surgeon, Pittsburgh Steeler, Proposing Research, Rotator Cuffs, Shoulder Injury, Stephen Weber, Taking Aim, Tendon Injuries, Tiger Woods, Unproven Medicine

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After just two months in the job, the California Medical Association’s new chief executive officer, Alfred Gilchrist, has called it quits.

The physicians group said Gilchrist, who assumed the post in November, will return to Colorado to resume his position as the CEO of the Colorado Medical Society, the CMA announced Thursday.

Gilchrist submitted his resignation Tuesday, according to a statement from the Sacramento-based CMA, and his last day is today.

“The bottom line is my heart remains in Colorado, and so that’s where I need to be,” Gilchrist was quoted in the CMA announcement.

Dustin Corcoran, the CMA’s deputy CEO and former vice president of government relations, will serve as acting CEO, the association said.

Tags: Acting, Bottom Line, California Medical Association, Chief Executive Officer, Cma, Colorado Medical Society, Corcoran, Deputy Ceo, Former Vice President, Gilchrist, Government Relations, Heart, Job, Medical Group, Physicians Group, Resignation, State Medical

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Dr. Richard Pan, a UC Davis medical school professor, has received a statewide humanitarian award from the Medical Board of California.

The board awarded Pan the 2010 Physician Humanitarian Award for his efforts to improve health care access, especially for children.

The board is the state regulatory agency responsible for licensing and regulating doctors.

Pan is an associate clinical professor of pediatrics. He’s also in the race for the state Assembly’s District 5 seat, which covers parts of Sacramento and Placer Counties.

At UC Davis, Pan established a residency training program called Communities and Physicians Together, which places physicians in disadvantaged communities, so they can work with advocacy groups to promote healthy lifestyles.

Tags: Advocacy Groups, Associate Clinical Professor, Davis Pan, Disadvantaged Communities, Doctors, Dr Richard, Health Care Access, Healthy Lifestyles, Humanitarian Award, Medical Board Of California, Pediatrics, Physicians, Placer Counties, Regulatory Agency, Residency Training, School Professor, State Assembly, Uc Davis Medical, Uc Davis Medical School

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Elijah King, 2, above, plays with his mom, Carrie King, on Friday as ther- apist Vanessa Avila-Pons, center, offers guidance at the UC Davis MIND Institute. As team leader of an early intervention study of autism, Avila-Pons demonstrates communicative techniques to use in playtime. Research assistant Katerina Monlux watches the session.

Most parents never think they’ll have to learn how to play with their own children.

But if a toddler is diagnosed with autism, moms and dads can spend years with the child and a therapist, drawing with crayons and playing hide and seek. Research is proving that as parents color and stack building blocks with their kids, they are subtly teaching them to overcome cognitive, language and social delays.

“When we first came in, he wasn’t talking, he didn’t respond to his name, he wasn’t making eye contact,” said Cindy Jensen of her son Cooper, who’s now almost 3.

After more than a year of specialized play therapy through the UC Davis MIND Institute in Sacramento, Cooper is speaking in seven-word sentences, learning to take turns and initiating pretend play. “It’s a lot of training, but it’s worth it,” Jensen said.

Treatments for autism are geared to children between 3 and 5 years old. Researchers said there is growing urgency – even a sense of obligation – to develop effective intervention for much younger children.

New diagnostic tools can identify autism in kids as young as 12 months, and prevalence of the disorder is reaching record numbers. The federal Centers for Disease Control and Prevention reports one in every 110 children has an autism spectrum disorder.

Researchers at the MIND Institute are conducting a study adapting a specialized program, the Early Start Denver Model, for children to begin as young as 1 year old. The model focuses on building relationships with children and teaching skills through play: 20 hours every week with a therapist, and at least five hours a week with parents.

“What the child learns is that it’s more fun to do things with others, rather than alone,” said Sally Rogers, professor of psychiatry and behavioral sciences at the MIND Institute. “Kids with autism enjoy playing with others, they enjoy being tickled. They just don’t know how to initiate.”

Rogers co-authored a previous study, recently published in the journal Pediatrics, which found that autistic children who received this therapy showed significant improvement in IQ, language, motor skills and adaptive behavior compared to a control group of autistic children who did not receive the same therapy.

Some kids improved so much that they no longer met the diagnostic criteria for autism, classified instead as having a less-severe developmental disorder.

“We’re trying to identify these kiddos early so they can learn in a typical way,” Rogers said.

The coaching channels an autistic child’s learning pattern toward eye contact and verbal communication, before autistic developmental characteristics become entrenched.

“This is unique in that parents learn the model,” said Vanessa Avila-Pons, a therapist and team leader for the early intervention study at the MIND Institute. Avila-Pons demonstrates play techniques and offers guidance while parents play with their children.

During a recent session, Carrie King played with her 2-year old son Elijah. King held a plastic toy gun for a game of helicopter.

“Go!” Elijah said. King pushed a button, sending a small plastic disc spinning through the air and onto the table. Elijah was delighted. After a few more times, she handed him the toy. He fiddled with it but couldn’t get the same result. He looked up; King reached out her hands, palms up.

“That’s good she responded,” Rogers said, watching from the other side of a two-way mirror. “For these little ones, eye contact is hard. A lot of parents wait for a word.”

Kids don’t know that eye contact and gestures are communication tools, Rogers said. By giving Elijah the toy without showing him how to work it, King forced him to ask for help. By holding out her hands, she reinforced Elijah’s request for help through eye contact. King had introduced to him a new gesture that means “help” or “give me.”

“Push,” King said, “push!” The disc flew. King opened her eyes wide and let out a “Wow!”

Rogers nodded.

“She’s using simple one-word phrases, because that’s where he’s at,” she said. “The use of the word ‘wow,’ shows kids that words are not just for labels or requests. It’s an emotional word. ‘Wow’ is social. We want kids to know that words are used in a lot of different ways.”

Elijah and King will finish their initial 12-week coaching this week, then move to the 25 hours of weekly therapy over the next two years. King said she was relieved when she enrolled Elijah in the study, soon after he was diagnosed at 18 months.

“It’s so great to get a diagnosis, because your life can start,” she said.

Four years ago, when her older son Josiah was 2 years old and diagnosed with autism, her reaction was more emotional.

“I remember feeling, ‘I don’t know my child,’ ” she said, taking a deep breath.

“When you have a baby, and it has all its toes, and it’s apparent to everyone that it’s normal, you start to dream for the child,” she said, raising a tissue to the corner of her eye. “But when you get a diagnosis with autism, you have to let go of all those dreams. … You don’t know if the child will talk, get a job, have a friend. You have to let go of everything.”

Now, every time her sons learn a new skill, she said she’s filled with pride. “But you still cry.”

Josiah and Elijah are part of another autism study at the MIND Institute looking at siblings of children with autism, their risk factors for developing the disorder, and early symptoms among infants.

King said she supports this research so families with autistic children get better care than is available now.

“Nothing will change unless they have documented information over time,” she said. “This program is so important. Play is a powerful learning tool.”

King looked at Elijah, crayons in hand and beaming. “You see the child become a child.”

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Tags: Autism Spectrum Disorder, Building Relationships, Centers For Disease Control, Centers For Disease Control And Prevention, Cindy Jensen, Crayons, Denver Model, Diagnostic Tools, Disease Control And Prevention, Early Intervention, Eye Contact, Intervention Study, Katerina, Moms And Dads, Play Therapy, Playtime, Pons, Record Numbers, Uc Davis, Word Sentences

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“Lice Lady” Deanna Fox, left, and Latika Alqarwani, co-founder of Nitpik, display Nitpik’s head lice oil. Fox makes house calls in an unmarked van and offers lice-eradication treatments for $80 an hour.

Lice.

For parents with school-age children the word alone might hatch a wave of panic, or at least trigger an involuntary scratch of the head.

Head lice, insects that thrive on the scalp and feed off human blood, are a never-ending problem at schools.

The bugs are about an eighth of an inch long and aren’t difficult to comb out. But the nits – the eggs – look like tiny sesame seeds, as small as the period at the end of this sentence. Mother lice lay nits near the hairline and glue them to strands of hair, making removal a challenge familiar to many parents.

Enter Deanna Fox, the “Lice Lady.”

Charging $80 an hour she visits homes throughout the Sacramento region, picking out every last nit and louse, guaranteed.

Anonymity is also guaranteed – to Fox’s clientele, that’s as important as eradication.

Fox is a lice specialist for Nitpik, a company co-founded by Latika Alqarwani of Fair Oaks, a marriage counselor and mother of two. Alqarwani and her cousin started the company in 2007 to provide natural, alternative lice treatments.

Alqarwani said she was inspired by ancient, pesticide-free lice remedies from India.

“In India, we always have different home remedies, so we said, why don’t we put these remedies to the test and see if they work?” she said.

Over-the-counter products are “basically pesticides,” Alqarwani said.

Lice around the world also have developed resistance to pesticides. Chemical remedies now have a 50 percent success rate, said Terri Meinking, whose Miami-based company tests lice products.

For a year, Alqarwani and her husband, an Intel employee, worked on recipes. The final product is a mix of essential oils from India and France. It smells lightly of lavender and rosemary.

The product kills lice through suffocation and unsticks nits, making them easy to comb out, Alqarwani said.

Nitpik guarantees clients will be lice-free after two treatments.

A year ago Fox started the mobile lice clinic.

First, she screens each head of hair in the household. Infested hair is saturated with the essential oils. Fox then meticulously combs through the hair, over and over, with a thin-pronged lice comb.

“Our treatment is very soothing and relaxing,” Alqarwani said. “It doesn’t tear the hair out and it’s even comforting.”

Of greater comfort to many is Fox’s hush-hush promise. Although lice attacks are common, it’s an affliction many people don’t want to admit to.

Fox arrives at a client’s house in an unmarked vehicle. She carries the tools of her trade in an anonymous box.

“We don’t announce to the neighbors that we’re coming,” she said.

Social stigma has driven a recent revolution in school lice policies. Schools traditionally practiced a no-nit policy, sending home children with any nits in their hair.

In 2005, the California Department of Public Health moved to a no-lice policy, similar to that of the American Academy of Pediatrics. Kids with nits are not automatically sent home.

“Nits are often confused with other particles such as dandruff, and just because you see nits doesn’t mean the child will get lice,” said Dr. Vicki Kramer, chief of vector-borne disease at the California Department of Public Health.

The Folsom Cordova Unified School District changed its no-nit policy in 2007. Nits are less of nuisance today. When kids are found with live lice, parents are notified by the end of the day. Kids are re-checked 10 days later.

“Several families were having a very difficult problem dealing with lice, and their children were losing a lot of school days, meaning their academic progress was affected,” said Mary Ann Delleney, the district’s health coordinator.

“It is an amazingly horrible experience to go through,” said Jill Lillie, a Los Altos resident whose daughter wrote the book, “Natalie’s Lice Aren’t Nice!”

Natalie Lillie got lice when she was 8 years old and missed a week of school. Her favorite stuffed animals had to be bagged for two weeks. Her clothing, sheets and blankets were thoroughly laundered. Even worse, she wasn’t sure her friends were still her friends.

“One of the hardest things about having lice is telling others you have it,” she said. “I wanted to share my message with other kids and tell them even though it’s a bummer, it can happen to anyone and it will go away.”

Tags: Comb, Eradication, Essential Oils, Fair Oaks, Hairline, Head Lice, Home Remedies, House Calls, Human Blood, Intel Employee, Latika, Lice Remedies, Lice Treatments, Marriage Counselor, Nits, Pesticide Free, Sacramento Region, Sesame Seeds, Strands, Success Rate

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