Bambini Newsletter   February 14, 2012

ADHD Rx Concerns      


ekgAccording to the results of a survey of 817 pediatricians published in the current issue of Pediatrics, only about 15% ordered an EKG upon starting a child on a stimulant medication. And this makes sense. Last year, the results of a study were published that compared the rate of cardiovascular events in children exposed to stimulants with those who were not. There was no statistically significant difference.

 

Nevertheless, case reports have been published that suggest there is reason for concern. And the American Heart Association does recommend a baseline EKG before stimulants are begun. We've discussed the matter among ourselves, and likely will not check EKGs on children placed on very low starter doses, but will start running them on children that are on higher doses.

 

Another area of some controversy as of late is the risk of suicidal ideation in children treated with ADHD drugs. Strattera, a "milder" non-controlled drug has carried a warning about an increased risk suicidal thoughts for some time now.

 

Last month, an advisory committee to the FDA recommended that a comparable warning  be added to the package insert for Focalin, considered to be the mildest of the stimulant drugs. 1.8 million children in the US have been placed on Focalin in the last six years.

 

With this new information in mind, we have decided to lower the maximum interval between office visits for children on ADHD prescription medications from three to two months. Moreover, we will be placing increasing emphasis on the use of adjuncts such as supplements, chiropractic care, and neuro-feedback. For even more detailed information about alternatives, visit unritalinsolution.com. 

Free Medical Advice      

healthtapHealth Tap is a new interactive service that puts doctors and patients in touch. Dr. Alan Green -- pediatrician, professor, and best-selling author whose website has been around since the early days of the net -- serves as medical director.

 

Members post questions that respected doctors (more than 9,000 have signed on so far) can post responses to. Available both at home or on the go.

 

But some caution is advised -- you can sometimes get what you pay for. The query about your son's diaper rash might be answered by a well-meaning gerontologist. Some doctors could be more interested in gaining notoriety than providing keen clinical insight. Finally, responses are not immediate, and few will likely be integrative.  Still, it may be worth a bookmark. 

Practice News     


Dr. Malak will be helping to care for a sick family member and likely will have somewhat reduced availability for the next month or so. Thank you for your understanding.

 

The hospitalist program at Vassar appears to be going well. Thankfully, we have had very few patients on their service. The hospitalists will continue to care for our inpatients there for the foreseeable future. Although we currently continue to see newborns at Vassar, we are re-evaluating the practicality of continuing to do so.

 

conciergeOn a positive note, we are considering the addition of limited Saturday morning office hours. Stay tuned.

 

We are also pondering the addition of so-called concierge services - that is, services that insurance companies do not pay doctors for. These might include email contact directly with the doctor or PNP, house calls, longer visits, school / camp forms, prior authorizations, direct cell phone connection to the doctor or PNP after hours, or discounts on allied health practitioner care. These concierge services might be covered by annual, monthly, or line-item fees. Again, stay tuned.

 

Do you have something to say about concierge care in general or here at Bambini? We'd like to hear from you. Post your comments for public view here on our Facebook page. As always, feel free to share feedback confidentially through our website.