Monthly Archives: October 2011

American Academy of Pediatrics Recommends Ritalin for 4-year-olds

The American Academy of Pediatrics has modified their recommendation for diagnosing and treating children with ADHD this month. Previously children from age 6 – 16 were recommended to be evaluated and possibly treated. The new recommendation includes children from age 4 up to age 18. So in that sense, 4 is the new 6.

Ritalin (methylphenidate) is used to treat attention deficit hyperactivity disorder (ADHD)

My concern with this recommendation is treating children with psychostimulant medication at such a young age. I am not a parent myself, and I cannot fully comprehend how hard it must be to raise a child with behavioral difficulties, but why medicate at an age where physical, neurological, emotional, social, etc. development is so sensitive? Why not wait two more years?

I consider it a given that the vast majority of parents have their child’s best interest in mind. Children can be spectacularly odd, even freakish. Why is there no place in society for children that are behaving so oddly and exhaustively? Ritalin – Ritalin syrup – at age 4 just seems too early to me, and more like a quick fix aimed to please busy parents.

My hypothesis is that if some parents would deal with their own inflated expectations and dream of what their child should be like, their child’s behavior would seem a lot more acceptable.

Tfaces_of_calvin_and_hobbeshis is an emotional topic, and it certainly provokes emotional reactions. My grandfather had severe ADHD as a child, and the situation was sometimes out of control. He was often punished and beaten in school. His own father made him wear high-heel shoes to school one day to humiliate and punish him for his behavior. Back then, teachers knew nothing about ADHD. As he grew up, however, he matured and the severity of his ADHD lessened. People with ADHD usually lose the H (hyperactivity) as they mature. My grandpa went on to achieve great things.

I shouldn’t generalize from one case, but that doesn’t change my opinion that 4-year-olds, who are nowhere near 1st grade school-age, are too young for psychotropic medication for ADHD. Parents should stick it out and seek alternatives at least until the critical school-age of 6 years has been reached. Until then, children aren’t mandated to have to function in a class-room setting in a way that is socially appropriate.

Art & Anatomy by Walid Aziz Basharyar

The next Frank H. Netter:

This is just one of the many videos hand-crafted, beautifully sketched and thoughtfully explained, by a medical student. I, along with other medical students, draw upon these videos for illustration of tough concepts or different views on anatomy that our medical school professors lack the time to explain during their summarized hour-long lectures.

In case you were wondering, Frank H. Netter, MD, illustrated an atlas that has been very popular amongst both medical school professors and students. Additionally, there are anatomy flashcards used by medical students across the country called “Netter’s Flashcards”. We joke around about how instead of having fashion, national geographic, or sports magazines readily available for reading while on the porcelain throne or before going to sleep, we read our Netter’s. I use my flashcards during lunch breaks at school and as nighttime reading at home.

Basharyar, the illustrator and narrator in these videos, gives me another great resource to help with visualization of anatomy, because, as you may or may not know, cadaver anatomy can be dry, ropey, and have many abnormalities or anomalies. My professors make fun of us, claiming that we are always crying around about how “but it doesn’t look like the atlas!” Anatomy isn’t an easy feat, although I am arguably enjoying it the most out of all the subjects I’m currently taking. Enjoy these videos as you brush up on your anatomy the summer before medical school or during your anatomy course while in medical school.

Don’t forget to get your Netter’s Anatomy Flashcards if you’re learning anatomy now in undergrad (A&P class) or if you want to get ahead of the game before starting anatomy in medical school! Cheers!

Hand of Hope

Maybe you’ve seen this before. “Hand of Hope” is commonly referenced to in the medical field when referring to innovative technology, miracles, life and death, etc. Dr. Joseph Bruner, a well-known surgeon from Vanderbilt University Medical Center, was performing a fairly new and technologically innovative surgery on fetal spina bifida. The patient’s names were Julia Armas and Samuel Alexander Armas, an obstetrics nurse and her 21-week-old fetus, respectively.

Samuel Alexander Armas, Spina Bifida Fetal Surgery

Samuel Alexander Armas, Spina Bifida Fetal Surgery


Spina bifida is a common disorder (1-2 cases in every 1000 births) that occurs when the the neural tube fails to close during embryological development. The opened tube can present with a fluid-filled sac with the spinal cord contents protruding into it on the fetus’s lower back and can be fatal if not treated in the womb.

During this intra-uterine procedure, the uterus can be displaced from the body via a cesarean section, opened, and skin grafts are used to close off the neural tube opening of the fetus and prevent further damage the spinal cord might have undergone if exposed to the amniotic fluid surrounding the fetus. When Dr. Bruner opened Samuel Alexander’s cozy uterine house, a little hand reached out and grabbed his finger tightly. Some accounts of the story say Dr. Bruner claims it was one of the most moving moments he had ever experienced. Others report that the story was inaccurately written to support pro-life advocates and that the fetus’s hand was pulled out. (We learned that the fetus reached out in development class from a professor in medical school; nothing was mentioned about abortion, probably since the picture has nothing to do with it.)

The fetus was born without the serious issues other spina bifida patients would have had to deal with. Samuel Alexander grew up walking with leg braces but avoided the many surgeries he would have had to have if this clinical trial surgery wasn’t available for him or searched out by his mother. Now he is 11 years old and probably quite grateful that his mom “went out on a limb” to get this surgery done for him, not to mention he is still a fetal superstar, if there is such a thing.

Most Competitive Medical Residencies

I was doing some research to find out which residencies are the most competitive. I haven’t decided on a residency for myself yet; I am trying to keep an open mind until I do my rotations. I have to add that these rankings are subjective, because the selection process can vary greatly. This is what I came up with in order of most to less competitive residency fields/programs:

1. Plastic Surgery
2. Dermatology
3. Neurosurgery
4. Otolaryngology
5. Orthopedics
6. Radiation Oncology
7. Anesthesia
8. Diagnostic Radiology
9. General Surgery
10. Internal Medicine / Pediatrics

Also, these numbers here are two years old but a guide line, courtesy of AAMC:

USMLE Step 1 Scores of Matched Applicants

Unfortunately it’s getting harder to secure a great residency each year even though there will be a significant physician shortage in the near future. Currently, there is a shortage of 13,700 in physicians. By comparison, in 2020, there will be 759,800 physicians (in all specialties) yet a demand of 851,300 physicians, essentially a shortage of 91,500 doctors, according to the AAMC. As paradoxical as this sounds, it’s true. This is especially true for primary care physicians, but also in other specialties.

While medical schools are expanding, upping the number of graduates, residency slots have remained the same. Proposed cuts in Medicare, the primary source of graduate medical education funding, could further worsen the situation.

The reason for the discrepancy right is simply the amount of money that a physician will earn depending on the specialty. While primary care is challenging and highly stressful, it unfortunately offers only roughly 25% of the pay that might be earned in neurosurgery. Medical students, usually deeply buried in debt, often naturally choose a specialty that will free them of their debt sooner rather than later.

Medical Billing and Coding

The ever expanding field of medicine offers many different routes and careers. Have you ever thought about medical billing and coding? Hospitals and practices are often overwhelmed and outgrown by their paperwork, so skilled medical billers and coders are extremely important. Every time a patient enters a hospital, a medical record is updated or created. Along with the medical record, a medical biller codes and submits a claim. Doctors are in dire need of employees that understand the profound complexities of medical billing. Additionally, with the new transition into completely electronic medical records and patient databases, more training is required to work within the health care system.

The Allen School Online offers an accelerated program that only takes 9 months on the contrary to 15 months, enabling its students to get their degrees faster, and thereby join the medical profession faster. This is a great way of giving students an edge, because too many schools and colleges offer degrees that take forever to complete, thus making them uneconomical. The benefit of such a program becomes evident to anyone who is part of a long-term program because it’s almost impossible to devote quality attention to multiple areas. Holding a job, raising a family, being a spouse, etc. on top of schooling is an insane challenge. Thus, I have found that it’s best to do schooling as fast as possible, with all the necessary commitment and devotion.