Tips for Getting the Most Out of Your Pediatrician Visit, By Laura K. Whitney MD

Be On Time
Most offices schedule patients for a set appointment length, such as 10 or 15 minutes, beginning at the given appointment time and including time for paperwork, initial evaluation by a nurse, and time with the doctor. When you arrive after your appointment time, some of the allotted time has already passed. This means the doctor may have less time to deal with your concerns, and if the visit cannot be completed in the scheduled time, the next patient will have to wait longer for his appointment.

Be Organized
Know the names and dosages of all your child’s medications, including over-the-counter medications and vitamins or supplements. If the primary caregiver cannot be present, make sure the adult bringing the child to the doctor has all the details of the child’s medical history and current symptoms. It is most helpful to send a written list of all pertinent information, along with any questions you would like answered. Do not rely on medical files already at the office as it takes considerable time to review old records. Missing details could hinder the diagnosis and treatment of any current problems. The majority of the visit should be spent addressing the issues of the day, not reconstructing what happened in the past.

Be Honest
Providing complete information to your doctor is essential. Without it, the correct diagnosis may be delayed or missed altogether. Your pediatrician is not sitting in judgment: if she has been in practice for a while, be assured she has heard it all. Do not omit any medications or other treatments you have given the child, and if your child has seen a specialist or other provider, be sure to mention it. Report all symptoms accurately and answer questions truthfully, even if the answer is embarrassing. You may ask to speak with the pediatrician independently of the child if you wish to convey sensitive information, or a teen may request to talk with the doctor while his parents wait outside.

Be Present, Even for Teen Visits
It is appropriate for teens to have time alone with the pediatrician, so they can open up about issues they would rather not discuss in front of a parent. However, teens may not know all the details of their personal medical histories or those of their families. They may not clearly communicate parental concerns to the doctor, or they may fail to report the results of the visit to the parent. Also, while teens are legally allowed to receive certain medical treatments without parental permission, these generally don’t include routine vaccinations, which are given at some teen well checks. For these reasons, an adult should be present with the teen at the beginning of the visit and remain in the waiting room until the visit is complete.

Dr. Whitney is a general pediatrician with The Children’s Medical Center, PA in Greenville, SC. Her interests include toddler feeding issues and helping children develop healthy habits.

How to keep your kidneys happy and healthy, By Dr. Rich Feldenberg

When things run smoothly, we tend to forget the importance of all the moving parts that make up our lives. Our kidneys are certainly no exception. We don’t think about how much they are doing for us each day until something goes wrong. The kidneys have the important task of keeping our internal environment constant. They maintain the precise chemical composition of the blood, and through their intricate architecture of filters and tubules, they regulate the right amount of water in the circulation and remove waste products from the blood. They also produce several important hormones, one of which keeps us from becoming anemic and another which activates vitamin D.

When our kidneys are working well, we don’t notice all the help they’re giving us, but when your kidneys become sick then it becomes obvious how important they are to maintaining a healthy life. Kidney failure can result in massive swelling from fluid retention, dangerous shift in your blood’s mineral balance, and the accumulation of toxins in the body. These problems can be fatal, and in some cases dialysis or kidney transplant is necessary for survival. Since dialysis and transplant are both major medical interventions, it is undeniably best to try to keep your kidneys healthy from the start.

What can you do to maintain good kidney health? While you have no control over your genetics, there are things you can do to help your kidneys continue helping you. Below are my recommendation for taking good care of your kidneys.

1. Drink plenty of fluids. While there is some controversy over exactly how much fluid is necessary to stay healthy, it is clear that low fluid intake is an important risk factor for kidney stones. In addition to causing a lot of pain, a kidney stone can cause a urinary blockage that could permanently damage kidney function. A daily fluid intake of around 2 liters or 67 ounces is often enough to minimize kidney stone risk.

2. Maintain healthy bladder habits. Those that hold their urine for long periods throughout the day and empty the bladder infrequently are at an increased risk for urinary tract infections (UTIs). UTIs can cause permanent scars in the kidney and recurrent UTIs can lead to kidney failure. Emptying your bladder about every 3 hours during the day and making sure you empty completely each time can help cut your risk.

3. Avoid frequent use of medications that are known to be damaging to the kidney. The main over-the-counter medication in this category would be ibuprofen. This can cause a decrease in blood flow to the kidneys and can sometimes lead to kidney failure. There may certainly be times when ibuprofen is fine to use for pain or inflammation, but overuse puts your kidneys at risk. If necessary, use sparingly, follow the directions on the bottle, and take with lots of fluids. If your pain or inflammation is not improving, then get checked by your doctor.

4. Be sure your blood pressure is under good control. Chronic high blood pressure is a common cause for kidney failure and the need for dialysis. Get your blood pressure checked, and if it is high, be sure to follow your doctor’s diet, exercise, and medication recommendations.

5. Talk to your doctor right away if you have any symptoms that could suggest kidney problems or kidney failure. If you notice blood in the urine or swelling in the legs, you shouldn’t wait to seek medical care. Get regular check-ups and periodically have your urine checked for blood and protein. Have your blood pressure measured. If you have diabetes, take extra care to keep your blood sugar levels in check so you are less likely to suffer diabetic kidney disease.
Dr. Feldenberg is a pediatric nephrologist at St. Louis University School of Medicine. His science blog is http://darwinskidneys.wordpress.com