I am a Pediatrician. I am writing a post for Doximity about what my kids have taught me about medicine. As I started writing I immediately rememered how LITERALLY LIFESAVING Tu Diabetes was for our family in the early years… If you have time on your hands here is a draft: It’s about my now 23 year old and has some details about her diagnosis and how hard those early days were. I’d LOVE to see everyone’s thoughts and feedback. It feels so hopeful to me… It’s about Diabetes tech and how it saved her life.
This is a post for Physicians! So PLEASE if you have any input, remember 80% of the physicians in the US will see it!!
Top three things My Oldest Kid Taught Me About Medicine.
When I first get up on Sunday Morning I do two things:
Read my Sunday Doximity Business News
Check my 23 year old’s Dexcom Weekly report and forward to her.
Not necessarily in that order, I usually do “ Dexie” first.
I saw this prompt:
“What I have learned about medicine from my kids”
When I saw this prompt after reading my Sunday Doximity Business news, ( I had already reviewed her dex report and forwarded to her) I became flooded with emotion… and compelled to write.
So here goes…
I remember being a young resident at St Louis Childrens Hospital… running around, doing intakes, writing my best H and P’s…
Jim P. Keating taught me how to concisely put together my thoughts towards the end of my H and P
- Diagnosis One
- Diagnosis Two
- Diagnosis Three
Anyhow, I digress… I was a fresh faced 25 year old… nobody even believed I could possibly be a doctor…
“Are you SURE you are a doctor?”
When I started out in practice… I was not in the “mom” club… It was a subtle thing… but I knew my practice knowledge was missing something… probably a fair amount of empathy among other things…
Being a mom…
Now we have three kids… I recently realized god gave me these three kids for a reason…. Because he knows I can handle it.
“ Oh, here is this MD, ped’s residency trained mama, with a decade of caring for kids… she can do it! “
What better mom for a kid with type one diabetes and celiac? What better mom for a kid with high functioning autism” or whatever we are calling it these days…
My third kid is “normal”, whatever that means…
Everybody has something though, right?
So let’s start with the oldest, Kennedy. Kid two we will “save” for another time.
Kennedy was diagnosed at age 9 and 11/12 on June 12. That is her diaversary. If you are outside of the T1D community that is your “diabetes anniversary” We used to celebrate it every year with a cake, until life got too busy. Just less than a month later she became a 10 year old. The months were a blur, and I remember talking with other mom’s on Tu Diabetes back in those early years. A mom noted “I DARE” you to keep my kid alive for 7 hours” as she was ranting about her elementary age child’s hours away from home while in the care of her school.
Hint, Hint: Technology, Web based Community
We mom’s were tech obsessed. I had to switch doctors to get her an Omnipod, but we did it. She had to have the very best doctors. And she did. Her endo in those early years was Andrew Braemer, MD a super empathetic and kind young endo physician at Vanderbilt who wore a Dexcom, despite not having diabetes. I remember him showing us the tracing which was a flatline 80 for 24 straight hours. It was curiously FLAT. Then we fought for the dex and six months later we got that too. I am a Savvy highly educated physician, and I had to fight like hell. Can you imagine what our patients go through?
We ended up losing Dr Bremer to the NIH, he is the Chief of the PGNB ( Pediatric Growth and Nutrition Branch for those of you not in the know. ) We really enjoyed our time with him and appreciate everything he did for us. It set the stage for (decent) adherence in her teenage years.
Hint Hint: Positive reinforcement as a tool for behavior change, shared decision making, empathy
I truly believe that our early fight for tech saved her life in some ways, because somehow she became adapted to “wearing these two things” before she was in “ The throws of her teenage years” which are rife with rebellion. Most teenage girls with T1D are not so lucky.
We paid cash for Dexcom in those early years. We did whatever it took.
Now we have the Omnipod/Dex with the algorhythm that is constantly pulling her blood sugar to 100. Her A1c is 6.8. She’s a young woman now, her knowledge around nutrition warrants an honorary nutrition degree, a masters, in fact. (Don’t forget the Celiac) She is also living in France, away from “ American Corn Syrup flavored everything”
She has Artificial Intelligence 24/7 doing much of what she had to do herself before. And her low’s are less than 1%. Time in range often 75 to 80%. The massive difference is during the night.
An absolute life-saving f%^%ng miracle.
So if I had to distill my learning around medicine into three top takeaways for just this one kid, they would be as follows.
Patient facing self management Technology is lifesaving
Most Patients DO want to self manage, if given the opportunity.
Artificial Intelligence for patient self management is in its infancy.
Now T1D is a tiny community of 3 million in the US. Because of the hideous nature of this disease, companies like Dexcom and Omnipod ( and many others) have come to the rescue for these kids and adults and families managing this disease.
There is one final learning that I gleaned from my experience with my oldest kid…
We can harness the exact kind of self management principles that we use for T1D, and apply it to the 100m people in our country with Metabolic Syndrome. And we can do that in the highest value, lowest cost healthcare setting, outpatient Primary Care. So our largest chunk of population at risk for disease can help themselves earlier… and either prevent disease, or bring their diabetes, hypertension and pre-disease states into remission.
What are you waiting for?
If there are any mama’s from the 2010 to 2016 still around… How are your young adult kids doing??
Best, Natalie Davis, MD