Puberty: How Early is "Too Early?"

A study published today in the journal Pediatrics indicates that among girls in the United States, the onset of puberty is earlier than it has ever been.

Lead investigator Dr. Frank Biro of Cincinnati Children's Hospital examined approximately 1,200 girls aged 7 and 8 years and determined that among 7-year olds, 10 percent of Caucasian girls and 23 percent of African-American girls had started developing breasts, the earliest sign of pubertal development in girls. Among the 8-year olds, 18 percent of Caucasian girls and 43 percent of African-American girls had entered puberty.

This is a stark contrast from a similar study in 1997, when among 7-year olds, 5 percent of Caucasian and 15 percent of African-American girls had started puberty. In the 1997 study, among 8-year olds, 11 percent of Caucasian girls and 43 percent of African-American girls had started puberty.

But why?

Is the "Artificial Pancreas" finally coming for Type 1 Diabetics?

Families of children with Type 1 Diabetes know all about two devices that have revolutionized treatment of the disease: the insulin pump and the continuous glucose monitoring system (CGMS).

Patients with Type 1 Diabetes suffer from an autoimmune condition in which immune cells (that normally fight off infections) attack the body's own pancreas for reasons that are not entirely clear. This results in destruction of the pancreatic beta cells, normally the site of insulin production and release into the blood stream. Insulin is the hormone responsible for keeping blood glucose (also known as blood sugar) at normal levels throughout the day. Without sufficient amounts of insulin, blood sugar rises uncontrollably, causing both short- and long-term adverse effects on the body.

In the past, the only way to keep blood sugars in check was to give multiple injections of insulin throughout the day. Now it looks like there may be a new piece of technology on the horizon that comes as close as we've seen to mimicing the actions of the pancreas itself.

Online appointment booking -- just like OpenTable (just not as tasty)

A couple days ago, one of my cousins sent me an email asking if I had heard of zocdoc.com, and whether I'd consider joining. This meant absolutely nothing to me, but I figured this was a suggestion from family, so what the heck.

So I took a look. And this is the next big thing: online booking for doctor's appointments.

Needless to say, a phone call to ZocDoc HQ and a few clicks later, and voila! Now you can book your appointments with me either by phone (301-647-9847) or online. You can either go to zocdoc.com and search me out, or go directly to my booking page at:

http://www.zocdoc.com/doctor/ali-mohamadi-md-2757

I think this is pretty incredibly cool. I hope you find it useful as well.

Be well,
AM

Diabetes, the Swine Flu, and You

News reports about the H1N1 influenza ("swine flu") pandemic keep coming, but one aspect of the story is constant: although the majority of the cases are mild, H1N1 is occasionally a killer.

The first doses of the vaccine became available in early October, but supply has been scarce. It turns out the H1N1 vaccine may only need a single dose to be effective (previously, it was thought two separate doses might be needed to protect against the virus), but still all children under the age of 10 will need two doses. All of this is good news, because to date over 3,000 people have died from swine flu since it was first isolated in Mexico in April.

The deaths are frequently described as occurring in people with underlying diseases, but occasionally in healthy young adults. The underlying diseases are rarely described, and I have been watching to see if diabetes is mentioned as a comorbidity -- and it occasionally is. For example, an Italian man with diabetes and chronic heart problems was the country's first swine flu victim. While fighting the flu virus, he developed a staphylococcal infection, pneumonia and kidney problems.

So if you or your child have diabetes, what should you do?

Buying into (or is it selling out to?) social networking

Well, I've completed the superfecta.

Facebook Page? Check (Dr. Ali Mohamadi)

Twitter account? Check (@dralimohamadi)

Blog? Check (dralimohamadi.blogspot.com)

Website? Check... almost (www.dralimohamadi.com)

Time will tell whether this is a colossal waste of time or a great new way to communicate with families I see in the office/people who are interested in learning more about pediatric endocrinology. Please let me know what you think and feel free to participate however your social networking mind sees fit.

The website, you'll see, is still a work in progress. Please let me know what adjustments you'd make. I'm open for suggestions, and unlike certain members of the Washington Redskins, I won't call you a "dim wit" if you boo me.

Be Well,
AM

Paging Dr. Gupta -- My 2 cents on intersex and gender (re)assignment

One of my closest friends since medical school, Dr. Anuj Gupta (who is now a psychiatrist in NYC) happens to be one of the most intelligent, insightful people I know. So if he comes to me asking my opinion on anything, I know I'd better either a) know what I'm talking about, or b) do some reading on the subject.

Anuj came to me asking my opinion on something he will be discussing with his group on Friday. Not surprisingly, I had to do some reading on the subject or else risk being the butt of their jokes.

The topic is gender reassignment and whether the act of surgically changing one's sex to their "true" gender identity actually heals the psychological wounds these individuals carried prior to the procedure. The article Anuj pointed me to, written by esteemed Johns Hopkins psychiatrist Paul McHugh, MD, can be found at: http://www.pfox.org/Surgical_sex.html

Who am I? Why am I here?!?!

Anyone remember this guy?

In case you've forgotten, this is the great Admiral James Stockdale, one of the most highly-decorated officers in the history of the US Navy, with 26 personal combat decorations including the Medal of Honor and 4 Silver Stars.

But chances are, if you remember him, it's for being Ross Perot's running mate in 1992. And chances are, if you remember him, it's for opening the Vice Presidential debate that year by staring into the camera with a crazed, far-off, cross-eyed look and uttering those famous words: "Who am I? Why am I here?!?!" If that doesn't do it for you, go to youtube and type in "Phil Hartman and Stockdale." Hilarity is sure to ensue.

The point is: at this very moment I feel a little like Admiral Stockdale stepping into the limelight. I know very well that outside of my parents, wife, and some wonderful families who have stayed very loyal to me as I have gone from a Pediatric Endocrine fellow at Johns Hopkins to opening my own practice in Chevy Chase... no one will probably lead this. So why should I have stagefright at this moment?