tag:blogger.com,1999:blog-39759426126354215392024-03-14T01:35:52.900-04:00Pediatric EndoblogAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3975942612635421539.post-36180953626337330472010-08-09T10:45:00.006-04:002010-08-10T14:22:20.329-04:00Puberty: 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. <br />
<br />
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. <br />
<br />
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.<br />
<br />
But why?<br />
<a name='more'></a><br />
Anecdotally, pediatric endocrinologists have noted the exact same findings over the past 20 years as published today, so it doesn't come as a complete shock to the medical community. Theories include: a change in nutritional intake (more heavily dependent on proteins and carbohydrates and lower in fiber than before); contamination of the water supply and meats with steroids and other products given to livestock or found in plastics, like BPA; and the significant increase in the obese population among children.<br />
<br />
I personally believe this latter problem is at the heart of the matter.<br />
<br />
The hormone leptin is a key player in telling the brain "enough is enough" when it comes to eating. After a filling meal, the amount of leptin in the bloodstream increases, and when leptin reaches the hunger centers in the hypothalamus (an area in the central brain), the body gets the signal that it is full. <br />
<br />
Leptin also has been found to play a key role in instructing the hypothalamus and pituitary glands to release the hormones GnRH (in the hypothalamus) and subsequently FSH and LH (in the pituitary gland), the latter two of which are in charge of starting puberty. <br />
<br />
In children who are overweight or obese, there is a higher amount of leptin in the bloodstream due to the fact that the child's nutritional intake -- especially compared to lean peers -- is in excess. The body, by releasing more leptin, is trying to tell the child to "stop eating." The side effect of this is that even at a young age, the excess leptin tells the brain to release the hormones of puberty, which gets the process started earlier than one would expect.<br />
<br />
In other words, obesity leads to increased leptin. Increased leptin tells the hormones of puberty to kick in. And if the child is overweight or obese from a young age, this all starts earlier than ever before.<br />
<br />
Yet another reason to continue to work hard on curbing the obesity epidemic.Ali Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com0tag:blogger.com,1999:blog-3975942612635421539.post-57851397825838736202010-01-14T11:52:00.003-05:002010-01-14T12:02:30.611-05:00Is 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).<br />
<br />
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.<br />
<br />
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.<br />
<a name='more'></a><br />
Developing this technology would not have been possible without the advances of the past decade.<br />
<br />
First came the development of the insulin pump. This is a device that stays attached to the body for up to three days at a time has significantly changed the treatment of diabetes. With this device, patients can program into the pump how much insulin to give without having to stick themselves with a needle multiple times each day.<br />
<br />
Second, and more recently, engineers created the CGMS device: a system that, like the insulin pump, is attached to the patient's skin. The CGMS is able to read blood sugars in near real time, an improvement compared to the conventional method of using a needle to draw small amounts of blood from the skin (usually the fingertips) multiple times a day to check blood sugars.<br />
<br />
The question has always been: is it possible to perfect a system that is able to check blood sugar levels and then simultaneously supply the proper amount of insulin without the patient having to stick their fingers or program the how much insulin should be pumped multiple times a day?<br />
<br />
The answer lies in the creation of a new technology which researchers have call the "artificial pancreas" or "closed loop system." After years of tweaking, the system finally appears ready to test. The premise is: the CGMS device will gather blood sugar data and "tell" the insulin pump what the numbers look like. Based on the trends of the blood sugars, the pump will decide how much insulin to give the patient at any given moment. This is similar to how the pancreas normally senses the body's blood sugar levels and secretes insulin in response.<br />
<br />
Animas, a subsidiary of Johnson and Johnson, is partnering with the Juvenile Diabetes Research Foundation to pilot the first closed loop device, with hopes of forever changing the way Type 1 Diabetes is managed.<br />
<br />
This is an idea I have discussed at length with many of my families with Type 1 Diabetes, but to be honest I don't think any of us thought it was this close to happening. In truth, there are many hurdles to jump before the final product is unveiled and deemed safe for public use. But the wheels are turning, and this is one of the best developments in the treatment of the disease in a long time.<br />
<br />
Please see the link below for details:<br />
<br />
http://bit.ly/4VBB3W <br />
<br />
Be Well,<br />
AMAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com0tag:blogger.com,1999:blog-3975942612635421539.post-807335645824099242009-11-17T20:42:00.000-05:002009-11-17T20:42:15.742-05:00Online 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.<br />
<br />
So I took a look. And this is the next big thing: online booking for doctor's appointments.<br />
<br />
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:<br />
<br />
http://www.zocdoc.com/doctor/ali-mohamadi-md-2757<br />
<br />
I think this is pretty incredibly cool. I hope you find it useful as well.<br />
<br />
Be well,<br />
AMAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com2tag:blogger.com,1999:blog-3975942612635421539.post-24846236773474680872009-09-23T11:08:00.008-04:002009-11-18T09:47:21.684-05:00Diabetes, the Swine Flu, and YouNews 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
So if you or your child have diabetes, what should you do?<br />
<a name='more'></a><br />
<strong>First</strong>, be informed.<br />
<br />
The Centers for Disease Control and Prevention (CDC) has several webpages on the H1N1 flu. One that is updated regularly is: <br />
<a href="http://www.cdc.gov/h1n1flu/">2009 H1N1 Flu (Swine Flu)</a>.<br />
<br />
They also have a webpage about H1N1 and diabetes, which has numerous hyperlinks to other information:<br />
<a href="http://www.cdc.gov/diabetes/news/docs/swine_flu.htm">H1N1 Flu (Swine Flu) Information</a><br />
<br />
Other agencies also have information of interest: The HHS has a webpage with quite a catchy title: <br />
<a href="http://flu.gov">flu.gov</a><br />
<br />
It has information about bird flu, swine flu, and "routine" flu.<br />
<br />
<strong>Second</strong>, plan to get all the flu shots this fall.<br />
<br />
Children with diabetes and everyone who lives with them should get the "routine" flu shot, which is already available, and later, when it's available, also get the H1N1/swine flu shot (or shots, if it turns out that two shots are needed for protection from H1N1). Every year, there's a risk of an epidemic of routine viral flu, and this year is no different. The "routine" flu shot will help decrease the risk of getting the routine flu, but will not protect against the new H1N1 strain. Just the same, getting the H1N1 vaccination will not decrease the risk of getting routine flu.<br />
<br />
<strong>Third</strong>, follow routine advice that the CDC is suggesting for everyone:<br />
<br />
* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.<br />
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.<br />
* Avoid touching your eyes, nose or mouth. Germs spread that way.<br />
<br />
By putting these three steps together, your child with diabetes might not guarantee that he/she will be spared from the flu this fall and winter, but the chances of missing out will be significantly improved. And in this case, missing out is actually a very good thing.<br />
<br />
Be Well,<br />
AMAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com1tag:blogger.com,1999:blog-3975942612635421539.post-59793082152175399942009-09-22T13:00:00.002-04:002009-09-22T13:05:07.373-04:00Buying into (or is it selling out to?) social networkingWell, I've completed the superfecta.<br /><br />Facebook Page? Check (Dr. Ali Mohamadi)<br /><br />Twitter account? Check (@dralimohamadi)<br /><br />Blog? Check (dralimohamadi.blogspot.com)<br /><br />Website? Check... almost (www.dralimohamadi.com)<br /><br />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.<br /><br />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.<br /><br />Be Well,<br />AMAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com1tag:blogger.com,1999:blog-3975942612635421539.post-57759701031124691842009-09-16T20:03:00.006-04:002009-09-18T09:58:27.876-04:00Paging Dr. Gupta -- My 2 cents on intersex and gender (re)assignmentOne 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.<br /><br />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.<br /><br />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: <a href="http://www.pfox.org/Surgical_sex.html">http://www.pfox.org/Surgical_sex.html</a><br /><br /><a name='more'></a><br />Although I cannot pretend that I have taken care of many patients with gender identity disorders, the issue of gender assignment in newborns is one that I do have some experience with. This is a topic of great medical and ethical controversy: everytime I see a newborn with ambiguous genitalia I know very well that whatever gender the family chooses for that child around the time of birth, when the baby grows up to assume an identity of his/her own -- and when he/she learns that his/her gender was chosen by the parents -- there is a good likelihood it will cause confusion, anger, and distress in that individual.<br /><br />Briefly: a newborn with ambiguous genitalia is defined as one in whom it is difficult or impossible to determine whether the external genitalia are male (penis/testicles) or female (clitoris/vagina) at the time of birth. This can be caused by a number of different conditions, and I could write a book on each. But the key is: there are a subset of genetically male children (XY karyotype) whose genitalia more closely resemble a female's than a males, and conversely there are genetically female children (XX) whose genitalia more closely resemble a male's than a female's.<br /><br />If you take only one thing from this overly long post I am writing, here it is: an individual's sex is determined by the manner in which they are reared rather than their genetic makeup. An XY individual who is raised as a girl (usually following surgery to create female external genitalia) is a FEMALE. An XX individual who is raised as a boy (and who often has a series of surgeries to produce a phallus) is a MALE.<br /><br />When a baby such as this is born, they often spend time in the NICU in order to have labs drawn to first determine the genetic sex of the baby, and then to make sure there are no potentially life-threatening conditions that may have resulted in the ambiguous genitalia. Once this information is known, what typically ensues is a series of conversations between the parents and urologists (who would perform any desired surgery to create either male or female-appearing external sexual organs), endocrinologists (who help discuss why the child's genitalia developed in the manner they did, and discuss future options for hormone replacement) and psychiatrists (to help with the understandable and expected emotional stresses the family will face).<br /><br />I can only speak from the standpoint of an endocrinologist. In my field, there are two distinct thought processes on what the optimal approach should be. One is to <span style="FONT-STYLE: italic">perform surgery within the first months to year of life based on a quick but well-reasoned decision</span> <span style="FONT-STYLE: italic">based mostly on the ease of the surgical approach</span>. If it is less difficult for the urologist to create female genitalia, then the child should be raised as a girl. If it is easier to create a phallus, then it should be a boy. This is irrespective of the child's genetic sex (ie, karyotype). In this philosophy, the child will mold his/herself to take on the sex that the parents have assigned, whether or not that sex is the same as the genetic sex.<br /><br />The other approach is to go by the philosophy that <span style="FONT-STYLE: italic">although it is important to assign a sex to the child early in life, surgery is usually neither urgent or emergent</span> (excepting conditions that are incompatible with life unless surgery is performed immediately, such as cloacal exstrophy). Advocates of this approach believe that the parents can make their best reasoned judgment around the time of birth and raise the child with the sex they have chosen for legal and social purposes, but that ultimately it is the child that will declare what sex he/she is. By not making a definitive decision (by holding off on surgery), adjustments can be made if the child determines that the parents' choice was wrong.<br /><br />Anuj, directly to you and for your conference on Friday: let me paraphrase Dr. Claude Migeon, a mentor of mine who is one of the pioneers of pediatric endocrinology and the world's foremost expert in intersex conditions. Dr. Migeon would tell you from his experience that individuals who are genetically XY -- who usually are exposed to more testosterone than XX individuals, especially in utero -- develop what he calls a "male brain" regardless of what gender they are assigned by their parents. These XY girls tend to be somewhat more aggressive and more drawn to "typically male" activities. And Dr. Migeon would tell you that the grand majority of the time, when a teenager that was born with ambigous genitalia comes to him years later complaining that the parents chose "the wrong sex," it's an XY female -- an individual with a male genetic sex who was raised as a girl.<br /><br />Less anecdotally and straight from the literature, there is the case of David Reimer. In 1967, John Money, a prominent sexologist at Johns Hopkins Hospital, recommended that David, a boy who had lost his penis during a failed circumcision, be sexually reassigned and raised as a girl. Despite being raised as a girl from the age of 18 months, Reimer was never happy as a girl, and when he learned of his sex reassignment, he immediately reverted to living as a male. Money never reported on the negative outcome of Reimer's case, but in 1997, Reimer went public with the story himself. His case, as well as numerous cases of genetically male (XY) infants with ambiguous genitalia at birth who have been reassigned and raised as females such as Dr. Migeon's, suggest that gender identity is innate and immutable.<br /><br />If you want my opinion, let me quote Dr. William Reiner, a psychiatrist and urologist at Hopkins, who belives, above all, parents and physicans:<br /><br /><ol><li>Must be flexible</li><li>Must be observant</li><li>Must listen </li></ol>to the patient. I would think this goes for the child who is coming to grips with the discordance between genetic sex and the sex the parents chose, as well as the adult who believes his/her "true gender" and genetic sex were never the same to begin with.<br /><br />For this reason, while Dr. McHugh has reservations about gender reassignment due to having "witnessed a great deal of damage from sex-reassignment," I would argue -- at least in children -- we owe them the respect and opportunity to make for themselves a decision that was never granted them in infancy. After all, it is they, and not their parents, who are the only ones who will ever know what really feels right on the inside, even if it looks nothing like how they were raised on the outside.<br /><br />Be Well,<br />AMAli Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com0tag:blogger.com,1999:blog-3975942612635421539.post-77914606490735363582009-09-15T16:10:00.003-04:002009-09-23T16:02:46.109-04:00Who am I? Why am I here?!?!<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilEBnjP9v32LG2r46R4eX9y7rnt4hCXJN_p4e-4gKo4XpfeLPjZROLN3dx9cCBu_tSMo1uGxWB4MW34-dm5icZUYE3Bk2UwKluNnd8tTpv3PJOMrrxYXS6MaUS_01UNG9R4Gjn5vxMUzQ/s1600-h/stockdale.jpg"><img id="BLOGGER_PHOTO_ID_5381795550756160962" style="WIDTH: 180px; CURSOR: hand; HEIGHT: 180px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEilEBnjP9v32LG2r46R4eX9y7rnt4hCXJN_p4e-4gKo4XpfeLPjZROLN3dx9cCBu_tSMo1uGxWB4MW34-dm5icZUYE3Bk2UwKluNnd8tTpv3PJOMrrxYXS6MaUS_01UNG9R4Gjn5vxMUzQ/s320/stockdale.jpg" border="0" /></a><br />
<div></div><div>Anyone remember this guy?<br />
<br />
</div><div>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.</div><br />
<div>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.</div><br />
<div>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?</div><br />
<a name='more'></a><br />
<div>Probably because when it comes to blogging, I have no clue what I'm doing.</div><br />
<div>But here's what I'd like to do.</div><br />
<div>I would like to use this space to discuss some of the fascinating things I see in my office -- talk about some of the really interesting conditions that I am fortunate to encounter on a daily basis and why I consider it so stimulating to have the privilege to "do what I do" for work. </div><br />
<div>On the one hand, it's really intellectally rewarding to do the detective work necessary to make a diagnosis, as well as to come up with a plan for treatment. But even moreso, it is rewarding to have the opportunity to sit down with an entire family, talk through the science of it all and better yet hear firsthand from the patient and his/her parents how living with a chronic illness affects them all. The strength of the family bond and the resilience of children never cease to amaze me.</div><br />
<div>In return, all I ask is for each of you to be my muse. Please chime in and respond to my posts (even if only to tell me how I just wasted five minutes of your life that you will never get back...) Feel free to ask questions and provide your own personal viewpoints. In turn, I will use your thoughts and ideas to craft a blog that I hope becomes a dialogue between you and I.</div><br />
<div>If I can't see you in the office once a week, at least we can play "internet tag" through this blog.</div><br />
<div>And if not, I'll just ride off into the sunset like good old Admiral Stockdale. Whatever happened to that guy anyway?</div><br />
<div>Be Well,<br />
AM<br />
</div><div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div><br />
<br />
</div><br />
<br />
<br />
<br />
<div><br />
</div><br />
<br />
<br />
<br />
<div></div>Ali Mohamadi, MDhttp://www.blogger.com/profile/05898385458343463419noreply@blogger.com2