March 2014
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March 2014 posts

If your newborn is diagnosed with hypospadias

As a pediatric urologist, I am frequently asked to consult with parents whose newborn son has hypospadias.  

Hypospadias is usually diagnosed during the physical exam right after the baby is born.  When parents see the abnormal penile anatomy they naturally want to learn about the diagnosis and understand what, if anything, needs to be done. Answering these questions, discussing options, and performing reconstructive surgery to help restore normal penis appearance and function are some of the most rewarding things I do as a pediatric urologist. 

I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is well tolerated, and a good outcome with a normal, or near normal, penis appearance and function can be achieved.

It is not urgent to treat newborns with hypospadias because they can usually pee (urinate) just fine through their existing urinary opening.

In fact, when hypospadias is the only condition noted in a newborn physical exam there is a low chance of additional developmental abnormalities. Additional tests and studies on the baby are usually not necessary.

It is important to note that if any unusual shape of the penis or urethral opening (where the pee comes out) is present then circumcision (if desired) should not be performed until after the child is examined by a pediatric urologist. This is because the pediatric urologist may need to use the foreskin tissue for the surgical repair. 

Here are answers to some commonly asked questions:  

To Mammogram or Not to Mammogram? A note on recent studies

A Canadian medical research study has recently been published questioning the value of doing screening mammograms on women in their forties. The article has spurred controversy because the results contradict multiple other similar research studies which showed that women in that age group who get regular mammograms actually are spared death from breast cancer more often that women who are not invited to screening.

Some problems with the methods of Canadian study, published in the journal BMJ, were pointed out by a scientist at the University of Washington, Judith Malmgren, who has worked with Swedish Medical Center doctors to see how women in their forties have fared in our system. Click here to read Dr. Malmgren’s letter to the editor of BMJ.

There are two ironic features to the Canadian study. First, the authors say it is okay for women to not get screening starting in their forties “when adjuvant therapy for breast cancer is readily available.” This means that it is okay to diagnose breast cancer later because you can mop up bigger and more advanced cancers with treatment like chemotherapy, radiation and bigger surgery. But at Swedish, we do not think that many women prefer more severe therapy rather than earlier detection.

Secondly ...

Weak link between epsilon toxin and MS

A recent article has been published suggesting that MS may be caused by a bacterial toxin. The bacteria is Clostridium Perfringens, a common bacteria found in soil and a cause of food poisoning. This bacteria can produce a number of toxins, one of which is the epsilon toxin.

This study found that about 10% of people with multiple sclerosis (MS) had antibodies to the epsilon toxin, compared to 1% of people without MS. In pathology specimens from mice, the epsilon toxin was found to bind to blood vessels in the retina of the eye, and to myelin in the brain. The authors also reported a single case of a woman with MS who was infected with Clostridium Perfringens and that was producing the epsilon toxin.

Though this study has been widely discussed online, I think that it is unlikely that this will be the answer to the MS problem. This study was primarily in pathology tissue, which found that the toxin was able to bind to myelin. Many more studies will be needed to determine whether this toxin is capable of causing damage to myelin of the type that is seen in MS. There are many other known toxins to myelin, but so far none seem to be the cause of MS.

They tried to show that ..

Pituitary Tumors: Diagnosis and Management

The Swedish Pituitary Center at the Swedish Neuroscience Institute is one of the country’s largest centers for treating disorders of the pituitary gland – including pituitary tumors. The center brings together endocrinologists, neurosurgeons and radiation oncologists to offer a comprehensive, multidisciplinary approach to the diagnosis and treatment of these tumors.
 
Tumors in the pituitary gland are quite common and many of them are so small they may go undetected throughout life. Although 99 percent of pituitary tumors are benign, the associated symptoms can be
debilitating, especially with hormone-secreting tumors. Regardless of the type of tumor, individuals with pituitary tumors may experience headaches, blurred vision, impotence/infertility, and mood changes.

Adding kale to your repertoire

Thank you to everyone who stopped by for the first week of National Nutrition Month yesterday! It was a big success and you made it possible! The overall feedback we received was very positive for the Kale salad we shared, even those who thought they didn’t enjoy kale! This proves a great example of exploring new, nutritious foods to add to your current diet that you might not have tried (or liked) before.

For those who found the below recipe too salty, you can reduce the sea salt to 1/2 teaspoon and add just ¼ cup of gorgonzola cheese. The sea salt is pertinent to “massage” the kale which helps tenderize the leaves. You may also substitute gorgonzola cheese for a reduced-sodium goat cheese or feta instead. Enjoy!

Massaged Kale Salad


Lymph nodes in children

One of the most common referrals to my pediatric surgery practice is (in the parents’ words) “to check out this lump and make sure it’s nothing to worry about.”  Lymph nodes are part of the less publicized part of the circulatory system: the lymphatics.  Lymphatics play a key role in our body’s immune system, and lymph nodes grow in response to an infection in the “neighborhood” to produce cells necessary to hopefully resolve the infection. 

About half of all children will develop enlarged lymph nodes (cervical lymphadenitis) in the neck for example, and the vast majority of these are in response to a minor infection in the area (sore throat, sinus infection, ear infection, etc.).  Often the infection is quite subtle and might not be identified.  These nodes typically go through a pattern of growing and then receding in size once the infection resolves.  This process can take several weeks to months.  The nodes may become tender, warm, and there may be some redness of the overlying skin.  Your child might complain of pain in the area, be fussier, have fever, and/or have decreased appetite.  If the node itself becomes infected, it can turn into an abscess and would require antibiotics and a drainage procedure.  Any possibly infected lymph node should be evaluated by your doctor.
 
Some enlarged lymph nodes ...

Enjoy the taste of eating right - National Nutrition Month 2014

In honor of National Nutrition Month®, the Registered Dietitians and Diet Technicians of Swedish Medical Center will be promoting healthy eating and proper nutrition each Wednesday in March during lunch hours (11am-2pm) at the First Hill, Cherry Hill, Ballard, and Issaquah Campuses.

This year’s theme is “Enjoy the Taste of Eating Right”. Research by the Academy of Nutrition and Dietetics found that taste is the main reason Americans will select one food over another. This creates a complicated dilemma, as the foods you love will likely become the ones you eat the most. The challenge is to create easy to prepare, delicious, and nutritious meals and snacks that are low in fat, sodium, and added sugar.

The nutrition experts will be providing healthy tips, recommendations, and information to encourage and improve the nutritional health of the Swedish community. There will be ...

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