Vitamin D- not as helpful as hoped for

Vitamin D- not as helpful as hoped for 

About a year and half ago (May, 2009), I posted an essay that reflected some exciting possibilities for Vitamin D being helpful to health.

As noted at the time, the preliminary evidence suggested that increasing the level of your Vitamin D could possibly reduce the chance of a range of serious illnesses, such as diabetes, multiple sclerosis, and colon cancer, from developing.

The American Academy of Pediatrics had also recently established a recommendation for Vitamin D supplementation for all children, a policy we at Advanced Pediatrics supported.

Today, the nation's leading panel of medical experts, the Institute of Medicine (IOM) published a major report on the use of supplemental calcium and Vitamin D.

http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx

After studying over 1,000 studies on taking extra Vitamin D and calcium, the IOM found that with few exceptions, it was a bad idea.

Here are their findings:

• With regard to calcium, most Americans take enough calcium to meet all their needs.   The one exception are girls ages 9-18.   Older women tend to actually take too much and increase the risk of kidney stones.
• Vitamin D levels in America are much better than one would think.  An adequate blood level of 25-OH-D, the form of Vitamin D that should be measured, is 20 ng/ml, not the 80 or 100 that was once proposed as a goal.
• Taking extra Vitamin D can cause harm to your health.  Over 9 years of age, exceeding an intake of 4,000 Units a day can be harmful.
• The recent claims of health benefits from taking more Vitamin D than simply bone health requires are not supported by this review.
• The recommended dietary allowance for calcium every day is 700 mg for ages 1-3, 1000 from 4-8, 1300 from 9-18, 1000 from 19-70, 1200 from 51-70 females, 12000 if over 71.
• For Vitamin D the recommended dietary allowance is 600 units a day from age 1-70, and 800 after that.

Bottom Line:

The promise and hope that Vitamin D might do more than help bones form has been disproven.

No longer will we be recommending supplemental Vitamin D for most children.

The guidelines above will be our guide for calcium and Vitamin D intake, which is actually quite adequate for all but 9-18 year old girls who should work to make sure they take 1300 mg of calcium a day.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Advanced Pediatrics Upgrades its Electronic Medical Record System

Advanced Pediatrics Upgrades its Electronic Medical Record System

Dear Family,

Everyone at Advanced Pediatrics is very excited to announce that we are upgrading our electronic medical record system.

As many of you know, we have been pleased to lead the way in the adoption of electronic medical record-keeping.  Our office opened with a fully integrated electronic system almost eight years ago.  Microsoft recognized us as a pioneer in this field in 2003.

Now that eight years have nearly passed, we have found a new system that will offer a far more robust system, particularly in our ability to communicate information to every family.  More on those features later.

Right now we want to be sure you know the key items you should be aware of for our four day transition period:

• First, we have all worked very hard to limit the time of transition to only four days.
• Those days will be Monday, November 15- Thursday, November 18
• Advanced Pediatrics will remain fully open during these four days.  
• Phone access will remain completely unchanged in this time period.
• During the days from Nov. 15-18, we will not be scheduling pre-scheduled appointments.
• This means that during Nov. 15-18, we will not be scheduling check-ups or well-baby visits.
• No appointments during Nov. 15-18 will be made on any but the same day.
• During Nov. 15-18, only, in order to be fully trained on the system, the office will take a step we do not plan to do again- limit times for medical care to Noon-1 and 5-6PM.  All three providers, Drs. Lavin and Hertzer, and Ms. Rieger will be available during these times.
• Starting November 19, our regular scheduling will resume, all under our new system
• One last point, since the system will be new, we are going to enter insurance information at every visit, to be sure we have all your information correct in the new system.  So please be sure to bring your insurance card to every visit for awhile, and plan for a few extra minutes to check in.

We appreciate everyone's understanding during these four days.  We will work hard to be sure we can answer all questions anyone has at anytime during this interval, just as we do everyday.

Once completed, we will be very excited to share many of the advances our new system offers.  A couple examples include:

• Electronic prescribing, no more carrying prescriptions to the pharmacy (unless you ask to)
• A secure web page where you can see your family's lab results, and communicate with the office electronically

As with our current system, the overall goal is to get rid of as much frustration as possible when it comes to getting information to or from our office.   Helping you is our key goal, and managing medical information is central to that purpose.

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

A Word on Getting the Word Out

Dear Family,

This is a quick note to discuss how we let everyone know about activities of interest at the practice.

As you all know, Advanced Pediatrics is committed to developing responses to the most pressing
problems and challenges families face.  With that in mind, we have developed programs that range
from lactation counseling, to parenting, to school and cognitive issues, to nutrition, and beyond.

So far, we have decided that when a program is developed at Advanced Pediatrics, we will let everyone
on the email list know about it.  We do realize that not all families are interested in any specific program, far
from it.  After all, most of our programs are relevant to only one age group, and the issue at hand may not
be an issue even for all the children in the relevant age group.

But there are two reasons we do send the information out to everyone:

1. It may turn out you have a friend whose family would be interested or helped by the program
2. It may be nice to know the full range of what goes on at Advanced Pediatrics.

We will try not to send too many emails out to avoid clogging in boxes as well.

So if you get notice of an upcoming approach to children with attention issues but your oldest child is 2 years old, or if you get notice of a lactation counseling service but your youngest child is 15 years old, please don't think we want your 2 year old to get help with math or your 15 year old to address infant issues, it really is just our attempt to circulate information as widely as possible to help as many as possible.

Thanks again for your trust in us,

Dr. Arthur Lavin

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Flu Vaccine Appointments still Open

Flu Vaccine Appointments still Open

Dear Families,

We wanted you to know that our prediction that this flu vaccine season would be far calmer than 

last year's has seemed to come true.

We have plenty of vaccine, so face no shortages, at this time.

And, we wanted everyone to know that appointments to get a flu vaccine at Advanced Pediatrics

are still open and available.

These appointments are currently on October 26 and October 28, both in the early morning period.

So if you want to come in for a flu vaccine, just call 216-591-1515 during normal office hours and 

you can get an appointment.

We are very pleased this year's provision of flu vaccine has gone so smoothly and once again appreciate

your patience and cooperation in ensuring that all children in our community will be protected in time.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Flu Vaccine Update

Dear Families,

Just a quick note that the flu shot clinics are underway.

I did want to let you know that all indications are that the supply of influenza vaccinations this year appears to be abundant.  

Shipping of vaccine remains one set of vaccines at a time.  That is why we are offering one or two flu shot clinics in every email.

It's understandable if you get notice that a flu shot clinic is on a single day or even two days, that one might think they better hurry to grab an appointment, after all only one or two days are being offered.

But the point of this note is to emphasize that we will be offering a series of days, perhaps announcing one or two at a time, but enough over time to accomodate everyone.

So, in great contrast to prior years, in particular last year when we had a scary pandemic and two flu vaccine programs to administer, we look to this year being wonderfully calm.

So please, when you get notice of a flu shot clinic here, don't feel any pressure, we will be offering a number of such opportunities.

Thanks again,
Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Bringing Neuroscience Breakthroughs Home:

Advanced Pediatrics at the 2010 International Meeting on

Evidence-Based Cognitive Training

Advanced Pediatrics at the Forefront of Neuroscience

On September 24, 2010, some of the world’s leading neuroscientists, doctors, and psychologists gathered at the annual Cogmed Conference, held this year in Chicago, to review recent research on evidence-based cognitive training. 

            Advanced Pediatrics was pleased to once more take its place as the first clinical office in the United States to offer Cogmed working memory training, widely regarded as the most substantial form of evidence-based cognitive training to date.

            Every year, the Cogmed Conference has drawn an increasing level of attendance and level of expertise.  This year was no exception.  The number of professionals present was double the prior year’s total.  Clinicians from Korea, Singapore, Sweden, Costa Rica, South Africa, and from over 100 sites across the United States were present.

TOPICS DISCUSSED 

What is evidence-based cognitive training?

Evidence-based cognitive training is any program that has the brain conduct exercises that improve the function of the mind enough to significantly improve the person’s life.  Many programs make such claims, but evidence-based cognitive training are only those programs that can point to research published in well-regarded peer-reviewed journals.

What is Cogmed Working Memory Training?

Cogmed working memory training is perhaps the evidence-based cognitive training with the most evidence of successful impact.  The program is the result of many years of highly regarded neuroscience research at the Brain Institute of the Karolinska Institute in Stockholm.  Its founder, Dr. Torkel Klingberg, received the Philips Award as one of the world’s leading neuroscientists in 2008(?).  After spending years in careful development and evaluation, many thousands of people have completed Cogmed Working Memory Training with results very consistent with the research findings: 80% of those trained have improvement in cognitive function large enough to improve the lives of those trained.  Improvements cited include better attention, organization, and success at school, work, and home.  Centers that have studies and published their findings on Cogmed Working Memory Training include Harvard, Stanford, New York University, Notre Dame, York University (UK), and the Karolinska Institute (Sweden), among a very rapidly growing list of the world’s leading centers of research on the brain.

What is working memory?

Working memory is the ability of the mind to consciously hold more than one piece of information at one time and do something with those bits of information. 

And so, working memory is not really memory as we think of memory.  Memory is about remembering something from the past. Working memory is about doing something with information at hand in the present.

Perhaps the best way to appreciate this idea is to think of the brain’s job falling into three connected goals:

1.To take in information

2.To understand information it takes in

3.To do something, complete a task, with information it understands

 Working memory is the function of the mind that connects understanding and doing. 

 Once you know something, working memory appears to be the most important function of the conscious mind that translates knowing into doing.

How important is working memory?

As noted above, Dr. Alan Baddely developed the concept of working memory about 40 years ago.  Ever since then, neuroscientists have found more and more proof that working memory may be at the root of many of the most common problems in thinking, namely:

·   Getting something done

·   Understanding complex directions

·   Completing assignments on time

·   Remembering what you were asked to do

·   Being socially successful

·   Doing well in school

·   Doing well at work.

WHO PRESENTED? 

Present were some of the world’s leading experts on how the mind generates attention.  These included:

Dr. Susan Gathercole, head of the British lab where some of the most important work on defining the core element of attention, working memory, has been done.  She presented recent studies that demonstrate how nearly all children who struggle in school have a deficit in working memory, and, further,  enhancing working memory can improve nearly all children’s level of academic achievement.  www.yorkU.edu.en

Dr. Mark Rapport, one of America’s leading researchers on ADHD, from Florida, presented just published ground-breaking work on exactly what in the mind of a person with ADHD.  Key to his findings was the actual causes of the impairments that ADHD causes, namely school failure, social isolation, disorganization. www.childrenslearningclinic.com

Dr. Rosemary Tannock, widely regarded as one of the top authorities on the management of ADHD, presented her recent findings on the impact of evidence-based cognitive training on school performance and the symptoms of ADHD.  www.

WHO BENEFITS FROM EVIDENCE-BASED COGNITIVE TRAINING?

The conference also featured presentations from a wide variety of practitioners across the US and the world sharing their experiences on the impact of evidence-based cognitive training.  Their observations offered proof that evidence-based cognitive training has a positive impact in these settings:

Schools.    Several schools presented their findings that students who undergo evidence-based cognitive training do better in their studies- more organized, calmer, more confident, less distracted, better able to follow directions and expectations, more homework completed, with improved grades.  As noted above, one study demonstrated such improvements for children with and without working memory deficits.

Traumatic Brain Injury (TBI).   Adults who had evidence-based cognitive training noted improvements  on task completion, occupational performance, and satisfaction with performance, overall health.  The adults described being more alert, more awake, more aware of what is happening, lifting the fog, better able to help their children with homework, more focused, and overall more confident.

Down Syndrome.   This presentation was also from Dr. Gathercole’s group, the leading authorities on the working memory in the world.  They found that initial observations on a group of children with Down Syndrome, with intellectual level of function averaging at the five year old level, responded well to evidence-based cognitive training. Teachers of these students, who were unaware of their training, spontaneously reported to parents that these children seemed calmer, more focused.  Parents agreed and also noticed decreased hyperactivity, less frustration, and that they remembered instruction sets better.  Based on the strength of these observations, the group will be conducting a randomized controlled trial to prove and measure the impact of evidence-based cognitive training in children with Down Syndrome.

Depression in the Elderly.  This study from Georgia demonstrated that evidence-based cognitive training can reduce the burden of depression in the elderly.

Cognitive Loss from Cancer Treatment.  Children whose brains are exposed to chemotherapy or radiation lose cognitive abilities an often suffer a loss of ability to concentrate or focus.  This team from Duke presented many years of work demonstrating that evidence-based cognitive training can restore enough of this lost function to make a significant difference.

BOTTOM LINE

·         An explosion of understanding of how the brain actually works is just now leading to applications that can help each of us think better and more effectively.

·         Evidence-Based Cognitive Training represents the best of those applications.

·         Cogmed represents the best of the evidence-based cognitive training protocols.

·         Advanced Pediatric is the first clinical office in the United States to offer Cogmed Training to its patients and to the general public of all ages.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Advanced Pediatrics Earns the Respect of Angies' List Customers

Advanced Pediatrics Earns the Respect of 

Angie's List Customers

We wanted to share some very good news, and thank everyone in the practice 

for their good words.

This week I received notification from Angie's List that Advanced Pediatrics has an "A" rating in their Health Category.

We are thrilled to have earned your respect, appreciation, and trust, and will continue to work hard to earn it.

Some of the comments were quite moving, we are truly very grateful to be able to help out.

Here are two sample comments from families:

"Dr. Lavin has been our family's pediatrician since we moved to Cleveland over 15 years ago. He has helped me raise my three kids into healthy teenagers. He almost always leaves time to just chat and usually listens well to our concerns."

"My daughter had been sick and I took her into Advanced pediatrics They saw her immediately, we got a "same day" appointment. Kelly (the P.A.) listened to my daughter's breathing, then sent her literally next door for an x-ray. How convenient! Then the x-ray walked us back to Advanced Pediatrics and handed the radiologist's diagnosis off to the office. We got a prescription and were on our way, in less than an hour. Then I was concerned that my daughter wasn't recovering at a good rate. They got me in immediately with Dr. Lavin, he listened to my concerns, then checked out my daughter. He let me his opinion and backed it up with research and a personal anecdote, which was reassuring. Neither Dr. Lavin nor Kelly makes me feel silly when I have a worry, they value my opinion and work with me toward my daughter's best health!"

Thanks to all once more,

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.