Getting to the Root of the Matter

Getting to the Root of the Matter

Kathleen Ang, BS       Charles W. Hartin, Jr, MD        Philip L. Glick, MD MBA

As pediatric surgeons, we never expected to be writing an article such as this, but the rash of skin infections related to shaving various parts of the body is reaching epidemic proportions. In the last decade, pubic hair removal has been on the rise amongst teenage boys and girls.  This practice can be traced back to ancient Egypt and Greece in the 17^th century.  By the 1940s, female body shaving, especially in the underarm region and legs was established as the cultural norm, and pubic hair removal trailed closely behind, booming in popularity since the 1980s.  The reasons for shaving are vast and have been evolving since the practice first began.  First done to prevent parasite infestation,  it is now practiced to increase feelings of sexual attractiveness and the desire to feel “clean” and “neat” in the most intimate of body regions.

                As the incidence of pubic hair shaving has risen, so has the outbreak of infections caused by antibiotic resistant staph bacteria (MRSA), which thrive on normal skin in warm, moist places such as groin creases and armpits.  Improperly shaving these areas can cause small cuts in which the antibiotic resistant bacteria can invade, possibly leading to infection of the soft tissue around the area (cellulitis) or formation of pus pockets (abscess).  Over 1000 kids with skin infections are seen annually at Women and Children’s Hospital of Buffalo and approximately 20 percent of which are likely related to improper shaving of the groin, legs or armpit areas.

                To prevent or reduce such infections, we recommend using hair removal techniques that minimize skin damage or we suggest avoidance of shaving altogether. Tweezing, waxing, sugaring and epilation are all mechanical techniques to pull each hair from its root and are time consuming, painful, cause damage to the skin, and should generally be avoided.   Another method is chemical depilation, which works by dissolving the hair follicle so, it can then be wiped away providing a smooth result. Although inexpensive, depilation can result in a chemical irritation and cannot be used near the genitals.   Permanent methods of hair removal that destroy the hair follicle, e.g., lasers and electrolysis, have risen in popularity, but are expensive, time consuming and results vary.  Shaving is the most common method of hair removal but should be performed with electric razors, clippers or single use safety razors (on well lathered skin) designed specially for the armpits, legs and pubic region.  Trimming pubic hair using scissors and a comb to avoiding contacting the skin is the safest, cheapest, and least irritating of removal methods.  Adolescence is a very difficult stage of development.  Avoidance of complicating it with preventable skin infections seems prudent.

Ms Ang is a Medical Student at SMBS, SUNY@Buffalo.  Dr Hartin, Jr, is a Pediatric Surgical Fellow at WCHOB and Dr. Glick is a Professor of Surgery, Pediatrics, and OB/GYN, WCHOB and SMBS, Department of Surgery, SUNY@Buffalo

Gronkowski Rule: Fact or Fiction?

Gronkowski Rule:  Fact or Fiction?

I enjoyed Allen Wilson’s commentary about the success of the Gronkowski boys in the NFL  A dream comes true for Gronkowski - News - The Buffalo News http://www.buffalonews.com/incoming/article10937.ece.  A common thread throughout the article was the competition fostered by their dad.  Wilson’s only erratum was not giving equal credit for the boy’s success to their mom, Diane; as I recall, she was also a competitive collegiate athlete.  Most importantly, Gordie and Diane deserve much credit for emphasizing a balance between academics, citizenship and athletics;  They’ve raised 5 good boys.

Our family met the Gronk Nation via Amherst Hockey House League.  Our son Zack played on several teams with Chris or Dan.  In 1992-93 both boys were on the Penguins (mini mites) with Zack.  Although the house league rolled 3 lines (A, B, and C lines), when Dan and Chris were on the ice together (A line), they were a goal scoring machine and unstoppable; even at that age, they were men amongst boys.  Following that season , the two boys were never drafted onto the same team again, much to the protests of Diane who wanted the convenience of only having to drive to one practice or game, instead of two.  Although never officially stated, the Amherst Hockey Board of Directors were alleged to have passed the “Gronkowski Rule,”  which stated, that in  order to maintain competitive balance in the house league,  only one Gronkowski  per team.  FYI, in 95-96 Zack’s team, the Kings (squirts) won Super Sunday;  thanks Dan. 

Unless there is reform of New York State government, the joke is on us!

Unless there is reform of New York State government, the joke is on us!

A funny thing happened on the way into a local store this week, I ran into a politician. He handed me a flyer, and said, “I’m Robin Schimminger, and I hope I can count on your vote.”  I took the leaflet, and then walked on.  In the check out line, I read the flyer.  The bullet point that caught my eye was “Reforming State Government.”   On my way, I introduced myself and asked him what he meant by “Reforming State Government” He said, “what do you mean?”

“What do I mean?”  Again pointing to his flyer I asked, “what are your plans for reforming state government?”   I explained to him, the NYS citizens are completely fed up with Albany politicians and the dysfunction of NYS government.  Why are our state budgets always so late?  Why is there no transparency to the budget process?  Why does our state spending exceed the state’s revenues?  How was he going to stop Sheldon Silver’s strangle hold on the government? Again, I asked him how he was going to “Reform State government?”  This was reminiscent of Abbot and Costello’s routine,  “Who's on First?”

He explained to me how he had the endorsements of  business councils and federations of NYS.  Again, I asked him how he was going to “Reform State government?”  He told me,  as an individual he was powerless to fix the problems I had asked him.  His faux smile was now glued on more tightly. And then like a good politician he asked me where I lived.  He realized I  didn’t live in his district and he stuck his hand out, said thank you and walked away.

I didn’t write this to be specifically critical of Mr. Schimminger, but as an incumbent, he is part of the problem.  I would ask the same questions to my NYS Senator Mike Razenhofer or NYS Assembly person Jim Hayes, but his obvious fumbling around the giant elephant in the room is emblematic of the problems in NYS. 

My wife and I are transplants to WNY.  Our family has thrived here.  However, since our arrival we have seen the state’s death spiral increasing its velocity.  Our kids, like many, move away for college, graduate school and permanently relocate.   We’ve watched the population of WNY shrink; not an insignificant concern for 2 pediatric doctors, let alone the future of WNY.  As SUNY@Buffalo faculty, we feel the bite of Albany’s budget tardiness and contraction.  Albany’s failure to pass UB 2020 legislation was pathetic; I understand why President Simpson has decided to “retire.”  Our taxes are too high, our infrastructure is crumbling, and the down state political machine is strangulating WNY’s ability to fix itself.

Clearly Mr. Schimminger and the remainder of his Albany incumbent cronies just “don’t get it.”   His campaign motto, “promises are easy to make, performance takes hard work” is disingenuous.  If there were qualified people to replace all the incumbents, it would be an admirable goal. Our current state legislature environment is polarizing.  Will they be able to “reform state government?”  If significant NYS Government Reform does not happen, the joke will be on us!   Governor Cuomo we need your help; keep your boot to their necks.

Is it a right, privilege, or a necessity to communicate via social networking with my doctor?

Is it  a right, privilege, or a necessity to communicate via social networking with my doctor?

The question I (http://twitter.com/glicklab (@glicklab)) recently posed to a 3rd year medical student was,:  "Is it  a right, privilege, or a necessity to communicate via social networking with my doctor?" 

I'd love to hear what you (@Susannahfox) and your followers at e-Patients.net have to say about this.  any primary sources you could recommend to us would be greatly appreciated.

As some back ground information:

    - By social networking I'm not referring to emailing with your doctor.  Which, BTW, email is an avenue of communication underutilized by  physicians.   But in some highly integrated environments, i.e., Kaiser Permanente,  has been shown to be efficient, effective at disease management, and accepted by both the patients and the medical staff.

    -  By "a right" I'm referring to the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. In it, patients have the right to accurate and easily-understood information about their health plan, health care professionals, and health care facilities. Also, patients have the right to know their treatment options and take part in decisions about your care. Parents, guardians, family members, or others that they  choose can speak for them if they cannot make your own decisions.  But currently no where does it state how this information is communicated.  Traditionally, >99% of this is done face to face, physician to patient or to their health care proxy.  But does, the option of communication via social networking need to be added to future versions of the  Consumer Bill of Rights and Responsibilities in the future? 

    - By "a privilege" I'm suggesting that at this moment, 2011, physicians are in a voluntary "op-in"  mode to participate in social networking.  In a recent American College of Surgeons Survey as high as 80% of surgeons have visited a social networking site, but most use if for personal reasons only.  Only a small percentage of us, early adaptors,  have recognized the power of social networking for patient related matters and we need to help move our colleagues from awareness and understanding to adoption and institutionalization. 

    -By "necessity" I'm asking, can we afford to miss this opportunity?  Our health care system is severely broken.   We need to get in on the proper trajectory or system will collapse because of excessive cost and less than satisfactory results.  Many solutions have been suggested and recently legislated;  time will tell if these "fixes" will work.  However, social networking may be another tool to help us control costs, improve disease management (especially chronic diseases), improve patient satisfaction, improve physician satisfaction, decrease excess utilization of services, empower patients with shared decision making, improve health literacy, and/or to help to level the playing field with information transparency to shift us from a fee for service health care market to a pay for performance health care market at both the physician and hospital levels. 

Again, I'd love to hear what doctors, patients, and  the e-pt community have to say about this.  any primary sources you could recommend to us would be greatly appreciated.