If you don’t have an Advanced Directive… keep reading.

Advanced DirectiveBy Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group.

Do you wonder why every medical facility asks for an advanced directive, living will or DPOA when you check in? Do you even know what that is? Do you know why it’s important? Do you know why every adult (18+) should have one? Do you know how to get one?

In short, an advanced directive documents your health care wishes in the event you’re unable to tell others how you want to receive care.

According to AARP, an advanced directive is a general term that refers to the various documents that includes phrases like living will, instruction directive, health care proxy, durable power of attorney (DPOA) and health care power of attorney.

Advanced Directives are FREE or nearly FREE!!!

Does that get your attention? It’s easy to get advanced directive health documentation taken care of at low or no cost to you at all. You don’t have to have an expensive lawyer to be able to have this part of your healthcare information enacted. All you have to do is fill out a form, then have it notarized (this may be minimal cost but generally less then $5.)

A notary can be found at places of employments, banks, financial institutes, real estate agencies, hospitals etc. I often joke with parents that they should pass out Advanced Directive forms at their next family gathering and have everyone above the age of 18 fill it out. It can always be revised later, voided or a new one executed as life circumstances change (marriage, deaths, children become adults etc.)

Important Terms to Understand

Living Will

A living will (or instruction directive/advanced directive) tells health care professionals and your family what you want or don’t want done concerning your health care needs if you are unable to voice or make your own health care decisions. This has nothing to do with your will of your possessions that an attorney helps with (Uncle Joe gets my boat, etc.)

An example of a situation that you might use the health care directive/living will is while you are sedated for surgery and an emergency or new problem arises and someone has to make a decision, but you are sedated and not available to make it for yourself. Another example is you are in a car accident and hit your head and you can’t make decisions for yourself until the swelling goes down and the breathing tube is taken out. This is when family and medical professionals can look at your advanced directive (health care directive) to answer some of these questions.

Durable Power of Attorney

Durable power of attorney (DPOA/health care proxy) is someone (one or two people) designated to know your wishes and make decisions on health care situations only in the event you are unable to make those decisions. Often it’s a spouse, family member, or trusted friend. The idea is that you have discussed your wishes and desires about your health care BEFORE the need to make those decisions arises.

Talk to your family about if you would want to be on a ventilator for longer than a month, would you want antibiotics and feeding tubes if there was no hope of you getting better, do you want CPR if you are brain dead. These are all difficult conversations for some, but growing up in a healthcare family, these were all things we talked about on a casual level, maybe at the dinner table.

I’ve been told several times, “I don’t want that paperwork filled out because I want them to do everything possible to make me better if I’m ever in that situation.” Just because you have an advanced directive filled out doesn’t mean the hospital will not care for you or provide every opportunity for recovery, it just means they have YOUR opinions about certain situations in writing in case any of them arise.

There are other forms for those that choose not to have a breathing tube, CPR etc. done that is usually referred to as a DNR meaning “DO NOT RESUSCITATE”. Again, this is only put in affect if you’re not breathing or your heart has stopped. To be blunt, you’re already dead by clinical definition, it’s just if you want techniques and machines used to help possibly bring you back to life.

Every medical provider will do everything in their power to help you unless there is strict paperwork filled out that mandates that they omit certain care/treatment!

Many forms have all the above terms/information included in a single form, so you don’t have to fill out a bunch of separate paperwork. You fill out what you want filled out, you don’t fill out what you don’t want to address.

These forms sometimes have a location on them related to organ donation wishes. All adults should consider organ donation. I will be writing another blog in a few weeks about DNR and organ donation. That may answer some questions and tell you about our family’s personal experience with organ donation.

Until then, get your advanced directive filed out and notarized and then give a copy of it to family, your primary care provider and take with you with any hospitalization/surgery.

AARP is another source of more information on this topic or the state of MO website: ago.mo.gov.  Information can be found at http://livingwillforms.org/mo/

Preparing for Launch: Life Changes When Your Child Goes to College

By Jennifer M. Sauer, M.D.

In the words of Thomas Rhett’s song “Life Changes”

“Ain’t it funny how life changes
You wake up ain’t nothing the same and life changes
You can’t stop it just hop on the train
You never know what’s gonna happen
…And I wouldn’t change it for the world, the world, oh no”

Preparing for Launch: Life Changes When Your Child Goes to CollegeA monumental “Life Changes” moment is about to happen for this Pediatrician Mom. There will be dorm bedding and decorations to buy, books to order and making sure she can check her tire pressure of her car. But this blog is about how I get to prepare for the emotional launch of a college child first-hand.

Come August, we’re going to move the girl we’ve been so focused on for 18+ years into her dorm room three hours away.

This is something that we all know will happen when we bring a baby into the world, but it sneaks up on us parents. The saying “the nights are long, and the years are short” is very apparent to me right now. I could be saying “Houston, there is a problem.” But the child (the rocket) is ready to fly. The goal is to raise functioning, independent members of society, but when it gets right down to it, it’s hard to let go.

So am I nervous? Yes, but also excited.

I know that perspective of a situation is what we can control. If you think about being nervous, our heart rate and blood pressure go up and we can’t sleep. When we are excited, our heart rate and blood pressure go up and we can’t sleep.

Research conducted at Harvard University (Journal of Experimental Psychology: General © 2013 American Psychological Association 2014, Vol. 143, No. 3, 1144–1158) showed  “Individuals can reappraise anxiety as excitement using minimal strategies such as self-talk (e.g., saying “I am excited” out loud) or simple messages (e.g., “get excited”), which lead them to feel more excited, adopt an opportunity mind-set (as opposed to a threat mind-set), and improve their subsequent performance.

Fear of the unknown can be looked at as scary or as a new opportunity.

I’ve preached to my kids over the years, and they say I should just have a book of one liners:

  • “If I don’t have expectations for you, who will?”
  • “With great gifts comes great responsibility.”
  • “Perfectionism is NOT an obtainable goal. Work hard but you can also learn from failure.”
  • “You are resilient.”

Thomas Edison said, “I have not failed. I’ve just found 10,000 ways that won’t work.” So as a parent, we’ve been preparing for days, weeks, years before the moment we help launch our child into a new phase of their life. We hope that we have instilled our knowledge into them over the years so they can pull from the life lessons they’ve already experienced. These are tools in their toolboxes to deal with what is yet to come.

Preparing for Launch: Life Changes When Your Child Goes to CollegeAt our daughter’s recent college orientation, there were “lectures” for the parents while the students were whisked off to set their first semester schedules (no parents allowed for that process).

Topics that were discussed included Eustress- moderate or normal psychological stress interpreted as being beneficial for the experiencer. The student will need to have new experiences to grow instead of just interpreting the outside world as big and scary. There will be stress with this new chapter of all of our lives (both her and the family left behind in Lees Summit) but we need to teach our kids that they are resilient (resilient is my favorite word in the whole dictionary).

If I were actually doing a VLOG, I am told by my to be college freshman that I would be talking with my hands and emphatically saying, “SEE?!?! STRESS IS NORMAL! IT’S EVEN HEALTHY!”

Her college is now the one that will preach to her on a daily basis and they expect self-authorship.

Kids need to take control of the wheel with us in the background. In turn, they get the chance to show how resilient they really are, but also to relish in THEIR own accomplishments. Will I cry when I leave our daughter in her dorm room? I’m sure I will, but to quote Dr. Seuss, “Oh the places you’ll go”.

I am labeling this new adventure of life as exciting and look with positive anticipation of what is to come. The countdown has begun.

The importance of taking vacation: Travel pics from Wendy, Julie and Rhonda.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group.

Have you ever wanted to just get away on a vacation? Did you know that vacation and mental breaks away from day-to-day stressors are actually healthy? Yes, you can take a vacation for your health!!!

Here at Lee’s Summit Physicians Group, we recommend that our staff takes mental breaks by going on vacation and taking time away from the office. Three staff members have shared their recent adventures with us with pictures (for those of us who can’t afford to travel and want to live vicariously through their pictures!)

Wendy Johnson, Care Coordinator, is an adventurous type of person.

She and her husband love to travel and see new things. Thailand was one of her most recent adventures. When asked WHY there, her response was it has been on her bucket list. She has been intrigued by architecture and the countries amazing traditions. She enjoyed seeing an elaborate temple from the 14th century. Wendy said, “seeing the floating market where the local community pilots their little boats to the docks to sell their produce right out of the boats was really something worth seeing.” She even got to see them “cook in the little dug out boats.”

When asking Wendy what was unexpected about her adventures, she said the traffic in Bangkok. “Motorcycles are very common. At the red traffic light, they all make their way to the front of the line and take off as a pack when the light turns green.” Unfortunately, after eating off the food trucks, Wendy came home with food poisoning. She was not wanting THAT experience in her travels!

Wendy’s advice when traveling to Thailand is to walk the city streets and cut through the alleys so you can experience how the locals live. She also encourages the use of Groupon as this was her “best bargain trip” and it was that it was amazing. “Travel opens your eyes to how fortunate we truly are” so that we “appreciate even he small things.”

Vacation is Healthy: Thailand Vacation is Healthy: Thailand Vacation is Healthy: Thailand

Julie Gramlich, Insurance and billing supervisor took at trip with her son’s school class to Italy.

Her favorite part of the trip was the gondola ride in Venice! “I have always seen those on TV and thought it was really cool that I was getting to ride one!” One thing unexpected that she learned is how much she loves ice. In Italy, ice is rare and most locals don’t use it at all. Julie said she was surprised at how much she missed ice.

When traveling there, Julie recommends using guided tours. Tours give you special access to some places and keeps you on schedule. She would recommend to avoid summer time heat there. She experienced melting July heat. “The most beautiful place was Capri.” She describes the beautiful country side and said that the architecture was breathtaking.

Vacation is Healthy: Italy Vacation is Healthy: Italy Vacation is Healthy: Italy

Rhonda travels a little closer to home, Warsaw, MO, the spoonbill capital of the world!

Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group, likes going back to her hometown about 98 miles away from KC. She loves “being with old friends” and attending local events, allowing her t0 run into friends that she hasn’t seen in years.

Rhonda boasts of the many things to do in Warsaw, and it’s close to both Truman Lake and Lake of the Ozarks. Things to do include: fishing, water sports, bike trails, antique/flea market shopping and taking in the beautiful scenery. She recommends making the 1.5 hour trip from KC as a day trip or a nice, long weekend.

There are several wineries along the way from KC to Warsaw. One of the top things to see is the Missouri conservation fish hatchery. “Kids love this!” she adds.

In April Warsaw hosts the Benton County Wine Stroll featuring many Missouri wineries. June is Jubilee Days on the harbor with craft tents, carnival, parade, and live bands. During the summer boating and fishing is top of the list of things to do and many enjoy swimming and jet skiing as well. October is Heritage Days with craft tents and festivities at the Harry S. Truman Overlook. This event takes you back in time to experience an old school house, general store, soap making, blacksmith exhibits, root beer and kettle corn!

Vacation is Healthy: Warsaw

Rhonda’s favorite spots in Warsaw include:

  • The Landing Bistro & Lounge with “a great view of the Lake of the Ozarks with an awesome gift shop.
  • Nix Bar, a local favorite.
  • Red Wing Coffee, they grind their own special blends and make wonderful desserts to satisfy your sweet tooth!”

Rhonda would live in Warsaw again if she could… she said it was a “great place to grow up and a great place to go back home to.”

Vacation is Healthy: Warsaw Vacation is Healthy: Warsaw Vacation is Healthy: Warsaw

So here is to travel, staying healthy and enjoying the sights, sounds, smells of the world around us! Have a great summer!

How do you know if your child has a concussion?

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Spring fling… for sports goers sometimes that’s more than just having fun. Spring brings more physical activity and sometimes falls and concussions. New standards and precautions are in place to keep brains healthier and ultimately happier.

Symptoms of Concussion

ConcussionSymptoms of head injury and concussion a few hours after an event is memory loss of what happened right before the injury. There can also be confusion, headache, dizziness or trouble with balance, nausea or vomiting, sleepiness, and being fussy/cranky.

Symptoms that can occur hours to days after the injury include trouble walking or talking.

Memory issues include problems paying attention, trouble sleeping, mood or behavior changes, vision changes or trouble with bright lights/sun or even noise.

If you notice these symptoms report them to the coach and seek treatment from medical professionals. Exams, testing and follow up is a must for a successful recovery.

Treating a Concussion

Treatment includes limiting activity until symptoms resolve which includes physical rest and mental/brain rest. In other words not going to school or work to avoid mental exercise/stress and not returning to exercise or activity that stresses the body. Also avoiding screen time until symptoms are resolved, then slowly introducing it back into daily life… YES. It means your PHONE and TEXTING or SOCIAL MEDIA TOO!

Oh, part of treatment is brain rest, so allowing the person to sleep is okay, just make sure that they’re checked on frequently, and when they do wake, that they are evaluated to make sure symptoms are not getting worse. Returning to school sports will also include notification to the athletic trainer or coach for retesting before returning to normal practice and game routine.

Be Careful Out There!

Be careful out there this spring/summer, but remember that activity is always important for healthy bones/muscles and brains/minds, so don’t use this article as an excuse to rest your brain and body for too long. Activity keeps us young and healthy.

Source: In part from the Up to Date patient handout: Concussion in children and adolescents.

Top 5 Insurance Related Tips for Making the Most Out of Your Next Office Visit

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group

Lee's Summit Physicians GroupThe following tips are the top five common questions we hear related to insurance and first visits with our providers.

What should I know, especially a new patient visit to make the most of my visit with my doctor?

The best thing keep in mind is KNOW your insurance. We, as your health care provider and staff, don’t know everything about your insurance. And please be prepared to pay your co-pay.

Educate yourself on your co-pay amounts for your Primary Care Physician and Specialists

If there’s anything you need to know about your healthcare coverage (besides which physicians are in your network), it’s your premium, deductible and copay amounts—call the number on the back of your insurance card to get this information. Be prepared to pay your co-pay and to present your insurance card and photo ID at every visit.

What will my provider need at my first visit?

Be proactive and have a list of medications, strengths and how you take them. Be prepared to list allergies, past surgeries, and past medical and family history. This will save the nurse time, and the faster they can get all this information entered into your chart, the more time you will have with your physician.

Make a list of questions for your provider. (*Note* They may not be able to address all of your issues in one visit.)  If you have a chronic condition such as Diabetes or hypertension, it would be helpful to keep a log of your blood sugars or blood pressure readings to make sure you are on the correct medication and dosage. Remember to be your own advocate!

How do I know if my insurance requires a referral?

The best way to know if your insurance requires referrals is to contact your insurance carrier directly. The phone number should be located right on your insurance card. Your insurance card may even indicate if you require a referral directly on the card itself. If this is the case, make sure the nurse is aware that you need an insurance referral so it can get to the proper staff that handles the insurance referrals.

Many specialists will need a physician-to-physician referral which will include a fax from our office stating why you are being referred to them. We normally fax the order, office notes, insurance information and labs, x-rays or anything else pertinent to why you are being referred to them. We do our best to make sure we are directing you to a physician that is in your network, but ultimately this is up to you to verify prior to your appointment with that specialist.

Learn which physicians and practices are in your provider’s network.

Even though you have health insurance, that doesn’t mean you can visit any doctor or hospital and be covered. We do our best to keep you within your network, but you’re responsible for knowing what hospital you can go to, specialists you may be referred to and what lab and pharmacy your insurance prefers.

With all this information, I hope your next visit to your physician’s office will be more efficient and informative for you!

KNOW your history! ASK questions! PROTECT your children! IMMUNIZE!

By Dena Pepple, R.N. for Lee’s Summit Physicians Group

I love to read, and historical fiction is my favorite subject. For Christmas, my wonderful sister-in-law gave me a Barnes & Noble Nook. Since then, I’ve probably read three books a week about wars, orphan trains, politics, and more. Oddly, in several of these books disease epidemics, that we now have vaccines for, were an integral part of the story. As a pediatric nurse who talks to parents daily about immunizations, I found this very interesting.

Many of these diseases I’ve never seen personally, yet statistics and history tell me of their toll on human life.

In the 1920’s, 10,000+ lives were lost for several years in a row due to diphtheria. Polio paralyzed or killed thousands in the 1940’s and 1950’s. At the height of the measles outbreak, prior to vaccination, an estimated half a million children per year got the disease, with many progressing to pneumonia, encephalitis, and death.   These, and many other diseases, were tragedies that today’s vaccines have saved us from.  Vaccines have protected us so much that most people, like me, have not witnessed the death and destruction that many of these diseases have caused.

Knowing this disease/vaccine history and having the lives-saved statistics of vaccines at our fingertips:

…I wonder why some parents choose not to immunize.

I think there are three main reasons.

ImmunizationFirst, we in the vaccine world are “victims of our own success”. Most of the diseases we vaccinate for have seen a 90%+ decrease in reported cases. We rarely hear about or see these diseases and think it won’t happen to us, or it’s only in other countries.

Second, some parents have had no information about vaccines, and have genuine fear.

Lastly, there’s a HUGE amount of partial/mis-information easily available to us, and touted as the whole truth.

Of course, we don’t want to fix the first reason listed above, vaccine success. Keeping children healthy is what we are all about.

We can, however, work on the information problem. I tell parents, the most important thing for them to learn/do is: ASK QUESTIONS!!! If you have a worry, ASK!  If something does not make sense, ASK! If you have a sixth sense about something, ASK!

The second thing I advise is consider the source and check facts. A children’s hospital is most likely more thorough and reliable than your neighbor, or a random web site. Below is a list of some partial or mis-information statements I’ve heard, followed by factual clarification.


While many diseases have been wiped out or rarely occur in our country, they are still present around the world and are only a plane ride away. If an unvaccinated or under vaccinated person travels and contracts the disease from an infected person, then brings it back home, he/she may infect others. This opens us up for further spread of the once thought to be gone infection.

This is happening now with measles. We have already had 5 outbreaks of measles here in the United States this year. If this rate continues, we will have 3 times more cases this year than last year.

Polio is prevalent in other countries as well, so it is only a plane ride away. My dad had polio in 1951. He “saw black” for 4 days, was in the hospital for over a week, had severe muscle ache/pain and was very weak for about a month. He was lucky. In 1952 >3,000 people died from polio, and >21,000 were paralyzed. Until the disease is eradicated worldwide, we NEED to vaccinate.


The infant is already exposed to thousands of germs on a daily basis, whether they are in child care or not. Even if he/she got 11 vaccines at the same time, he/she would only use 0.1 % of his/her immune system to respond. Therefore, they can easily handle the number of vaccines given at any one time.

The goal is to protect them as early as possible when they’re most vulnerable to these diseases. Also, even though the number of vaccines has risen over the years, the antigen (substance that induces an immune response) load has gone down due to the refinements in the vaccines. This means we can protect our little ones from more diseases, while having an overall lower antigen load than previous generations received in their vaccines.


Some parents believe that too many vaccines at once can cause problems, including developmental issues. Study after study denies this. In fact, by delaying immunizations, their children are at greater risk of contracting these diseases. These diseases can cause numerous health problems, up to and including death.


Natural immunity may last longer than vaccine derived immunity, but that is why there are booster shots. The risks, symptoms, and complications associated with getting the disease (to get that “natural immunity”) can be far worse. When my children got chickenpox 25 years ago, it was a breeze. Their main issue was itching and I had a week off of work, but many aren’t so lucky.

One of my little 6 month old patients was admitted to the hospital with so many blisters he looked like he had 3rd degree burns. One of our nurse practitioners took care of an 8 year old with chickenpox encephalitis. This child had brain damage, and spent months in the hospital and rehab. Pneumonia, cancer, and death can and does occur as a consequence of this “natural immunity”. In addition, there are some diseases, like tetanus, that don’t provide natural immunity.


Yes, there is a small amount of formaldehyde used in the production of vaccines to prevent contamination. Most of it is removed at the end of processing, before packaging. Some are concerned that it is used at all, but formaldehyde naturally occurs in the human body. Our bodies are continually producing/processing/eliminating formaldehyde, with about 1.5 mg always circulating in a 15 lb baby. One banana has 20 times more formaldehyde and one pear has 600 times more formaldehyde than a single vaccine.


Yes there is, and yes it does! Herd immunity is a form of immunity that occurs when a significant number of the “herd” (you and me) are vaccinated, which then provides protection for those in the “herd” who do not have immunity (newborns, immune-compromised, elderly, etc). This is usually achieved with an 85-95% vaccination rate.

The higher the percentage of vaccinated persons does two things: there are less people in the first place who are susceptible to the disease, and if you don’t get the disease-you can’t give it. The “herd” then cocoons those who are still vulnerable to the disease. If less children are vaccinated, it weakens the herd, leaves the unvaccinated vulnerable to disease, which they can then spread to those who are not immune.

Sir Winston Churchill once said, “Those who fail to learn from history are doomed to repeat it.”  The statistics and stories are in our history books.  I’ve read about them on my Nook. Let’s learn from our “history” and NOT repeat it.

KNOW your history! ASK questions! PROTECT your children! IMMUNIZE!

Prescriptions can be expensive. Here are some tips that could save you a lot of money.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

PrescriptionsOne problem we run into as health care providers and as patients is what to do if medications are too expensive. There are several options that you can check into to either get discounts or to get medication changed to something that is more affordable.

Know Your Insurance

First, know your insurance and how to look up what medications are on “formulary”. A formulary is what medications the drug companies have agreed to cover based on your plan. This can be dictated by your employer or by the insurance company that contracts with other drug companies. The list can change every 6 months or yearly, so check back frequently.

Just because technology helps us with our medical charting, it doesn’t magically know what your insurance plan covers because each employer can be unique.

Patient Assistance Programs

There are also patient assistance programs ran by drug companies. Your pharmacy should be able to help you with this or you can look up the company that makes the medication and ask for customer service.

An organized, easier way to look this information up is to go to needymeds.org. This has all of the drug company discount programs linked by simply looking up the drug name. You will have to fill out paperwork and possibly provide financial information to qualify, but often some assistance can be given especially to low income households.

There are some state and local medical assistance programs, ask around in your area for more information. There’s also a lot of information you can find on Google.com by searching “medication assistance”.

There are websites to look at, savings cards, and assistance that can be applied for.

Prescription Cost Savings Apps

Have you ever considered downloading free apps on your phone to compare costs? These apps can provide lots of cost saving information.

GoodRx is one that I reference frequently.

Sometimes, mail order or online pharmacies will save you more money than getting it filled at a local pharmacy. Also not all pharmacies have the same costs, so check pricing at more than one local pharmacy, especially for expensive prescriptions. The pharmacist or pharmacy staff can look up if taking #2 500mg tablets is cheaper than a single 1,000mg tablet for instance. Again, knowing your formulary can help with this.

Samples and Savings Cards

One last tip: Don’t forget to ask for samples or a savings card at your appointment or when you’re prescribed something. Medical offices often get discounts that can’t be found on websites. But then others are the same online as in your doctors office.

The bottom line is that there is no reason to stop taking medications or to go without. Work with your provider on what can be done for your particular situation, don’t just assume that we know what the situations is. We don’t know unless you communicate with us about these situations, and we want to give you the best care possible!

A Coronary Calcium Scan Could Save Your Life

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group

Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men. Coronary heart disease (CHD) is the most common type of heart disease, killing over 370,000 people annually, per the American Heart Association. Alarming statistics, but with the Coronary Calcium Scan physicians are able to catch the beginning stages of heart disease and then refer you to a cardiologist if necessary.

On a personal note…

The reason I felt the need to write about Coronary Calcium Scans, is that I lost my husband in January due to unknown heart issues. I wanted to make sure everyone knows about this simple test that could possibly save your life. Or at least make you are aware there’s a chance you could have heart  disease.

My husband had a very physical job and he was an avid golfer. He rarely went to the doctor and didn’t present with any heart issues other than family history of heart disease. He did have normal cholesterol and triglycerides, normal EKG, no shortness of breath or chest pain prior to his death.

My husband was only 56 years old. Due to his age, an autopsy was performed. This is how I learned of his heart disease.

I felt compelled to tell my story so I could spread awareness that this test is available. I recommend you to talk with your provider to see if you would be a good candidate for the Coronary Calcium Scan. I feel that if my husband would have had this test done just because of his family history, we would have known he had heart disease and been more proactive. We could have been referred to a cardiologist for additional treatment.

So, how can we be proactive in our own heart health?

Artery ComparisonFirst, ask your physician if you are a good candidate for the Coronary Calcium Scan. Your physician will order the scan based on risk factors, family history, age, cholesterol levels, blood pressure, diabetes and smoking history. Men, age 35-70, and women, age 40-70 should ask their physician or make appointment especially if they any of these risk factors as mentioned above.

A heart computerized tomography (CT) scan, also called a calcium-score screening heart scan, is used to find calcium deposits in plaque of people with heart disease.  They are the most effective way to spot atherosclerosis before symptoms develop. They look for the plaque inside the arteries of your heart that can eventually grow and restrict or block the flow of blood to the muscles of the heart. The measurement of calcified plaque with a heart scan may enable your doctor to identify possible coronary artery disease before you have signs and symptoms.

The doctor will decide if you are low or intermediate risk for heart disease. If low or intermediate risk, the cardio scan can determine presence and degree of calcium, indicating probable cholesterol build up. (See scoring chart)

The outcome of the test may indicate the need for medication or lifestyle changes to reduce the risk of heart attack other heart problems. If you are high risk, the best test is a cardiac catheterization-dye test as it will give more detail and ordered by a cardiologist.

Coronary Artery Calcium ScoresSome imaging centers and hospitals in the Kansas City area are offering these scans for as low as $50 (out of pocket cost) and a written order from your doctor. Little preparation is involved, no caffeine 4 hours prior, no antihistamines 24 hours prior, and no vigorous exercise 2 hours prior to the exam. This of course may vary depending on where you schedule your exam.

I have my scan scheduled in about a week, and I encourage everyone that has a family history, or any symptoms listed above, please take this step and be proactive. Talk to your physician to ensure your heart is healthy… not only for yourself but for your family.

For more details of the CT scan go to www.heart.org and as always, if you are experiencing any symptoms: chest pain, tightness, pressure, shortness of breath, numbness in legs and arms, weakness, pain in the neck, jaw or throat, call 9-1-1 or go to the nearest emergency facility.

The Epidemic of Kids and Technology – Part One: Ages 1-5

By Daniel E. Gershon, D.O. and Laura Salitros, D.O. – Lee’s Summit Physicians Group

This is the first in a series of blogs about children and technology.

Child with Cell PhoneWe’ve wanted to write about this subject for the past two years. It has become painfully clear to us that electronics/screen time (TVs, computers, tablets, and smart phones) has become a major concern as pediatricians. The effect it’s having on kids and adolescents is staggering. A typical day in our office will involve evaluations for ADHD, learning difficulties, anxiety, depression, sleeping problems, and extreme behaviors.

We’ll go ahead and call it an EPIDEMIC.

Most parents today grew up with electronics, including smart phones while they were in high school. It is a big part of who they are and their way of life. Consequently, they introduce screens to their children at young ages. Kids will often see their parents in front of screens. No one is to blame. Technology moves lightning fast. It moved so fast that science got a late start and is now telling us there are inherent dangers in what we are doing.

Let’s start with some science first:

When every finger swipe brings about a response of colors and shapes and sounds, a child’s brain responds gleefully with the neurotransmitter dopamine, the key component in our reward system that is associated with feelings of pleasure. Dopamine hits in the brain can feel almost addictive, and when a child gets too used to an immediate stimuli response, he/she will learn to always prefer smartphone-style interaction – that is, immediate gratification and response over real world connection. This is a mild version of the dangerous cycle psychologists and physicians see in patients with drug and alcohol addictions.

The Critical Period

Toddler and ComputerBetween birth and age three, our brains develop quickly and are particularly sensitive to the environment around us. This is called the critical period in some circles because the changes that happen become the permanent foundation upon which all later brain function is built.

A child needs specific stimuli from the outside environment for the brains neural network to develop normally. Spend too much time in front of a screen and development becomes stunted. Their social skills (frontal lobe) can be effected as well. Empathy, the near-instinctive way you and I read situations, get a feel for other people, can be dulled, possibly permanently. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children.

AAP recommendations for children younger than 2 years were based on research on TV and videos, which showed that in-person interactions with parents are much more effective than video for learning of new verbal or nonverbal problem- solving skills.[1] Before 2 years of age, children are still developing cognitive, language, sensorimotor, and social-emotional skills, which require hands-on exploration and social interaction with trusted caregivers for successful maturation. Therefore, adult interaction remains crucial for toddlers to learn effectively from digital media.

For example, from 12 to 24 months of age, toddlers can begin to learn novel words from commercially available “word learning” videos, but only if their parents watch with them and reteach the words, essentially using the videos as a learning scaffold to build the language skills.[2]  In fact, recent reviews of hundreds of toddler/preschooler apps labeled as educational have demonstrated that most apps show low educational potential, target only rote academic skills (eg, ABCs, colors), are not based on established curricula, and include almost no input from developmental specialists or educators.

An additional concern is that the formal features (ie, bells and whistles) that are designed to engage the child in an interactive experience may actually decrease the child’s comprehension or distract from social interaction between caregivers and children during use.[3]

Here are some troubling numbers:

In 2011, 52% of children zero to eight years of age had access to a mobile device. By 2013, this access had increased to 75% of 0- to 8-year-olds.[4]

A large international study (2013) with almost 300,000 children and adolescents found that watching between 1 and 3 hours of TV a day led to a 10% to 27% increase in risk of obesity.[5]
(It should be noted that TV viewing in children has decreased dramatically in the past two years with content moving to smart phones and tablets)

Here are some frequently heard comments from our parents:

“Sometimes I just need to get things done.”

YES! Sometimes we parents need to get stuff done and cannot supervise our kids like we would like to. We like to think of these as worst case scenarios, not something we do regularly. Don’t forget that engaging even our youngest toddlers in household responsibilities early on results in benefits for the entire family in the long run. Yes, it requires a lot of work up front, but it will be worth it

“He focuses better on the TV or tablet than on anything else.”

Boy and TVDigital content can be very stimulating. However, evidence shows that digital media is likely harmful to attention and executive function.  See this article about a study that was published in Pediatrics in 2011. This may be one of the factors as to why ADHD numbers have significantly risen over the past decade.

As a child spends more time in front of a screen, their frontal lobe has a harder time turning on when acknowledging a spoken voice, looking at books, or picking up visual clues. It prefers the digital or electronic format.

“I don’t really have a strict limit because we only use educational media.”

Even the AAP distinguishes between quality digital media and media that should be avoided, such as violent or fast-paced media. This doesn’t mean that “educational” shows/apps don’t count. Kids need time to engage in unstructured play. They need to be read to, talked to, and engaged with. They also need regular physical activity and adequate sleep.

“My kids can’t settle down for the night without having the TV on.”  

Results from one study show a relationship between screen time and poor sleep, especially when screens are used in the evening hours.[6]  As mentioned above, we are seeing a lot of kids with sleep issues. Some are due to common, age appropriate reasons, but many are due to screen time.

“It helps my child calm down when she gets upset.”

Distraction can be helpful in distressing or painful situations. This is why many children’s hospitals have child life departments available to help during painful or otherwise anxiety provoking procedures.  We use virtual reality in our office for vaccines and blood work.  However – Using screens to alleviate the discomfort of everyday disappointments or frustrations interferes with our children learning healthy emotional regulation without reaching for an external device.

One reason that children may be less socially engaged during digital play is that gaming design involves behavioral reinforcement meant to achieve a maximum duration of engagement, which may explain why interrupting children’s digital play leads to tantrums.[7]

“The TV is on in the background all day, but they’re not actually watching it.”

However, having the TV on in the background distracts children from their play, interferes with good language exposure, and decreases parent-child interaction, all things that can have an effect on their development. It is amazing what kids pick up from background TV. Yes, my son, at 4 years old, asked me if my heart was healthy enough for sex!

Here are our recommendations for ages 1-5:

1) No screen time for anyone under 24 months of age
Exceptions are video chatting (Facetime) or worst case scenarios (DMV, illness/doctor’s visit, etc.)

2) No screens in bedroom
Having screens in the bedroom was an independent factor associated with obesity. As kids get older, the temptation and addiction will only get worse. This is a place for quiet time, music, drawing, reading, sleeping, etc.

Limit Screen Time3) For ages 2 through 5 years old: No more than 1 hour a day of quality content.
Use sources like Common Sense Media to help you determine what is quality and what is not. Most evidence now suggests that long amounts of time in front of a screens is more damaging than short exposure (30-45 minutes).

We recommend teaching your kid that screens are an earned privilege not an expectation. It should never be a part of your everyday routine. Kids can look out the window while in the car. They can eat their meal or they can be hangry by their next one.

4) Find apps and games that you can play with your child.
Studies show that retention is much better when educational apps/games are played with a parent vs. alone with a device.

5) Develop a Family Media Use Plan

6) Watch the time YOU spend in front of screens
Try your best to wait until the kids are asleep. If it is work related, let them know.

Finally, we know parenting is the hardest job there is. There is no perfect parent. It is our goal to let you know electronics can be harmful and potentially damaging to a child’s developing brain through the age of 5. Hopefully we have given you some tips on how to safely raise your kids in an electronic/digital world.


[1] Brown A; Council on Communications and Media. Media use by children younger than 2 years. Pediatrics. 2011;128(5):1040–1045

[2] . DeLoache JS, Chiong C, Sherman K, et al. “Facetime doesn’t count”: video

Do babies learn from baby media? chat as an exception to media Psychol Sci. 2010;21(11):1570–1574 restrictions for infants and toddlers.  Richert RA, Robb MB, Fender JG, Wartella E. Word learning from baby videos. Arch Pediatr Adolesc Med. 2010;164(5):432–437

[3] Vaala S, Ly A, Levine M. Getting a Read on the App Stores: A Market Scan and Analysis of Children’s Literacy Apps. New York: The Joan Ganz Cooney Center at Sesame Workshop; 2015. Available at www.joanganzcooneycen ter.org/wp-content/uploads/2015/12/.  Guernsey L, Levine MH. Tap Click toddlers learn language. Child Dev. Read: Growing Readers in a World of

2014;85(3):956–970 Screens. San Francisco, CA: Jossey-Bass; 2015

[4] Rideout V. Zero to Eight: Children’s Media Use in America. San Francisco, CA: Common Sense Media; 2013

[5] Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA; ISAAC Phase Three Study Group. The worldwide association between television viewing and obesity in children and adolescents: cross sectional study. PLoS One. 2013;8(9):e74263

[6] Michelle M. Garrison, Kimberly Liekweg, Dimitri A. Christakis Pediatrics July 2011, VOLUME 128 / ISSUE 1

Article Media Use and Child Sleep: The Impact of Content, Timing, and Environment

[7] Hiniker A, Suh H, Cao S, Kientz JA. Screen time tantrums: how families manage screen media experiences for toddlers and preschoolers. In: CHI’16. Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems; May 7–12, 2016; New York, NY. 648–660. Available at: http:// dl. acm. org/ citation. cfm? doid= 2858036.2858278. Accessed May 9, 2016

LSPG loves keeping GREEN and helping others in the community including Hope House.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Did you know we are GREEN here at LSPG? Not too many people know this. Our office is always looking for ways to help our community and to be GREEN.

Dr. Trites, Julie Gramlich and others help us recycle and stay earth friendly. Often, employees bring clothing/toys/books in for other employees to pick up to use so that they continue to get use and not just thrown away.

Hope House

Hope HouseAnother thing we do, is support Hope House with surplus lunch supplies. Darlene Barnard, Dr. Barnard’s wife, is always eager to come pick up extra and take it to our local Hope House. I asked Darlene one time, How did you get involved with hope house?

“When our youngest was in 5th grade (15 years ago), we had a Thanksgiving dinner at his school. We had a couple of extra roasted turkeys, and all the trimmings as leftovers. We had enough for over 30 meals. One of the parents had lost a friend to a domestic violence incident that year and had a connection at Hope House in Lee’s Summit.

She contacted the staff at Hope House and three car loads later-they had food for their clients. I’ve taken food and donations there ever since. I’m part of the Summer Lunch Program that delivers a sack lunch to school age children throughout Lee’s Summit, Greenwood and Raymore in areas of need. On Fridays I take the surplus sandwiches and food supplies to Hope House.”

LSPG is GREENDarlene and others at Lee’s Summit Physicians Group set a good example by donating time, items, food, clothing, etc. so that those in need can put those things to good use. When we donate, that allows organizations to spend their limited budget on other needs so that our community can truly benefit.

Darlene added that “Anyone can help by donating time to Uplift to deliver food to the homeless, sorting clothes or  food donations at LSSS, donating time at the local dog shelter or non-profit of their choice. Sharing a little of yourself to those in need is something I find worthwhile.”