When we were girls, my older sister Connie took it upon herself to help me with “my problem.” Her chosen method of helping included shouting, “You can’t eat that!” whenever I lifted a morsel of food to my lips. Sometimes my sis (who was a head shorter and half my weight) would appear from nowhere, screeching, hands extended like talons, to wrestle a spoon, fork or Ho-Ho from my hand. Connie was the reason I became a secret eater.

It’s hard to keep a secret when it jiggles at everyone you pass. I don’t know why, but when you are fat total strangers take it upon themselves to advise, council and chastise you (to your face and behind your back) about your size and your habits. Random shoppers at the grocery store give me something my friend Paige calls the “stink eye” after seeing food in my basket that they deem inappropriate for someone of my bodily bounty.

A woman I did not know once accosted me in the dairy section of a Whole Foods Market to tell me that I was headed to an early grave and that she knew of a diet that would save my life. I stood dumfounded as she whipped out a note pad and jotted down the principles of the eating plan for me, as well as a shopping list for that day. True story.

If you are overweight and overwhelmed by help — kindly ask these people to back off. The rest of you can help the overweight people in your life by giving them the unconditional love and acceptance they deserve at any weight.

If you don’t know the overweight people you see — keep your comments to yourself. Unsolicited counsel may launch fat folks into the rich, creamy arms of Ben & Jerry.

Update: Since my emotional reorganization and commitment to follow my own heart and not someone else’s advice, I have lost 10 pounds without even trying.

We would need to establish clear guidelines to maintain the confidentiality of the student and the institution concerned. I am suggesting that a piece of work be forwarded to Homeopathy Online Editor Chris Kurz. He will remove any identifying names from the piece and forward it to me. I will then forward the work to two or three markers and compile the final article. If I need to edit the comments of markers, for reasons of space, I will post the edited version back to markers to ensure that, in so doing, I do not misrepresent their ideas.

Currently, my opinion is that those “marking” the piece be identified. As educators working in the field, we should be comfortable that our work is open to scrutiny. My sense is that through this transparency we can help to provide an element of public accountability. However, potential markers: Please feel free to disagree with me here. If confidentiality for all will result in a more honest and open discussion, we can adjust the ground rules I propose.

I suggest that one graded piece of work be submitted to each issue of Homeopathy Online. We will eventually attempt to represent the whole range of the homoeopathic curriculum: from first to final year; from basic materia medica to advanced case analysis.

A growing body of evidence about the realities of our educational practice will help to create a clearer sense of standards around the world. It will provide a valuable resource for educators and administrators working towards the moderation of standards of education and training in homoeopathy. As such we would be providing the European Council for Classical Homoeopathy (ECCH) and the International Council for Classical Homoeopathy (ICCH) with information to inform their work on the core curriculum, assessment, and the definition of appropriate standards for graduate professional homoeopaths.

To Participate

1. Tutors willing to participate, please contact me directly.

2. You are invited to suggest the subjects you would most like to see discussed in this way.

3. Students willing to submit pieces of work, please contact Homeopathy Online Editor Chris Kurz. Please do not submit any work at the outset, but do note the subjects and levels for which you have material available. We will contact you once a subject has been chosen.

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It seems to me that this medium offers tremendous potential for helping the profession – particularly those involved with education – to come to terms with the difficult task of moderating students’ work. That is, to address such questions as:

* What standards are we applying to various levels of attainment achieved by students as they move through courses?

* What criteria define a competent graduate?

* What evidence do we require from students to make an accurate assessment that criteria have been met?

As an emerging profession, we have, I believe, two great advantages over more established practices. First, our relative youth, as far as development of standards goes, gives us a tremendous opportunity to innovate, to learn lessons from other professions, to avoid traps they’ve made for themselves. In the U.K. we are currently working in an arena which is regulated on a purely voluntary basis. We do not have external pressures which enforce uniformity and conformity. Secondly, we can use the tremendous potential offered by modern communications to help us in our task.

Proposal

A student or practitioner submits a piece of work. He or she also submits the grade and tutor’s comments the work received, as well as the guidance provided by the institution for the student in addressing that particular assignment.

The work (not the comments) is posted to a variety of tutors who are told to grade and comment on the work. They are asked to react to it as if the work were handed in at an appropriate point in their own courses.

Finally, the essay (or other piece of work) is submitted to Homeopathy Online, along with the comments of the markers, the grades they awarded, and the original marks achieved by the piece of work. As an editor working on the Education column, I will attempt to present the issues which arise from this. For example, markers might well disagree on the standard achieved. Actually, it’s hard to believe they won’t! To explore this, I might be saying things like, “Marker A seems to weight breadth of knowledge from many different sources highly. Marker B is more interested in the writer exploring his or her own ideas, looking for originality.” In this way we will begin to see how teachers approach the task of grading assessments, see what kind of criteria they employ, and so on.

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Any travel expert will tell you bringing along a portable CD or tape player is a good idea, but it’s much more important with this age group.

Teens love to listen to their own music and may even enjoy the getting there as much as the being there if they’re allowed to spend it with

‘NSync, TLC or Kid Rock. Be sure to bring extra batteries if the Backstreet Boys start losing steam.
If you’d like to actually communicate with your teen in the car, books on tape may be the answer. According to readers asked to give travel tips to peekaboo.com, comedy books on tape are a real generation-melder.
If the budget and your patience level allows, consider allowing your child to bring a friend. The tentative teen traveler won’t feel so trapped if given someone to roll eyeballs with in the backseat when Dad starts belting out “99 Bottles of Beer on the Wall.”
Privacy is rule No. 1 for teens. Consider adjoining hotel rooms and family suites, which are more plentiful these days. This works two ways:

While Jimmy and his pals play Nintendo or watch a movie next door, Mom and Dad can unwind in peace.
Involve your teen in destination and attraction planning. You may want to scour every butter churn in Colonial Williamsburg, but plan a day or two of roller coaster mayhem at nearby Busch Gardens.

If you’re driving, plan meals with the teen in mind. Perhaps you can find a picnic spot near a basketball court or a soccer ball-worthy park.

Or enjoy a restaurant outing with your child — something you couldn’t do when he was a squirmy toddler.

Put the teen in charge of the family photo album for the trip. This encourages creativity, while involving the teen in the family’s adventure.

This is not to say that if a child is not saying “Mama” or “Dada” by age one, that a hearing evaluation is not necessary. A clear and detailed history from the parents will contribute to a pediatrician’s ability to filter out what is and is not a delay. Pediatricians and parents must keep the lines of communication open and actively discuss developmental issues that are of concern to either one of them.

Parents, both in my real-world practice and my cyberpractice, have never-ending questions regarding their children’s development. It is an important part of our job as pediatricians to evaluate development (both subjectively and objectively) at each encounter. Each of us has our own way of looking, asking, and evaluating children to make these assessments.

Many pediatricians have been faulted by their peers and patients for what is seemingly a lack of attention to developmental issues. It is not always clear to me whether this is based on all the silent observation that we (or should I say, I) engage in or if it is a true oversight in the practices of pediatricians. I can’t say this enough: an open line of communication and a good rapport with your child’s health care provider is essential. A confident “Don’t worry” by someone you respect and trust can steer you away from endless sleepless nights. Keep in mind that many delays are often picked up first by loving parents, who spend endless hours observing, so trust your observations, and when in doubt… always ask!

I know the tentacles of fear run rampant. I myself vividly remember calling my friend, who is a pediatric orthopedist, when my sixteen-month-old daughter had not started to walk independently. I was neurotic — despite knowing that all of my daughter’s other developmental milestones were normal and that I myself had not walked until 17 1/2 months!

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What is an appropriate developmental schedule for each child? What questions can a parent ask the pediatrician to ascertain whether or not their individual child is “on the right track” of development?

Of course, there are standardized developmental charts, the most common of which are the Denver Developmental Scales. These charts allow health care professionals to choose a few major milestones in order to screen a particular age group with respect to gross motor, fine motor, language, and cognitive development. But as with most standardized charts, there are limitations to the Denver Developmental Scales. There is a wide range of “normals” spanning several months — and the environment, lifestyle, and even physical attributes of each individual baby can lead to an interpretation of delay or acceleration within that range.

The parent is often the best source of developmental information for the pediatrician to help make an evaluation. In order to aid your doctor, a reference book, such as Caring for Your Baby and Young Child: Birth to Age Five is a must for parents. This book breaks down children’s development by age and gives a general idea of what warrants concern and what does not. Be sure to discuss your findings with your doctor and be sure he or she takes the time to listen and interact with you.

Before a patient of mine enters the exam room, I can often be seen peering out into the reception area. Unbeknownst to the parents or child, I am watching the nine-month-old whom I have followed since birth tentatively pulling up to a stand on the waiting room couch. And when Mom thinks I am absent-mindedly cooing with her three-month-old, I am actually watching for a response to my voice and face. My evaluation is far more extensive than merely running through a checklist of predetermined developmental milestones. I have found that it is a general impression of a child’s development and progress, rather than an individual milestone, that is predictive of a delay.

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My thirteen-month-old can walk by himself — he has taken as many as ten steps at a time when he needed to get somewhere. He can even stand up from a squatting position. Most of the time, though, he will only walk holding my hand. He crawls over to me, takes my hand, pulls himself up and then leads me away. This is all he wants to do, all day long. If I continue to let him take my hand and walk with me, am I preventing him from really learning to walk on his own? I really believe he is using me as a crutch. He has a lot of friends from his playgroup, and they all seem anxious to walk on their own. His first step was almost a month ago and this has been going on for all that time.

These questions, and those like them, are some of the most frequently asked in pediatric practice. Although development is a very unique process for each child, parents (and grandparents) are commonly concerned about whether their children fit into the normal spectrum of development.

When I am asked why I chose Pediatrics, with all the more lucrative fields in medicine available to me, inevitably my mind wanders to one word: change. It is the wonder of watching my young patients change and grow before my eyes that keeps me here. It is magical.

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Some patients take chromium picolate to improve their glucose levels. However, this supplement has only a minor effect on blood glucose levels in humans.

Diabetes medications and insulin must be taken very carefully. Missing doses of a medication or taking extra amounts can cause severe and even life-threatening reactions. If you feel like you do not know enough about your medications and how to take them, discuss this with your doctor.

Symptoms of a Salivary Gland Disorder painful, swollen glands under the tongue, behind the ear or in the neck a bad taste in the mouth dry mouth fever

What to Do About the Condition, call the doctor for advice and an appointment. In the meantime, avoid spicy foods and citrus fruits.

Treatment may include antibiotics to get rid of the infection.

Pretty much every fitness professional now knows that the body will go to great lengths to ward off starvation. Clients who are intent on dieting are routinely advised to get off a very-low-calorie diet after just a few days so the body does not compensate by slowing its metabolism, conserving energy and defeating the attempt to burn fat.

But new research indicates that energy deficits of only hours, not days, appear to set the body up to retain fat. A number of recent studies have associated dietary restriction or poorly timed eating with such unwanted changes as lower metabolism, higher body fat, higher injury rates, menstrual disfunction and reduced bone density.

An ambitious study at Georgia State University analyzed female athletes’ energy intake and expenditure hour-by-hour for 24 hours of a typical training day. (Reported in Medicine and Science in Sports & Exercise, March 2000.) Those individuals who had energy deficits greater than 300 Calories at times during the day tended to have a higher percent body fat.

We in the exercise profession like to think that regular intensive exercise will keep up the resting metabolism rate and protect the exerciser from any depression in metabolism that might be triggered by a little dieting. Not so in this study. The subjects were all world-class athletes in training in four disciplines involving different mixes of aerobic and anaerobic exercise: artistic gymnasts, rhythmic gymnasts, middle-distance and long-distance runners.

Exercise will increase metabolism, but eating too few calories to replace those burned will depress resting metabolism, nevertheless.

The proportion of body fat retained by the athletes was related to the magnitude of their energy deficit.

Athletes experiencing the largest calorie deficit within the day tended to have the higher body fat percentages.

Athletes with the most calorie deficits of greater than 300 Calories tended to have higher body fat percentages.

Athletes with the most total hours of energy deficits in the day tended to have higher body fat percentages.

Athletes with the greatest total calorie deficit for the whole day tended to have higher body fat percentages.

In brief, the body seems to respond to quite small and short-term deprivations of food by preparing to store fat. On the other hand, the athletes in this study who ate enough, often enough, to replace the energy burned in life functions and exercise had the lowest body fat ratios.

This is new support for your message: Exercise is good. The right amount of good food at the right time is good. Going hungry in an effort to burn fat is futile.

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