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F8 Sunday, February 25, 2007
The Hutchinson News


The Ritalin kids grow up
Los Angeles Times

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classroom attendance, the opposite has happened, Fishback said. The most important training received in medical school, said Dr. Tom Simpson, who has practiced medicine for 31 years, with 29 of those in Sterling, “was learning how to study medicine.” “There is no expectation that I learned all I would need to know,” he said. “Anyone who practices medicine understands there is a constant learning curve. Ninety percent of the drugs we learned to use when I was in medical school we don’t use anymore. “I read probably conserva, tively six to eight hours a week , to keep up in the field,” he said. “I’ve been doing so for 30 years. It’s always been that way .” Dr. Andrew Post, an osteopath in family practice at the Medical Center in South Hutchinson, said the Internet was an important tool while going to school and since he completed his medical residency in 2005. “There’s a service I use called that has the most current research,” Post said. “Basically they have review ar, ticles and expert opinion on the most current medical diagnosis and treatment. It has information on the most cutting-edge

For Devin Barclay life with , attention-deficit disorder has been a winding road. And seven years after he quit taking medication for the condition, “it’s still winding,” he says with a laugh. But as the 23-year-old navigates his way into adulthood, he’s managed to pay the roadside distractions a little less attention. And he’s learned a thing or two about getting himself from one destination to the next without taking major detours. In 1990, when Barclay was 7, he was diagnosed with ADD and began taking Ritalin – a stimulant medication that he and his parents referred to as “the thinking pill” – to help him sit still and pay attention in class. Over the next decade, almost 2 million American boys and girls were similarly diag-

nosed, an unprecedented growth of a medical condition that, before 1990, had been so rarely recognized that the national Centers for Disease Control and Prevention did not even track it. Today the children on the , leading edge of a wave dubbed by some “the ADD generation” have reached the cusp of adulthood. And as they take on jobs or college, care for themselves away from home, enter into adult relationships and become parents, these newly minted grown-ups are carrying out a massive natural experiment. It seems like only yesterday they were fidgeting in their seats, sprinting around their classrooms and daydreaming their way through addition and subtraction. Most, just like Barclay struggled through elemen, tary and middle school on Ritalin as the practice of medicating attention problems in children took off steeply in the

United States: Between 1990 and 2005, production of the two stimulant compounds most used to treat ADD – methylphenidate and amphetamine – increased seventeenfold and thirtyfold, respectively . Now many are choosing to do without the drugs that profoundly affected their experience of childhood and school and, in many cases, made it possible for them to learn alongside other kids in mainstream classrooms. It is one of the first decisions of their adult lives. Mostly it , was parents who dictated whether and when they would start medications to sharpen their focus. But the decision to stay on or go off these drugs is one that these teens and young adults have made for themselves – with little research to guide them. Whether the results will be

● See ADD / F9

technology out there.” He doesn’t just access the service to keep up, but to research particular questions that come up during a patient visit or diagnosis, Post said. The Internet has also changed the way some patients interact, Post said, because they can do their own research and they ask many more questions. Among the greatest advances in the medical field for diagnosis and screening are in the field of radiology and diagnostic imaging, several of the doctors agreed. “Diagnostic imaging allows physicians to peer beneath the skin without a scalpel and allows a direct view of internal organs,” said Dr. Curt Thompson, an interventional radiologist at the Hutchinson Clinic. Such screening allows doctors to detect disease at an early stage and to exclude diseases, such as cancer, Thompson said. It also allows a doctor to gauge the extent of a disease’s progress and its response to therapy . “We are able to visualize, to see much more of what we used to only guess at,” Simpson said. “I think some of my younger colleagues have an advantage in that they’ve learned to read some of these. I rely more on the radiology people to help me.” Which points to another wonder in the changing world of medicine, he said. “If someone comes into the emergency room in Lyons at night after being in an accident

and we do a CAT scan to see if there’s brain injury we’ll send it , to a radiologist in New Zealand,” Simpson said. “He’ll review it and call me in 10 or 15 minutes and say ‘It looks OK’ or ‘There’s bleeding on the brain.’” The clinic uses experts in Hays during the day Simpson , said, but goes overseas at night. “Interestingly some of the , better medical centers in the world right now are in India,” he said. “Medicine is becoming global.” His biggest concern about the training physicians are receiving today however, is that the , emphasis on technology is replacing exposure to clinical skills, Simpson said, “laying hands on a patient, making a diagnosis from taking a good history and giving a good physical exam.” Fishback, at KU Med, said he couldn’t disagree, which is why the school has introduced a laboratory where actors play patients to help students learn to listen and diagnose. “The average six to seven minutes a doctor has to see a patient in the typical practice is not a lot of time to do a physical exam,” Fishback said. “We have relied for years on X-rays and CT scans and MRIs and lab tests to get past the physical diagnosis that older docs were taught to do. We are trying to get more hands-on, but the trend is awfully hard to fight. Insurance companies know a doctor’s time is expensive, so they push this technology pretty hard.”

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for people suffering with arthritic pain or pain from a labral cartilage tear. While arthroscopic surgery has been around since the 1970s, hips have been one of the last joints to come around for this type of surgery Severud said. , Before the development of this procedure, few treatment

options for hip pain were available, and a hip replacement was virtually inevitable. Now, candidates for arthroscopy include active individuals who just happen to have painful hips. Described as “minimally invasive,” it evolved along the same lines as arthroscopic surgery for other joints of the body particu, larly knees and shoulders. In hip arthroscopy small inci, sions are made in the patient’s hip area. A camera lens is in-

serted, and the image is displayed. The doctor can visualize the bone structure and determine the nature and extent of the problem. Severud can clean out the frayed lining and inflammation, which may prevent the deterioration of the joint. The patient will realize a reduction in pain and won’t have a long recovery because the procedure is not invasive.

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