Have you ever wondered how ads that seem to be made just for you pop up on Facebook, Google and just about every other site you go to?

It’s called “behavioral advertising” and it’s rather cleaver and sneaky at the same time.

Check out a recent sidebar of Ads I noticed on my Facebook Home page:

Interestingly, the day before I was online hunting for information about photography, travel writing and an online program I was interested in. Coincidence? Not at all.

Behavioral ads emerge because of our online behavior. Our search history is actually food for the the code of the ads. We leave digital breadcrumbs in cyberspace that leads these ads to our site. CDT explains it this way:

So, we leave a trail of our digital cookies all over the web that lead the ad network right back to our computer. It’s no wonder that when I did my hunt for “shoes” after my hunt for photos, travel and writing, up came this ad:

Now that you know the reality, you can be a step ahead of these groups and not let them use your desires for their  financial gain. As adults, this shouldn’t be too challenging to do. However, helping our kids and teens understand this may not be so easy. That’s one of the reasons it’s so important we be involved with our kids online lives and make sure they are not involved with social media until they are teenagers. It takes some wherewithal and maturity to truly negotiate this world smartly.

When you do talk to your kids about the financial reality of the online world, use the pictures in this post and remind them of what Will Rogers once said:

 “Advertising is the art of convincing people to spend money they don’t have for something they don’t need.”

If that doesn’t work, pull out the Borg analogy.

In the world of Star Trek, run ins with the Borg were not easy. In fact, they were down right futile.

Many people today describe the same futility with online ads. They just cave because they find them too alluring – too powerful.

Luckily, we’re not Borg. And, most of us have the power to say “resistance is not futile – I’m not going to click that ad today.” That’s what I do and what I teach my kids to do. I know you can do the same.

If you feel yourself feeling weak, just ask yourself this: where would you rather have your money housed…in your bank account of the bank account of Facebook and the Ad Networks they partner with??

(Borg Image)

By now you’ve heard the news. Like it or not, the new Facebook Timeline is coming to a Facebook profile near you. In otherwords, yours, mine and all of our closest, and not so closest, friends.

Not wanting the change to completely catch me off guard, I decided to take the leap today.

At a first glance, the Timeline looks sort of cool. It’s a true timeline of our Facebook life with pertinent information upfront.

However, my joy ride was quickly interrupted by some hidden speed bumps that boil down to one concept: the temptation to over share.

Unlike the former profile which asked for basic facts about our lives, education, likes, employment, this new Timeline goes a step further into the core of our lives from issues of health to details of travel. And, it does so by offering cleverly placed drop down menus that tempt you to offer up information that most of us wouldn’t have even considered putting on a resume, or on Facebook…before the introduction of the Timeline.

Tricky, I know.

The subtle massaging our our desire to share begins as soon as we transition to the Timeline with these categories:

 

The first true new category is “Map” which is really an expansion of Facebook Places. When you click on “Map” a big map page opens that allows you to enter a place you’ve visited. I decided to enter “Boston” since that’s the nearest major city to my current home. Here’s what came up:

Posting location information online is still controversial. Many people are not sure it’s safe and wonder how much location information we should be providing about ourselves online, past or present. It’s one thing to say casually “I visited Boston once” but do we want to provide a visual trail complete with dates? I’m not so sure we want that much information about ourselves online, that complete of a personal record, with people we are not true friends with offline.

I had my next Timeline head scratching moment with the Status Bar. At a quick glance, the Timeline’s status bar looked just like the familiar status bar of the old profile page…except it now has a new item called “Life Event”.

If you click “Life Event” you get a variety of options prompting you to enter all sorts of data, data that you may not have considered staring before these drop down menus emerged. That’s the issue I have with these screens. Many people, like most, will look at these drop down screens and move on, uninterested to post more information than they were going to before these screens were created. But, what about the emotional vulnerable among us or teenagers? Those are the folks I worry about when I see the following screens.

First up, “Family & Relationships”:

It’s not unusual to share expanding a family or getting married. But, we have to be careful about encouraging sharing loss. That has to be done in a healthy way and to people who are true friends. I’m not sure I like the idea of someone posting that as a status…that’s not as healthy as posting “I’m sad…someone died today”. People will notice the latter much more than a change in status and reach out more effectively.

Next up, “Health and Wellness”. Check these out:

We know from studies that sharing information online and online support groups can be beneficial. However, it has to be done correctly and actively. Changing a status won’t yield the same result as posting on one’s wall “I’m really upset – had a tough doctor’s appointment” or “Guess what – I’m cured!” In all cases, the success of posting health information will boil down to whether a person has a health group of friends online and how active those friends are online. A person can have 500 Facebook Friends but if those people are not active online, no post will matter.

Finally, “Travel & Experiences”. Some of these categories may be fun while others definitely TMI. Take a look:

The success of sharing this type of information boils down to why you are sharing the information, who is receiving the information, and the risk of sharing the information, if any. For example, telling the world you have decided to marry your new love for photography with your love for dogs to help your local dog pound find homes for abandoned puppies would be an outstanding piece of information to share. On the other hand, while visiting a friend in Thailand, living out your dream to get a tattoo may not be so wise, especially since you are in your late 30s or 40s, have kids, a job…all those fun life issues where a tattoo may be so well received.

As if the above issues are not enough to contemplate, the changes in Privacy settings that came with the new Timeline are equally mind boggling. Like the Timeline itself, they, too, look and feel very different. So, spend a few minutes playing around and making sure your settings are what you want them to be for everything on your site, including the 3rd party applications. Then, sit down with your teenagers who have Facebook pages and help them understand the new Timeline.

Information online can be like water in a sink with a slow leak…one way or another, some will escape. So, post with care and hope for the best.

Reading the tweets and news stories condemning Paula for not disclosing her diabetes sooner, and accusing her of doing so for personal gain, I’m reminded of the old American Indian Proverb:

Never criticize a man until you’ve walked a mile in his moccasins.

She was incredibly honest with Al Roker on TODAY for her reasons to stay quiet initially: “I came home, I told my children, I told my husband, I said, ‘I’m gonna keep this close to my chest for the time being’ because I had to figure out things in my own head.”

And, in the same interview, she noted changes she’s made since her diagnoses in her diet and in exercise and in what her show does and doesn’t promote:

“I have always eaten in moderation….You know, people see me on TV two or three times a day and they see me cooking all these wonderfully Southern, fattening dishes. That’s only 30 days out of 365….And it’s for entertainment. And people have to be responsible.”

Did you know that when a person gets diagnosed with a chronic condition, the person experiences the same 5 stages of grief as when a loved one dies? Noted by famed physician Dr. Elisabeth Kubler-Ross, they are:

1. Denial
2. Anger
3. Depression
4. Bargaining
5. Acceptance

As with all grief, moving through these stages takes time. There are many starts and stops and it’s easy to get stuck along the way. Having experienced first hand all of these stages when I was diagnosed with Rheumatoid Arthritis 2 1/2 years ago, I can tell you the process is incredibly intense, not at all easy and slow. So, 3 years may seem like a long time to you, a person without a chronic condition, but to someone learning to adjust to a new normal, it’s actually not that long at all. Remember, this process becomes the start of the rest of someone’s life.

The reality of chronic diseases is they are much less like the American Indian Proverb I quoted initially and much more like this Dutch Proverb:

Sickness comes on horseback but departs on foot.

One reason I’m stepping forward to support Paula is because I’ve seen how powerful celebrity and expert spokespeople can be in the world of chronic conditions. In the arthritis world, pro golfer Phil Mickelson has had a very well received campaign sponsored by Pfizer for psoriatic arthritis and Enbrel. His campaign and ads helped me enormously even though I have a different form of arthritis.  They came on TV when I was facing a particularly though time with my RA and gave me just what I needed to feel more hopeful and positive about the future , the medications I found myself on, and the activities I put on hold. Incidentally, no one questioned why Phil waited over a year to come forward with his story or why he was partnering with Pfizer to help others with arthritis. If Paula can do that for diabetes, more power to her!

We live in a media world where the glass is always half empty and reported that way. How about we start looking at the glass as half full and start giving people trying to help others the benefit of the doubt for a change.

Never say never. One of these days it will happen, guaranteed. You will be on the trip of a life time, the very trip you’ve been planning for months, when suddenly you hear that poorly timed comment “Mom, I’m not feeling so great”. You’ll freeze and immediately think: “this can’t be happening!”

We learned first hand just how paralyzing it can feel to have sickness strike on vacation just a few summers ago while visiting Disneyland in California. We should have suspected something was up as soon as we were heading out the door with the first comment of “Mama, I’m not feeling so great” but disbelief masked my ability to see illness close at hand. Pale, burning with fever, and complaining of a sore throat, by the second flight in midair there was no denying our daughter was sick.

Once at our hotel in Disneyland, we gave her what we could – ibuprofen, fluids, and expectorant. She slept well but by the next morning was not much better. The sleep took the edge off and she was clearly able to function better but being a pediatrician I strongly suspected she had strep throat and needed an antibiotic. Being a mom I knew she needed to see a doctor. But, where?

Being an East Coast doc, I was unfamiliar with the West Coast medical system and being a mom didn’t want to waste an entire day in an ER for a problem I knew was really an office based problem. Not really knowing what to do, we called the front desk who referred us to a house call physician service that would come to the hotel within an hour, see my daughter, and often provide medication on the spot if needed.

So, we made the call and as promised with in an hour a doctor from an on-call physician network, www.housecallphysicians.org, arrived at our hotel room, interviewed and examined our daughter, agreed with me that strep throat was likely the diagnosis, handed us a bottle of antibiotics for our daughter, whipped out his credit card machine (this is a pay now, submit to insurance later situation but much cheaper and convenient than a traditional ER visit at a grand total of $240.00), and went on his way. Within 12 hours our daughter was much better and by the next day she was riding Tower of Terror! So, in the end, we lost perhaps a day out of our vacation and had an experience that was reasonable and comfortable.

Even as a physician, I felt like a fish out of water during this entire ordeal. That was not my medical system and at that moment I was a mom and a tourist. Thankfully, we were in the continental US and not overseas. But, there are many resources you can call and use to get yourself and your family care. House Call Physicians is California based and there are similar groups emerging nation-wide and internationally to address the growing need of traveling and displaced families.

This can occur to any of us while visiting within the United States or over seas. While my brother was living in Vienna, Austria, their 2 year old son developed ear pain in the middle of the night while relocating to their new home. While a chronic problem for my nephew, they did not have any medications with them and were not familiar enough with the country to know what to do. The hotel they were visiting recommended a 24hour urgent care center which provided top-notch care and gave them the medications my nephew required. My husband and I had a similar experience a few years prior to that while visiting London. We both arrived not feeling so great and the hotel arranged for a doctor to come to our hotel room. Turns out we both had contracted a bacterial illness while traveling, not too surprising since it was the height of flu season at that time. Two cases in two different countries but with one very common and important similarity: the hotel staff was the conduit to medical care, and the medical care was able to come to us. The other avenue we could have each taken would have been to call our local US Embassy or Consulate. Those offices are always available to US Citizens while traveling overseas and are available to help find medical care when needed.

It is disappointing when sickness strikes on vacation and the person sick will likely feel horrible for any change of plans that need to occur – and plans will have to change a bit while the person is actively sick or if fever is present. Keep in mind that the same illness restrictions when at home apply for vacation sickness, too. The way to think about it is if you would be staying home from work or your child from school, you likely shouldn’t be going to a museum or an amusement park.

Out of the unexpected you’ll often find the most amazing moments of your vacation. For us, the hotel staff not only helped us get medical care for our daughter, they helped us shake the stress and enjoy our vacation. We couldn’t return to the room without a treat waiting for one of us: Balloons, cupcakes, cards from Mickey and pals. Totally unexpected and just the “medicine” our family needed.

So, when in doubt, call the front desk.

(Originally posted December 2007; Updated December 2009)

A former physical education teacher in my home town, John Passarini, once told me: “No child is disabled. They are all just differently abled.” That was his philosophy during his many years teaching generations of kids in our town and now teaching teachers how to coach and teach.

I thought about John and his motto a couple years back while watching ABC’s Extreme Make Over Home Edition. The team was remodeling a home for a family born with a genetic disorder. Their old home was limiting for the child’s needs and didn’t allow a moment of peace for the parents who desperately wanted to allow this child, as well as their other two children, to reach whatever potential was with in each of their abilities.

Fast forward to the new home. Spacious. Filled with doors wide enough for wheel chairs and equipment to aid mobility. The home had stairs for those who could use them as well as an elevator. Each of the kids rooms had just what was needed. And, the home had a play room that also was a therapy room. You should click through the pictures to get an idea and also here the father’s own words:

At the end of the show, though, after seeing the house, with tears in his eyes, he echoed what John said to me many years ago. He said that he doesn’t feel that children, even children with major issues, are really disabled. He feels they all have something to offer and the key is recognizing that and not being held back by what they can’t do but by trying to see past that and looking at what the child can do. In other words, seeing that every child is abled…just in different ways. A good reminder for all of us.

Last year, the Florida State legislature attempted to gag pediatricians from discussing gun safety with families. That law, referred to as the docs n’ Glocks Law, was overturned by a Federal Judge this past September after strong rallying by the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence.

Judge Marcia Cooke’s ruling was a huge victory for gun safety education and for pediatricians. Her ruling validated what pediatricians in Florida, and every other state in our Nation, have been attempting to explain for a very long time: this issue isn’t about gun ownership but about gun safety.

The recent  tragic death of a Texas 8th grader, Jaime Gonzalez, is a grim and very real reminder of how serious events can become when any type of gun is involved.  According to reports, police could not discern that the gun was a pellet gun and the events unfolded in a way that forced them to act so that the school student body and staff would be safe. That’s their job. Playing Monday morning quarterback isn’t going to change the event. However, we can prevent future events by recognizing that we need to do better in providing gun safety educations in our schools, for parents in their homes and for pediatricians in their offices.

For some reason, gun safety education is one of those topics that everyone agrees is important, including pediatricians, yet no one takes enough time to truly do justice to when they have a family, or group of students, in front of them. With kids still bringing guns to school, we have to stop assuming that someone else is providing that important talk and step up.

Parents need to have the talk with their kids, whether they own a gun or not.

Schools need to have gun safety education in their health and safety courses and in their Open Circle times.

And, pediatricians need to fit it into their busy office visits.

We should be having it at home with our kids.

Communities and schools can think outside the box and post information and links to resource on websites and in newsletters. Drama classes could organize skits. Art classes could make posters. Both of these avenues have been very successful with other hard to discuss topics such as drug and alcohol use and abuse and high tech issues.

As long as you do more today than you did yesterday, the students in your community will more safe tomorrow and the likelihood of another school gun incident will go dramatically down.

This is a New Year’s Resolution we can do something about – and we owe it to the Jaime Gonzalez’s family to do just that.

Technical Name: Asthma

NickNames: reactive airways, wheezing

What is it? narrowing and swelling of the tubes of your lungs that occurs when trigged by a variety of stimuli such as viruses, allergens, season changes, pets, insect stings

How is the diagnosis made? Asthma is frequent wheezing and is a clinical diagnosis that is usually given after a child has wheezed on more than one occasion and responded to bronchodilators such as albuterol.

Typical Ages: infancy to adulthood

Treatment: when I think about asthma therapy, my goals are to:

1. decrease the severity of the episodes

2. maximize airway function

3. keep the child doing what the child loves to do

Some kids just have episodic asthma when faced with their trigger such as a cold or weather change. These kids may just need treatment of that exacerbation with:

1. a bronchodilator to get the airway big again: albuterol inhaler

2. an antiinflamatory medication to eliminate the swelling: a steroid – either oral or inhaled

For kids with frequent exacerbations or symptoms that are starting to interfere with the actitities they love such as sports, preventative medications are available: inhaled steroids and an immune mediator called Singulair.

How will I know what is best for my child?

Your pediatrician will help you develop an asthma action plan for your child so you’ll know what medication to use and when, including at school.

Can asthma be dangerous? The honest truth is that asthma can be very serious and can be fatal if not treated correctly. Any child having trouble breathing who has asthma needs to be seen right away – even in the middle of the night. So, if your child is having trouble breathing:

1. give your child a dose of albuterol by inhaler or nebulizer

2. go to the nearest emergency room or call 911

Will my child out grow asthma? May kids do “out grow” asthma meaning it is worse when they are younger but often asthma does persist in one way or another throughout a person’s life. Your child’s history over time will tell this story but keep in mind that there are many adults with asthma living full lives and doing great things!

Online Asthma Resources

1. KidsHealth Asthma Centers

• Parents
• Kids
• Teens

2. Does my baby have asthma?

With the federal health reform bill inching closer to becoming a true law, it’s still up for debate whether it will even begin to put a dent in turning around our very confusing, disjointed, expensive and chaotic health care system.

The issue, of course, is that health insurance is not even the tip of the iceberg. Without reforming the innards of the health care system and giving people a system that they can understand and use more easily, it matters very little whether people have insurance coverage.

At the same time, true reform is less about any system and more about how people address their own lives and health habits. Even in a broken system, there are many things we can all do to improve our overall health and minimize our need to see doctors, be on prescription and nonprescription medications, and need medical procedures.

If we all applied ourselves to spending more time on the areas that improve our health for the better — such as exercising more, losing weight, addressing health problems that put us on medications — we’d all be better off, and our health care system would actually start to be unloaded and cost less, even in its current form.

This doesn’t just apply to adults but kids, too. Kids deserve to enter their adult lives as healthy as possible, so be honest with them about their health issues — whatever they may be. Help kids overcome health issues today so they can be more healthy tomorrow. Believe me, if your kids are overweight or dealing with some other medical issue, they know it and want help addressing it.

With the new year upon us, this is the perfect time to examine the habits we have that maximize good health and be realistic about the habits we have that put our good health at risk. For example, ask yourselves:

- What do I do for exercise?

- What do I eat and drink drink each day? (Keeping a log for a week can be very eye-opening!)

- How many packs of cigarettes do I smoke per week — or day? (If “none,” congratulations!)

- Do I have health problems I need to address?

- Am I on medications I’d like to be off of?

- When was the last time I went to the doctor for a general physical?

Sit down as a family and answer these questions together. Then work together on the issues that you all have in common and help each other with the issues unique to each person. By the end of 2010, you’ll all be more fit and will have kicked some habits you’ve needed to for a long time.

You deserve to live a healthy life, and that type of reform can’t be found in any health care law but starts with you and the changes you make in your life.

In fact, those are the only health care reform changes that really matter in the long run to you and your family, so start reforming today.

(Initially published January 2010)

Tweet Seats. A hard-to-believe it exists new trend that is so surreal you want to pinch yourself to be sure you’re not asleep and dreaming.

As noted in the LA Times:

“Perhaps the most unexpected thing about “tweet seats” is that they exist. Perhaps the second-most-unexpected thing about them is that they appear to be a growing trend.” 

Clearly the brain child of some group’s communications department, these high tech seats are popping up in arts venues big and small. The concept is to use what they love and can’t seem to live without to attract otherwise nonconcert and theatre goes to fill a seat: social media.

The problem is, the majority of arts patrons are happy with the unplugged event. In fact they prefer it that way. It’s one of the many reasons the arts is so refreshing given our very plugged in lives. Attending an event is a completely unplugged experience. It allows us to be in the moment and just enjoy what’s occurring. For a couple hours, we allow ourselves to get swept to another time and place and forget the issues in our lives that can weigh us down.

We don’t need studies to inform us of the benefit of these experiences, although they exist, because we’ve had them! If we allow technology to impinge upon them, though, the downsides to us as individuals as well as a society will be profound. This won’t be about PR buzz anylonger but our collective need to be disconnected from time to time and understand the boundaries of technology within our lives.

This description from a symphony concert goer in USA Today drives this point home, written from a concert goer who had to sit next to a tweet seat section:

“Their texting thumbs were moving faster than the violinist’s fingers…They would occasionally nudge each other and read what the other person had up on his or her screen. They didn’t even look up to applaud at the end of each selection. The fact that they were watching their handheld devices, they missed out on what was happening on the stage.”

Given the concerts and shows I’ve attended, I could see that easily occurring. When tweeting, you’re focused on the tweet, not what’s around you. Tweet at the wrong time, you’ll miss the highlight of a symphony or a soloists finest moment. You may miss the best scene in the play or musical – the one that causes the audience to laugh hysterically or clap out of the blue. Those moments are what create the magic of a live performance…not what you are posting or reading on a twitter feed, no matter how cleaver.

While I’m not a fan of tweet seats, I do think there is a way that twitter can be used to help Gen Y feel more comfortable with venues that they may not actually see themselves at – yet. Since Gen Y does love a good social media buzz, using twitter before a performance, during intermissions, and after could have the same effect as well as helping this generation stay engaged with the performance unplugged. The feeds could offer give aways that rely on answer questions from what occurs during the show. Chats could occur with cast members, musicians and conductors during breaks from the Playbill can be discussed.

So, tweet away, fellow arts lovers…but please, not during the show.

Technical Names: RSV Bronchiolitis

NickNames: RSV, wheezing virus

What it is: viral infection of the small airways of the lung; can cause a true viral pneumoniaas well.

Typical Ages for Illness: All ages; most severe in young and premature infants and children with heart and lung problems including congenital heart disease and asthma. Interesting fact: all kids become infected by RSV by the age of 2 and many of us get it multiple times throughout our lives.

Typical Symptoms:

adults: bad cold symptoms

older infants and children: similar to a bad cold

young infants: lethargy, trouble eating, fast breathing, cough, wheeze.

Etiology: Respiratory Syncytial Virus

Seasonal Issues: occurs predictably between November to March

How’s It Spread? Direct contact with secretions – person to person or on objects.

Incubation Period: 4-6 days but can range from 2 to 8 days

Diagnosis: Usually clinical – based on symptoms and high index of suspicion given out breaks in community. Rapid assay test available in many offices and emergency rooms – most useful if a child needs to be hospitalized to control infection.

Symptom Duration: 7-14 days, as with most viral illnesses with the most intense symptoms early in the illness.

Treatment:

• cold treatment: saline nose spray and bulb syringe, humidifier
• +/- breathing treatments such as inhalers or nebulizers
• fluids
• tylenol or motrin for fever and discomfort
• some children do need to be hospitalized due to severe respiratory symptoms such as trouble breathing and needing oxygen, or due to underlying heart and lung problems.

Call Your Pediatrician if your child has:

• high fever, or fever not gone in 2-3 days
• vomiting or diarrhea and can’t hydrate well
• lethargy
• sick appearance
• trouble breathing despite treatment
• blue or gray color to lips or fingernail beds

Prevention:

• stay home if sick
• good hand washing
• having the child cover his or her mouth when coughing, if possible
• cleaning toys and objects likely contaminated by respiratory droplets
• a medication called Synagis before RSV season is available for kids under 2 years of age that are high risk – premature babies younger than 35 weeks and congenital heart disease children. This is usually given starting in November as RSV season begins. Your pediatrician will alert you if your child falls into this group.

School and After school Activity Issues

• may return to daycare when fever free for 24hours and able to eat and drink normally, and breathing normally
• avoid large groups of kids if cough is not controlled to prevent further spread
• if on antibiotics, needs to be on them for 24 hours before returning to school
• activities should be curtailed until the child has the energy to participate without becoming winded or fatigued.

Internet Resources For Parents

General Info on RSV (KidsHealth)

General Info on Bronchiolitis (Kids Health)

How Lungs Work (KidsHealth)