Village Pediatrics Las Vegas

10/28/2024

On intimacy after delivering a baby:

Doctors tell you to wait 6 weeks after delivery to be intimate. That number is arbitrary and based on the amount of time it typically takes for a wound to heal.

What they often DON’T tell you is that after delivery, and especially during breastfeeding, your body enters a low-estrogen state. Symptoms are similar to menopause; including decreased vaginal elasticity, decreased libido, decreased lubrication and sometimes depressed or anxious mood. You might also have low energy, brain fog, poor sleep or night sweats. All of these things can make intimacy painful and undesirable.

Even if your “wounds” are healed (vaginal or c-section) your body might not be ready for intimacy. In fact, it might take months or years to return to baseline. Breastfeeding causes release of prolactin which suppresses production of estrogen and progesterone. Which, in turn, suppresses ovulation (and periods) as well as causing symptoms that mirror menopause.

Topical estrogen therapy can help with the vaginal symptoms until your body returns to its pre-baby hormone levels. Pelvic floor physical therapy can make a huge impact in preventing incontinence and decreasing pain.

I’m hosting a webinar on Intimacy through Menopause on December 7 at 1pm PST. Given the overlap in symptoms during the postpartum period, the event is relevant to mothers as well.

You can register here: https://lu.ma/a1yhgro8

10/16/2024

Most of my patients are under 5 years old and many were born during the height of the pandemic. Some were born in hospitals that had strict prohibitions on visitors. Some were born at home.

I have several school-aged kids and college students in my micro practice. I’m genuinely concerned about the role of social media in their lives.

I’m currently watching (with horror) the show Social Studies on Hulu. It’s a documentary about the social lives of several LA teenagers who give the producers access to their smartphones. And I just started reading The Anxious Generation.

The social experiment happening right now gives me a lot of trepidation about the mental health of these kids. And it’s beyond the ability of parents or physicians to control.

Personally, I think this issue is one of the hardest parts of being a parent. It’s like the cruelty of the entire world has a mainline directly into the undeveloped minds of children.

I’m going to host an Under the White Coat Book Club on this topic. I anticipate a rich discussion.

You can follow my writing and sign up for the Under the White Coat newsletter on Substack.

09/08/2024

I absolutely love Substack! It’s such a lovely creative outlet for me to write about medicine, women’s health, intimacy, technology and the cultural shifts that affect people’s lives.

This week I published an article about perimenopause and pole dancing. It’s been incredibly well received!

You can check out my writing and medical education videos at
Dramberhull.substack.com

09/06/2024

No lies here!

As flu season approaches, please keep children home when they’re sick and remember to practice good hand hygiene. Washing hands or using hand sanitizer when you pick them up from childcare is a simple but healthy habit to get into.

09/01/2024

One of my Substack notes went viral this week. It’s the first time that so many people have paid attention to something I said online. I felt a mix of delicious external validation and trepidation that someone would say something obnoxious. The comments were overwhelmingly supportive. I’m grateful to everyone who took the time to respond.

As my patients are heading back to school, I’ve spoken with several grade school aged kids who have smartphones. As most of us are aware, our devices are powerful tools that can become devastating weapons. Which means that adults have the responsibility to teach children about online citizenship.

I picked up this book by Dave Anderson and Blake Fleischacker. It’s an excellent resource that parents can read with children about the importance of conducting ourselves respectfully online.

In related news, someone mentioned me in a comment today by saying “I’m not a fan of everything she writes about but her take on the healthcare system is important.” I genuinely appreciate that readers find value in my work without agreeing with me unconditionally. Learning to move through a world filled with people we disagree with is part of what it means to be American. And I appreciate respectful differences of opinion that don’t dissolve into hostility.

08/26/2024

I was trained for over 14 years in academic medicine that my best was never good enough. That I constantly had something to prove. That my intelligence and work ethic were always subject to being torn down.

That environment made me self-conscious, timid and defensive. A shell of my former self.

As a business owner and creative, I have a lot of toxic conditioning to unlearn. Starting with not apologizing for being human.

08/24/2024

Just in time for Back-to-School, I’m cooking up some content on talking to kids about body safety and technology.

Kids are curious. If they don’t get answers from trusted adults, they’ll ask Google. Which can lead to frightening and inaccurate answers.

Hit me with your questions and I’ll do my best to prepare a developmentally appropriate toolkit.

08/18/2024

I’m so pleased to offer medical education on the importance of pelvic floor health in this week’s Substack post! My colleague, Dr. Kelsey Daniels and I discuss childbirth, incontinence and pleasure.

We also touch on pelvic floor issues that affect intimacy as well as men’s health. All topics that are rarely discussed in doctors’ offices but that have a huge impact on the quality of life.

Go check out our enlightening conversation at dramberhull.substack.com

I’m increasing my content offerings on Substack to include articles on the healthcare system, integrative medicine and intimacy. I also offer interviews, educational videos and a Literary Salon. Long-form content gives me a voice in the attention economy that I can’t dice up into 90 second clips. Please consider joining the thoughtful community I’m fostering on Substack!

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05/28/2024

I’m not a South Park fan but this pretty much sums up what it’s like to access care in the United States. It’s the reason why so many primary care doctors are leaving insurance-based clinics to start cash-pay practices.

Direct Primary Care is more affordable than many people think. And it puts the doctor-patient relationship before the profits of the insurance companies.

Let's navigate the American Healthcare System!SOUTH PARK: THE END OF OBESITY is now streaming on Paramount+!Stream full episodes of South Park at https://sou...

05/20/2024

There’s a free college savings webinar on Wednesday hosted by my trusted fiduciary. I’d highly recommend tuning in!

The "oh yeah, we need to do that" across savings, investing and insurance

04/05/2024

Yesterday, I met with an integrative psychiatrist .us who uses evidence based therapeutic modalities to help patients heal the damaged parts of themselves. Rather than spending 15 minutes with me and prescribing a pill, we spent 90 minutes on a diagnostic evaluation and shared decision making on approaches to therapy.

In addition to Cognitive Behavioral Therapy, I was offered a variety of other options including:

-Internal Family Systems Therapy
-BrainSpotting
-Sound Integration into therapeutic sessions
-Advanced Integrative Therapy

We discussed my history of mental suffering which escalated in parallel with my achievement in academic medicine. And my decision to leave the meat-grinder of academia and avoid pharmaceuticals whenever possible.

We spent the last 20 minutes of the session on Brainspottig: which felt to me like a guided meditation. Allowing me to feel grounded in the moment and to leave the session with a new tool that I can deploy whenever I feel anxious or overwhelmed. A tool far more powerful and less destructive than Xanax.

03/21/2024

I have a 2yo patient who has autism. I don’t do the full diagnostic testing to give him that diagnosis so I have to send him to a specialist that does. I know of 2 in my city who do that. One doesn’t take his insurance and charges $2100 for the evaluation. The other won’t do the assessment for another 6 months.

In the meantime, he’s receiving therapy through the state-funded Early Intervention Program. But he would benefit from more specialized and advanced therapy. However, those therapists won’t get paid by the insurance company to treat him if he doesn’t have the ICD-10 diagnosis code for Autism on his record. So he has to wait 6 months or his family has to pay out-of-pocket for the assessment.

This kid also needs to see an eye specialist. I sent the referral to the specialist’s office yesterday morning and received a call in the afternoon. The referral had the name of the clinic and the name of a doctor who has seen other patients of mine. The administrator asked me to update the referral with a different doctor’s name or insurance wouldn’t pay. Fine. Repeat task and send.

Then the child’s mother gets a call from the specialist’s office that insurance won’t pay the eye physician to see the patient unless the referral comes from an “in-network” primary care doctor. Which means that the child will have to be seen at a different clinic, despite the fact that I’ve taken care of him since birth, to get a piece of paper to pacify his insurance company. The family pays $1700/month for this insurance policy.

I have countless stories like this. Children being denied everything from care for disability to asthma inhalers so that private equity and insurance executives can make their Maserati payments.

This is a systemic failure. This video does an excellent job of explaining how the corporatization of healthcare is affecting Emergency Medicine.

Private equity is swallowing up America's emergency rooms. 1 in 4 ERs are now staffed by private equity-based firms. The waits are longer, the bills are high...