Chapters Transcript Video Panel Discussion 2 II, I have two questions. One is really just a quick fact check of something I heard from a lecturer half a year ago. Um that the fish oil that you get uh for Omega three fatty acids from uh from fish is great, helps, helps you and that if you're a millionaire and you can get the prescription uh fish oil, then that helps you. But all the other uh fish oil capsules and everything you can get from the marketplace that is over the counter is really worthless because something about the process of pulverizing fish, uh leaches calcium from the fish bones into the fish oil makes it completely um unhelpful for the consumer. And yet it's a multibillion dollar industry, of course. So, uh if, if you could comment on whether that's true or not, um I have not heard that, but I'll say I'll say this. Um I have really shied away from putting my patients on, on fish oil unless they have to get prescription fish oil. It is much purer which is really what you're talking about as well. It is so many capsules anyways. So, because it's the EPA and DEA component So they'll say 1000 mg, two pills. And you look, and it's really 350 mg of the active ingredients. So now, oh, add that up. How much you're going to take? 10 pills a day. So I actually, my patients who need treatment in general, I've been doing pheno frate TriCor who like literally need treatment for high triglycerides. I use a low dose uh pheo um or if they don't want to, then we'll do if their triglyceride is over 500 then I will do Lavasa. Um if they, if that's what the family wants, but I don't, I have not heard that, but I mean, it makes sense to me. I mean, definitely the prescription ones are um are very pure. That's why they're, each pill is really almost almost a hun 1000 mg of epa and DH A. Um But um I don't know if you'd be a millionaire but you have to have triglycerides over 500 for that. Uh One other question is more of just a sense of trending, you know, for a long time. Now, we've had this recommendation to get lipid screening for our population and, and for, for many, many years, we've all suspected that if you have high cholesterol, this as a very young child, this probably leads to problems. But, you know, shout out to the Netherlands for having eye popping charts and game changing information with long term follow up. So all the people who are worried about statin is affecting puberty and causing problems and we can't possibly start a lifetime medicine in an 11 year old with a sky high problem. Uh You know, the anyway, we have a game changing information now that we never had before. So my question is this, um uh are we looking at not only awareness in the general pediatric, um uh gen general pediatricians of getting screening done more universally. Uh And you know, now, now that we have really obvious reasons to do so, but do you foresee in five years or 10 years that general pediatricians are the ones starting the statins, general pediatrician? You know, like right now, if I asked an internal medicine doctor, if they ever referred to a cardiologist in order to make a decision about starting a statin, but it would be a jaw drop, right. So, so right now, I, I love the chart. It was a very great algorithm of when to refer. Uh But I'm a little confused about where are we going with this? And should I just start getting comfortable ordering these medicines? Yes. Yeah. So, so um absolutely, pediatricians can absolutely start statins and we have no, I, I don't, I'm very happy I have, I have several that I like help manage, you know, um uh help them start. Uh I think largely, you know, you know, we don't get trained in this in residency. So it is getting comfortable getting comfortable, obviously internists. That's what they do. Right. So, once the patients are 21 and 22 often they'll just start seeing their internists and they'll follow them. That being said, my FH patients, I actually hook them up with a preventative cardiovascular cardiologist. I think it's very important with those patients. They are much higher risk than just a general person with like mixed dyslipidemia. Um, because there are clinical trials that they will be made aware of. There are new drugs that are out there. Um Even adult cardiologists don't know some of the drugs I have parents who have come in and are not being managed appropriately. Um So, but as pediatricians, I think absolutely, we can start statins. I have no problems with it. I am very cognizant that you guys get a very little bit amount of time with each patient. Um I get a lot more time and so I think it's easier for those of us to be able to, you know, take the time to discuss everything and go into it. You guys have to also at the same visit, make sure they're developing normally and growing and their anxiety and all the other things are to do. Oh, and by the way, you're going to start statin and so I just, I, you know, I think that's also part of it for you guys. But absolutely, if you, if general patricians want to start setting, there's no monopoly for like cardiologists or endocrinologist at all. Um, I, my guess is it's somewhat of a time, it's a time and a comfort for, for you guys, I'd say. And with that lipid work group that, um, Doctor Sidiki mentioned, um, there are target cardiologists, nephrologists out there in the adult world with Atlantic health that we refer those highest risk patients like the FA FH patients. Doctor FBG and adult cardiologist and Doctor Feldman, a pediatric nephrologist actually run those groups. So whenever my patients are graduating or if you ever need um to know some of those names, then I look for them and they target um people in the local area that they would recommend for those much more complicated patients. Hi. So my question is if you have a patient who is over the age of eight, who is obese has failed lifestyle modification, very sedentary and is a cardiac patient. At what point do you start referring them to endo to give the meds to start treating the obesity like the wigo v? That's that category. So sorry. So you said obese greater than eight years of age deliberately? I said that. Yeah. Yeah, I mean, I think it depends on the lipid panel uh that you have too. If you have abnormalities like we talked about, then, you know, we would definitely screen if there's a strong family history um as well that might come into play. But I think some of it depends on the results. But uh the, the other uh just a plug for endocrine is that they have the Kid Fit Program, which is another really great resource for our community um which focuses on patients who are overweight with other risk factors, maybe diabetes hyperlipidemia. And they partner with endocrinology and they have a physical activity program as well that they incorporate, which I don't know, uh Lindsay if you have anything else to add on that. But the other thing, um endocrine is very great about allowing us to refer to their dietician. Um It is harder for the general practitioner just to refer to the dietician. Um So there are some yes rules on that which um I don't think anyone from endocrine is here in order to clarify that. But if you ever have any questions, um but endocrine, all their dieticians see all their patients just like your program is at their visits while for us, when we see them, we refer to the dietician for extra guidance on that and then they can talk further about the Kid Fed program. Thanks. Hi, I have two questions for you. Um The first is um is there anything as a general pediatrician if we have someone with type one diabetes that's going to be starting on a statin because of familial hypercholesterolemia that we need to be aware of that, we need to follow more carefully. So, sorry, miss. So someone with type one diabetes type one diabetes. Yeah, you need to follow more. So, yeah, that's so, I have a patient recently who's being started in statins because of their high cholesterol. And, um, and, uh, the cardiologist was concerned about starting the statin. Um, uh, because the type one diabetes that need to work more carefully with the endocrinologist. Is there something to that or the one I can think of is that of the studies in older individuals where there's like this increased risk of developing type two diabetes is my guess is maybe what they're thinking because all the type one diabetics I'm on, I treat them just that I have treat them just it does not, it does not. Uh uh no, not that. I mean, it's very different from type two diabetes, obviously. Yeah. So that, that, that was very weird to me. OK. The second question is that quality project that you just presented was uh uh great. Do you, are you working with Njap for other people outside of um Atlantic Health system and uh to, to participate in? So we are, thank you, by the way. Um We are working on uh, no, we are not working in Jaap quite yet. Um But we are trying to see how we can incorporate this and spread this project to other parts of Atlantic Health. So family medicine has been really interested. Um and also the general pediatrics groups we can definitely partner with. Um, again, it's, it's, it's not a particularly, uh, uh, you know, hard tool to incorporate in the practice because it's already developed. So, I feel like, you know, we've been talking about that a lot with the lipid work group as well. Um, but, you know, as far as NJ API, I don't think we're quite there yet. Oh, that's a great idea. Yeah, I don't. No, that's a great idea. I can definitely look into that. Thank you for that suggestion. Yeah, it's a lot. Absolutely. And, um, it'd be a lot easier than they and we didn't have to think so hard or work so hard to do. Pay anybody. I mean, you know, we know it's, it's, it's something that we're forced to do, but if we can move it out there more it seems like. Absolutely. Yeah. No, I think that's a great idea. I'll look into it. Thank you. I actually have a question for you. Doctor brothers. Oh, do you have another question out there? Yeah, that are very high quality. So, availing ourselves to those is great and most of them are paid for by insurance. So it's super helpful just going on that. Do you have any resources that you recommend to the general practitioners when they're giving these nutrition guidelines? I know that the National Lipid Association has a great website and some handouts because sometimes when you start talking about reducing this by 20% reducing, sometimes it's nice to list out. Ok. What are the good fats. These are the foods, bad fats. So what resources do you, I mean, so chop has on our, we have a like a what's called a PFE patient family education. And we actually have a lot of really nice handouts through the nutrition. Um like portal part that um has we've got like heart-healthy snacks, um you know, healthy fats, like what you're saying, um uh healthy breakfast ideas. So we, we try to focus more on not so much like counting the numbers, but really like some ideas for kids um that they can choose like choices they can make. Um So I like, I sometimes print out those snack facts and things like that and bring them home. They're really, they're actually really good. So, um I think that's really helpful and that's a good question. OK. No time to the pediatricians. Thank you. Um So, you know, typically before I start a patient on a statin, one of the things on my checklist uh is to send N BT A genetic testing for FH what is your threshold for sending uh NBA testing? And then also I want to throw it out to the pediatricians. How difficult is it in your office to send genetic testing on patients? Um I guess I'll, I'll start so it's really variable. So um our, our Medicaid patients are free. I have personally a hard time um promoting something where I have to ask the families to pay, even if it's a couple of $100. Although I certainly will, you know, will tell them that. But if it's free, that's one of them. I mean, certainly a perk. Um, but generally anybody with an LDL of 160 or high, um, or even in the one fifties or higher and a strong family history of early heart disease. And the family history is really, um, significant or someone's adopted and they've sit, they're sitting in the one fifties, one sixties, um, for LDL cholesterol. Um, I do discuss it. Some parents don't want to do it. They are worried about, um, like long term life insurance and things in the future. Um, and I, I do understand that but I kind of do tell them, well, it's going to be noted already. They have high cholesterol. It's already going to be in their chart so they're already going to be dinged if so, so to say, um, but, you know, some families want to, some families don't, but I, I do like to bring it up usually for those, those reasons, not with LDLs, less than 130 usually not even 130 to 140. All right. I, um, we have run over, thank you so much. Uh, we learned a ton today so far. Um, Published Created by
