Correcting bunions; prescribing books for children; weight-loss surgery: Upstate Medical University's HealthLink on Air for Sunday, March 6, 2022
Orthopedic surgeon Scott Van Valkenburg, MD, discusses treatment options for bunions. Pediatrician Jaclyn Sisskind, MD, shares her love of reading with her young patients. And bariatric surgeon Timothy Shope, MD, tells how much weight you can lose through surgery.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an orthopedic surgeon goes over treatment options for bunions.
Scott Van Valkenburg, MD: "... Some people think that when they come to be evaluated for something, it means that they're to the point that they are going to have surgery or something. And that's never the case ..."
Host Amber Smith: A pediatrician who is enthusiastic about reading talks about how she incorporates books into her practice.
Jaclyn Sisskind, MD: "... It's such a wonderful way for children and adolescents to connect with the people around them, their teachers, their parents, their friends, and even at young ages, reading helps build so many tools that we need for our lives ..."
Host Amber Smith: And a bariatric surgeon explains how much weight someone can expect to lose through surgery. All that, and a visit from The Healing Muse, coming up after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll meet the "Readiatrician," a pediatrician who works books into her medical practice. Then, how much weight can you lose through surgery? But first, bunions can be debilitating, and we'll hear from an orthopedic surgeon about options for treatment.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Bunions are those bony bumps that may develop on the joint at the base of the big toe, and they can cause pain and stiffness and deformity that can be debilitating for some people. With me to talk about solutions for bunions is Dr. Scott Van Valkenburg. He's an assistant professor of orthopedic surgery at Upstate, and he specializes in the foot and ankle, so people with bunions are among the patients he cares for. Thank you for your time, Dr. Van Valkenburg.
Scott Van Valkenburg, MD: Thank you so much, and thanks for having me.
Host Amber Smith: What causes bunions?
Scott Van Valkenburg, MD: They're a very common thing that we see. The technical term for them is hallux valgus, so that's an interchangeable term you might see. It's mostly related to genetics and our DNA. And it's partly the way that we develop.
We think it's more of a process that occurs, in some people who are predisposed to it, but it occurs over a lifetime and generations, rather than any particular thing that the person does, individually.
Host Amber Smith: So the type of shoes I wear has nothing to do with it?
Scott Van Valkenburg, MD: That's a debate that's still goes on.
You know, in decades past it was felt that it was more related to shoewear. But now, with less people donning the type of shoes that was thought to cause them and still bunions being as evident as they ever were, it's thought to play a lesser role. So leaning more towards genetics and DNA rather than any formative thing, such as footwear.
Host Amber Smith: What is the average age for the patients that you see with bunions?
Scott Van Valkenburg, MD: There's something called juvenile hallux valgus, or bunions that begin occurring at a young age and in children in their teenage and adolescent years.
And then another, classification of a more typical degenerative type of bunion that typically occurs more in the fourth and fifth decades of life. So someone in their 40s and 50s. and they often start out as being minimally symptomatic. People often live with them for a number of years prior to maybe developing symptoms later on.
Host Amber Smith: Is it evenly divided among men and women?
Scott Van Valkenburg, MD: Women seem to be slightly more predisposed to it, and so that perhaps give some credence to the argument of shoewear, which may have some contributions, just not the major contribution.
Host Amber Smith: Do bunions have anything to do with arthritis, osteoarthritis?
Scott Van Valkenburg, MD: Great question. You know, a typical bunion is not truly related to arthritis. Now, a bunion that develops over time, and you have malalignment of that joint, that may then lead to arthritis, but a true bunion is not part of an arthritic process.
What's interesting is that oftentimes, bunions can be confused with arthritis because arthritis often leads to something that some people refer to as a dorsal bunion, meaning a bump or a bone spur off the very top or the dorsal surface of the joint. So rather than off the inner side, you know, protruding immediately or towards the inside of the foot, a bump protruding up, directly up, with a still well-aligned toe. And that is an arthritic process because the arthritis causes the bone spur dorsally. So you maysee or hear the term dorsal bunion, and that is an arthritic term.
Host Amber Smith: I was going to ask if when you see patients, are patients a pretty good judge of whether they've got bunions or not, or is it trickier?
Scott Van Valkenburg, MD: Yes, I would say that people, especially, I think, with modern internet and everything, people, a lot of times, do their own investigations and there's pictures and stuff, so they can compare their foot to others on websites and that kind of thing. But once in a while, and I would say it's less than 5%, but people sometimes do come in and think they have a bunion, and it's something else. But inevitably it turns out to be something in its own right as justification to talk about and be evaluated for. So I guess in general, I don't really encourage anybody to try to figure out their problem. If they're having pain or a problem, they can seek care and advice about it.
Some people think that when they come to be evaluated for something, it means that they're to the point that they are going to have surgery or something. And that's never the case with orthopedic foot and ankle care.
Host Amber Smith: So pain might be one reason. Are there other reasons that someone should consult a doctor about their bunions?
Scott Van Valkenburg, MD: The short answer is pain should be the major driving factor for the decision to think about a surgical intervention.
But again, similar to my last response, I guess it's never a bad idea, if you're wondering about it: Seek consultation.But if it's not painful, I wouldn't recommend surgery,with some minor exceptions. If it develops to be so significant, and they're unable to get shoes on, obviously I have seen those patients, that their deformity is so significant, and even though they just are stoic people or have learned to cope with it, so they're not necessarily in pain, but they really ran out of shoewear options. Or also if they start developing significant deformities in the other toes that can be related to the bunion, sometimes that's an indication or a reason to do something.
Host Amber Smith: Do you need an X-ray to get to the diagnosis of bunions?
Scott Van Valkenburg, MD: You should, definitively, if you're going to start thinking about ways to manage it, because I always tell patients there's no real normal foot, and you're speculating a lot to look at a foot from the outside and try to determine everything you need to about it. A weight-bearing X-ray, it's kind of like playing a detective and usually the most vital information that we have. We can tell a lot, and it's funny because the difference between a non-weight-bearing X-ray and a weight-bearing X-ray are really significant, but a weight-bearing X-ray tells, a big, and typically an accurate story about that foot.
Host Amber Smith: This is Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with orthopedic surgeon Scott Van Valkenburgh about bunions.
What about conservative measures? Changing shoes, wearing inserts, sleeping with corrective devices on your feet -- do they ever correct bunions?
Scott Van Valkenburg, MD: I think people have different philosophies about that, but my philosophy is that no, there's nothing that I've seen out there or encountered that actually provides true correction, meaning that X-ray is going to be similar, whether you put a splint on it overnight or not. That being said, I do think that conservative measures are the best way to start, and the goal of the conservative treatment is not necessarily correction but minimizing symptoms and making it something that can be lived with. So early conservative measures include wider shoes. And the good thing is that with modern shoewear, most athletic-type shoes, sneakers, are made with a mesh top, or mesh body, rather than the old leather shoes, and so there are more accommodative (options).
So at any given shoe store there's a lot of options that can accommodate for that bunion. And then, other measures: Sometimes I'll utilize a toe spacer or a little bunion pad, which again, sometimes when the patient is wearing it, it can provide some symptom relief, but I'm very careful to make sure a patient understands that there shouldn't be an expectation that when they take the thing off, it's going to be straighter. Because it typically isn't.
Host Amber Smith: What about anti-inflammatories or cortisone injections? Have you ever seen those be helpful?
Scott Van Valkenburg, MD: Anti-inflammatories certainly can be helpful. Sometimes people have a painless bunion, painless deformity, and then they develop an inflammatory process because of the bump, you know, perhaps they were wearing or doing some activity or wearing, you know, hiking boots for a long period of time one day, and then they get a kind of a bursitis what we call an adventitial bursitis, meaning an inflammatory change in the tissue directly over the bump. That can certainly be addressed with anti-inflammatory medications. I typically do not use cortisone injections for bunions, unless it's one of the bunions that has started causing arthritis; cortisone injections are more a treatment for arthritis of the big toe.
Host Amber Smith: What happens if someone leaves, if they have severe bunions and they leave them untreated? Are the bunions just going to keep getting worse?
Scott Van Valkenburg, MD: Oftentimes they do progress. Now, obviously there's a limitation on that. They can't progress forever. I've seen in my practice some pretty significant ones, ones where the big toe goes underneath the second toe or even the second and third toe.
And I would say that, I've never seen someone's condition develop, some problem with their ankle or knee or hip or something, because of a bunion. So again, it's not as if it's an urgent or dire need to have it addressed, but if it is a problem in its own right, meaning that if they're having pain or if it's causing balance issues or something like that, then that's something that might be addressed.
Host Amber Smith: If someone's interested in surgery, what do you tell them to consider?
Scott Van Valkenburg, MD: Well, typically we go right to the X-ray and try to classify the deformity as, is it a kind of a mild, medium or severe? There's a litany of types of procedures, all with different corrective potential, meaning how much of a deformity they can correct. And also each procedure has a different recovery and different risk of complications and different types of complications. So often, the art form of surgery is to try to customize the right type of procedure for any given patient.
Oftentimes the ones that provide less correction, so the less-powerful osteotomies (bone-cutting surgeries), are easier to recover from and (have) lower complication risks. And then when you get to really big deformities, you have to do a little more, and oftentimes those procedures carry a slightly higher complication risk.
But there is usually a very nice balance you can find.
Host Amber Smith: Are the surgeries always done, is it an open procedure, or are you doing any sort of laparoscopic stuff?
Scott Van Valkenburg, MD: The standard currently is still open procedures. Now there are some in the country, most notably one of my mentors, Dr. Johnson, down in New York now, who are pioneering a minimally invasive bunion surgery. It doesn't use arthroscopy, but it uses X-rays, and small incisions with a very high-speed burr that can cut just bone, it's safe to cut just bone, beneath the skin. It is something that I've practiced on it in a lab setting, but haven't adopted in practice yet. I'd still say that the standard is still open osteotomies.
Host Amber Smith: So are you basically, taking out the part of the bone that is the bunion? You're just cutting it off or shaving it off? Is that sort of the goal?
Scott Van Valkenburg, MD: That is one of the goals. It's a component of it, but actually if done in isolation, it does not resolve the problem. It tends to be a failure. So in orthopedic training, we pretty much avoid just shaving down the bunion. There are some indications where something that is really bothering them, where we end up educating and deciding like, listen, this is not going to correct the problem, and it might progress, but we're just going to shave down the bunion. But I would say that is quite rare. Typically, in order to actually correct the issue, the surgeon would need to remove some of the bump, but then also reshape the bone by cutting it, or what's called doing an osteotomy, meaning you cut the bone. We cut it in a certain orientation so that it can be altered, change the shape of it, move the head or the ball part of the joint over to the outer side of the foot so that it is back in the position that it ought to be in.
Host Amber Smith: What is recovery like? How soon does the person get back on their feet?
Scott Van Valkenburg, MD: The majority of bunion procedures typically are two weeks, with minimal weight bearing, meaning maybe a little bit on the heel, but I put patients in a splint. It's small, almost the size of a typical hiking boot, and give them crutches and just a little weight on the heel for the first couple of weeks.
Then after two weeks, as long as the incisions look good, usually it's a walking boot and weight bearing as tolerated. There are some procedures, like a fusion procedure, where, we limit the weight bearing for another two to four weeks, but most of them, people can be weight bearing after two weeks.
Host Amber Smith: If a person has bunions on both feet, do you ever operate on both feet at the same time?
Scott Van Valkenburg, MD: I received some sage advice from a mentor once who indicated he had tried that once and to never do it.
And I think one of the things is people often just think, oh, it's just a bunion, what can go wrong? Surgery can be a complex thing, and it's imperative for those first two weeks to care for it and stay off of it and keep it elevated.
And no matter how you cut it, if you did both sides at the same time, you would be compromising the other side to some degree. Now that may not always lead to a complication, but I think it would create a higher risk of complication than it would be if you just did one at a time, so I would definitively advise not to do both.
Host Amber Smith: After a bunionectomy, can a person expect to be free of bunions for the rest of their life?
Scott Van Valkenburg, MD: Unfortunately, the honest answer to that is no. Your tissues, your body continues to go through degenerative changes, and the movement of the first metatarsal, meaning swaying out into what forms a bunion, can continue. The recurrence rate after having a bunion surgery is somewhere in the 15 to 20% range in the (medical) literature. That's variable depending upon the type of procedure is done, but it can return. When it does, my experience is that it oftentimes is to a more limited degree, and the symptoms aren't significant.
I'd say it's quite rare. Bunion procedures are very frequent, very common, and it's pretty rare that I see someone 10 or 15 or 20 years after a bunion procedure where that side's bothering them more. Oftentimes, I'll see a patient who had a bunion surgery 15 years ago, and now is here to look at the other side, and when you look back on the other side, it looks like you still have some deformity there, but I would say that 90% plus have indicated that that doesn't bother them, and they want a similar result on their other side.
Host Amber Smith: If a bunion re-forms after a person has already had surgery, what are their options? I mean, can they have a second surgery?
Scott Van Valkenburg, MD: They can. On the menu of types of procedures for bunion correction, you may be picking from a different side of the menu. It does oftentimes limit some of the types of procedures you can do, but inevitably there is something that can be done. I would say that this is a process. I still have never encountered a situation that I say, well, nothing can be done there. There's always something we can do to help, to try to help.
Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Van Valkenburg.
Scott Van Valkenburg, MD: Thanks for having me.
Host Amber Smith: My guest has been Dr. Scott Van Valkenburg, an assistant professor of orthopedic surgery at Upstate who specializes in the foot and ankle. I'm Amber Smith for Upstate's "HealthLink on Air.Next on Upstate's "HealthLink on Air": has your child's doctor ever prescribed a book to read?
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Dr. Jaclyn Sisskind is a pediatrician who loves to read, and she's been known to write prescriptions for particular books to patients when she thinks it might help them. Her nickname is "the Readiatrician."
And with me to talk about that is Dr. Sisskind herself. She's an assistant professor of pediatrics at Upstate. Welcome back to "HealthLink on Air," Dr. Sisskind.
Jaclyn Sisskind, MD: It's a pleasure to be back again.
Host Amber Smith: I know you enjoy reading. Why is it important, particularly for children and adolescents?
Jaclyn Sisskind, MD: It's such a wonderful way for children and adolescents to connect with the people around them, their teachers, their parents, their friends, and even at young ages, reading helps build so many tools that we need for our lives. It builds vocabulary. It builds the opportunity to think about other people and other situations and other worlds outside of their own. And it gives kids the language to be able to express how they might be feeling when they are exposed to it in a book or in a picture that they see in a book.
Host Amber Smith: Does it build imagination?
Jaclyn Sisskind, MD: Absolutely, to experience something they might not have thought of before. And many children's books have an element of the fantastical to it or the imaginative. And it gives kids permission to think about things in a new and different way, which really opens up a world of possibilities for them.
Host Amber Smith: Do you think that making books a part of childhood has a lasting effect on people into adulthood?
Jaclyn Sisskind, MD: For sure. It certainly did for me, and I'm noticing that with my children as well. When you ask someone a book that they enjoyed as a child, you can almost see their face change with the joy of that memory.
And there are certain characters or certain situations that carry through, not to say that every book that you read as a child is going to change the way that you face adulthood. But I think that the experience of reading lots of different things, being exposed to lots of different things, in childhood makes a big difference.
One example that I always give people is that one of my favorite books when I was young, kind of in middle grade, was "Anne of Green Gables" by Lucy Maud Montgomery. And in that book, the main character, Anne, has to go help one of her friend's little sisters, who has diphtheria. And I got a question right on my pediatric boards (exams) about diphtheria because of a scene in that book, it just stuck in my brain.
It was like Anne and Diana were friends of mine. And when I was faced with that question, I remembered that. I think that the things that we read when we were kids really stick in our heads for a long time,
Host Amber Smith: That's funny. I was going to ask if it matters, what type of book? I mean, some kids like fiction and some like nonfiction, poetry, even graphic novels.
Does it make a difference what a kid gravitates to?
Jaclyn Sisskind, MD: So glad you asked this question because often parents ask me, "Well, they like to read 'Dog Man,' " for example. "Dog Man" is a very popular graphic novel, and parents will say to me, "But that's not really reading." And of course it is really reading. Reading magazines, reading graphic novels, nonfiction, fiction, historical fiction, biography, whatever someone is connecting to counts as reading. Reading is the act of interacting with text and with narrative and making it a part of what you're thinking about, and that applies across the board. And I actually think it's very important for kids to be exposed to all different types of books so that they can decide what it is that they really like. You know, it's one thing for a parent to say, "My kid doesn't like reading," and we can offer some things. But the flip of that is for a parent to say, "Oh, my child loves reading. They devour books," but if they're just devouring one kind of book, if they're just really into one series or one type of fiction, and they haven't learned what else is out there, they might actually like lots of different kinds of books, and what a service to be able to show them when they're young. You know what? You like sci-fi, or you are really interested in biography. I think that's a great thing to teach kids when they're young and focusing on just the classics or just what would be considered to be a chapter book is not necessarily the way to go.
Host Amber Smith: Well, I'd like to ask you, because we've seen a lot of this in the news lately about book bans. Some schools and some public libraries are banning certain books -- "Of Mice and Men" by John Steinbeck, "To Kill a Mockingbird" by Harper Lee, "Speak" by Laurie Halse Anderson, even the graphic novel "Maus" by Art Spiegelman. And these are books that are popular and award-winning that have been used for years in educational curriculums. What is motivating groups to ban these books?
Jaclyn Sisskind, MD: So glad you asked me this question. This is it's truly a passion of mine. I am not entirely sure where the motivation is coming to ban books, and I think a lot of it comes down to adults feeling uncomfortable. I see in my office, many times, when parents want to talk about different things in front of their kids, or they ask me how to broach particular topics with their kids, and this could be about a family has got a divorce coming up. It could be that they're not ready to have "the talk," and I know this is an audio medium, but I did the air quotes around "the talk." Right? You know, they want to discuss puberty, body changes or relationships. Parents maybe don't know how to handle talking about gender with their children or history or what might be happening in the news right now.
And they get uncomfortable. I think that parents and adults don't like to enter a conversation in which they feel unsure because adults like to be sure. And when we feel unsure or unsteady, it is easier to say, "We just don't talk about that," as opposed to saying, "Let's explore it together." And so I think that there are so many motivating factors right now around freedom to read and limiting access to books and different materials and what it boils down to is people being afraid of something that they're not familiar with or being unwilling to open up to something that they haven't encountered before.
And certainly, there's all sorts of different political motivating aspects behind it. And I am not a politician. That's not for me to speak on that, but I think a lot of it really just comes down to discomfort and people not liking the feeling of being uncomfortable.
What's remarkable to me is that I think one of the best ways to start an uncomfortable conversation is with a book because you can read a book together with your child or your adolescent, and you can be open and say, "You know, I've never read a book like this before," or "What's happening in this book makes me uncomfortable because of X, Y, or Z. And how does this book make you feel? And let's talk about it together."
And then you can explore this topic that you're not sure about through the lens of a book, through a character that you become invested in. I think it takes a lot of that fear away, and many of the books that are being banned in different school districts in libraries across the country are books that, as I've listened in on these town halls and school board meetings, many of the adults involved admit that they have not read, that they are uncomfortable with what they think the subject matter might be, what they've heard the book is about based on the cover or the title alone, based on the author alone, and that to me is a mistake.
I think if someone is certainly willing to read a book and say, "You know what, this made me uncomfortable, and here's why," that's a different story from just a blanket "I don't want to talk about this."
Host Amber Smith: Do you think that banning the books, backfires, does it make kids want them all the more, if they're told they can't have them?
Jaclyn Sisskind, MD: I'm a parent, so I fall into this trap sometimes, right? Like, I'll talk about how great broccoli is or, oh my gosh, you can't have any broccoli tonight because I ate it all, in the hopes that my kid will be more excited to eat it. But I think when it comes to books, that's not necessarily true.
A great example: You talked about "Maus." So, "Maus" is a graphic novel by Art Spiegelman that is written about the Holocaust and his parents' experience during the Holocaust. In the book, the Jews and other people who are persecuted by the Nazis are depicted as mice, and the Nazis are depicted as cats.
And it talks about all the experience of the Holocaust, but through this cat and mouse instead. That book is taught mostly in high schools, and shortly after it was banned, it sold out everywhere. You couldn't get a copy in any bookstore. You couldn't get it on Amazon. There was this big rush on it.
All of us that had it on our shelves from when we were in high school or college felt very cool that we already had a copy, right? So I think there's an example where people might say, "Look, this got a lot of attention. Any press is good press. And the book flew off the shelves. Isn't that what you want?"
But not really, because most of the people who are buying up copies of "Maus" were adults, who wanted them for themselves. When we talk about book banning, we have to keep in mind that for many kids, the public library or their school library or classroom is the only place that they have access to those books.
Many kids don't have the means to get to a bookstore or a library on their own for transportation reasons. Many kids don't have the money to be able to purchase a book on their own, or again, to get to the public library. And so if a book is banned, yes, it might increase the conversation around that book briefly, and maybe someone could say, "Well, if this book is banned, it's edgy. It's the cool thing to do. Kids will want to read it," but we have to think about the fact that many kids won't have the opportunity to get that book in their hands, unless it is available in the schools or the public library.
And when we say that a book is being banned because it's inappropriate, what we're really telling the kids that see themselves reflected in those books is that they are inappropriate simply for being who they are.
And it erases them, and it makes them feel like their story isn't worthy of being told. To me, that's such an important point, that kids need to be able to see themselves and their experiences in books, even if it makes other kids uncomfortable, because when we ban some books to, quote-unquote, protect some kids, what we're really saying is that there's only one kind of kid that's worthy of protection and that everybody else isn't.
Host Amber Smith: Are there any books that you would not want your own children to read?
Jaclyn Sisskind, MD: I think that my kids can read anything that they want to read, and if they don't like it, or the subject matter is too much for them, or they don't understand it, or the print is too small, I think they're going to put it down, or they're going to ask me a question about it. But anything that's in my house, anything that they would find in the school library, anything that we would go to the public library -- I'm trying to think of anywhere else they would access books -- if they went over to a friend's house, in a non COVID world, when they could walk in any house, they could pick up a book and read it. That would be fine with me. And if they found something that they were uncomfortable with, or they didn't understand, we would talk about it.
A great example of this is, a couple nights ago, I was putting my 4-year-old to bed. My husband had a Zoom meeting, so he was like locked away. So I put my 4-year-old to bed. We read a story. And my 9-year-old is waiting for me because we're reading a chapter book right now together. And he was sitting in my bed waiting for me, and he promised he wouldn't read ahead in the chapter book because then I would be lost, and it's a good book, and I didn't want to miss anything.
So he was sitting in my bed waiting for me, and he got bored. So he picked up the book that I'm reading that was on my nightstand. And I walked in and said, oh, you're reading my book. And he said, "Yeah, it's a little hard for me to read. The words are big, and the print is small." He picked up that the font and kids books is a little bigger.
And he said, "What's this book about?" And I told him what the book was about. And he said, "Oh, that sounds interesting. But I don't think I want to read that. Let's get back to my book," and we just moved on, and it was fine. And I thought it was nice that he saw that I read, which he knew anyway, but that he was welcome to pick up anything he wanted in the house and that we could talk about it.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with "Readiatrician" Dr. Jaclyn Sisskind. She's an assistant professor of pediatrics at Upstate.
How do you work books into your pediatric practice?
Jaclyn Sisskind, MD: I love working books into my pediatric practice. It is probably the thing that gives me the most job satisfaction these days and has been such a lift during the pandemic.
So when kids come to my office, they get a brand-new book to take home with them. If they are between the ages of 6 months to about 7 years old. There's a program called Reach Out and Read that helps provide training on how you can use books in your practice. And they help with securing funding for kids 6 months to 5 years.
And I felt like that wasn't enough for us. I wanted to be able to give to older kids as well. So I've been able to secure a few grants where we now give books out to kids up to age 7, maybe even 8. And I'm working on being able to get books for older kids, too. When I walk into the room with a book, it does so many things.
First of all, it shows parents reading is important, and here's how important I think it is, that I'm going to start off your whole pediatric medical visit by showing your kid a book and talking to them about it. The second thing is it shows the parent, or the caregiver who's there, how to interact with a book and your child at whatever age the child is.
So when I walk in with a book with a 6-month-old, the parent looks at me like, "I don't know how to read to this kid yet." And it's nice to be able to show you can use the book for so much more than just reading. I think that a lot of parents feel that the way to read to your child is to sit down at a prescribed time, they're in your lap, you open the book up, and you read every word, and then they say, "Well, my kid loses interest," or "They want to flip the pages too quickly," or "They want to talk about the pictures."
And that's really where all of the important stuff is. You don't have to read the words to read the book. So I'll walk into a room and show a 6-month-old a book. It's often a board book at that age, and I'll knock on the board book to make a noise and see if they look up at the noise. And if they're interested at me, I will hand them the book and see if they can pass that book from one hand to the other, or if they bring the book right up to their mouth and start chewing on it, which has all the gross milestones that we're looking for as far as motor development at that age. With a 3-year-old, I'll open a book up, and I'll say, you know, there are some fish on this page. What does a fish say? What color is the fish? How many fish do we see? Or, can you show me somebody who looks happy in this page?
There's a book that I'm using right now in my office for 4-year-olds called "Too Many Carrots," and it's about a bunny who likes carrots so much, they just keep gathering them. And the whole house is full of carrots. They're coming out the windows. It's very cute. Andthere's a picture of the house where it looks like it's just about to burst, and I'll say to them, what do you think is going to happen next, based on what you see? And a lot of times the kids will say, "There's going to be carrots everywhere!" and I'm like, exactly, that's predicting. That's visual intelligence. That's understanding what happens next.
Even, with kids, when we're looking to see, can they follow an object, I'll hold the book up, and then I'll drop it.
And if that 1-year-old follows the book down, then they're demonstrating what we call object permanence, which is understanding that objects move and don't disappear when they're out of sight. So these are all developmental screening things that I can do with the book in the room. So much more fun than having a parent fill out a questionnaire.
And it also demonstrates to the parent, these are lots of ways you can play with a book together as opposed to just reading it.
Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but we'll be back shortly with more of our interview with "the Readiatrician," Dr. Jaclyn Sisskind.
Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith. I'm talking with "Readiatrician" Dr. Jaclyn Sisskind. She's an assistant professor of pediatrics at Upstate who loves reading.
Do you ever encounter patients, maybe older patients, who just straight out say, "I don't like reading"?
Jaclyn Sisskind, MD: Absolutely. Every day. It's one of my favorite things, because when someone says, "I don't like reading," it's fun to just say, oh, I'm so sorry to hear that. You must not have gotten this book yet, and then I launch into a full-scale pitch of a book that I think they might enjoy. Sometimes I will base this off of something that they're wearing, if they've got a particular character on their shirt, or if there's something we've talked about earlier where you know, they're into sports. Something that they've brought up to be able to launch into a conversation about that, and I'm pretty chatty during my exam. And so as I'm looking in their ears and listening to their lungs and tapping on their knees, I'll just chat about the book.
And so many times when we're done, the kid is so excited to give that book a try. And then for me to be able to say, you know, the library is like right up the road over here, I guarantee they have this in your school. My husband, for the holidays last year, made me a prescription pad that I can write books and authors down on it.
And it says "your prescription from the Readiatrician," which my patients find very amusing, but it's great to be able to write down a title and an author and hand it to the kid. And I always make a note in their chart about the book that we discussed, so when I see them the next year, I can say, Hey, did you like that book?
Or if they are reading one already, I'll write down what they read. If they've recommended a book to me, and I read it, then I'd make a note, so I remember to talk about it with them next year.
Host Amber Smith: What is your favorite book to be a baby's first book?
Jaclyn Sisskind, MD: I love "The Very Hungry Caterpillar." I know that sounds like it's such a classic. It is truly my favorite baby book to give. And if someone ends up with five copies, that's fine because they're going to go through five copies of it. "The Very Hungry Caterpillar," in my mind, is one of the most perfect baby books ever written because you get so much out of it.
So for anyone who's listening and doesn't know, you should go right away to read this. It opens up, there's a leaf with a little egg on it. A tiny caterpillar comes out, and he's very hungry, and it goes through the days of the week. So on the first day of the week, he eats through one apple, and then the next day he eats two pears, and then three plums and four oranges and so on and so on. The book is written with little punch holes that go through the vegetables or fruits that he's eating, so kids can stick their fingers in the holes. Then he gets so full, and he goes into a cocoon, which Eric Carle, the author, later said he should've made a chrysalis. And then it turns into a butterfly.
And in this book you get fine-motor planning because they can stick their fingers in the little holes of the book. You get colors, you get learning the days of the week, you get counting, you get some vocabulary words that kids aren't necessarily used to. So he eats through like salami and sausages and some things that are just not your typical baby foods.
And you get the life cycle of a caterpillar. All in one little book. I mean, I just think it's wonderful. So that's one of my favorite baby books to give, but there are so many new books that are coming out all the time that are wonderful that I like to give as well, but that's always my go-to.
Host Amber Smith: Do you have a favorite book for a kid who's getting ready to start kindergarten?
Jaclyn Sisskind, MD: There's so many "getting ready for kindergarten" books out there. And so my answer would certainly, change all the time, but right now there's a book that I really like called "School's First Day of School." And it's a book that talks about the first day of school from the perspective of the school.
And so the school has the voice through the book. It starts just before the first day of school, and the school is looking around and remarking at how big it is and how clean it is, and it doesn't know what's going to happen. And then all the kids show up and the school is caught by surprise. And it's like, "I didn't expect there to be so many of them, and they're so loud."
And one kid on the playground is sort of saying, "I hate school," and it hurts the school's feelings. Like the building's feelings are hurt when it hears that. And my son's favorite page in this book is, there's the playground, and the kids at recess are going down the slides, and the school says, "Oh, so that's what those are for."
And my son just lost it. He thought that was the funniest thing he'd ever heard. And at the end of the day, all the kids go home. And the custodian comes in and is cleaning up, and he's sort of become friends with the school. And the school says, " You know, when we first met, I thought this was your house."
And the custodian says, "No, I live somewhere else."
And he says, "Oh, well, I hope you come back tomorrow."
"You know, everyone's coming back tomorrow."
And the school is so excited to see the children again. And it's that wonderful, typical trope of first-day-of-kindergarten anxiety, anticipation, what's going to happen, but told from the perspective of the building.
I just think that's great.
Host Amber Smith: Are there books that you think would work particularly well for parents to read along with their children, particularly parents that maybe aren't used to reading to their child?
Jaclyn Sisskind, MD: There are a lot of great children's books out there that are fun for parents to read as well.
And I think if parents are only thinking of the memories of their own children's books and haven't dipped into children's literature in the last 20 years, they would be just overwhelmed with the number of enjoyable choices. I mean, Dr. Seuss is great, but there's so much more out there now than that.
One of my favorite books to recommend to parents and young kids is the "Elephant & Piggie" series by Mo Willems. "Elephant & Piggie" are early readers. They're very simple to read, and they are done with very simple designs, and it's just the speech bubbles. And the two characters. are just talking back and forth to each other. Every once in a while, there's another character in the book, but it's almost always just Elephant and Piggie, and they are playing pretend, or they are having fun, or they're having an argument, or they're doing something imaginative together.
It is really entertaining to read. It's almost like putting on a little play with your kids. And the way the book is written, because it's speech bubbles, when someone is shouting, the letters are huge. And when someone's whispering, the letters are teeny-tiny, and it's easy for kids, even those who can't read yet, to pick up on how the characters are feeling and how their speech is changing.
So that's a great one to read together. I think any book that has a call and response to it, where there's a refrain, is a good one to read, and so, by that, I mean a book where every page sort of ends on the same predictable note. A good example of this would be like the song "I Know an Old Lady Who Swallowed a Fly," and every verse builds on it, but the end of the song is always, "perhaps she'll die."
And then you start the next one, right? So when there's a line that's always very predictable, and a parent is reading to their child when they get to that predictable line, the child can fill in the blank and feel like they're participating in that reading experience as well. And that makes it more engaging for both of them.
Host Amber Smith: How do you feel about electronic books?
Jaclyn Sisskind, MD: I think electronic books are fine. I think that some people would argue that there's some research out there that paper books are better than electronic. And I haven't seen that research. I don't know. All I know is that reading is reading, and if a child is really engaged in reading and they prefer to read on a electronic book, a tablet, a Kindle, what have you, I'm fine with that. What I don't like is for kids to have access to a book on some sort of tablet, and then they also have access to other things on that tablet, like games and texting and chat, and that's interrupting the flow of their reading. But just from the stance of whether it's better to read on a page or a screen, I don't think there's much difference as long as the child is connecting.
And I'm not, you know, promoting any particular brand, but some of those brands out there, if a child doesn't know the definition of a word, they can click on it, and it will tell you, or it can make the font bigger. And for some kids that makes reading a little more of a game. I'm OK with that.
Host Amber Smith: Do audiobooks give the listener as much value as a reader reading the same book, do you think?
Jaclyn Sisskind, MD: Absolutely. I think we need to understand, there are so many different kinds of learners out there in the world. Some people are very visual learners. Some people are auditory learners. I think as adults, we can all understand that, right?
There are some adults out there who would say, "If someone's explaining something to me, I've got to have a piece of paper. I've got to write it down," or "They have to draw me a diagram," or "It's like, you might as well have not told me at all." And for other people, they can be looking at a page, for example, I don't know, putting together a piece of Ikea furniture, but they can't figure it out by looking at it.
But if someone read the directions to them, then they could do it, no problem. And I think when I was in school, that was not as celebrated, and more and more teachers are realizing that there are all sorts of learners out there. So for some kids, audiobooks is definitely the way to go. And I think another great example of that is how many adults like to listen to podcasts? I don't think anyone would say, "I get the same enjoyment listening to a podcast as I do sitting down and perhaps reading the entire transcript of a podcast," if someone has the ability to hear the podcast. So I think an audiobook is going to have the same benefit.
You're still connecting with language. You're still learning about other worlds.
Host Amber Smith: Before we wrap up, I want to ask you if there are books that you found yourself recommending during the pandemic to help with the heightened stress that so many of us are feeling?
Jaclyn Sisskind, MD: I was reading a lot of children's literature during the pandemic, a lot of it with my children and a lot of it on my own. I think that for adults, reading children's literature is nice because you feel like you're accomplishing something more quickly because most of the books move along at a more rapid pace.
And it brings your mind back to a time of when you were younger. A lot of times people will ask me, how do you know if a book is age appropriate for a certain child? And I don't think that that's really the right question because for me, age appropriateness is not just based on subject matter, which I think is what parents are asking, but more on your individual child, what's their reading level, what can they handle? What brings them joy when they're reading? What opens their mind when they're reading? And so, to that end, during the pandemic, I found myself recommending a lot of picture books to children of all ages, even adolescents and their families, because there's a lot to explore there.
I found myself reading a lot more poetry than I used to because it was small, and my brain was exhausted at the end of the day. And I could just focus on one poem and move on.
But there were two books that really were big in our house over the last couple of years. One is called "Starfish" by Lisa Phipps. This is a middle-grade novel in verse -- a novel in verse is a series of poems that all go together. And it's a book about a young girl named Ellie who is overweight, and she is teased for her weight. And the biggest bully in her life is her mom. And also kids at school. And she learns in this book how to love herself for who she is and to take up as much space as she deserves.
And that's why the book is called "Starfish," because she's spreading her arms and her legs out wide on the cover, and she's taking up space. And that book was a wonderful discussion in my house about bullying, about standing up for what you need and trusting that you are enough as a person. And that book, when I finished it, made me feel so happy and just renewed as a person, and I've been recommending it to everybody.
And the other book that we read that was wonderful over the last year was called "Amari and the Night Brothers" by B.B. Alston. The way I describe it to patients is imagine Harry Potter, except that the main character is an African-American 12-year-old girl. And she learns that she's a magician. And she goes into this magical world, much like Harry, except that the world that she goes into is kind of like the FBI. And they're all solving these mysteries in the magical world. It's a great book that is exciting, and it had us all flipping through the pages. There's a second one coming out this year that my son can't stop asking about when is it coming?
But also in this book is again, themes of bullying, themes of racism, themes of inequality that got a lot of conversations going in our house as well. So those were the two big, hot books that we've read recently.
Host Amber Smith: Well, I really appreciate you making time to share your passion with us today, Dr. Sisskind.
Jaclyn Sisskind, MD: I will come back and talk about books anytime you'll have me.
Host Amber Smith: My guest has been Dr. Jaclyn Sisskind. She's an assistant professor of pediatrics, who loves reading, at Upstate Medical University. I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from Dr. Timothy Shope from Upstate Medical University. How much weight does someone lose after bariatric surgery?
Timothy Shope, MD: It's not immediate. But the majority of people will notice a substantial amount of weight coming off within that first month or so. When we talk about the weight loss for these operations it's generally a year to a year and a half is the timeframe that we talk about for maximum weight loss. But that is pretty well front-loaded, meaning that the first six or eight months is where are they going to experience the majority of that weight loss, and then the next eight months or so, a little bit here and there will come off. It really depends on the starting weight as far as how much weight they will lose in that first month. But I think on average, somewhere around 20 to 30 pounds in the first month is pretty typical. They don't wake up lighter from surgery. In fact, because of the fluid that we give during surgery and during the hospital stay, some patients will go home up a pound or two. That's not unusual, but realistically within that, those first couple of weeks, they are really starting to drop that weight.
Host Amber Smith: You've been listening to chief of bariatric surgery Dr. Timothy Shope from Upstate Medical University.
And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: E.D. Watson is a poet in training at the Institute for Poetic Medicine. She sent us an exuberant celebration of the body and urges us to do so, even as it ages and seems to turn against us. Here is "In Praise of the Body":
So much is made of the soul,
a thing we cannot prove or hold
and yet for this we pray, we sigh
we kill we moan
and damn ourselves, imagining
some place else is home --
but the body
the body is a fact
and I say bless it, bless its appetites
bless it limp and bleeding
each labored breath, the skin gone slack
bless its cavities and hollows
bless the curve at the base of the back
and bless each toe.
Call it friend instead of traitor
for no greater intimacy exists
than to be within its wetness
slickness pulsing, breathing
aching and excreting. Sleeping.
And when we say we love, remember
what we love is this: a mother's veined
and freckled hand, a child's nub of chin
the inside of a lover's thigh
where hairs grow soft and thin --
oh bless it
bless it all
and kiss your friends upon their mouths
that they may feel your lips
press your nose into their scalps
bear witness to what unravels them
the nodules, failing kidneys
gout, each one of us an envelope
of pain and iridescence, each ecstasy
so fleeting. Place your hand
upon your chest and feel your heart there,
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," how kidney donations are matched to recipients. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.