Pubdate: Fri, 13 Oct 2006
Source: Toronto Star (CN ON)
Copyright: 2006 The Toronto Star
Author: Amandrea Gordon, Family Issues Reporter
Bookmark: (Harm Reduction)
Bookmark: (Youth)


Neither pediatricians nor adult doctors, these are specialists who 
work with adolescents and are seeking recognition for their field in Canada

Growing up with a chronic disease is hard. So are depression, school 
stress, and navigating the ups and downs of romance.

Add adolescence to the mix and life can get very complicated. 
Sometimes even dangerous.

Sarah Ripley, 22, remembers. Diagnosed with diabetes at age 4, she 
had adjusted to the daily ritual of blood-sugar tests, insulin and a 
strict diet. Until teen hormones kicked in, and with them the urge to 
fit in with peers, to party and push the boundaries.

"I was a stubborn teenager," says Ripley. "I was going to do what I 
was going to do, regardless of what anybody said."

Enter Dr. Rahul Saxena, a specialist in adolescent medicine, who is 
trained in the complexities of teen health, brain development, 
behaviour and psychology. He loves the energy and challenge of that 
age group, and the opportunity to provide the emotional and 
psychological support that are as much as part of his practice as medical care.

"Dr. Saxena figured out how I could find a way to fit my adolescence 
in with my diabetes," recalls Ripley. "He didn't talk to me like I 
was a patient, and use all these medical words. I could really relate 
to him and understand what he was saying."

Ripley met Saxena when she was in Grade 10, after a social worker 
referred her to the Galaxy 12 Teen Consultation Clinic in 
Scarborough, at the Centenary site of the Rouge Valley Health System.

She's gone regularly ever since -- through her toughest teen years, 
during bouts of depression and acting out, when she left home and 
then became a single mother at 19.

"He was the best thing that came into my life at that time," says 
Ripley, now the mother of a 2-year-old daughter. "I don't know where 
I'd be without him."

She's currently in school full-time taking a course in American Sign 
Language and deaf studies.

There are many reasons for teens to have their own doctors primed in 
the issues they're facing. Next to the early years, adolescence is 
the most dramatic developmental stage, both physically and 
emotionally. It's also a confusing and contradictory time, as youths 
try to forge their own identities and break away from parents, but 
still need adult guidance and support.

Reckless behaviour tends to peak at this time, whether it's 
experimenting with drugs or sexual activity. Mental illness often 
surfaces in teen years.

At the same time, this is the stage when kids with chronic diseases 
need to take over the reins of their illness and learn to balance 
safety with rebellion.

While adolescence used to refer to the teen years, it is now 
considered a stage that can start in pre-teens and extend through the 
early 20s, when, as recent research has shown, the brain is still 
developing. That's why some adolescent physicians, like Saxena, still 
see patients well into their 20s.

Despite increasing pressures and complex choices faced by modern 
youth, adolescent medicine is largely unknown. And unless a child is 
facing a specific problem like substance abuse, mental illness or an 
eating disorder, it's hard to get access to an adolescent medicine 
specialist. (See accompanying story for available options.)

"Adolescence today seems a hell of a lot more stressful and 
complicated than when we were kids," says Saxena, 37. "And in 
adolescent medicine we shy away from few topics."

Adolescence is an ideal stage to influence future health care 
choices, says Sandy Marangos, manager of child and adolescent 
ambulatory services at North York General Hospital.

"If you've had a positive experience in your younger years, you're 
more likely to continue with health care and treat it as a part of 
your lifestyle," she says.

Adolescent specialists are trained to speak without judgment and 
treat youth with respect they don't often get at that age, she says.

Many teens in good health will get everything they need from a 
pediatrician, who is trained to deal with children up to 18, or a 
family doctor. But others may be reluctant to confide in a physician 
they've known since infancy or one their parents use. And the result 
may be they don't ask about topics like sexual health or drug use.

According to the Child and Family Services Act, kids age 12 and up 
can seek medical care or counselling without consent of parents. But 
some reluctant kids may be more likely to get the care they need in 
the hands of an adolescent medicine specialist.

Debra Katzman, head of adolescent medicine at the Hospital for Sick 
Children, says when teens come forward, it's often over problems that 
are stigmatized such as sexually transmitted diseases, substance 
abuse, unintended pregnancy or depression. So it's important there be 
few roadblocks to providing care.

"It's not just seeing someone for an ear infection. It's recognizing 
that when they come in for that ear infection there are actually lots 
of other things going on ... it's never simple."

At hospitals like Sick Kids, physicians for adolescents work in 
multidisciplinary teams that include psychiatrists and psychologists, 
social workers, dietitians and nurses. Those with their own practice, 
like Saxena, who also spends two mornings a week at Sick Kids, also 
have access to other specialists.

Many physicians in the field would like to get recognition for 
adolescent medicine as a sub-specialty in Canada. This would result 
in standards of training and care across the country, more research, 
funding and attention.

In the U.S., which pioneered adolescent medicine in the 1950s, it has 
been an accredited pediatric sub-specialty since 1991. There are many 
more services available to teens there.

That's where Saxena got his training. After the Toronto-born doctor 
completed his pediatrics residency at Children's Hospital in 
Winnipeg, he headed to Mount Sinai Hospital in New York to study 
adolescent medicine for three years. He is one of a handful of 
Canadian doctors who are U.S. board-certified in adolescent medicine.

Unfortunately, he says, there's little incentive beyond a passion for 
the work to enter this field in Canada. Despite more training, he 
earns less money than most pediatricians. He spends a minimum of 30 
minutes with each patients and usually sees eight to 10 a day, 
billing OHIP according to time codes. Pediatricians can bill per 
service and usually have a steady stream of patients coming through 
for routine problems like ear infections.

Katzman notes that those working with adolescents need to be flexible 
and sensitive. Sometimes that means accommodating a patient who is 
late or a no-show, or rearranging the schedule for someone in crisis.

"When you get a kid who's asking for help, you have to seize the 
moment. Unlike with an infant, this might be the only time you're 
going to get this kid."

Knowing their kids are in the hands of a trusted physician can be a 
huge comfort for parents. Caroline, a Whitby mother of two teenagers 
who didn't want her surname published, says she was relieved to find 
Saxena after one of her daughters became depressed a few years ago at age 16.

"There's no way she could have sat down and talked to our family 
doctor the same way," says Caroline, who occasionally gets included 
in their sessions. "I could probably tell him anything and I think 
the girls pretty much can, too."

Saxena says much of his practice comes down to preventive health 
care. And often using a "harm reduction" approach.

"To me, harm reduction is the spectrum of, 'Ideally you shouldn't do 
this negative behaviour at all. Pause. But ... if you're set on doing 
it then let's discuss the various methods of minimizing the harm you 
are about to potentially cause yourself.'"

That might mean teaching kids to be realistic about the risks of 
recreational drugs and warning against daily use. It could be 
promoting sober transportation from a party, and advising about safe 
sex. It might be talking about the emotional side of sexual 
relationships for young girls who are dating older guys.

"I think one of the big things that makes adolescent medicine useful 
is it gives kids tools to strive for the independence and control 
they crave in a safe way," says Saxena, a father of two young boys.

But he stresses that youth have to be motivated by something that 
matters to them.

"As long as you can help them see change as a way to reach their own 
goals or avoid their own perception of failure then you have a chance to help."
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MAP posted-by: Beth Wehrman