The Medicine of Cause and Effect

The Medicine of Cause and Effect

12/01/2017

When a doctor dedicates 40 days of his life to literally walk in his patients' shoes, people notice. As many as 40 percent of Jay Gardner,  MD's patients have diabetes. For most, their days are punctuated by finger sticks to check blood sugars, carefully watching carbs ingestion, and getting multiple daily doses of insulin.

Dr. Gardner and his partner, Chantal Lutfallah, MD are pediatric endocrinologists at Our Lady of the Lake Children’s Health Endocrinology. Daniel Hsia, MD also joined the team, helping transition pediatric endocrinology patients to adult care.

“Diabetes is a lot of what we do, but endocrinology is extremely varied,” Dr. Gardner said. “It includes all the glands, many of which communicate with each other through the hormones they produce.”

Blood sugar disorders like diabetes, growth concerns, thyroid problems and problems associated with puberty account for most of the patients seen by pediatric endocrinologists.

Dr. Gardner works to teach his patients about causes and effects that trigger or worsen them. Many diabetes patients have to wear blood sugar monitoring patches and cell phone sized insulin pumps.

Effective teaching requires first that we understand, and earlier this year, Dr. Gardner took that to heart. For Lent, Dr. Gardner decided to live as his diabetic patients do by wearing an insulin pump and blood sugar monitor for the entire 40 days. In order to truly endure and suffer temptation, Dr. Gardner fitted himself with an insulin pump, including the needle-inserted cannula that slips below the skin.

“Patients endure this burden. I knew I could learn something, maybe have a new perspective,” Dr. Gardner said. Rather than delivering insulin, Dr. Gardner’s pump delivered doses of saline in response to blood sugar fluctuations recorded by a separate continuous glucose monitor he wore.

“I started on Ash Wednesday and continued all the way to Easter Sunday morning,” Dr. Gardner said.

He learned plenty from the experience. For one, he realized just how tedious it can be. For example, at mealtime everyone could sit down and eat except him. “My wife and kids could start eating but I still had to count my carbs and put it into my pump.”

He also learned what a significant impact his diet has on his own blood sugar levels. Even though he does not suffer from diabetes, he observed surprising swings in his blood sugar levels directly caused by foods he was eating. Where he used to dig into a generous bowl of Frosted Mini-Wheats, he cut his portion back considerably when he saw its effect on his blood sugar after he arrived at work. He also makes sure to include protein with his breakfast now.

Dr. Gardner’s long-term goal with most patients is to teach them to help manage their own conditions. Young teens often struggle with all of those time-consuming steps such as checking blood sugars and counting carbs.

“One of the most fulfilling times for me is when they get a little older, they mature and start to take care of themselves,” Dr. Gardner said. “If I can help lift the veil, show them why they need to take care of those things and connect those dots.”

It’s often a long journey before teenage patients reach the point where they learn to take care of themselves. “Families are very frustrated; they bring up concerns of their child gaining so much weight, which can seem insurmountable,” Dr. Gardner said.

For Dr. Gardner, it’s the cause-and-effect of the body’s glands and hormones that’s truly fascinating. They create feedback loops, which is similar to complicated engineering systems. As a child, Dr. Gardner loved math and may have been destined for a career in engineering. Slim Goodbody put a stop to that. The star of a PBS children’s program called “The Inside Story With Slim Goodbody,” the character dressed in a bodysuit painted with life-sized muscles, bones and internal organs. He taught his young viewers about healthy habits by singing catchy songs about the human body, Dr. Gardner recalled with a smile.

He became fascinated with how the human body functions. Another important influence on Dr. Gardner’s career choice was his older sister, who as a child had to overcome myriad neurological issues.

“Just my growing up and seeing all of what she went through, those things fostered my interest in being a physician,” Dr. Gardner said.

After graduating from Tulane University, he enrolled at LSU School of Medicine in New Orleans where he thought about becoming a neurologist. But he didn’t enjoy his neurology class. What he did enjoy was his clinical rotation in pediatrics.

“Even though kids are sick and some of them do suffer, the positive part is so many of these kids get better and become well,” Dr. Gardner said. “They glow, their shining faces, the appreciation they have, that kind of environment was really attractive to me.”

While some of his classmates recoiled from the intricacy involved in studying the endocrine system, he fell in love with it, a perfect mix of engineering-style cause-and effect and pediatric medicine.

“What attracted me were those feedback loops,” he said. “The relationships and communication between parts of the body, how they feed back on each other, is very much like engineering,” Dr. Gardner said.

He’s careful not to lecture his patients. Instead, he prefers a technique called motivational interviewing. By asking open ended questions, he encourages children to open up about their condition and to seek answers.

For example, if his patient is overweight, Dr. Gardner might ask them if it’s okay if they talk about their weight. If they say yes, then he might ask if they’d like to lose weight, and if yes he can talk about methods and tactics that work, and so on.

“I want to just provoke thought; I want them to discover the answer; I’m there just sort of pushing them along,” Dr. Gardner said. “I encourage the parents to do the same thing, but it’s hard. You have to take the time to do it, and some kids don’t want to engage in that way”

Education is essential for patients with diabetes. Dr. Gardner and Dr. Lutfallah are hands-on when it comes to helping their patients. The two have both volunteered at an annual summer camp held every July in Leesville for diabetic children. Diabetes Camp is put on by the Louisiana chapter of the American Diabetes Association. Children and teens from all over Louisiana attend the camp, which provides comprehensive medical support, fun activities but most important of all, the chance to connect with other kids who battle the same conditions and regimens every day.

“They really need to meet other children with the condition, to learn some new perspective, understand their condition better, make it more of a priority, and learn there are other kids just like them who struggle just like they do,” Dr. Gardner said.

“Kids and families need to engage with resources, including the camps,” he said. “It’s about creating those relationships.” In the end, even physicians and other caregivers can learn to provide better care. “I learn from families; their experiences can then help me refine my skills over time,” Dr. Gardner said. “I always have to keep an open mind.”