Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Annual checkups for teenagers provide an opportunity for the following:
Promote healthy lifestyle choices that include nutrition and exercise. Many teens maintain a diet high in saturated fats and low in complex carbohydrates (fruits and vegetables) and milk and other dairy products. Adolescents should have at least 60 minutes of vigorous exercise per day. Unfortunately, many teens experience less that this goal per week while utilizing social media (Internet, text messaging, Facebook, etc.) for greater than three hours per day.
Screen sexually active teenagers for sexually transmitted diseases (STDs) and HIV; 2009 statistics demonstrated that high school students were engaged in high-risk sexual patterns. Approximately 46% of this demographic were sexually active. However, 39% did not use a condom and 77% did not use birth control pills or other methods of contraception. In 2009, there were 8,300 new HIV cases in individuals 13 to 24 years of age. Nineteen million new (non-HIV) STDs were reported in 2009 -- one half of which occurred in individuals 15 to 24 years of age. Finally, over 400,000 live births were delivered to mothers between 15 and 19 years of age.
Screen sexually active teens at risk for HIV infection. Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2013
46.8% had ever had sexual intercourse 34.0% had had sexual intercourse during the previous 3 months, and, of these 40.9% did not use a condom the last time they had sex
15.0% had had sex with four or more people during their life
Assess whether teen has an eating disorder such as anorexia nervosa, bulimia, or obesity. This assessment is reached by determining weight and stature and asking about body image and dieting patterns. The obesity epidemic is real -- 12.5 million children between 2 to 19 years of age are overweight. This value has tripled since 1980. The flip side of this issue is the prevalence of eating disorders. More than one-half of teenage girls and nearly one-third of teenage boys use unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives.
Discover if teenager is experiencing emotional problems such as depression or anxiety. Several studies have determined that 3%-5% of teens will experience a bout of clinical depression. Warning signs include (1) low interest in pleasurable activities, (2) change in appetite -- weight loss or weight gain, (3) insomnia or hypersomnia, (4) fatigue/loss of energy, (5) decrease in concentration skills which may be reflected academically, and (6) thoughts of death, suicide ideation, and/or attempts.
Ask teenager if they have a history of emotional, physical, or sexual abuse, as well as bullying. Bullying is one of the biggest challenges that teens are facing. Unfortunately, many teens are forced to deal with bullying while their parents and teachers are unaware on the specific nature and severity of the problem in their school. Data from 2010 indicate that approximately 160,000 students miss school each day as a result of being bullied or fear of being bullied. School districts and administrators have often adopted a "zero tolerance" approach to bullying. However, progressively more frequent cases of "cyber bullying" using social media are replacing the overt verbal threat and/or physical assault that is the more traditional experience in past years. Research indicates that in 2010 approximately 2.7 million students were the victims of approximately 2.1 million bullying contemporaries. That means that about 282,000 high school students are attached each month. Unfortunately, those being bullied may react in two ways to repeated bullying. Some who have been the victims of bullying respond by adopting the policy of "the best defense is a strong offense" and become a bully themselves. Other teens see no alternative but suicide. Nationally, suicide is the number three cause of death for adolescents (behind automobile accidents and homicide).
Discuss the health risks of smoking, alcohol abuse, and other drug abuses (including anabolic steroids). Approximately 20% (6 million) of teens smoke cigarettes with the huge majority aware of the immediate and long-term associated health risks. A 2011 CDC study indicates that 45% of questioned teens admitted to alcohol (beer, wine, and spirits) in the month before being questioned. More concerning perhaps is that 64% of those questioned admitted binge drinking (five or more drinks in rapid succession) in the month prior to the study.
Ask teens about learning or school problems to determine if they need special counseling.
Screen teenagers who have a history of absences or declining school performance for dyslexia, learning disabilities, or attention deficit hyperactivity disorder.
Identify signs and symptoms of disease, illness, and health conditions. Most studies indicate that the majority of teens suffer from sleep deprivation. Specialists recommend the average teen requires eight hours of quality sleep per night. Many teen sleep patterns are disrupted by chronic and excessive caffeine (sodas, coffee, "energy drinks"). Couple this behavior with difficulty turning off electronic lifelines (cell phones and computers) and it is easy to understand that the first two hours of the high school day are often filled with "zoned out" pupils.
Screen for high blood pressure. Unlike adults who commonly have "primary" or "essential" hypertension, children and teens suffering from high blood pressure need a vigorous evaluation in an attempt to locate a primary cause.
Test teenager's cholesterol level if their parents have a serum cholesterol level greater than 180 mg/dl. A 2010 study indicated that 14% of normal weight teens and 43% of overweight teens have elevated cholesterol levels.
Screen teenagers who have multiple risk factors for future cardiovascular disease (for example, smoking, high blood pressure, obesity, type 2 diabetes mellitus, excessive consumption of dietary saturated fats and cholesterol) for total serum cholesterol level.
Assess health risk factors for overweight teenagers to determine their risk for future cardiovascular disease.