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Jul 24
  • Written By Scott Drochelman

    • Ask The Expert – Dr. Nancy Zimble

    Ask The Expert - Dr. Nancy Zimble

    What A Pediatrician With 40 Years Experience Wants You To Know

    Nancy Zimble is a pediatrician in Los Angeles California with over 40 years of clinical experience. Over the course of her career during routine check ups she has helped thousands of families navigate the typical developmental challenges of childhood. She has also advocated for her patients with more complicated medical issues.

    Dr. Zimble is a graduate of Vassar College and Tufts University School of Medicine, and moved west to do her pediatric residency at Los Angeles Children’s Hospital. She is a devoted mother to two young adult daughters, whom she adopted and raised as a single parent.

    Dr. Zimble believes that every child deserves the opportunity to grow up healthy, happy, and resilient. She works closely with parents to provide guidance on everything from nutrition and sleep to emotional well-being and behavior management. Her approach is grounded in the belief that we are all doing the best we can, but there are times when early diagnosis and intervention can improve the quality of the child and their families’ lives . She is constantly evaluating and incorporating best practices for the increasing learning and mental health challenges of our children.

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    Episode Transcript

    Speaker 1:

    Coming up on this episode of The Courage to Change, sponsored by Lionrock.life.

    Dr. Nancy Zimble:

    So we’re talking about 18 years ago, but I had already been in practice for about 20, maybe 25 years when this happened. She was halfway through her senior year at a pretty exclusive school around here. Things didn’t seem right. She wasn’t where she said, but she was… Her grades were okay. But she was playing soccer every day. I was going to her soccer games every day. I was not uninvolved, but something was really wrong. And she had gotten accepted to some colleges and was waiting to hear from others. Everything seemed until suddenly it didn’t. We were on track for everything you expect to happen. The word that comes to mind is devastating. Like, What? What? How is this possible?

    Ashley Loeb Blassingame:

    Hello, beautiful people. Welcome to the Courage to Change, a recovery podcast. My name is Ashley Loeb Blassingame, and I am your host. And today we have Dr. Nancy Zimble. Dr. Nancy Zimble is a pediatrician in Los Angeles, California, with over 40 years of clinical experience. Over the course of her career during routine checkups, she’s helped thousands of families navigate the typical developmental challenges of childhood. Dr. Zimble is a graduate of Vassar College and Tufts University School of Medicine. And she moved west to do her pediatric residency at Los Angeles Children’s Hospital. She works closely with parents to provide guidance on everything from nutrition and sleep to emotional wellbeing and behavior management. Her approach is grounded in the belief that we are all doing the best we can, but there are times when early diagnosis and intervention can improve the quality of the child and their family’s lives.

    She’s constantly evaluating and incorporating best practices for the increasing learning and mental health challenges of our children. This episode is so informative. And Dr. Nancy Zimble is wonderful. And I’m so grateful that she came on to talk to us. We learned things, like we could all use an extra 20 minutes of sleep for brain health and the challenges that our children went through during COVID. There’s so much here. And I really want everyone to walk away with the understanding that we are all doing our best. And Dr. Nancy Zimble absolutely reinforces this as she talks about her own struggles with her children, her daughter, through mental health challenges that she did not anticipate. And I hope you get as much out of this as I did. And without further ado, I give you Dr. Nancy Zimble. Let’s do this.

    Speaker 4:

    You are listening to the Courage to Change, a recovery podcast. We are a community of recovering people who have overcome the odds and found the courage to change. Each week, we share stories of recovery from substance abuse, eating disorders, grief and loss, childhood trauma and other life-changing experiences. Come join us no matter where you are on your recovery journey.

    Ashley Loeb Blassingame:

    I’m so happy that you came. Thank you for being here.

    Dr. Nancy Zimble:

    Thank you for asking me.

    Ashley Loeb Blassingame:

    This is very exciting.

    Dr. Nancy Zimble:

    This is my most fancy podcast.

    Ashley Loeb Blassingame:

    Oh, I love it. I love that we get to be the fancy podcast. Well, thank you for being here. I’d love to talk to you a little bit about how we connected and what your interest in recovery is, how that came to you.

    Dr. Nancy Zimble:

    I follow your podcast. I found it when I was listening… I walk a lot, I listen to podcasts a lot. And I loved your podcast. And I think how we connected was, I responded to one of your podcasts and you reached out back to me. And I listen to recovery podcasts because I am a pediatrician with kids in recovery and I’m a mom of a young adult in recovery, and replay over and over and over and over how we could have done things differently.

    Ashley Loeb Blassingame:

    I think that’s a common conversation and one that… Well, my kids are really little and I still think, am I doing this right? Should I have done that differently? Is this going to be the thing that ends up what we’re talking about in Family Week? I joke with my husband, and go, That’s going to end up on the top hits in Family Week, whatever just just happened. You’ve been a pediatrician for so long, so obviously, kids and health are a huge part of your life. What made you want to get into pediatrics?

    Dr. Nancy Zimble:

    So, my first name’s Nancy. I was a little kid. I was a voracious reader, and people always gave me books about Nurse Nancy. And then at some point, I started volunteering at the Children’s Hospital in Boston and realized, Oh, women can be doctors. No one had told me that. It was a long time ago. We said you could do anything in my house, but we weren’t that specific. Anyways, I was the eldest of four kids, so I was a care taking person to start with. I was always drawn to it from the time I was little. But by the time I was about 12 when I started volunteering, I knew for sure I wanted to go into medicine. And I was pretty sure it would be pediatrics just because I love taking care of kids.

    Ashley Loeb Blassingame:

    I think that the relationship with our doctors, the relationships with our pediatricians has changed over the course of the last, let’s call it, 20 years. Especially, we’ve all seen a transition in the last even five years with mental health, addiction, all of these things. And you are talking to parents and kids on the front lines. What have you seen change… Let’s call it, 10 years, let’s go 10 years. What have you seen over the last 10 years change from a practice perspective?

    Dr. Nancy Zimble:

    First of all, I want you to know that I have a very different practice than most people in the world, I think. These small… Small-

    Ashley Loeb Blassingame:

    Good.

    Dr. Nancy Zimble:

    Exactly, exactly. I started more than 40 years ago. It’s a very small… I have one partner. We’ve been together the whole time, which is really unusual. We met in our training, we sit across a partner’s desk. Well, it used to be every day together, but now we don’t both work every day. It’s very unusual to have that small, intimate kind of practice. It’s really a luxury. It’s a pleasure. It’s a joy. Know the families really well from the time of birth. This is the time of year where we’re waving them off all to college and doing their adolescent checkups. So, very different kind of practice, very intimate. I had patients from birth through college. I have second… A very big second generation practice now, which is one of the greatest choice.

    Even this week, a mother came in with her four year old. The mom grew up to be a doctor, which is I think the greatest compliment of all. And her mom, who’s now the grandma, came with for the checkup. And we just talked during the checkup about the day when I sat in the kitchen and tried to teach this baby how to nurse, who’s now the mother. And we really know our families. I think one of the things that has changed a lot, I don’t know so much if it’s COVID or if it’s, like you said, the past 10 years, is the second generation uses our skills in a very different way. They’re looking for a quicker fix it seems. They want an answer, and most of the kinds of things we deal with don’t have an answer. It’s let’s try this… I’ve always answered behavioral stuff, especially by saying, there’s probably three ways we could approach this.

    Let’s try plan A, and if that’s not working out we’ll go to plan B. A lot of people coming in are looking though for… We just want the prescription. They got used to urgent care. Maybe they got used to Amazon delivering overnight. We joke about that. This isn’t Amazon, you can’t have it by tomorrow. We’ve got to stay in the solution for how we’re going to get mental health care for all our kids. I don’t want to focus on my own child because her story, but I will say it was shocking to discover 17 years later that our roadmap to recovery is absolutely no better, no clearer. What do you do? I could tell you how to get through cancer. I could tell you who to go through. I could tell you what the protocol would be. There’s absolutely no better window, no better… Well, I can only call it a roadmap. Like, What do you do? How do you help? It’s not there. It’s just not there.

    Ashley Loeb Blassingame:

    Yeah. Unfortunately, it’s there if you have money, resources and know people. And it is one of the things that people will call me and say, Can you help me? And I will help them get through the system and help them with the right people and the right connections. And the thing that’s so heartbreaking about it is that people say to me, Well, how do you do this if you don’t know an Ashley, or you don’t know a person, or you don’t hire a case manager? I don’t have a good answer. And I feel the same way you do about it. It’s really unfortunate and what it tells me is that it’s that way in a lot of other areas of healthcare.

    Dr. Nancy Zimble:

    Absolutely.

    Ashley Loeb Blassingame:

    So, I know that it’s that way as it relates to mental health and to addiction, but I also know that it’s that way as it relates to cancer, which I don’t know anything about in regard to getting help. I have thought many times that most of us, if we have a legal problem, we hire a lawyer. And if we have a health problem health, we are coming to a place where we require a liaison for our healthcare.

    Dr. Nancy Zimble:

    Yes, you must have an advocate. If there’s one of the things that I hope will come out of today, people will realize that. Two things I wanted to see, one is, reach out to your pediatrician. Not all of us are doing what my practice is still doing, but as our practice has slowed down and as we know these families well, I think we are way more available to help them with this. And there has to be, I call it, the conductor of the orchestra, with a lot of complicated medical problems, it has… You have to have that person. It’s not that I’m going to do the therapy, I’m not a psychologist. But I have referrals. I know the kind of services you do need.

    Ashley Loeb Blassingame:

    So, let’s talk a little bit about the… So you’re a pediatrician, you’ve worked with kids, you’ve worked with at-risk kids, you’ve worked in… You, as a medical doctor, did all sorts of rotations. You’re very in tune with developmental processes and milestones. You have all this experience, and then you are surprised by what’s going on in your own house. You more or less… Let’s just say, you didn’t see it. You were surprised by it. What was the experience like of feeling like you missed something that you deal with professionally, but didn’t see in your own home? How did that feel as a medical professional? And then as a parent, what kind of emotional process did you go through?

    Dr. Nancy Zimble:

    So we’re talking about 18 years ago, but I had already been in practice for about 20, maybe 25 years when this happened. She was halfway through her senior year at a pretty exclusive school around here. Things didn’t seem right. She wasn’t where she said, but she was… Her grades were okay. She was playing soccer every day. I was going to her soccer games every day. I was not uninvolved, but something was really wrong. And she had gotten accepted to some colleges and was waiting to hear from others. Everything seemed until suddenly it didn’t. We were on track for everything you expect to happen. The word that comes to mind is “devastating”. Like, What? What? How is this possible?

    Even though I’m accused of having a judgmental voice, I do try very hard to not be in judgment about it’s… I’m a problem solver, that’s what I do. So, what do I do? My kid’s in trouble, how do I fix this? And then in the beginning, there were so many different theories. I grew up in New England, very proper, traditional, and that part of my family was very much like, Well, no wonder your kid’s in trouble. She lives in crazy la la land where people do so many horrible things, and they’re so loosey goosey and hippie dippy and all those… In the most negative way. Now I love hippie dippy, and I probably always did, but then it was like an insult. The California people thought that… My closest family here, I think, thought I was too strict.

    I was still calling parents and saying, Are you home? Are you serving? And I was not letting her drive to any parties because I was so nervous about… Those years, huge drinking and drug issues, huge. I’m going to say happily, we’re seeing actually less of that now, and hopefully, we’ll get to that. But it was a shock. There was a huge psych problem. It was not a drug problem primarily, I don’t think. But I felt, Well, how can I be advising people if I didn’t even see this in my own… The anxiety that goes with having a kid in this much trouble. How do I save my kid? I’m a reader, so I read every book I could find. There were a lot of books at that time because there were so many kids getting sent to wilderness, and programs, and send them away. California is, I’ve come to find, particularly liberal about saying, Get them emancipated, and you can get out of here when your parent has spent every penny they have to put you in treatment.

    I never knew you could put that much money on a credit card, by the way. Pretty much, I would say, her college education went right to trying to do recovery. So, it was devastating. And it was devastating to my persona and, of course, to our whole family. I have a younger child who’s a few years younger, her sister, and it was really traumatic for her too.

    And I look back on it and say, How would I do it differently? There’s nothing… I felt I was saving her life. Did I make always the best decisions? I’ll never know that. But she reminds me to how grateful she is that I never gave up. And I think the one theme in every book that I read was, you can’t give up. There’s people who say, “Lock the door”. There’s people who say, “Cut them off”. And you have to walk that line and find the… Are you enabling or are you helping? I just had to trust my gut and I think… I don’t know how parents do it without 20… At that point, I had, let’s say, 25 years of clinical experience. I had to trust my gut with that, that I could do this and I could do that. And at some point, all betts were off. She wasn’t even going to make it to her high school graduation, physically. A lot of great things happened out of it. She’s a smart, loving, amazing heart kid who cracked me open again in this process.

    Ashley Loeb Blassingame:

    The amount of therapy and self-discovery and communication practice and just emotional growth that my family that we as a unit had to go through was a masterclass in how to get through life and the world. And even though I wasn’t spending that time getting a world-class education the way that I could have been, what we were doing was either equally as valuable if not more valuable in the long run. Did you have an experience?

    Dr. Nancy Zimble:

    I have a really hard time saying it was equally valuable because it would’ve been nice not to have a detour.

    Ashley Loeb Blassingame:

    Totally.

    Dr. Nancy Zimble:

    And it wasn’t just a detour because we are on a totally different road now. Again, devastating financially. I’m a physician, but I have to struggle because of this, and what’s happening to medicine and to my retirement fund. It’s not just on her. And I, again, would do it again in a second, so don’t go there. But she is a very spiritual person, this child of mine. And she’s not a child, so I shouldn’t say that. I had to stop everything and really listen then, and I really got to get in in touch with that again. I am now a yogi and have been for many year… Some of it came from her and some of it came from, I had to find a way that, put your own oxygen mask on.

    It was killing me. I woke up one day and weighed 60 pounds more than when we started and I was like, Oh my God. I saw this picture like, Oh, I didn’t know that happened. I just had to start taking care of myself. And so, I had to embrace all those things. And those things relate so much to the mental health epidemic now. It’s like, our kids aren’t sleeping, our kids aren’t meditating, our kids aren’t breathing. All those things are turning out to be so valid. There’s Harvard studies now that say this really is good for our hormones in our head. So, I did get much more on that journey and I feel… I joke with my younger daughters very into fashion. I joke about how I got to find my hippie clothes again. I did feel much more comfortable in some ways in my skin, but many times, there was this horrible thing going on that I couldn’t bring to the office.

    Your real question was, do I think we were better off for it? We were changed, I’ll say… I’ll give you that. And I’m having a great life, I can’t say I’m not. But do I wish none of this happened? Terribly wish. Also as a physician, you know big time how fast life can change. You know that. I did my training at Children’s Hospital in Los Angeles. It was the tertiary care center even a million years ago, when I did my training, where we took care of critically ill kids. And I remember, as a brand new intern, one of the attendings, the grownup doctor saying to me, You okay taking care of a kid who you know isn’t going to make it? He had a fatal illness. No one had said that to me yet. And it’s just you are faced with that. The thing we all love about being a pediatricians, I think, is that the majority of kids can be really sick and get better, and do what they need to do to get better, or their family does.

    But we all experience a new cancer in a perfect kid or a brutal genetic problem when you get through birth that wasn’t recognized before, or just these devastating things where we would say, This is the day we have to go home and hug our kids a little tighter. All the time. All the time. So, we knew that. It isn’t, again, that we took… At that stage of my life, I was treating a zillion kids who… Not a zillion, but plenty of kids who were in trouble like this. And did I ever for a second think it couldn’t happen to me? No, I never thought that. Or to my child? Never. One out of 10 kids is going to unmask a mental health issue, is going to unmask addiction. That’s a number we’ve been saying since I started in medicine, since my education. We don’t recognize… We know if you have ADD, it’s a little more common. If you’re adopted, it’s a little more common. If you have a family history, it’s definitely more common.

    But we don’t know the majority of those one out of 10. Why did it happen to them? We don’t don’t know that, until their brain is tested. I remember saying to my kid one day, “You realize your friends who you’re getting high with are going to school the next day and they’re going to college next month, right?” That’s the difference. I remember pulling the car over and looking her in the eye and saying, “You do realize that whoever you were just getting high with, they’re still doing their stuff?” I had a fair amount of insight before she even went off the rails, but it could happen to anyone.

    Then 2020 came and everything changed. And I want to, again, say the good news is I think we’re dealing with less problems with smoking, drinking, and substances. Not that it’s not still there, it is, absolutely. And I think from what I hear with my daughter’s work is there’s a lot of people who thought they were doing better, and they got shaken.

    Ashley Loeb Blassingame:

    Yeah, they got shaken.

    Dr. Nancy Zimble:

    They got shaken. We all got shaken.

    Ashley Loeb Blassingame:

    We all got shaken.

    Dr. Nancy Zimble:

    So, what do we do? Everybody had to find their comfort. It was a hard time. But interestingly, what came out of the mess was much more mental health issues than actually the addiction pieces, so far. Here, the kids were so isolated that I think they didn’t know how to… Some of them certainly found a way, but they didn’t really know how to make that be their primary focus, and instead, they had trouble connecting again.

    Ashley Loeb Blassingame:

    So, what did you see… As a pediatrician, going through… You saw… You had the decades, you had your own kids, you had kids in your practice, so you got to see them before, during and after, or at least before and after. And then you had new kids. So, you had the 40 years of experience and you had the new kids and you got to watch them progress. Talk to me about some of the things that COVID and that experience did to these different groups. So the before and after, and then the ones who never knew anything different.

    Dr. Nancy Zimble:

    So, that is probably a entire course to go through that, right?

    Ashley Loeb Blassingame:

    Yeah.

    Dr. Nancy Zimble:

    Because developmentally, now this from in the parallel with addiction is, you know in addiction, we say whenever you got in trouble, that’s where you’re stunted, right?

    Ashley Loeb Blassingame:

    That’s where your emotional maturity stops.

    Dr. Nancy Zimble:

    Yes. Oh, that’s much better, much better language. But yes, that thing is very true with COVID too. But every age, developmentally, has a task. We have COVID babies, three-year-olds are COVID babies still. I have babies picture this in my office. I work a 100% in the office with a mask. It’s what I love about Zoom to me is for typical people, it’s probably getting to give someone a hug because I get to see your face, your eyes, your mouth.

    Ashley Loeb Blassingame:

    Did you do masks before COVID?

    Dr. Nancy Zimble:

    Never. Never in my life did I wear a mask. Pediatricians, we would say, have great immune systems-

    Ashley Loeb Blassingame:

    Yeah. You have to.

    Dr. Nancy Zimble:

    … because they’re spitting on us all day long. Now, three years later, I would say right at this moment in time, I’m wearing a mask mostly to protect myself from these horrible viruses that all the kids have. But that’s another story. So, I’m going to say this… The one year mark, I would see these top… These infants who turned one, learning to walk, and I would look at their mothers and go, I haven’t even seen your face yet. I picture that, the mother, I’ve put the baby on the breast, I’ve taught her how to nurse. I’ve talked to her about so many important milestones of development with her kid, how to feed her baby, how to start solid foods, how to safety proof her house. And I haven’t even seen the person’s face. Isn’t that crazy?

    And some of those at three years out now, I still haven’t seen their face unless they’ve had a telemedicine. And I go, Oh, it’s nice to finally see you. I say to them all the time, We shop in the same markets, I wouldn’t know you. Because except for your eyes or if you have a really distinctive voice, I haven’t even really met those people. That’s so crazy. But developmentally, those kids have been kept at home. They haven’t had other kids to play with as much. Obviously, all that’s different this year but… So, we were seeing changes in milestones. We were expecting… And I want to say first because I want to go to the positive first. Some kids were living their greatest life. Imagine that you got to stay home. I would’ve loved to be home when my kids were babies, and get to have more time with them and do all my work on telemedicine.

    But some kids were not getting that. Their parents were like, they were working and they were glued to their apps. And even in my very middle… Upper-middle class practice, I am traumatized by a patient who told me that she put her kid in the playroom, her seven or eight year old and close the door when she had to work. And I thought, that kid is growing up with such fear. The kid would bang on the door and the mother’s like, What was her problem? What was her question to me? How do I get her to not bang on the door? And I said, Well, you open it, and you got to figure out another way. And actually, she left my practice because she felt I didn’t support what she had to do to get through COVID.

    We saw some really rough things happening. Kids weren’t getting enough outside time. We have an epidemic of kids who can’t see distance because their eyes didn’t accommodate to the light. I always thought it was they were doing too much screens, but it was really what they weren’t doing. That was the problem. They weren’t using their eyes to see distance. And now, they’ve gone back to school, they all have holes in different places. Some of them did their older sister’s algebra and some of them didn’t ever learn how to read. And so, the teachers are really being required to figure those academic parts out. There’s so many different things going on. And remember that in development, there’s a huge range of typical anyways. We say, you can walk from the time you’re… Walking can… I’ve seen an eight month old walk, typical walking’s around a year. We’re not worried if you’re up to 16 months or so that you don’t walk. The parent worries, but developmentally, we don’t have to.

    So, there’s a huge range to start with. And now, there’s little issues. Are you learning to talk? Is someone talking to you? They weren’t going to mommy and me classes, so they weren’t getting that feedback. Or we had a group that we ran for two years online on Zoom on Monday nights for the community questions and answers. And we had preschool teachers there who would say… One of them who would say, The kids didn’t learn to climb. They didn’t have that climbing equipment that they would get in preschool, so they didn’t learn to go up vertically. And it’s little things that I think sometimes parents don’t even realize is a major thing. Not only did they not learn to climb, but they didn’t learn to wait their turn because how do you learn to wait your turn? Some other kid says, Hey, you can’t cut me. So, they weren’t getting that social stuff.

    I had a middle school kid call me up, he couldn’t figure out how he was supposed to make friends. I thought it was so sweet that he called me. His mom said, Well, just call your doctor and talk, which was really sweet. And that’s another thing I’d like to… I think I did say in the beginning, be sure people know… It’s okay to talk to your doctor, but we’re not giving it away anymore. You got to have telemedicine, and we will talk and we will give you some ideas seeing a lot of it. But he said, I don’t know how I’m supposed to make friends. Yeah. He wants to play video games and he wants a friend to play with him. And I thought, Well, that’s an interesting one.

    So, there were so many repercussions. And at the same time, a whole group of us, we formed a community of valley pediatricians. There were about 18 of us… Maybe there was about 12 pediatricians and six mental health people in this community that did this Zoom. But we would text each other a bazillion times a day. Have you seen this? Have you seen that? A lot of us were taking this course together. UCLA offered a course on ACEs-

    Ashley Loeb Blassingame:

    Yes.

    Dr. Nancy Zimble:

    … which is adverse childhood events.

    Ashley Loeb Blassingame:

    All of my favorites. Yes.

    Dr. Nancy Zimble:

    Yeah. And it was such a luxury to be able to take it. Because usually you’re so busy at work that you don’t… There was a huge amount of time. But it was one of my favorite silver linings of COVID. And we would all meet up on our Zooms and do this class. And it was like… Consolidated everything we were seeing and talking about. And I remember one day going, Oh, I think this thing where… This was very early in, it was right in the beginning. And I remember thinking, COVID is going to turn out to be an ACEs for some of these kids.

    Ashley Loeb Blassingame:

    For the people who don’t know about ACEs, can you give a little blurb on what that-

    Dr. Nancy Zimble:

    So, I would say the simplest way to say it… Oh, I have a good analogy to give you. That stands for adverse childhood event. And typically, in my life, I would think of it as your family got divorced, your house flooded. It could be anything. But really devastating huge things. And later in life, or even at the time, that trauma shows up in other ways, depression, anxiety, substance abuse, learning issues, there’s a whole screener scoring system for which of these things happen to you. And it’s trauma and you can’t… Your body has huge hormonal problems. Biochemical things happen that when you’re anxious and you feel your heart race, that’s because of a biochemical. And so, these biochemicals change your way of thinking, they change your way of functioning. And you can’t have too many of those, some of those might… Some of these biochemical things were originally meant to protect you when you lived in the jungle and a tiger came at you.

    So, here’s the way I heard it explained in COVID, you jacked up your biochemicals to fight the tiger, but the tiger never left your living room. For three fricking years, you had that tiger there. And those biochemical changes lead to all sorts of things. For some of the school age kids, I think, they got off that, I say, it’s the hamster on the little wheel, they got off that wheel. So if you’re eight, you know the deal, now you’re eight. You get up, you brush your teeth, you put your clothes on, you eat your breakfast, your mother says, Hurry up, get in the car, we’re going to be late. And you go to school. They know the deal. It’s what we call the quiet middle years for most kids. So, they got off that training.

    And now we say to them… Now you’re going to middle school, by the way. You were eight when it happened, and now you’re going to middle school. And it’s big and you’re going to have a lot of teachers and you’re going to get a locker, and you’re only going to know a few kids there. So, you’re starting all over. You didn’t slowly get taken through that transition. But every age is something different, I think. And every situation’s a little different. Because if anybody had anything when this started, by the way… If your kid was just little nurturing, you could get them through anything, but they needed that extra little, which is a lot of kids, it blew up during COVID for those kids mostly.

    Ashley Loeb Blassingame:

    So, what we would say is, so these ACEs… I think the thing about the ACEs for me, and something I talk about a lot is that they are huge predictors of disease. Mental health is… To me, that makes sense, that was obvious. Wasn’t obvious was the links to lung cancer-

    Dr. Nancy Zimble:

    Heart attacks.

    Ashley Loeb Blassingame:

    … heart attacks, diabetes, all these… Really? And so, what I think I heard-

    Dr. Nancy Zimble:

    Hormones. Everything’s about your hormones, baby, now.

    Ashley Loeb Blassingame:

    Right. Right. And so, what I think I’m hearing you say is, for all the children, COVID added an ACE. Is that fair to say?

    Dr. Nancy Zimble:

    Not all children did.

    Ashley Loeb Blassingame:

    Right. Okay. A lot.

    Dr. Nancy Zimble:

    Yeah, I think a lot did. But remember, for some kids, that’s their only point. They were living a dream life. So, maybe having just that one point isn’t going to affect them long term.

    Ashley Loeb Blassingame:

    We admitted way more children into the psych hospitals. There’s some effects that we know happened. And I don’t think it’s rocket science for most people to go, This is going to affect… It’s going to affect everybody who went through it, period. From adults, to child, in some way, whether it’s positive, negative or otherwise. But from your perspective, what do you think some of the big challenges we’re going to start to see, maybe some that we don’t think about, that aren’t the obvious ones.

    Dr. Nancy Zimble:

    Right. I tell everybody, there’s very smart people looking at that data now, they weren’t worried about that. The first goal was to survive. They’re not talking about all that data that they’re now since the numbers have slowed, although they’re not gone. I’m one of those people that still wears a mask in the market, and I’ll probably wear one on an airplane forever. But it’s not gone. But we’re learning to live with it. And now some people can look at that other data that isn’t just about life and death. The first year, and maybe even two or three years, was about life and death stuff. And now they can call through that data and say, Okay, we’re starting to see the numbers about how many kids got into psych hospitals, and how many suicide attempts there were, and terrible, terrible things. I hear from teenage kids because I listen to a lot of them.

    I have an older practice, which means I have a lot of older kids. And I’ve known them their whole lives. So, some of them will talk to me, or by not talking, I also can infer some things, I guess. They say, I thought I would go back to school, and my friends would all talk about what it was like for them. But no, we just went right back to school and had to work. There are probably some schools that are doing a better job of that.

    Ashley Loeb Blassingame:

    Interesting.

    Dr. Nancy Zimble:

    But I don’t think in general, LAUC is one, which is no surprise given their number.

    Ashley Loeb Blassingame:

    No surprise.

    Dr. Nancy Zimble:

    One week, I had… Think it was last year, all the years to me feel like one big year, all the COVID years.

    Ashley Loeb Blassingame:

    Yeah.

    Dr. Nancy Zimble:

    I hear a lot of people say that. I had three girls from different schools in one… High school girls, in one week, burst into tears when I said, How are you feeling about getting to go back to school? So, it was at that point when we were going to go back to school, I think it was about a year ago. And they burst into tears and I said, What’s up? And they said, How can I do Spanish three? I didn’t really do one or two. I used the book, right? They’ve been sitting there on their Zoom, the book is down here, because you know you piled up my iPad so you could have my face at the right height. The book’s right here, the teachers all knew, we knew the teachers knew because they talked about it on these meetings we were having. But-

    Ashley Loeb Blassingame:

    What are they going to do?

    Dr. Nancy Zimble:

    They just went right into Spanish three as if nothing was wrong. So, some kids really learned Spanish. They maybe watched, I don’t know, the Spanish soap operas or, again, had their finest moment could focus on it. Everybody picked a different subject maybe to stay on top of or okay with. Some kids never learn geometry because that is 10th grade for most schools, and you don’t use it again so much. You go into precalc or algebra two in 11th depending on which school you’re at. So, what does that mean in life? I don’t know. Did we lose some architects? Because they now don’t understand that. I don’t know what that means, but we’re not talking about it as far as I can tell. So, some of the people in this group that we formed, we would talk about… We wrote something, we called our manifesto, our COVID manifesto. And we wrote it in the first year, when I was looking back on it, not long ago, thinking, what are the things we need to focus on when kids come out of this?

    And at that time, we didn’t even think it would be this long, but nobody seems to be focusing on them that I can see. Maybe I’m just not privy to it. We thought we should have little pop-up psych stations on every high school where you find some psychs from that neighborhood and you get them to agree.

    And this idea that they would volunteer just makes me want to throw up. Nobody can afford to volunteer anymore. You have to pay them and have them see… Let the kids know you can come in, and then talk about it. We have to get more psych help. We have to… I want to use that word, normalize that… We expect you to have problems from this. This was not what we expected your life to be like. And we could never have foreseen this in our wildest dreams. Imagine, put yourself in ninth grade and say, if your world shut down in ninth grade like that, that was not on your radar. It was not on anyone’s radar. So, if you’re hurting, it doesn’t mean you’re mentally ill. It doesn’t mean… I wonder how much harm we’re doing now publicizing this and saying, and ha ha, we can’t fix it. Haha, we don’t have enough psychiatrists or psychologists to make this better. I wonder how much harm we’re doing for the kids by saying that.

    Ashley Loeb Blassingame:

    What are you telling parents who are dealing with… What kind of tools are you giving them in your practice?

    Dr. Nancy Zimble:

    You have to know how a pediatric office works. The way pediatricians see patients is fast. If you don’t see a lot of kids, you can’t pay your bills.

    Ashley Loeb Blassingame:

    Correct.

    Dr. Nancy Zimble:

    None of what we’re doing now is the fast visit, it seems. Even if you come in for an earache, it’s… By the way, can I ask you… He doesn’t want to go to school anymore. That’s not a 10 minute visit anymore. And remember what I told you, insurance isn’t going to pay for it. They’ll literally send back a bill saying you’re not a mental health provider, you can’t pay for… We don’t pay you for… We don’t recognize or pay you for anxiety. So, you have to figure that part out.

    Ashley Loeb Blassingame:

    For people who don’t know you’re billing under… The way that insurance works is you would bill under a code, and that code has a time period attached to it. So, that seems pretty-

    Dr. Nancy Zimble:

    Well, it’s sometimes for time, and it’s sometimes what they call now medical complexity.

    Ashley Loeb Blassingame:

    What kind of things are you telling the parents?

    Dr. Nancy Zimble:

    So, number one, recognizing what our visits are. Number two, knowing that we now probably spend 40 minutes with our teenagers, and especially… It is more girls than boys, but we’re seeing things in boys that we never did. So, we say… We do these screeners, screeners are these questionnaires that I think they probably originally came from mental health places, but we do them, and then we use them as a stepping stone. So, if you circle high on a couple of things, that’s what I focus on. What’s your issue? Let’s talk about this. I say… Luckily, I know these parents and these kids, so I’m not expecting suddenly at 17 to see you’ve got a problem with your hip. Becasue your hip has been normal the past 17 years, and I know that for a fact because I’ve been checking it. It doesn’t mean it can’t happen, and I’d still do your whole exam, but I’m talking to you about so many regular things.

    Then I see these screeners and I see… I never even knew they went up as high as they did. In the old days, we would see every now and then someone had a four or a seven, and suddenly, I’m seeing in the teens pretty routinely of issues. Because they get a score of one, two, or three or… Usually, it’s one or two on these things. And then we pick those issues and we talk about them. We talk about safety, we talk about connection. Depends on the age, depends on the kid, depends on the family. So, then you have the subset of parents who, some of whom say, No, my kid’s fine. We have a great life. And then we have to boot the parent and say to the kid, Okay, what’s going on? Why do I not see the white of your eyes? Why are you looking down? Why are you not… What’s going on?

    And there’s stuff going on that the parents don’t know maybe, or they’re afraid to tell their parents because they know their parents are so stressed. Almost every screener, there’s one question that says, worries a lot. And I usually go right to that one. It’s on the middle of the page. And almost every kid has a one or two on that. And I say… And that didn’t used to be before COVID.

    Ashley Loeb Blassingame:

    Okay. Yeah, that was my question.

    Dr. Nancy Zimble:

    And when the parents do the screeners, it almost never is. It’s interesting because we don’t let the kids do them themselves until about high school. I think we start in high school letting the kids do themselves. And so, I just start… That’s often where I lead. I say, What is it you worry about? And almost always the answer is, school, academics and getting into college. Now. After what these kids have been through, can’t we make that easier for them? Somehow, I don’t know.

    You’re going to college, it’s going to be easier to get into college than getting into high school where you go, for a lot of my kids. What do you need help with, ask for help. Self-harm, We screen for that always. So, there’s so many things. We always did, but it was never… It was so rare. We’d have one or two kids a year that were seriously hurting. And now, so many are. And it’s hard to tell how much they are hurting. They perceive that they’re hurting, that’s enough. They need help. But we don’t have enough psychologists for all of them to go to. The waiting lists are three months. So now, we have to talk about being safe, and will you promise to call if you feel worse? And most of us at least have a huge referral network at this point. So, know your limits.

    And I definitely have had to fight with some parents to say, You got do this. You’ve got to do this. And I think sometimes I am, I guess, I can say, pissing parents off when I say… Sometimes I don’t get to read those screeners when I walk in the room. I go into the room and I see the kid and then I say, Now fill out your screeners, and I’ll see you next year. And then I sit down at my desk and look at the screeners and I go, Oh, I need another visit with this kid. And I see how many issues there are and I suggest we do telemedicine for follow up. And then it’s up to the parents to… That’s a really hard thing, we don’t… I try to say, You need follow up. And I do say, You need follow up, we need to talk some more.

    I’m not going to do your therapy, but I’m going to talk to you about what I think you need. [inaudible 00:37:44].

    Ashley Loeb Blassingame:

    Okay. Okay.

    Dr. Nancy Zimble:

    Right?

    Ashley Loeb Blassingame:

    Yep. Yep.

    Dr. Nancy Zimble:

    And eating disorders. Huge, huge, huge, huge. Lots of eating disorders these years. I say the kids took lessons on YouTube and how to do it, and that’s what they worked at. Can’t get them all into the eating disorder specialists. We’re blessed with several in LA, but I don’t know what people do in cities that don’t have them at all. One of the things they did in these years is all our major hospitals put out a lot of CME, continuing medical education. They knew the pediatricians were going to have to shoulder a lot of this.

    Ashley Loeb Blassingame:

    Yeah.

    Dr. Nancy Zimble:

    And they did, in fairness, try to make it a little easier for us by offering us this. Now, plenty of practices couldn’t afford to have doctors sit and watch this stuff for hours. I probably did 90 CMA hours these years, each of these years.

    And eventually, most recently, they actually gave us some algorithms of how to… If the kid has this, you do this. If the kid has this, you do do this. And if it really, they fail all these things, here’s your phone number that you can call. How to recognize the depth. Can you really make that assessment in a 30 minute visit? I’m not sure you can, but you can get an indication. And again, I don’t know how people do it with new patients, it’s much harder.

    I’m counting on the fact that I have had a relationship with this family. So, a lot of times I’ll just take a breath and go, You and I have been through a lot these years [inaudible 00:39:01]. I know this isn’t the way you want things to be. We got to deal with this. You’re a great parent. This isn’t how you want a parent. I use that line pretty often when I see there’s resistance. Everybody’s hurting in a different way. Sometimes it’s like, Oh my God, do I have to pay for therapy for her? They want the kid to get therapy. They genuinely do, but they’re looking for some way to, I don’t know, have the chaplain do it or… Yeah, you may as well talk to me then.

    Ashley Loeb Blassingame:

    Of course, you want to make the best decision. Of course, you want to give them all the resources. Of course, you want to drive them to all the [inaudible 00:39:32] things. And there are constraints that we all have. When you’re talking to parents about things that are going on with their kids as it relates to mental health and these things, one of the things that I’ve seen a lot is this struggle between resource allocation. And when I say resource, I also mean time and energy.

    Dr. Nancy Zimble:

    Yes, absolutely.

    Our biggest resource.

    Ashley Loeb Blassingame:

    Our biggest resource. Splitting between the academics and the mental health. So, I’ll have parents… I had a kid… I give you just a quick one. I had a kid who I was… The family I was working with who was having grand, this is a much more devastating than the ones I’m referring to originally, but he was having grand mal seizures. He was doing well in school, but he was using enough that he was having these grand mal seizures once a quarter because of his use. And he was in his senior year of high school. And, he, at the end of the year, he went to Mexico with the group of kids, whatever, and doing drugs, and had a grandma mal seizure. And I’m talking to the parents about, Hey, this is really serious. And they’re like, But he got into school. And if we take him at… If he defers a year, he’s not going to be able to take advantage of this. And then that’ll change this, and then that’ll change this.

    And so, a lot of this… I shared that particular story because I hear versions of that where families are like, Well, I do want to get them the help, but that’s going to take away from this extracurricular, this exam they have to take, their SATs, the whatever it is to keep them on track. And I’m not willing to do that, whereas I’m saying, I know. But if you don’t do that, it’s going to happen in college when you don’t have any say, and you’re not oversight, and all these things. Are you having those conversations with people and getting similar resistance?

    Dr. Nancy Zimble:

    Absolutely. And we had that even before COVID, I’ll say.

    Ashley Loeb Blassingame:

    Yeah. Yeah. Oh, yeah.

    Dr. Nancy Zimble:

    It’s that thing I hate about addiction medicine where we say, Not me. I won’t say we… You have to hit your bottom. They don’t see it as urgent enough. They’re limping through that mental health piece, hoping… And there’s some truth to it that the self-esteem the kid will build in the other areas will save him. You know this from the addiction work. When you come out of it, you have to have something to go back to. We have to find something-

    Ashley Loeb Blassingame:

    Or you have to build it. Yep.

    Dr. Nancy Zimble:

    So important for them to do. That is such a tricky, tricky thing, which is why I get back to pediatricians can’t do 10 minute visits. It’s impossible, there’s so much. I have a bazillion kids who have, they call it orthorexia, they want to eat healthy. And I say to the parents, Well, I’m worried, and I’m not going to see you again for a year according to your timeline. I think we need to bring them in for a weight check before school starts.

    I’m concerned because some kids eat really healthy, are so happy that they lost 20 pounds. And maybe they are okay having lost 20 pounds even, but they can’t stop. That’s the cycle where it is an eating disorder. And I can’t make them come back. I’m not allowed to do that. They could take advantage of it. They can come in, just jump on the scale. And I hope to God I’m going to say, All good, I was just being paranoid. She’s fine. But maybe not. And some of them come back. Now I’m seeing kids a year later, and they’re still losing. And I’m like, Oh, did you notice? And no, we didn’t notice because she was wearing these big sweatshirts. And yeah, that’s what I tried to warn you about. It’s so parallel to the addiction world.

    You see somebody thinking they’re going to start to… They can manage just having a joint. And there it starts. And all of a sudden, they’re high. And somebody has something better to offer. And boom, they’ve gone down the rabbit hole. And I want to say one other… I wanted to bring in one more thing. There are some parents that I think are overcompensating, that have managed everything in their house. And I mean in the nicest way. There were three kids under five, or maybe let’s say under six, because the six year olds had to do first grade, and the one year old had to take naps, and both parents had to work. So, they had to compensate, they had to overcompensate because what do we know is best for child development, it’s to let the kids figure out how to do stuff themselves. It’s going to take three times as long for him to put the shoe on. If you don’t ever have time for him to put the shoe on, he is never going to learn. Think how many times they had to fall before they could walk.

    And we don’t say, Oh, forget it. You’re never going to walk. We say, Oh, yay, you’re walking. And that’s what encourages them to do the next thing. And we have to do that with all our developmental milestones. Now I do five year checkups. And every checkup I do, I don’t think parents realize that. I learned that in these past three years. I’m not just looking at is the knee or the foot okay, I’m looking at how do you put your shoe on. So, at the end of the checkup with five-year-olds, I say, Okay, you can jump down and put your shoes back on. It’s a complex couple of directions. I say it pretty fast, probably even worse because in a mask, so it’s harder to hear.

    And is the kid listening? Is the kid able to listen? It’s so basic, but I’m assessing that a little bit. I’m not making a judgment. I’m not saying, Oh, he’s going into special ed classes because he didn’t listen. That’s not ever going to happen based on a one second interaction. But then before the kid even gets down, I see the mothers have stood up, opened the shoe, and are starting to put the shoes on for the kid. And I say, Wait, give me a minute. I just want to see if he can do it. But I don’t like to tell the kid that I’m watching him, but now I have to tell the kid because I can’t whisper to the mom because in a mask. I have noticed all these five-year-olds, the mothers are putting the shoes on for them. Where [inaudible 00:44:57] used to helping them do everything. We forget to say you’re having a soccer practice tomorrow, get your soccer bag ready.

    How do you learn that you’re supposed to bring your cleats? You get show up at the soccer field. It’s not the mother’s fault if you don’t have them, your kid has to learn that. So, there are some life lessons. And I will say that anxiety does serve a very good purpose in life. We’re so worried, and we need to be worried. It’s a real fear that that junior who’s going crazy because she has three AP exams and we told her not to take three AP classes in the first place, by the way. She has three AP exams next week, and she’s throwing up and can’t sleep and is studying all night. Well, how do we know if that’s horrible anxiety, or if that’s situational and that maybe just helps her to study.

    It’s fascinating to me because I love the behavioral developmental part of watching kids grow, but I think what you get is a sense of how incredibly complicated the issues are. And it can only be dealt with, I think, family by family, at least in my office. But I will say, reach out to your pediatrician, to parents, and say, They care. They know this is going on. You’re not alone. I think the kids need so badly to hear they’re not alone. Wouldn’t it be nice if we had a lot of groups that kids could go to? Guess what? Those groups are hugely expensive. The private psychs are doing them, but unless I have a family that can really afford it… And nobody has that kind of… Only a small percent, even here in LA, have that kind of resource. And they’re going to do it privately anyways. But we need to provide those kind of groups for kids to say, Well, how should we get through this, and how can we help each other? I have to say… I teach snap as a way to change your behavior. Yeah.

    Ashley Loeb Blassingame:

    Oh, for people listening. You have a rubber band on your wrist and you snap it, and it reminds you of a particular thing you’re trying to keep by the forefront of your mind.

    Dr. Nancy Zimble:

    It can remind you. Or if somebody is… It’s a habit changer. Oh, I use it a lot for biting nails. If you’re biting your nails… So when your mother says, don’t bite your nails, oh, now you really want to bite your nails because you can’t stop thinking about it. So if the mother instead says, Snap… And you don’t use these beads because fall apart, but you use a scrunchies, they’re big now. You’re not trying to hurt yourself, you’re just trying to change the behavior. So, we could teach things like that. We could teach mindful breathing. There’s a lot of techniques we could show kids. And I bring this into my regular pediatric practice. And I don’t think most pediatricians do. Because I can do that because I’m not seeing so many kids anymore. My practice has really slowed down since COVID. I’m, again, this tiny little practice.

    Ashley Loeb Blassingame:

    So, how would you suggest that the average parent best work with their pediatrician?

    Dr. Nancy Zimble:

    Parents aren’t thinking about their pediatricians that… As having any ability to help them in this way. I think they need to hear that. I’m shocked sometimes when someone comes in a year later and I say, Anything go on in the past year? No, everything’s fine. But she’s taking Lexapro, and they’re on three psych meds. And I’m like, Oh, what happened? Well, she was getting sad. We went to [inaudible 00:47:58] psych, and we got meds for her. They didn’t even-

    Ashley Loeb Blassingame:

    So, what should they do differently? That that’s what I would think to do.

    Dr. Nancy Zimble:

    Maybe that kid’s okay, so maybe that’s a happy ending. But maybe that’s a lot of meds for a kid. And maybe they could’ve called, and I would’ve sent them to a pediatric psychiatrist that might’ve managed it differently. Not all psychiatrists are comfortable. Although I would hope that if they’re not comfortable treating kids, they would say so. And again, some are fine, but they can… I’m always surprised that they call me because the cold’s still there in four days, but they don’t call me that the kid’s deeply depressed and they don’t know what to do.

    Ashley Loeb Blassingame:

    Okay. So, using the pediatrician to get resources for all the mental health and the physical health.

    Dr. Nancy Zimble:

    Yes. It’s a great starting place. Again, most of us have had some training in this, at least enough to say, oh, that’s a worry and we’re going to get you somehow to the right people. Sometimes, suicidal, they got to go to a place that has inpatient. We’ve got to direct you. Not all places can manage it. And here in LA, some of our kids have been… Some of our older kids have been sent to some pretty horrible psych hospitals that they shouldn’t even be seeing that kind of stuff, I don’t think. But we don’t have much inpatient psych. So, I do believe that pediatricians can be their advocate and help them get started in the process. And some of us are pretty involved in it. They think, well, we have this once a year free checkup. I think a lot of parents look at it that way. And we’re trying not to come in any other time because maybe insurance isn’t going to pay or their copays are so high, but their copays are always less than seeing a psychiatrist or a psychologist.

    Ashley Loeb Blassingame:

    And a sick visit. So, can you utilize a sick visit for any sickness?

    Dr. Nancy Zimble:

    Yes.

    Ashley Loeb Blassingame:

    If I’m depressed, I probably do not feel well, and that is sick visit?

    Dr. Nancy Zimble:

    Oh, yeah. A lot of times. So, somatic complaints, again, to explain it to people. Very often, mental health comes out as a physical ailment. Like stomach aches, chest pain, headaches is a big one in kids, school avoidance is often depression, or it’s a cycle, you missed school because you really were sick and now you don’t want to go back because you missed so much work, you know they’re going to kill you when you get back to school. Fatigue is a big one. So, are you tired because you’re really tired? Are you not sleeping because you just stayed up too late playing video games? Or are you not sleeping because you have anxiety and you can’t go to sleep? Sleep turns out to be so important. And guess what? None of our teenagers are sleeping enough. Who knew that a teenager still needs 10 hours of sleep?

    When my kids were little, if they went to bed, that I take a little nap when I was reading them a story and I was good for hours of whatever I wanted to do in the night. Now, sleep. So important, it makes anxiety better. It makes you function better. It makes your day go better. These kids are not sleeping. So, we have to encourage that. But we were talking about the somatic complaints. So, sometimes they come in because of fatigue and the mothers just want you to say… The mothers go, Tell her she has to sleep. They point their fingers, Tell her she has to sleep. She’ll listen if it comes from you. And I’m thinking like, Yeah. No, they’re not listening to me either. Come on. They’re going to nod their head or something, maybe be more respectful than they’ll to you. But they’re not… That doesn’t fix it.

    It would be nice if we could just say to someone, this is what you need to do, do it. And they would just do it. Yeah. But they’re tired, yeah, because they didn’t get enough sleep. But really, maybe that’s because they’re anxious, or maybe that’s because they’re really struggling in school and they’re staying up so late to do their work, or maybe they’re just struggling to make connection with someone and that… So, that’s the time that this cute guy called them, and they’re going to talk on the phone for two hours at midnight. I’m not saying they should, I’m just saying you have to decide what is fatigue. There’s a huge, we call it in medicine, a differential diagnosis for fatigue. Maybe your thyroid’s whacked. But we got to assess that. And that’s a sick visit. Anything that isn’t your well child visit is a sick visit.

    Ashley Loeb Blassingame:

    Well, thank you so, so much for being here. This is so helpful. And I think people really appreciate hearing from someone who says, I was there, I was watching, I didn’t know how any of this happened. You have all the experiences from start to finish, and it’s so valuable to people. So-

    Dr. Nancy Zimble:

    Thank you.

    Ashley Loeb Blassingame:

    I’m just super grateful and grateful that you’re your small practice, and the family… It made me want to cry. The families that you were talking about where there’s the generations coming in, and that still exists. It’s beautiful.

    Dr. Nancy Zimble:

    Not for long, but thank you.

    Ashley Loeb Blassingame:

    Yes, not for long. Well, thank you so much, Nancy. Thank you.

    Dr. Nancy Zimble:

    Well, it’s nice to meet you. You’re very easy to talk to you. You definitely have the right job.

    Ashley Loeb Blassingame:

    Thank you. Thank you.

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