A Newer, Safer Permanent Contraceptive Option for WomenBy- Dr. Joan Marie PellegriniWhen a woman is certain that she no longer wants the option to get pregnant, she has a choice of continuing on with her current contraceptive method or considering a surgical option. The most common choice for permanent sterilization is a tubal ligation (getting her tubes tied). A tubal ligation offers the benefit of being highly successful, relatively safe, and permanent. It is immediately effective and allows for a woman to discontinue her â€œpillsâ€. The pill is hormonal based and there are many women who are at risk of complications if they take hormones. These complications include blood clots, stroke, and increased risk of certain cancers. Because a womanâ€™s fallopian tubes are inside her pelvis, tubal ligation would require anesthesia, at least one incision in the belly, and must to be done in the operating room. The recovery time is several hours in the procedure center and then 1-3 days at home. Some women are not candidates for this procedure because of anesthetic or surgical risks.In 2002, the FDA approved a new procedure called Essure. This procedure is done in the doctorâ€™s office and requires no anesthesia. The doctor inserts coils into the fallopian tubes and these coils cause scarring and blockage of the tubes. The woman can drive herself home or to work after the procedure and there is minimal discomfort. Some other form of contraception (pregnancy prevention) must be used for 3 months after the procedure until a hysterogram (an xray using dye of the uterus) is done to confirm that the tubes are blocked. Many experts feel this procedure is safer than tubal ligation and has a similar failure rate. Neither of these procedures is 100% effective however, the failure rate is extremely low and better than that with hormonal manipulation (the pill).A quick look at the Essure webpage reveals that there are at least 6 gynecologists in the Bangor region that perform this procedure. Clearly, this procedure is becoming well-endorsed by the gynecologic community. There is one another hysteroscopic method that is FDA-approved. It is likely that in the future there will be even more options available and your gynecologist will advise you on which one is best for you.Permanent sterilization procedures should be considered irreversible. Studies show that 3-25% of women eventually regret having a sterilization performed. For more information:www.essure.com This site is supported by the company that makes the coils.http://www.uptodate.com/contents/patient-information-permanent-sterilization-procedures-for-women This site is not industry-sponsored and is an excellent source for non-biased information on sterilization procedures. There are also other excellent resources listed.http://www.americanpregnancy.org/preventingpregnancy/birthcontrolfailure.htmlThis site offers information on all of the methods used to prevent pregnancy. This site is not industry-sponsored.
By- Dr. David PrescottProgress Has Been Made on Suicide Awareness: Thanks to efforts of many groups such as the American Foundation for Suicide Prevention and, more locally, the Maine Youth Suicide Prevention Program, public awareness about suicide and suicide risk factors has improved. However, suicide continues to be a leading cause of death in the United States, and helping people cope with suicide continues to be a significant public health issue. Who is Most at Risk for Suicide? Suicide is the 4th leading cause of death in America for people between the ages of 18 and 65, and the 11th leading cause of death overall. Older adults (75 plus) and adolescents/young adults (15-24) continue to have high rates relative to other causes of death. However, the latest statistics available (through 2007) show a recent increase in overall suicide rates. Most people, about 90%, who commit suicide have a diagnosable psychiatric disorder. Most common are the mood disorders like major depression or bipolar disorder. People who have substance abuse disorders (alcohol or drug abuse and dependence) are also at high risk. What are Warning Signs for Suicide? One of the more common myths about suicide is that people who try to commit suicide do not tell anyone of their thoughts and plans. To the contrary, most people who attempt suicide have talked about it. Any talk about a suicide plan should be taken seriously and the person with the plan should be seen by a mental health professional or call a mental health crisis line. Common warning signs of signs of suicide include: Â· Observable signs of depression such as unrelenting low mood, hopelessness, and social isolation. Â· Increased alcohol or illicit drug use. Â· Recent impulsiveness or unnecessary risk takingÂ· Expressing a strong wish to die Â· Making a suicide plan or giving away important possessionsWhat to Do if You Know Someone Who is Considering SuicideIt is important to realize that no one thing that a person does, or fails to do, makes the final determination about a suicide attempt. Try your best to help, but remember that there are many factors involved in a suicide attempt. Good first steps include: Listen Attentively: Just listening to someone can provide important support and begin to help them feel better. Tell them you are concerned, and find out if they see a mental health professional. Encourage Professional Help: If the person is not seeing a mental health professional, encourage them to do so. Types of mental health professionals include psychologists, psychiatrists, social workers, and licensed professional counselors. You may be able to help them follow through on making a call or keeping an appointment. Mental Health Crisis Lines: Maine like most states has crisis phone lines to help people who are considering suicide. You can call 2-1-1 or 1-888-568-1112. Coping with a Completed Suicide: If someone you know has completed suicide, it is important to talk about it. There are support groups available where you will meet other people struggling with the same issue. It is common to immediately feel shock or numb. This is often followed by feeling sad and depressed, guilty, and angry. For More Information: American Society for Suicide Prevention: www.asfp.org Acadia Hospital: www.acadiahospital.org
Lawn mowers are real useful this time of year, but they can also be very dangerous if used improperly. TV 5 Healthy Advisor Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to help keep your yard work safe.Almost 80,000 times each year people check into Emergency Departments for lawnmower injuries. More than 9,000 of those victims are children, despite the fact that the American Academy of Pediatrics strongly warns against children being anywhere near lawnmowers, much less operating them. Walk-behind mowers result largely in extremity injuries, while riding mowers often include injuries to other parts of the body, including the head and torso.How can you reduce the risk of serious lawnmower injuries to children? Here are a few common sense ideas, as well as some others you may not have considered. 1. A lawn mower is a dangerous tool. The energy of a mower blade is three times the muzzle energy of a .357 Magnum pistol, one of the world’s most powerful handguns. The blade can throw a piece of debris, like a stone or piece of wire, at speeds up to 100 miles per hour. The result – one fourth of all hand and foot injuries caused by mowers include amputations of fingers, toes, hands, or feet. And the injuries are messy and complicated.2. Children should never ride a mower with an adult. Each year a number of children suffer severe, and in some cases fatal, injuries after falling off a mower and then being run over.3. The American Academy of Pediatrics recommends that a child be at least 12 years old before operating a power push mower, and be at least 16 to operate a riding mower. These age recommendations assume that the child is large enough to physically handle the equipment. Careful instructions and review of the operating manuals should be part of the routine of teaching a child or teenager how to use the mower. Ignorance is an accident waiting to happen.4. Children should not be around a yard being mowed. Debris thrown by a mower can easily cross a yard and strike a child. Additionally, mower noise prevents operators from hearing the usual cues that children are near. Subsequently, 5 percent of lawnmower injuries to children occur when the mower backs over them because the operator does not see them. So – – clear the yard before mowing, of both debris and of children. The American Academy of Pediatrics has issued strongly stated advice about how to best prevent injuries from lawnmowers. Please refer to the following web page for a nice synopsis: AAP Safety TipsBe safe! Donâ€™t bend the rules when it comes to lawn mowingâ€¦ the risks are too great!By- Dr. Jonathan Wood
Staying hydrated in the heat it’s something we all need to do. TV5 Health Advisor Dr. Erik Steele joined Carolyn Callahan on TV5 News at 5 to talk about it.
NOISE AND MENTAL HEALTH: Is chronic noise more than just a nuisance? HEALTH WATCH â€“ July 5, 2011David Prescott, Ph.D. â€“ Acadia HospitalWhy Worry About Noise? In much of Maine we are thankful for our ability to step outside of our homes and hear almost nothing. The peace and quiet of the majority of Maine communities is a benefit of living here. But, for many people across the nation and the world, chronic noise is not only a nuisance but a significant hazard to mental and physical health. The World Health Organization recently reported that over 1 million health years of life are lost each year due to ill health, disability, or early death due to traffic related noise. While most research has been done on the impact of noise that is difficult to control, like traffic or airplanes, there is mounting evidence that trying to reduce the amount of everyday noise in our lives can have important health benefits. How much noise is too much? Noise is measured in weighted decibels. The recommended noise level in a bedroom to help with good sleep is no more than 30 decibels. In a classroom, the ideal level of noise for learning is less than 35 decibels. Standing next to a vacuum cleaner is usually rated at about 70 decibels. While studies of American cities are still not completed, recent research found that about 40% of people in Europe live in a place where traffic noises are at an average of 55 decibels. Noise and Mental Health: The impact of chronic noise on mental health is not quite direct, but not hard to follow. Our bodies react to chronic high levels of noise with responses such as: â€¢ Increased production of hormones that are released in response to stressâ€¢ Decreased sleep. â€¢ Increased blood pressurePoor sleep and chronic stress response are clearly tied to increased risk for depression, anxiety disorders, and a variety of mental health disorders. Also, being in an environment with chronic stress, such as high noise levels, make it harder to recover from health and mental health problems. For example, preliminary research suggests that high noise levels in acute care hospitals is associated with slower progress in recovering from an illness. Noise and Development in Children: Exposure to high levels of chronic noise appears to slow the cognitive and learning development of children. Naturalistic studies of children who live near airports shows a decline in reading levels and long term memory associated with chronic noise. Interestingly, a group of children who had chronic noise removed, due to relocation of airports, showed improvement in the same tests of reading and memory. Are there any simple steps that can be taken to reduce the impact of noise? Obviously, people have limited ability to control things like where airports and roads are built. However, becoming aware of noise levels that you can control may have important health and mental health benefits. Some examples might be: o Consider turning off televisions and stereos in your home that are on â€œall the time.â€ o Be sure to reduce noise levels in the house when children, and adults, are sleeping. o If you work at home or your children study at home, consider setting aside agreed upon times for quiet, when radios, movies, and television are turned off. o Simply being aware of reducing your voice level may help, particularly if someone in your home is recovering from illness or mental illness. For More Information: American Psychological Association: www.apa.org/monitorWorld Health Organization: www.euro.who
By- Dr. Joan Marie Pellegrini It is that time of year and the lakes are warming up. As the temperatures rise, we will be spending more time in the water. Because of this, a few of us will get Swimmer’s Ear. This is an infection of the external ear canal that causes pain, itching, a wet and full feeling in ear, pain with jaw movement, drainage from the ear canal, and sometimes neck soreness (from swollen nodes). The CDC estimates that more than half the cases in this country are in adults. So this is not just a problem for children. The most important risk for swimmer’s ear is the duration of exposure of the canal to water that is contaminated. The water from lakes, oceans, and pools all carry risk. I would have thought that a chlorinated pool would be safer. However, this is not true. The chlorine in a pool causes irritation in the canal by accelerating keratin degradation (keratin is found in the protective layer of cells lining the canal) and actually increases the risk of swimmer’s ear (Medscape). So, what can you do to prevent this? First, I should mention some things that you should not do. Don’t try to clear the ear canal before swimming. The ear canal has a natural mechanism of moving wax and dead cells from the inside to the outside. Attempted cleaning can irritate the canal and make infection more likely. Never insert anything into the ear canal. Lots of swimming can wash away the protective wax coating in the canal. In order to protect the skin in the canal, you may use a mixture of vinegar and isopropyl alcohol. Place 2-3 drops in ear canal before and after swimming. If you are particularly prone to this type of infection you may try using ear plugs when swimming. Specialized petroleum coated plugs are available. However, you must avoid getting an accumulation of petroleum in the canal which could block the water that gets in from draining back out. When you get out of the water, try emptying any water in the canal by tilting the head to each side. Pulling on the ear lobe can help empty the water. Also you may use a hair dryer on the lowest setting. Once you have the infection, there are drops that can be prescribed to treat the infection. By no means should you try to clean out the ear canal with anything (including cotton-tipped swabs). If you are on vacation and will need to fly home, you should strongly consider seeking medical attention promptly so that the infection can be optimally treated. This is because the pressure changes in the plane can cause severe pain and some complications. An infection that is left untreated can cause the infection to spread to the inner ear or bone.A useful website:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001647/
By- Dr. Amy MoviusMedical care is always changing – and not just scientifically. There is a growing appreciation for the “ripple effect” of illness and hospitalization as we understand more about mind and body connection as well as the havoc being sick can wreak on ones life. Perhaps this is most obvious when children are the patients.Providing medical care requires a medical team. Amid the focus on treatment and procedures that surround a child’s illness, the single most important team member to the child, is often the Child Life Specialist (CLS). Most hospitals that provide pediatric care now have a Child Life Program. In the words of the certified CLS I work with daily, her job is to “do everything I can to make (the child) happy and feel better”. This involves more than “getting along with kids” or “liking kids”. Make no mistake, child life specialists are not fancy playmates: they are consummate professionals who have undergone rigorous study and training. This training focuses on the psychosocial needs of children of all ages. They often use therapeutic play to help them cope with and even conquer some of the challenges of being sick or receiving medical treatment that might otherwise be overwhelming. Children process information and experiences differently than adults and so have different needs to help manage difficult circumstances. Even the adults who love these children the most and have only good intentions may not understand or perceive how separate their child’s experience and needs are from their own: much less, how to explain what is happening while coping with their own stress surrounding their child’s condition. The services a CLS provides are many: a few examples of areas of expertise are below:1. Ease a child’s fear and anxiety with play.2. Foster an child friendly environment. 3. Provide medical preparation and support for children.4. Advocate family involvement/presence.5. Consider needs of siblings or other children affected by the illness.6 Support family with grief/bereavement.Feedback surveys leave no doubt as to the high value patients place on Child Life Services. However, it is not only the right thing to do, it is also good medicine. Research suggests that using child life services helps to contain medical costs by reducing hospital length of stay for children and decreasing the need for pain medicine. Lastly, the healthy coping skills developed during such an experience can be built upon for a lifetime.Reference:1. Child Life Services. American Academy of Pediatrics Policy Statement. Child Life Council Committee on Hospital Care, 20062. Child Life Council, Inc. www.childlife.org
By- Dr. Jonathan woodWhat does that mean? â€œExercise is medicineâ€â€¦?We think of medicine as something that:â€¢ You take to makes you feel better when you are ill (e.g. pharmaceuticals, etc)â€¢ You get when pills donâ€™t work to cures illness (e.g. surgery, angioplasty, etc)â€¢ You get to prevent or detect illness or disease (e.g. immunizations, mammograms, etc)What if there was something that was repeatedly shown to do all three? Wouldnâ€™t we call it â€œmedicineâ€?Improving our fitness has been repeatedly shown to do all three! So – – exercise is medicine. This concept is the focus of a recent initiative by the American College of Sports Medicine appropriately called â€œExercise is Medicineâ€. Their goal is to raise awareness of the facts and emphasize the proven benefits of improved fitness on overall health and specifically on the treatment and prevention of chronic diseases. The World Health Organizationâ€™s most recent Global Health Risks data (2004) rates physical inactivity at the 4th leading cause of death globally behind high blood pressure, tobacco use, and high blood glucose. Many feel we are in the midst of an â€œinactivity epidemicâ€, but few in the USA are truly aware of this.Some facts that you might not know:â€¢ Older adolescents and adults spend almost 8 hours/day in sedentary behaviorsâ€¢ 36% of adults engage in no leisure-time activity at allâ€¢ Low levels of fitness pose a bigger risk of death than mild-to-moderate obesityâ€¢ Active people in their 80â€™s have a lower risk of death than inactive people in their 60â€™sâ€¢ Low levels of physical activity expose patients to greater risk of dying than smoking, obesity, hypertension, or high cholesterolâ€¢ Regular physical activity has been shown in several studies to reduce the risk of many chronic diseases by alarming amounts:o Colon cancer â€“ over 60% reductiono Stroke â€“ 27% reductiono Heart disease and high blood pressure â€“ almost 40% reductiono Type II diabetes â€“ 58% reductiono Alzheimerâ€™s disease â€“ almost 40% reductiono and there is much moreâ€¦Additionally, regular physical activity in adolescents has been shown to lead to higher SAT scores and for younger children, it results in improved classroom behavior and less discipline issues in elementary schools.So, again, not only is exercise medicine, it seems to be better than what most of us traditionally think of as â€œmedicine.â€ Use the medicine! It may not always be easy, but it sure seems to be worth it!For more info and some specific suggestions, please visit the Exercise is MedicineÂ® website: http://exerciseismedicine.org
TV5 Health Expert Dr. Erik Steele joined Carolyn Callahan on TV5 News at 5 to discuss when its time to hang up the keys.
When Do You Cross the Line? By- Dr. David PrescottOver half of the adults in America report using alcohol during the past year. Of those, over 14 million people abuse alcohol at any given point in time. One of the most common questions faced by people whose alcohol and drug use is becoming a concern, is when has a person crossed the line from recreational use to problematic drinking? The line between problematic and non-problematic alcohol use is different for each individual, but some common criteria for problem drinking include: Â· Repeated Binge Drinking EpisodesÂ· Driving While Under the Influence of Alcohol or DrugsÂ· Drinking negatively impacts work, health, or important relationships.Binge Drinking: Binge drinking is defined as heavy drinking within a limited period of time: 5 or more drinks for males, 4 or more drinks for females. Obviously, drinking this much puts a person over the legal limit of blood alcohol content for intoxication. Some people who binge drink quickly become dependent on alcohol. In fact, genetics research suggests that certain people are predisposed to develop dependence very quickly. Alcohol dependence involves developing tolerance, where a person needs more and more alcohol to produce the same effect. Tolerance is a sign that drinking is likely a problem. How young do people start Binge Drinking? One of the most startling statistics about binge drinking concerns the early ages at which binge drinking first occurs. One in ten sixth graders report at least one episode of binge drinking. One in three high school seniors have consumed 4 or more drinks at one time in the past month. These statistics highlight that problem drinking begins well before the legal age to purchase alcohol. Early alcohol use is associated with a far greater risk of developing alcohol addiction later in life. Driving After Drinking: In spite of the public education efforts about the dangers of driving after using alcohol, the statistics on this issue are startling. Almost 1 in 7 adults (13.2%) acknowledge having driven after using alcohol. Maine rates are slightly below the national average, but still above 10%. Driving after using alcohol, particularly if this occurs repeatedly, is obviously a sign of problem drinking. Drinking’s Impact on Work, Health, or Relationships: A third way to address the question of whether alcohol use has crossed the line to become a significant problem, is to think about whether alcohol use has had any impact on work (or school), physical health, or important relationships. Without determining whether or not the impact is large or small, it is helpful to objectively determine whether a person’s alcohol use has ever impacted work (such as missing work due to effects of alcohol use), health (such as injury or contribution to chronic health problems) or relationships. Getting Help for Alcohol Problems: People for whom alcohol has become a significant problem often downplay the role of alcohol in their life. Denial is often viewed as a defining characteristic of alcohol addiction. So, if you try to point out to someone that they have an alcohol problem it is likely that they will disagree with you. Nevertheless, overcoming an alcohol addiction is usually very difficult to manage without help. Some simple tips for getting help include: Â· Talk with a mental health professional. A psychologist, social worker, or licensed professional counselor can help look at whether or not alcohol use is a problem in your life, and can help you understand better the factors that contribute to alcohol abuse. Â· Talk with a doctor or primary care physician. For some people, talking to your family doctor is more comfortable than seeking help from a counselor. Most primary care doctors have basic training in evaluating alcohol related problems, and can help you decide if you need further help. Recent research suggests that brief screening and intervention from primary care providers (SBIRT) is highly effective in addressing alcohol abuse. Â· Alcohol Addiction may be masking other problems. People who abuse alcohol may be trying to cope with an underlying psychiatric problem like depression or an anxiety disorder. Or, getting drunk may be a short term way to cope with family problems or a troubled relationship. Usually however, using alcohol makes it more difficult to sort out the original problem. Want More Information? Acadia Hospital: www.acadiahospital.org American Psychological Association Help Center: www.apahelpcenter.org Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/recovery/Maine Office of Substance Abuse: http://www.maine.gov/dhhs/osa/
By- Dr. Joan Marie PellegriniGiven Chris Ewingâ€™s weather forecast tonight, it may be a bit hard to fathom needing sun screen anytime soon. However, we are all hoping for a great, sunny summer. Since summer is only a few weeks away, this would be a good time to review some facts about sunscreen.First, letâ€™s review what SPF means. SPF stands for Sun Protection Factor and it is calculated in a rather complex way. There are two types of UV rays: UVA and UVB. SPF refers to protection from UVB. UVA is the type of ray that causes aging of the skin and sunscreen does not protect us well against this type of UV ray. UVB is the type that causes burning and is the type that is absorbed by most sunscreens. Also, there is no linear relationship to the SPF number and how much UV rays are blocked. SPF 15 blocks 93% of the rays and SPF 30 blocks 97% (these numbers are from a WebMD article that I have listed below). Guidelines recommend and SPF of 15 or higher. As you can see from the numbers above, buying a higher SPF screen does not necessarily give you much more protection. More chemical must be added to the screens to obtain the higher SPF and there are some experts who feel that the amount of chemicals in the â€œvery highâ€ SPF screens (over 30) may actually lead to more skin cancers (a very controversial topic). These types of sunscreen protect us because they absorb the UV light. Other sunscreens protect against both types of UV because they provide a physical barrier to block UV rays and usually contain zinc or titanium. They are also heavier and more obvious on the skin (think of the white paste that skiers use on there nose and lips). The WebMD article and the EPA article referenced at the end of this article list which ingredients protect against which type of UV ray.Next, letâ€™s review how the screen is supposed to be applied. Sun screen should be applied to all skin because most summer-weight clothes do not fully protect the skin against the damaging effects of UV radiation. Also, sunscreens that absorb light need to be applied at least 30 minutes before sun exposure because they must be given time to be absorbed into the skin. If you are using one of the sunscreens that provide a physical barrier (they contain zinc or titanium) then you can apply it just before going outside. You will need more than â€œjust a dabâ€ of any of the sunscreens. Sunscreen needs to be applied liberally and often. Therefore, buy a sunscreen that you will not mind using and one that will be easy to apply. The â€œbestâ€ sunscreen doesnâ€™t do you any good if it never gets used.What about vitamin D deficiency? There is some concern that the widespread use of sunscreen may be leading to our widespread vitamin D deficiency however this is quite controversial. I think it is safe to say that the vast majority of national guidelines and experts recommend using sunscreen in an effort to reduce skin cancer rates. If you and your doctor are concerned about your vitamin D level, then it is a pretty simple and safe measure to change your diet to increase your vitamin D intake or to add a vitamin D supplement.Some miscellaneous facts about sunscreen: If you find a sunscreen in your cabinet and you cannot remember when you bought it, it probably is best to throw it away and buy new sunscreen. The active ingredients in the sunscreen may become inactive after 2-3 years. â€œWater resistantâ€ in a sunscreen means that it will last longer in wet conditions. However, it too needs to be reapplied throughout the day (every 2-3 hours). Sunscreens that contain antioxidants offer advantages for skin healing after injury from the harmful effects of the sun.So, to answer the question of which sunscreen is best: buy the sunscreen that is at least SPF 15 and donâ€™t worry about buying the highest SPF you can find. Make sure you get a sunscreen that is easy to apply. If you have a problem with acne, there are sunscreens made specifically for the face that are not so comedogenic (tending to clog the pores). Wear other protective clothing such as hats and sunglasses and remember that sunscreen does not protect against all of the sunâ€™s damaging UV rays. Donâ€™t forget to reapply. These two articles are excellent resources:http://www.webmd.com/skin-beauty/features/whats-best-sunscreenhttp://www.epa.gov/sunwise/doc/sunscreen.pdfThis article addresses the concern of vitamin D levels when sunscreen is used frequently:http://ods.od.nih.gov/factsheets/vitamind/
Improved technology! Increased usage! Is there any concern for long-term radiation effects?By- Dr. Jonathan WoodCT scan usage has increased dramatically in the last 20 years. CT scans are a great diagnostic tool, but what is the risk associated with increased usage? Is there a significant increased risk of cancer in people receiving all these CT scans? Experts are working on the answer to this difficult question and the answer is not as conclusive as we would hope.Medical diagnosis has benefitted greatly in recent years from marked improvements in CT scan technology and the subsequent increased availability of scans. â€œHelical CT scanningâ€ and â€œmultidetectorâ€ scanners have resulted in improved image resolution and a dramatic decrease in the time needed to obtain these images.These changes are cited as the main reason for the impressive increases in CT utilization. In the past 10 years alone, CT use has increased 700%. An estimated 62 million CT scans are done annually in the US today, compared with 3 million done in 1980. And why the focus on CT scans rather than other radiology tests? The answer: CT scans involve much more radiation than simple x-rays or other radiology tests. The numbers illustrate this – – although CT scans account for only 15% of the exams involving ionizing radiation, they collectively account for approximately 70% of the total radiation delivered!An example – – one abdominal CT scan involves a radiation dose equivalent to 250 chest x-rays!Children account for 10-15% of CT scans in the US and the annual number continues to increase. This is important because children are likely more susceptible to the harmful effects of ionizing radiation. The main issues:1. Growing children have more rapidly dividing cells, exactly the cells most affected by radiation. Some estimate that a radiation dose administered to a child has a 10-fold increase in the cancer-causing potential as the same dose given an adult.2. Children have a longer lifetime over which radiation-related cancers could evolve.3. Depending on the location of the scan, CT scanning is not always tailored to the size of the patient, as it should be.So is there a true risk? The answer is a qualified â€œyesâ€.The baseline risk of cancer in the US population is already about 20%. A single abdominal CT in a child is thought to increase that risk over a lifetime by 0.1% to 0.3%. Given that 30% of people who have one CT have additional ones later, this may be a conservative overall risk. The data is difficult to interpret, given all the other factors that contribute to the risk of cancer, but it nonetheless seems quite clear that minimizing the number of CT scans is a good idea. Importantly, any reduction in CT use has to be balanced against the fantastic diagnostic value offered by CT scan technology used in the right situation. The immediate risk of not getting the information is often much higher than the long-term risk of developing a cancer.So what can we do?â€¢ As patients and parents, we need to ask questions and make sure that there arenâ€™t other ways to get the same information. We need to realize that â€œjust checkingâ€ involves real risk and we shouldnâ€™t ask for CT scans that are not going to help with the problem at hand. Many CT scans are ordered because people ask for them!â€¢ As physicians, we need to order these tests judiciously and work with our institutions to perform them in the safest possible manner in children. We also need to continually ask if there are other tests that can offer the same information with less risk – – tests like ultrasound, which donâ€™t involve ionizing radiation. Online Resources:An FDA handout for consumers: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048578.htm An NCI/NIH webpage for docs: http://www.cancer.gov/cancertopics/causes/radiation/radiation-risks-pediatric-CTâ€œImage Gentlyâ€ – a program sponsored by the Society for Pediatric Radiology: http://www.imagegently.orgCNN article on increased CT usage: http://thechart.blogs.cnn.com/2011/04/05/kids-ct-scans-increase-fivefold/
By- Dr. Amy MoviusHuman Lyme disease was first described in Connecticut in 1975: In 1987 it hit Maine incidence has been rising ever since. Middle-aged persons and school-age children are most often infected. Lyme disease is caused by bacteria that usually infect animals, but can also infect people. Lyme disease spreads from animals to humans when a tick bites an infected animal, â€œpicks upâ€ the infection, and then delivers or â€œcarriesâ€ the bacteria to a person it later bites. The most common symptom of Lyme disease is an expanding red rash around the bite site. It can occur from days to a month after the bite and is usually not painful. May is the beginning of Lyme disease season and officially Lyme Disease Awareness Month. It is an excellent time to prepare how NOT to become infected with Lyme disease (and other tick borne infections too!) over the coming months. The absolute surest way to prevent Lyme disease is to have no risk of tick exposure. Since this is impossible for many people, preventing and promptly recognizing tick bites is a more practical approach. The Maine CDC recommends following the simple â€œNo Ticks 4 ME” rules:1. Wear protective clothing2. Use insect repellent3. Perform daily tick checks4. Use caution in tick habitatsClothing is our first line of defense. Wearing long sleeves and long pants in outdoor areas where ticks may be present is a good start. If the clothing is light colored, it will be easier to see ticks as well. Pants can be tucked into socks and even taped to prevent ticks from climbing up the inside of pant legs. After clothes are worn outdoors, washing in hot water and drying on high heat should eliminate any ticks you may have missed.Insect repellents containing DEET or picaridin should be applied to the skin. Clothes can also be treated with permethrin, available at outdoors/camping stores, to repel ticks from attaching to them. Treating pets with tick repellents is also very important as they can give a Lyme carrying tick a free ride into your living room.At the end of every day you have been outdoors, take a shower as soon as possible. You should do a tick â€œbody checkâ€ looking for any critters who may have attached themselves despite your efforts. Ticks have to be attached for 24-48 hours before the bacteria can be transmitted to a person, so prompt removal is very protective. If you find a tick, you should carefully remove it by gently pulling it straight out with tweezers. Wash the area well and use a topical antiseptic afterwards. Use of petroleum jelly, nail polish and other home treatments are NOT recommended. Be on the lookout for any suspicious symptoms for the next month. Again removing ticks from pets promptly is also very important. Tick habitats include wooded or bushy areas and locations with high grass or lots of leaf litter. Extra care and vigilance in these environments is warranted.If a tick bite occurs, routine antibiotic use is NOT recommended: rather careful watching of the bite location isâ€¦ for a month! Any rash that occurs at the site should be seen by a health provider, even if you otherwise feel fine, at which time antibiotics can be administered. Many people who receive no treatment for such a rash (because they felt fine) will develop further symptoms, sometimes months later, especially arthritis of large joints. A small number of infected people can develop even more serious symptoms and a few may develop a chronic condition, despite antibiotic treatment.References: www.maine.gov.cdcwww.cdc.govThe Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases 2006: 43: (1 November)
Does Your Surgeonâ€™s Lack of Sleep Affect Your Surgical Risk?By- Dr. Joan Marie PellegriniSince we are all just a bit sleep deprived because of the time change, I thought it would be appropriate to cover the topic of sleep deprivation for this segment. I have covered this topic before but not as it concern the surgeon and the patient. It is not news nor is it controversial that all of us function better after a full night of sleep. We know that truck drivers and pilots are not allowed to drive/fly after working a determined number of hours and that there is a mandated amount of sleep time between shifts of work. Most of us are also aware of the work hour limits that have been placed on residents in medical training. However, there are no policies regulating how much sleep your surgeon must have before performing your electively scheduled surgery. This is a truly controversial topic because so many people have such strong feeling about it. Unfortunately, although there are strong feelings, there is little data to demonstrate how prevalent or how dangerous is this problem.There is at least one study (JAMA 2009) that demonstrates an increased complication rate when the general surgeon has had less than six hours of sleep. A recent editorial in the New England Journal of Medicine also raises this issue. This editorial addressed the specific issue of elective general surgery cases and how much should the surgeon disclose to the patient about their sleep habits the previous night. Patients and surgeons have several reasons why they may not want their surgery cancelled. Patients have mentally prepared for undergoing a procedure, arranged for time off work, arranged for childcare, etc. The surgeonâ€™s schedule also may not be very accommodating to rescheduling. And, the hospitalâ€™s OR schedule may not have any vacancies in the near future.In concert with the above scheduling issues is the fact that most of us are excellent at denying that sleep deprivation is so dangerous. Many of us, me included, have driven on the highway sleep deprived because we only had a few more miles to go. We say to ourselves: â€œI can do this. Iâ€™m not really going to fall asleep and crash.â€ When we are a patient, we expect our surgeon to be â€œtoughâ€. We believe that surgeons go through such grueling training in order to be able to handle the schedule. We often have no concern about the ability of our surgeon to function on little sleep.What type of elective surgery you are having also has an impact. If it is a minor procedure or one with little risk, then there are little data showing any compromise in care from a sleep deprived surgeon. This is because much larger studies are required to demonstrate a difference in outcomes when there is low risk of complication. My personal opinion is that patients receive excellent care for low risk procedures even when their surgeon is sleep deprived.If you are undergoing a lengthy or risky procedure then you may consider requesting your elective procedure be scheduled on a date that is not a â€œpost-callâ€ day. The day after a surgeon has been on call the night before is commonly referred to as the â€œpost-callâ€ day. Depending on what kind of practice your surgeon is in, their nights of call and covering the Emergency room may or may not be busy. None the less, if you have a choice, it is probably better to avoid a â€œpost-callâ€ day. Fortunately, it is becoming more common for busy surgeons not to schedule elective procedures on post call days. Second, it is permissible to ask your surgeon before your procedure how many hours of sleep they had the night before. This question should be no more controversial than asking your surgeon at your consultation appointment how many procedures they have performed or what their complication rate is. I will admit that it is a rare patient of mine that asks me any of these questions. Iâ€™m not sure if it because they are afraid to know the answer or they are unaware of the risk of surgeonsâ€™ sleep deprivation.It is my hope in the near future that patients and surgeons will become more aware of this issue. The solution will not be simple. Clearly, we cannot mandate a limit to the hours worked by surgeons. There is already a national shortage of general surgeons. Such a mandate would put patients at significant risk and perhaps would limit access to emergency surgical care. Also, surgeons have fluctuating needs for sleep depending on the influence of other stressors is in their life and what point they are in their career.It is my hope the healthcare industry will work toward awareness and solutions before the government becomes involved with mandates. Educated patients who ask intelligent questions of their doctor help ensure better care for themselves and other patients.References:NEJM 2010: 363:2577-2579.JAMA 2009: 302:1565-1572.General Surgery News February 2011.
Mainers with antlophobia are especially fearful this time of year. Antlophobia is a fear of floods.TV 5 Health Advisor Dr. David Prescott spoke with Jim Morris on TV5 News at 5 about phobias and what can be done about them.————–By: Dr. PrescottPhobias – Some are Rare, Some are Common: Phobias are intense, excessive fears about certain objects or situations. The number of people who suffer from phobias is surprisingly high. Phobias affect around 10 million Americans. Only depression and alcoholism rank higher than phobias in terms of common mental health problemsThere have been names given to dozens of different types of phobias. Some examples include: Triskadekaphobia Fear of the number 13Phalacrophobia Fear of becoming baldAntlophobia Fear of floodsChionophobia Fear of snowThe phobias listed above are relatively uncommon, and they rarely cause serious disruption on people’s lives. However, in some cases, people’s anxiety about a certain object or situation can become debilitating. People with severe cases of phobias such as social phobia or agoraphobia often go to great lengths to avoid such things as social interactions or crowds. Common Phobias Which Are The Focus of Mental health Treatment: Some common phobias that may require professional treatment include: Agoraphobia Fear of being in a place or situation where escape is difficult Social Phobia Fear of embarrassment or how one will act in a social situation. Health Related Phobias Fear of germs or sickness: or fear of healthcare proceduresEnvironmental Phobias Fear of heights, water, or fireSocial Phobia or Social Anxiety DisorderSocial Phobia, or social anxiety disorder, affects about 15 million American adults, and is one of the most common phobias. People with social phobia become overwhelmingly anxious and excessively self-conscious in everyday social situations. They usually experience an intense fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. In addition to subjective worry, they often experience physical symptoms of anxiety in social situations such as blushing, trembling, nausea, and difficulty talking. Treatment for Phobias is Highly EffectiveSadly, many people with phobias which negatively impact everyday life never get help for their problem. If left untreated, phobias and other anxiety disorders can become increasingly debilitating, since people’s first response is often to avoid an anxiety producing situation. Without treatment this avoidance can become more and more widespread and lead people to become increasingly isolated. Treatment for phobias may involve changing the way you think about anxiety producing situations, changing how you behave in these situations, or taking medication to alter your brain/body’s response to an anxiety producing situation. Effective treatments include: Â· Behavior Therapies: Behavioral therapies involve learning a relaxation response, then introducing the person to the phobic object while they are in a very relaxed state. Doing this very gradually allows the person to gradually overcome their fears. New technologies, such as virtual reality helmets, are proving to be highly useful as an alternative to actual exposure to a feared situation. Â· Cognitive Therapies: Another form of treatment focuses on changing how we think about something we fear. For example, people with social phobia often believe they will say something silly or embarrassing during a conversation. Helping these people change this belief, by perhaps having them practice a brief casual conversation, can help reduce the fear. Â· Medications: Medications such as anti-anxiety medications or a class of medication called SSRI’s, are often effective forms of treatment for anxiety and phobia. For More Information: Acadia Hospital www.acadiahospital.com American Psychological Association Help Center: www.apa.org/helpcenter
Are you at high risk for diabetes?A simple quiz can answer that question.TV5 Health Advisor Dr. Erik Steele spoke to Jim Morris on how to help.
By- Dr. Amy MoviusRespiratory illness season (including influenza) is in full swing AND thereâ€™s a nasty stomach flu â€œgoing aroundâ€.Â I spent most of last night at the hospital attending to such patients while sincerely hoping not to acquire or spread these infections further.Â This involves a lot of hand washing and sanitizing.Â What hand washing, as a subject, lacks in sensationalism it makes up for in usefulness. Whether talking about the common cold or more serious infections, it is often the single most important thing you can do to keep from getting sick.Â Take a moment to think about everything youâ€™ve touched in the past hour, much less the past day.Â Infection causing germs can be transferred to your hands by everything you touch, which can then be transferred into your body by touching your eyes, nose, or mouth.Â Likewise, if you are carrying an infection â€“ knowingly or not â€“ it can be spread to other people in the same manner.Â As a whole, we are not as diligent at hand washing as we think we are.Â Take after using the bathroom, for instance.Â One study found that although 91% adults surveyed reported always washing their hands after using public bathrooms only 83% – or 4 out of 5 – were directly observed to do so.Â In a study of middle and high school students only 58% of girls and 48% of boys cleaned their hands after using the school bathroom.Â Â People admit to hand washing even less at home after using their own bathrooms despite the fact they are still bathrooms.Â Only 32% people surveyed reported washing their hands after covering a sneeze or cough.Â Â Below is a reminder list for when you should wash your hands.Â 1.Â Â Â Â Â After using the bathroom (or changing a diaper).2.Â Â Â Â Â After blowing your nose or coughing.3.Â Â Â Â Â Before touching food (eating, serving, preparing).4.Â Â Â Â Â After touching animals (including pets).5.Â Â Â Â Â After outdoor activities.6.Â Â Â Â Â Before and after visiting anyone whoâ€™s sick: think about using an alcohol sanitizer here as well.7.Â Â Â Â Â Any other time your hands are dirty.Â Below is the proper hand washing technique. Â 1.Â Â Â Â Â Use soap (any type is fine) and warm water.2.Â Â Â Â Â Be thorough â€“ wash hands, fingers, nails, wrists â€“ front and back.3.Â Â Â Â Â Wash at least 15 seconds (one round of â€œHappy Birthdayâ€).4.Â Â Â Â Â After rinsing well, pat dry with a clean towel.5.Â Â Â Â Â Use paper towels to turn faucets and door handles in public bathrooms.Â Frequent hand washing can cause skin to become chapped or dry.Â If you have this problem you still need to wash diligently but pick a mild soap and generously moisturize after each washing.Â If there isnâ€™t a place to wash, waterless hand soaps or scrubs are a good alternative to keep nearby. Please follow these guidelines to protect yourself and those around you.Â Â When needed, gently remind others to do so as well.Â Reference: www.kidshealth.org
Corrections regarding statements about high fructose corn syrup (HFCS): The controversy and common sense.By- Dr. Joan Marie PellegriniLast month I discussed HFCS in this segment. I have been doing this segment since 2000 and have never received any mail commenting on my segment. However, this segment generated two well-written letters from experts in Massachusetts and New Jersey. They wanted to point out a few wrong statements that I made and also wanted to point out that HFCS is safe and no different than any other sugar. It also seems there was some confusion that I may have implied that HFCS is there reason we are having such an obesity epidemic. I agree with the experts on most points. I stated that HFCS is sweeter than table sugar and this is wrong. I also stated that that HFCS has only been around since the 1990â€™s and this is also wrong. It became much more popular then but it has been around since the 1960â€™s.It is quite interesting to me how much controversy this segment generated. I was unaware of the controversy surrounding HFCS until friends of mine pointed out to me there are TV commercials that try to convince the consumer that HFCS is the same as any other sugar. A quick search of the medical literature with the term â€œfructoseâ€ reveals that there is some scientific excitement regarding this molecule. One of the main problems with studying nutrition is that there is little funding available. Pharmaceutical companies only pay for research that will generate a new drug and therefore have a potential for profit. The NIH and USDA have limited funds for nutrition research (probably less than 5% of that spent on cancer and heart disease. I have no study to quote here except a quick Google search.). Much of the â€œnutritionâ€ research that is being funded is looking at supplements and vitamins, not at true nutrition. Another problem with many of the studies is that the study participants are given an unrealistic diet and therefore the conclusions are not translatable to the real world.There are plenty of studies to show that HFCS is no different than any other sugar. However, there are also several studies showing the opposite. Why did the study that I mentioned come to the conclusion that HFCS is worse for you? One of the main problems with that study is that the participants were fed an unrealistic diet of pure fructose. This is quite different than HFCS. Because of the differences in study design, percentage and form of fructose, etc, it is quite difficult to make any certain conclusions from the available literature.Here are some points that are not controversial:1) Americans consume too much simple carbohydrates (sugars).2) Sugared drinks are a major problem .3) Many foods that you buy in the grocery store have sugar, honey, HFCS, or other sugars hidden in them.4) Fructose is absorbed and metabolized differently than glucose.5) A quick look at food labels will reveal the ubiquity of hidden sugars.6) The obesity epidemic is very complex. There is no one issue to blame and there is no one simple solution.When I chose to cover HFCS, I chose this topic as one of several that Iâ€™ve done over the years focusing on various aspects of our diet and goals towards healthy living. Although I made some minor incorrect statements, I stand by my original conclusions: HFCS is controversial and it may or may not be different than other sugars. However, limiting sugars and HFCS is just one small part of the overall program of healthy living. By no means should HFCS shoulder all the blame for Americaâ€™s obesity epidemic.
Early Recognition of Mental Health ProblemsBy- Dr. David PrescottEarly Recognition a Key to Effective Mental Health Treatment: In mental health treatment, as with all of health care, early recognition and treatment is increasingly seen as critical to reducing the suffering associated with psychiatric disorders. The logic is simple enough. The earlier you detect a problem and do something to fix it, the less that problem will impact your life. But, while that logic makes sense to most of us, knowing exactly what to look for may be a little more difficult. When Do You Cross the Line to Needing Professional Attention? Obviously, this is a difficult question and the answer varies from person to person. Two questions that I like to ask in helping someone decide include: 1. Is this bothering you to the point where you want more support or would like it to have less of an influence on your life? 2. Has this problem started to interfere with your life and the things you used to be able to do? That is, are you now unable to accomplish things that you used to accomplish because of the problem? Here are some early warning signs of common mental health and addiction problems. As with any health problem, if you are in doubt, talk to a psychologist, mental health professional, or your family doctor. Early Signs of Depression: Most people know that depression involves recurrent sadness, hopelessness, and lack of energy. It is common to have these feelings for a couple of days every now and then. Signs that the depression may be more serious include: â€¢ 2 consecutive weeks of feeling sad or hopeless. â€¢ In teenagers and some adults, rather than feeling depressed, feeling mostly irritable or short tempered. â€¢ Missing school, work, or significant family events because you feel too sad or donâ€™t have the motivation that you used to have. Early Signs of Schizophrenia or Psychotic Illnesses: The onset of schizophrenia, a mental disorder characterized by disorganization in thinking, excessive suspiciousness or paranoia, or in some cases hallucinations, is typically in the late teens or early twenties. However, warning signs are often present long before the formal onset. These include: â€¢ Withdrawal from friends or family â€¢ Difficulty concentrating, confusion, jumbled thinking â€¢ Suspiciousness, fearfulness or mistrust of others â€¢ Changes in the way things look or sound, seeing or hearing things that aren’t there â€¢ Odd thinking or behavior: feeling odd, like something is wrongEarly Signs of Anxiety Disorders: Anxiety disorders include panic disorder, social phobia, and obsessive-compulsive disorders. The hallmark of each of these problems is debilitating anxiety that leads to avoidance of people and activities. Early signs of anxiety disorders include: â€¢ Repeated episodes of panic (feel like you canâ€™t breathe, like you may be about to die, short of breath). Single episodes of panic are somewhat common and may not indicate a disorder. â€¢ Avoiding important activities (school, work) or situations (going to the store) because of anxiety or fear of an anxiety attack. â€¢ Losing more and more time to activities designed to reduce or cope with anxiety (spending time alone, engaging in checking things or doing things over that you have already done). Early Signs of Drug or Alcohol Dependence: Often, drug or alcohol dependence start off as recreational drinking or drug use. Early signs of drug and alcohol abuse or dependence include: â€¢ Frequent episodes of binge drinking (4 or more drinks for women, 5 or more for men)â€¢ Missing school or work due to drug or alcohol use or feeling hungover. â€¢ Spend increasing amounts of time using substances or with people that drink/use drugs with you. How do I seek help? Seeing a qualified mental health professional, like a psychologist, psychiatrist, psychiatric nurse, or licensed social worker is a good start. Help may include counseling, medication, or a combination of the two. If you donâ€™t know a mental health professional, your primary care doctor is often able to make a recommendation. For More Help: Acadia Hospital www.acadiahospital.orgIn Maine Dial 2-1-1 for agencies that provide counseling.
By- Dr. Amy MoviusWe are on the threshold of a major winter storm, one accompanied by frigid temperatures. Many people (hopefully most) will be hunkering down and riding the storm out at home. Essential workers and others will have to venture out. Everyone needs to be prepared to stay safe from hypothermia and frostbite. It is recommended that people stay off the roads if possible during a major winter storm. However, it is still important to be prepared for the possibility of power loss at home. The following lists necessities for such an event:1. Have a back up heat source such as a wood stove or generator.2. Emergency supplies to have on hand include extra blankets, flashlight, matches, first aid kit, manual can opener, show shovel and rock salt.3. Drinking water, nonperishable food, and medication to last a few days are essential.4. Dress in several layers and wrap in blankets to conserve heat.5. If you are worried your environment isnâ€™t warm enough, go elsewhere (friends, neighbors, shelter) until your home is safe again.People who must venture out in their cars need to be especially careful. Anyone involved in a car accident or breakdown can be very susceptible to hypothermia/frostbite. If you must drive, first and foremost, go slowly and let someone know where you are going and what route you are taking. In addition, follow the guidelines below.1. Be sure your vehicle is in good working condition for storm driving. 2. Have emergency gear with you at all times. This includes a cell phone, flashlight, jumper cables, sand or kitty litter (for tire traction if needed), ice scraper, small shovel, blankets, warning devices such as flares.3. Extra warm clothing and hand warmers in your emergency supplies may also be useful.4. If you are taking a longer trip bring some drinking water, food, and any medication as well.5. IF YOU GET STUCK ON THE ROAD, place a flare in front and in back of your vehicle. While awaiting rescue, stay inside with a window slightly open for air circulation. Also, wrap yourself in blankets and run the heater for a few minutes each hour.Hypothermia occurs when the body temperature is abnormally low. It can happen to anyone though some people are more susceptible to it than others. The poor, elderly, those with substance abuse problems, and children are groups particularly at risk. Hypothermia can happen suddenly or more gradually, and is affected by how cold it is, how long a person is exposed to the cold, and each personâ€™s general health. Hypothermia can kill. The first sign is often some confusion or sleepiness which might not be obvious. Slow/slurred speech can follow as well as excessive shivering or NO shivering at all. Hypothermic people will have slow and clumsy body movements. If you think someone is hypothermic, seek medical attention immediately. If this isnâ€™t possible, move them to a warmer location, wrap them in blankets or lie close to them. Do not rub someone with frostbite or hypothermia – this will cause more damage.