By- Joan Marie Pellegrini Irritable bowel syndrome (otherwise commonly known as “IBS”) is a condition of the colon. We do not know what causes it and therefore it is very difficult to know how to cure it. The current most common medical theory is that IBS is a disorder of the nerves that control the function of the colon. IBS causes abdominal pain, bloating, gassiness, diarrhea, and/or constipation. The symptoms can be so severe that it limits one’s activity and ability to work. A doctor may diagnose IBS by the classic set of symptoms and by ruling out other common disorders. The doctor may order tests to rule out a malabsorption disorder such as lactose intolerance or celiac disease. Sometimes a colonoscopy is indicated in order to evaluate for inflammatory bowel disease. Once a patient is given a diagnosis of IBS, there is a four-pronged approach to treatment. The four prongs are: dietary modification, stress reduction, exercise, and (lastly) medications. Dietary modification: A person with IBS should keep a food journal in order to determine which foods cause the most symptoms. Common foods to avoid are milk products and foods high in fat. Also, it is important to add fiber. There are many types of fiber on the market and most of them will cause less gas and bloating than the fiber found in foods. Many people find that the soluble fibers cause the least amount of symptoms. I usually recommend to my patients that they use a combination of soluble (inulin) and insoluble (psyllium) fibers along with increasing the fiber-rich foods in their diet. If someone has diarrhea, then it is usually recommended to avoid or limit caffeine intake. On the other hand, caffeine can benefit the person with constipation. Stress reduction: Just about everyone with IBS notices that their symptoms are worse with stress. In fact just about every disease is worse with stress. There are many components to stress reduction with include psychological evaluation, counseling, breathing exercises, biofeedback, acupuncture, yoga, prayer, etc. Exercise: The colon is fairly responsive to exercise. Many people notice that their constipation is much improved with aerobic exercise. It is not quite understood how exercise benefits the bowel but it is a well known fact that it does. Exercise can also be a source of stress reduction. Medications: This is generally considered the last resort. There are medications that treat the symptoms such as laxatives for constipation, anti-diarrheals or anti-spasmodics for diarrhea, simethicone for the gas, and pain medication for the pain. In general, narcotics are least effective for bowel-related pain. Anti-depressants also may be effective. Finally, there are two drugs on the market for IBS (Lotrenex and Amitiza). These drugs have fairly serious side-effect profiles. If you or a loved one have been given a diagnosis of IBS, the goal is to manage the symptoms and not allow the disease to control your life. There is no cure but there is promise in the future as more reseach is done on bowel motility disorders. Just about every patient who embarks on a well-rounded treatment program will experience significant relief. However, most of the options listed above will need to become part of a person’s lifestyle in the long run. The following is one of my favorite sites for information on IBS:http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106
By- Dr. Jonathan WoodDoes a daily â€œdoseâ€ lower your risk of heart disease and stroke?Why do the Kuna, indigenous peoples from islands off the Panamanian coast, have virtually no hypertension (high blood pressure) and no increase in blood pressure with age? And why do these findings disappear with migration to urban centers like Panama City? This phenomenon has been described in similar isolated populations and usually, when investigated, is connected to a lower salt intake in the native environment. But the native Kuna have higher salt intake than their urban counterparts. So why the extraordinary differences in cardiovascular disease? The answer: cocoa! The Kuna drink an estimated (likely underestimated) 5 cups of a native cocoa drink each day. It is their primary drink and it contains large amounts of flavanols, a naturally occurring antioxidant and blood vessel relaxer. When this â€œKuna phenomenonâ€ was first described less than 10 years ago, a flurry of studies of chocolate and cocoa followed. Could this be the new â€œred wineâ€, something yummy that actually was good for your heart health? Unfortunately, to get the same amount of flavanol contained in the 5+ cups of Kuna cocoa drink, one would have to eat and estimated 4.5 lbs of dark chocolate or 15 lbs of milk chocolate! These amounts are obviously not practical nor advisable to suggest. So studies have been done looking at smaller amounts and trying to account for the other less healthy things (fat, sugar, etc) in commercial chocolate But it has been difficult. And the amounts still have seemed too large to promote without more solid data.But now, once again, chocolate is in the news – – and itâ€™s good news! A German study due to be published tomorrow in the European Heart Journal looked at detailed diet (including chocolate), blood pressure, several known cardiovascular risk factors, and some other demographics in a group of nearly 20,000 men and woman, age 35-65. This group was then followed over 8 years. 300 of them suffered heart attacks or strokes during that time. When controlled for all the other factors, it seems that the lower chocolate diet in these 300 people may be responsible: i.e. the more chocolate eaten, the lower risk of stroke or heart attack. Of note, the effect was more pronounced for strokes than heart attacks.The particularly interesting aspect of this study was the amount of chocolate that seemed to be needed to confer â€œprotectionâ€. The difference between the â€œlowâ€ chocolate group (more strokes) and the â€œhighâ€ chocolate group (fewer strokes) was 6 grams/day. And how much is 6 grams? Not muchâ€¦â€¢ 1Â½ Hersheyâ€™s Kisses = 6 gramsâ€¢ 2 little â€œrectanglesâ€ from a standard Hershey bar = 6 grams (i.e. 1 bar should last 6 days!)â€¢ 11 Nestle semi-sweet morsels = 6 gramsAnd should you choose milk or dark? Clearly, dark chocolate has more flavanols than milk chocolate, so if you like it, dark chocolate is a better choice.So should we all rush out and start a daily dose of chocolate? Probably not – – this study was a retrospective observational design and needs to be repeated in a prospective way. But is a little bit of chocolate okay or perhaps even healthy? Likely, yes. And it seems a very little bit (6 grams) may go a long wayâ€¦if you can control yourself and not eat the whole bar! Remember, our chocolate bars (unlike the Kunasâ€™ drink) have much more in them than just cocoaâ€¦ A good rule of thumb: everything in moderation!
By- Dr. David PrescottMore and more, health care providers are paying attention to the relationship between medical disorders and mental health problems. One the one hand, having a medical event like a heart attack or stroke leads to a greater chance of experiencing a mental health problem. On the other hand, high levels of psychological stress, depression, or anxiety, put you at higher risk for certain medical conditions. No matter which angle you take in looking at the mind/body connection, it is important to take steps to maintain good psychological health.Is there really much overlap between mental health and physical health? Absolutely yes! Several statistics and facts illustrate this point. â€¢ It is estimated that over two-thirds of primary care office visits are due to stress related symptoms. â€¢ 10-14% of people hospitalized for any medical condition have major depression. â€¢ The diagnosis of depression is estimated to be missed in up to 50% of visits to primary care doctors. â€¢ For certain medical conditions, like chronic obstructive pulmonary disease, about 25% of patients have diagnosable panic disorder. â€¢ High levels of hostility have been found to predict heart disease more often than high cholesterol, cigarette smoking, or obesity â€¢ Men high in optimism were less than half as likely to develop heart disease than were the more pessimistic men What are some of the medical conditions most associated with mental health problems?Cardiac Illness and Heart Attacks â€“ Both major depression and anxiety disorders, like panic attacks, are very common following a diagnosis of coronary heart disease or having a heart attack. It is estimated that one in six people who have a heart attack develop panic disorder, and over Â½ (up to 65%) of people develop major depression. Untreated major depression is even correlated with an increase risk of death within 6 months of a heart attack. Cancer â€“ About one in four people diagnosed with cancer develop major depression. Symptoms of depression may be difficult to diagnose during cancer treatment, since poor appetite, weight loss, and loss of energy are characteristic of both depression and treatment for cancer. Diabetes – Rates of depression in diabetes are very similar to cancer (about 25%). Not only is treating depression important in and of itself, but untreated depression may make compliance with treatment for diabetes more difficult. Obesity â€“ The relationship between obesity and depression is complex. In one study, women with obesity had a 37% higher rate of depression than women without obesity. However, it is not clear yet whether depression may cause obesity in some people, or whether obesity may cause depression. It seems likely that both are true! In any case, simultaneously treating both depression and obesity is the best hope for conquering these conditions. Why is it important to treat both medical illnesses and mental health disorders? While clinical anxiety and depression are more frequent in people with significant medical conditions, it does not mean that you are simply supposed to get used to the problem. Getting counseling or medication for anxiety and depression not only helps you feel better, but allows you to focus more energy on recovering from things like heart attacks or cancer. What can I do to make sure that both conditions are treated? Probably the most important step is to tell your doctor or your psychologist/counselor about your concerns with both your emotional and physical health. Donâ€™t think that the fact that you are feeling extremely sad or worried is something you should just keep to yourself, or is something that just happens after a major medical event. Ask your doctor, or a mental health professional, whether what you are feeling is normal, and if there is anything you should do to address the problem. For More Information: Mental Health America: http://www.nmha.org/go/information/get-info/depression/co-occurring-disorders-and-depressionAmerican Psychological Association: http://www.apa.org/helpcenter/mind-body
By- Dr. Amy MoviusSt. Patrick’s Day is Wednesday, March 17th – a lighthearted holiday of green clothes, shamrocks, and (for some) alcohol indulgence. If drinking is a planned part of tomorrow’s celebration, be prepared to distinguish the truths about alcohol consumption from the many leprechaun myths.Alcohol is a Stimulant Nope, it’s a depressant. The initial effects may cause euphoria, and thus seem energizing, but actually, it depresses the brain.It’s Better to Drink With a Full StomachTrue! Though you will still absorb the alcohol you drink, you will do so more slowly with a full stomach and so not feel the effects as rapidly.You can Learn to “Hold Your Liquor”False. Drinking alcohol is not like going to the gym where you can train you body to do more. If the same amount of alcohol doesn’t affect you like it used to, you are developing a tolerance, which is a sign of addiction. It means you need help!Hard Liquor Gets You Drunk FasterNope again. Alcohol is alcohol and you body doesn’t know or care if it was beer, wine or vodka: it’s all processed the same way. What defines “a drink” differs between the three: 12 oz beer, 5 oz wine, and 1 oz of 100 proof hard liquor (1 1/4 oz of 80 proof) are all equal to Â½ oz of pure ethanol alcohol. The person who only drinks glasses of white wine will have the same breathalyzer result as the one who drank the same number of “shots”.Women Get Drunk EasierTrue. Men and women of the same size absorb and metabolize alcohol somewhat differently. This is related to the different proportions of fat to lean muscle between genders as well as a difference in the amount of alcohol dehydrogenase present, the enzyme that breaks alcohol down.Coffee Can Sober You UpCoffee is a stimulant, which may make you feel more alert, but that is not the same as sober. BAC, or blood alcohol concentration (what a breathalyzer measures) decreases at a set, slow rate as the liver breaks the alcohol down. The BAC decreases at about .015 percent/hr. Coffee will NOT affect this. Neither will a cold shower, exercise or anything else. Time alone will sober you up.Drinking Some Alcohol Can Treat a HangoverNo way. The term hangover is derived from the Norwegian word “Veisalgia” meaning “uneasiness following debauchery”. The unpleasant symptoms include headache, nausea, and fatigue (to name a few) and are largely attributed to the dehydrating effects of alcohol consumption. In addition to the “hair of the dog” myth above, MANY products are touted as hangover remedies. They include medications, vitamins, supplements, and foods (bacon, egg and cheese sandwich for one). These products, and even “hangover kits”, can be easily purchased on-line, or at your local drug store. A 2008 article in the British Medical Journal attempted to study the effectiveness of many of these “remedies”. The found the only thing that cured hangovers was time. A better plan may be to prevent the hangover to begin with, by limiting alcohol drinking to moderation.The Younger Children Drink Alcohol The More Likely They Will Have A Drinking ProblemTrue. If you indulge in alcohol during this (or any other) occasion, don’t allow kids to participate. It’s simply not appropriate.If Someone Passes Out From Drinking You Should Let Them Sleep It Off Remember that alcohol is a depressant. It can impair and breathing, blood pressure, heart rate and can be fatal. If someone passes out you would be better taking them to medical attention, not leaving them in alone in a room. References:1. www.uwstout.edu/aod/resources/alcohol/myths_facts.html2. www2.potsdam.edu/hansondj/AlcoholFactsandFiction.html3. BMJ2008:337:a2769
By- Dr. Thomas RajanMarch 7-13 marks National Sleep Awareness Week, and it is a great opportunity to take the time to highlight the importance of getting a good night’s sleep.According to the National Sleep Foundation 74% of American adults experience sleeping problems a few nights a week or more, 39% get less than seven hours of sleep each weeknight, and 37% are so sleepy during the day that it interferes with daily activities.One of the reasons some people may not be getting a good night’s sleep is because of sleep apnea. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. According to the National Institutes of Health, sleep apnea affects more than twelve million Americans. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. Please talk to your primary care provider for more information on how you can get a better night’s sleep.
By- Dr. Jonathan WoodParasomnias are “repetitive unusual behaviors or strange experiences that occur in relation to sleep.” These include common occurrences like nightmares, night terrors, sleepwalking, teeth grinding, and bedwetting, but also the more unusual REM sleep behavior disorders and epileptic nighttime wandering. These can be confusing and sometimes quite dramatic. Fortunately, the most common parasomnias are generally the least worrisome. Sleepwalking is one of these common, but benign parasomnias.Who sleepwalks?Sleepwalking or “somnambulism” is common and most occurs predominantly in childhood. Up to 15% of children age 5-12 will sleepwalk at some point. Generally, the episodes become less common in adolescence, with the majority resolving before adulthood. That said, up to 10% sleepwalkers start in adolescence and 2-3% of adults will occasionally sleepwalk. What is the pattern?Sleepwalking occurs in deep non-REM sleep, a stage that occurs in the first third of the night. Eyes are often open and sleepwalkers will appear awake, albeit clumsy and generally purposeless in their movements. If they talk, their speech will often be slow, as will their responses to stimulation. Sleepwalkers generally have no memory of their escapades. These excursions are generally short and harmless, but occasionally have involved more complex and potentially dangerous behaviors like cooking or leaving the house.What predisposes to sleepwalking?Sleepwalking runs in families and there may be genetic factors. There also may be predisposing factors for sleepwalking, especially in teens and adults. These include use of alcohol or sedatives, emotional stress, anxiety, sleep deprivation, obstructive sleep apnea, infection, fever, and occasionally environmental stimuli. Contrary to older teachings, it is now known that there is no association between childhood sleepwalking and psychiatric disorders.What should be done?Be assured of the benign nature of sleepwalking. Be reassured that your child is not ill or disordered. Make the environment as safe as possible by removing obstructions in bedrooms, locking or alarming doors to the outside, etc. Generally, since sleepwalking occurs early in the sleep, parents are often awake when their children sleepwalk and can therefore help them back to bed. If sleepwalking occurs predictably and frequently, awakening your child 20-30 minutes prior to the expected event every night for a several months may extinguish the behavior. This should be discussed with your doctor. Medications are not recommended for sleepwalking. They are sometimes suggested, but the evidence for this is poor and generally comes with more risk than benefit.What should not be done?Don’t try to awaken the sleepwalker! It is rarely successful and can result in the child becoming confused, agitated, or even violent. Waking the child is difficult, counterproductive and unnecessary. The best approach is to let the episode subside and then direct the sleepwalker gently back to bed and to sleep. There is no point in telling children about their sleepwalking episodes: in some children this can cause unnecessary anxiety.What about sleepwalking adults?Sleepwalking in adults, as mentioned, is much less common. If onset is in adulthood, sleepwalking also has a higher incidence of being associated with an underlying neurologic disorder. A physician should be consulted about adult-onset sleepwalking to assure its benign nature. Sleepwalking that occurs later in the night may not be true non-REM somnambulism, but rather a “REM sleep behavior disorder”. This is more of an “acting out of dreams” disorder and is due the patient not having the usual semi-paralysis of muscles that normally accompanies REM sleep and dreaming. This can be dangerous to the patient and his/her sleep partner and needs to be investigated. It is particularly important to not try to arouse an adult from this type of disorder that occurs later in the night’s sleep.Conclusions?Sleepwalking in children and adolescents can be frightening, but does not mean your child is ill or disordered. They will virtually always “grow out of it.” Avoid medications and complex work-ups for this benign condition. Be calm, establish regular sleep routines, make the environment safe, and gently guide your child back to sleep.
By- Dr. Joan Marie PellegriniMost of us know that if we need surgery, we need to choose a qualified surgeon. We then assume that the surgeon and their hospital will do everything they can to prevent any post-operative complications. Unfortunately, the medical community has known for decades that surgical quality is heterogeneous across the country and sometimes even within a state or city. It is not news that some hospitals have lower complication rates than others. There has been quite a bit of research into what these high performing hospitals are doing that may be leading to better results. Fortunately for the consumer, there are now several national quality partnerships aimed at improving processes within the operating room and recovery room to actively reduce post-operative complications.These quality measures are attempting to “hard wire” certain processes. “Hard wiring” means that something will happen based on protocol rather than on individuals having to remember to ask for it to happen. Many industries have proven that protocols lead to better results compared to letting individual practitioners deciding what to do. Getting a patient ready for surgery and then recovering the patient is a very complex process and it is quite easy to forget seemingly unimportant details. We have good surgical results in this country but the goal of these quality initiatives is to have excellent results and to decrease our complications from surgery by at least 25%. Most of these initiatives started several years ago and there has been excellent progress.The quality measures differ somewhat depending on the type of surgery. However, it is now mandatory to do a “time out” prior to making an incision to make sure that everything that needs to be done has been done. Some of the things this” time out” verifies is that the team agrees they have the right patient and the correct procedure according to the consent form, the right antibiotic has been given if indicated and at the right time, that certain medications have been given if indicated, and that the necessary equipment is available and functional. Other measures that are addressed are the patient’s temperature and glucose level. Special warming devices are used to prevent hypothermia during surgery. Also, if the patient’s blood glucose level is elevated, they will be given insulin even if they are not diabetic in order to prevent certain post-operative complications. Extra oxygen is given to all patients after some types of surgery because it has been shown to reduce wound infections. These above measures are why some patients wake up in the recovery room with oxygen and insulin drips even though they do not have lung disease or diabetes.The good news is that there are many national quality measures that are being put into practice and are working to reduce complications as a result of surgery. Because these are national measures, you can be confidant that you will be given the same care no matter which hospital you go to as long as that hospital is participating in these programs. In the future, there will be even more quality programs nationally in an attempt to standardize care across the nation.If you would like more information you may search for SCIP (Surgical Care Improvement Project) or ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program).
By- Dr. Amy MoviusWintertime in Maine means playing in the snow, and after our very respectable storm this holiday, many Mainers and visitors did just that. Snowmobiling is a popular way to enjoy the snow in our state, though it is not an activity to be engaged in lightly as recent tragedies remind us. Snowmobiles are large, heavy, powerful machines. 35% of accidents involving snowmobiles that result in injury or death occur in people less than 25 yrs of age: 25% in 15-24 year-olds and 10% in children less than 15yrs. Males outnumber females three to one and head injuries are the leading cause of injury or death, usually from hitting a fixed object such as a tree. Children less than 16yrs are also frequently injured from falling off snowmobiles or having them roll over onto them. Children less than 8 yrs of age who are injured or killed are usually passengers or being towed behind snowmobiles. In persons over 16yrs, drowning from falling through ice becomes a prominent cause of death as well. Factors contributing to accidents include operator error, speeding, use on inappropriate terrain, snowmobiling at night, and alcohol use. Other risks to be considered when snowmobiling include frostbite, hypothermia, hearing loss, and white finger syndrome.If you choose snowmobiling as an activity for you and your family, please do so responsibly, and with the consideration of the following guidelines.1. Don’t let anyone less than 16yrs operate a snowmobile. Though this is not a legal requirement, the American Academy of Pediatrics urges you to think of operating a snowmobile as you would driving a car, requiring the same degree of strength, skill and maturity.1 Completion of an instruction and safety course is desirable. 2. Children less than 6 years should not ride as passengers on snowmobiles because of inadequate strength and stamina.3. A “graduate license” approach is recommended for new operators. Specifically new operator use should initially be limited to daylight hours and on groomed trails. Use of a speed limiting governor to limit maximum speed possible is also recommended for new operators.24. Never use alcohol or drugs before/during snowmobiling.5. Protective clothing should be used including goggles, waterproof snowmobiling suit, gloves, rubber-bottomed boots and an approved helmet.36. Carry emergency supplies including a first aid kit, survival kit that includes flares, and a cellular phone.7. Don’t snowmobile alone.8. Avoid ice is there is any uncertainty about its condition.9. Carry a maximum of 1 passenger.10. Use headlights and taillights at all times. 11. Never tow or pull someone behind a snowmobile (ex = in saucer, tube, sled, skis) for amusement.References1. Snowmobiling Hazards. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Pediatrics Vol. 106 No. 5 November 2000. Statement of Reaffirmation 20072. Maine Snowmobile Laws 2008-09 Footnotes1. Maine state law allows children 10yrs and older to operate snowmobiles without adult supervision and children 14yrs and older to cross public ways on snowmobiles.2. The effect of graduated licensing for teenage snowmobilers has not been determined. However, graduated licensing for teenage drivers has reduced the number of motor vehicle-related deaths in teenagers.3. Maine law currently requires persons under 18yrs to wear protective headgear on snowmobiles being used on public trails funded by the Department of Conservation, Bureau of Public Lands. This applies to both operators and passengers.
By- Dr. Joan Marie PellegriniThis is one of the times of year when many of you will be planning a road trip. Unfortunately, this is also a time of year of treacherous driving. Before you begin your trip, please take a moment to assess a few safety issues:ï® Is your car in good condition? Are the tires bald? Bald tires make driving in inclement weather much more dangerous. The economy is hurting most people and one of the things that many people chose to forego is car maintenance. Tires are expensive. However, failure to negotiate the weather and having an accident is even more expensive and can be very dangerous.ï® Do you have safety flares in case of an accident? You should also make sure your hazard lights work. This also happens to be the darkest time of year. If you are stopped on the side of the road, you want to ensure your visibility to other motorists.ï® Do you have warm clothes (hat, mittens, boots, coat) for each passenger. Many people donâ€™t bother with this detail because they will pre-warm their vehicle and donâ€™t plan on walking outside. However, there are many reasons why you may get caught walking. This is particularily important if your are driving in a snow storm.ï® Please remember that black ice is unpredictable and that bridges will ice over even when the road seems clear.ï® Please allow extra space between yourself and the car in front of you so that you may more safety come to a stop.
By- Dr. David RydellGastroesophageal reflux disease or acid reflux occurs when the lower esophageal sphincter or valve is faulty. This allows the food and fluid in the stomach which is very acidic to flow backwards into the esophagus. This can result in a burning sensation in the chest (heartburn) or a sour taste in the mouth. It can also cause a dry cough, asthma like symptoms or difficulty swallowing. These symptoms can be brought on in patients with a faulty valve by smoking, alcohol, overeating and laying down shortly after a meal. The lower esophageal valve is aided in closing by the higher pressure inside the belly cavity. In the case of a hiatal hernia (where part of the stomach has slipped through the diaphragm into the chest) this assistance is no longer present.Treatment begins by evaluating and eliminating the many food and lifestyle triggers. Symptoms are often brought on by eating citrus fruits, chocolate, caffeinated beverages (coffee, tea & soft drinks), alcohol, fatty & fried foods, mint flavoring, garlic, onions, tomatoes and spicy-foods. Lifestyle triggers include obesity and pregnancy due to the increase in pressure within the belly cavity and smoking.Medications come in three basic types:Acid neutralizers such as Tums, Maalox, Rolaids, Mylanta and Alka-Seltzer that contain hydroxide or bicarbonate ions to neutralize the acid that is inside the stomach.Acid preventers such as short acting Tagamet, Zantac and Pepcid or longer acting Prilosec, Prevacid, Nexium, Aciphex or Protonix work to block the production of acid by the cells of the stomach wall.The irritation of the esophagus is thus reduced, the patient is still refluxing they just have fewer symptoms.The third type of medication is a group that works to tighten the valve and promote the emptying of the stomach in the proper direction, out into the small intestine. These include Urecholine and Reglan.As with most medications there are a variety of potential side effects both mild and severe and these medications are only effective when we remember to take them at their regularly scheduled times.When lifestyle changes and medications are not controlling symptoms adequately there are surgical and endoscopic ways of correcting the faulty lower esophageal valve. The Nissen fundoplication or wrapping of the upper part of the stomach around the esophagus to recreate the valve was first performed in 1955. Since that time the procedure has been performed using both an open and laparoscopic technique. The long term results are very good with about 90% of patients not needing regular anti-acid medication 10 years after surgery. The major drawback is that it is an invasive operative procedure with the associated risks and complications.Two years ago a new endoscopic procedure was approved by the FDA. This procedure does not involve an incision, but rather with the patient asleep under a general anesthetic using the endoscope the valve can be recreated in patients with acid reflux and a hiatal hernia less than one inch. A permanent stitching material is used to create a one inch long 270 degree valve that has resulted in nearly 80% of patients being completely off all medications 2 years later. For more information visit www.endogastricsolutions.com/esophyx_for-pt.htm
By- Dr. Amy MoviusNoise induced hearing loss, or NIHL, is (unsurprisingly) hearing loss that occurs from being exposed to overly loud noise. It is often the insidious result of exposure to excess noise over time. Unfortunately, this type of hearing loss is permanent. NIHL can occur from exposure to high sound levels in the environment – such as traffic, or noise inherent in certain occupations. Likewise, NIHL from loud music has become a major concern for our teenagers and young adults due to the popularity of personal listening devices such as ipods.A more surprising source of noise pollution is loud toys. The groups most vulnerable to injury from noisy toys are infants and toddlers, for whom many of these toys are targeted. These children will often hold these toys close to their faces or even against their ears. While developmentally appropriate, this behavior increases the sound level, and therefore the chance of hearing injury. There is little in the way of oversight for the production of these toys. In 2003 the Toy Industry Association set a voluntary sound limit on toys of < 90 decibels at 10 inches away from the ear. For perspective, this is roughly equivalent to the sound of a lawn mower. This limit is also voluntary, NOT required, and there is no obligation for toy manufacturers to list the sound level on toy packaging either. Clearly, it falls to the surrounding adults to police the exposure of these children to excessively noisy toys. There are some easy ways to judge whether an audio toy's noise level is safe, and perhaps modify it if needed.Listen to the toy holding it 12 inches or less from your own head. If it is loud enough to make you flinch, it's too loud.For a more exact assessment, sound level meters can be purchased at electronic stores (around $40). Hold the meter up to the speaker portion of a toy - if it registers > 85 decibels, the toy is too loud.Noisy toys sometimes have volume controls and/or on-off switches. Keep them turned down, or even off.If a noisy toy doesn’t have any control switches, cover the speaker with packing tape to muffle the sound (for older children) or get out your screwdriver and remove the batteries altogetherFor many households with small children, Christmas and toys go hand in hand. This year, ask friends and family to let you screen the toys they want to buy your kids. Also, remember to protect your children’s hearing with ear plugs or ear mufflers when attending any loud events to celebrate this holiday season, as the noise levels at concerts, sporting events, and the like are often above safe limits. Lastly, if you think a toy is too loud, report it to the Consumer Product Safety Commission at cpsc.gov/incident.html.
By- Dr. Jonathan WoodThis Thursday, Nov 19th, 2009, is the 34th Annual Great American Smokeout. Join the American Cancer Society – – use this day to encourage smokers to quit smoking or to outline a long-term plan for quitting. Remember, less smoking = more birthdays!smokers who quit at age 35 gain an average of eight years of life expectancy smokers who quit at age 55 gain about five years even long term smokers who quit at 65 gain three years people who stop smoking before age 50 can cut their risk of dying in the next 15 years in half compared with those who continue to smoke.Other important facts to consider when making your plan to quit smoking:87% of lung cancer deaths can be attributed to tobacco. Quitting reduces the risk of lung cancer – – 10 years after quitting, lung cancer risk is cut nearly in half compared to the risk for people who have continued smoking during that time. 30% of all cancer deaths can be attributed to tobacco. Tobacco use remains the single largest preventable cause of disease and premature death in the US. Tobacco is responsible for nearly 1 in 5 deaths!Are you around children? o Each year, an estimated 150,000 to 300,000 lung infections in children under 18 months old are attributable to secondhand smokeo Secondhand smoke significantly increases the number and severity of asthma attacks in children, affected 200,000 to 1 million children each yearWhy quit now?Perhaps you think that if you have been smoking all your life, quitting canâ€™t really help youâ€¦ Not true!!! What can a lifelong smoker expect in terms of health advantages? 20 minutes after quitting: Your heart rate and blood pressure drop. 12 hours after quitting: The carbon monoxide level in your blood drops to normal. 2 weeks to 3 months after quitting: Your circulation improves and your lung function increases. 1 to 9 months after quitting: Coughing and shortness of breath decrease: cilia (tiny hair-like structures that move mucus out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce the risk of infection. 1 year after quitting: The excess risk of coronary heart disease is half that of a smoker’s. 5 years after quitting: Your stroke risk is reduced to that of a non-smoker.10 years after quitting: The lung cancer death rate is about half that of a person who is still smoking. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases. 15 years after quitting: The risk of coronary heart disease is that of a non-smoker’s.And how significant is the problem in Maine?14% of high school students and 18% of adults in Maine smoke.An estimated 79,000 children are exposed to secondhand smoke in Maine2,200 adults in Maine die each year due to diseases attributable to their own smoking.An estimated 27,000 children currently under 18 in Maine will ultimately die prematurely from smoking.Read more about Maine tobacco statistics at:http://tobaccofreekids.org/reports/settlements/toll.php?StateID=MEMore questions?So is there a safe way to smoke? Are menthol cigarettes safer? What exactly is it in cigarette smoke that is harmful? Is smoking really addictive? What does cigarette smoke do to the lungs? How does smoking affect pregnant woman and their babies? Answers to these and other questions can be found at:http://www.cancer.org/docroot/PED/content/PED_10_2x_Questions_About_Smoking_Tobacco_and_Health.aspSo how can you quit? No one said it is easy, but there are increasing numbers of resources available for smokers committed to becoming non-smokers. Go for it!A good place to start is the â€œBreathe Easy, New Englandâ€ website – – check it out and find out how to get help:http://community.acsevents.org/site/PageServer?pagename=C_NE_GASO_homepageThursday, November 19, 2009American Cancer Societyâ€™s â€œGreat American Smokeoutâ€ www.cancer.org/GreatAmericans
By- Dr. Joan Marie PellegriniFirst, I should declare a conflict of interest since I am an avid coffee drinker. None the less, Iâ€™ve had patients and friends tell me that they are going to try to cut down how much caffeine they consume. When I ask why they are concerned, I hear about the fear of heart disease, cancer, and breast disease. It turns out that these are not valid concerns.Caffeine acts on certain receptors in the brain and body to increase metabolism and alertness. Everyone knows that it helps keep us awake. Most of the time, caffeine is consumed precisely for that â€œside-effectâ€. The International Olympic Committee also knows that it is a performance enhancer and hence they test athletes for how much caffeine is in their bodies. A certain amount is acceptable.A typical cup of coffee contains approximately 100 mg of caffeine. Some brands are more potent. For instance, a Starbuckâ€™sÂ® â€œshortâ€ coffee contains 180 mg. A moderate amount of caffeine consumption is considered to be 2-4 cups of coffee a day (200-300 mg caffeine). Anything intake above 500 mg is considered to be a potential for adverse consequences. Too much caffeine can cause tremors, anxiety, insomnia, stomach upset, palpitations, high blood pressure, and a head ache. Each person has their own sensitivity to the effects of caffeine. Fortunately, there is no good evidence to link caffeine intake with any type of cancer or heart disease. It is now also known to be a myth that caffeine causes breast disease. Caffeine has only very rare interactions with any medications. Therefore, caffeine is an incredibly safe â€œdrugâ€. This is great news because it also is the most widely consumed drug in the world.Now that we can relax about the safety of caffeine, we need to ask ourselves why we consume caffeine and why we consume as much as we do. If you consume minimal or only moderate doses of caffeine, you do not need to worry. However, if you are one of many people who consume large doses of caffeine on a daily basis, you really should examine your habits. Do you get enough sleep? If not, what can you do to improve this area of your health? Do you have problems with inattention during the day? If so, why? Are you having problems with tremors, palpitations, high blood pressure, stomach upset, or diarrhea? Are you taking one of the few drugs that can interact with caffeine? Depending on the answers to the above questions: could you consider switching to a non-caffeinated drink? If you would like to look up the amount of caffeine in a drink, there is a very comprehensive website listing almost every drink available. This website is www.energyfiend.com.
By- Dr. David PrescottThroughout the course of history, people have coped with a variety of illnesses and diseases that have been severe and widespread. Along with the physical impact of such illnesses, each widespread disease or epidemic has brought various levels of social anxiety, stress, and in extreme cases near panic. While our society today is nowhere near this level of public anxiety, it is important to keep a balanced psychological approach to this issue. High levels of public attention and media coverage are necessary to help prevent the spread of influenza. However, these frequent messages can inadvertently raise our anxiety and lead to high levels of stress or feeling somewhat helpless. The following tips will help you deal more effectively with the psychological stress associated with flu season. Stay Connected: Following tips for minimizing the spread of influenza involves being careful about interpersonal contact. However, we should not let good health practices disrupt our normal social networks, which are important in maintaining a sense of “normal.” In the worst case, social isolation of people who have flu-like symptoms can add to stress levels and make coping with being sick more difficult. Try to offer support to people with the flu, and look for ways to stay connected that minimize the chance of spreading an illness (phones, computers). Deal with Facts: In times of high stress there is a human tendency to take rumors at face value, make false assumptions, or follow trains of logic that are not based in fact. Facts can be a little boring when compared to rumor, but facts are very helpful in reducing unwanted stress. Find a credible source, like www.flu.gov to stay updated. And, don’t forget to actually do the things recommended by health experts. Sometimes, rumors or false assumptions lead us to put off making good health choices. Pursue Many Roads to Better Health: Much attention has been given to the availability of flu vaccine. However, if you are not yet able to get the vaccine, try not to let that translate into, “There is nothing I can do!” Remember that there are lots of ways to work on staying healthy. Proper sleep, diet, and exercise help your body fight off illness and stress. Good hand hygiene, like washing thoroughly with soap and water, is something over which you have total control. And, be sensible about close physical contact with people who are ill. Have a Plan: One of the biggest ways that the anxiety cycles spins out of control, is to repeatedly go through the “worry” process without ever developing a plan to address the worry. Your plan doesn’t need to be complicated. But, it may help to write out or talk through what you will do if influenza is identified in your school or where you work. And, if someone in your family contracts influenza, just have a simple plan of what you will do until they are well. Communicate with Your Children: Children, particularly younger children, are very vulnerable to the stress around them. Most children will observe adult behavior and emotions for cues on how to manage their own emotions. That is, your children watch you to figure out how they should react. It is usually best to discuss flu prevention efforts honestly and simply, using information that is appropriate for your child’s age. Maintaining familiar routines, as much as possible, when a family member is sick is also helpful in reducing anxiety and stress in children. When has Stress Become a Problem that Needs Professional Help? Defining the line between normal anxiety and anxiety which requires professional help is, of course, largely up to an individual. Some guiding points may be if anxiety or worry begins to significantly interfere with your job, school, or family, then you may need to talk with a psychologist or counselor. Feeling hopeless or highly discouraged for 2 consecutive weeks or more is often a symptom of clinical depression, and should prompt a visit to your primary care doctor or a mental health professional. For More Information: Acadia Hospital Web Site: www.acadiahospital.orgAmerican Psychological Association Help Center: www.apahelpcenter.orgU.S. Department of Health and Human Services: www.flu.gov
By- Dr. Erik SteeleIf you think you have the flu, this year we want you to think a little differently before you go to see your doctor or the emergency department. We would like to have you think about â€¦ not coming? That’s right – consider not coming in. There are a few reasons to consider that approach:1. Most health care workers have not yet been vaccinated against H1N1 influenza (the so-called swine flu) and if all of them get the flu from patients coming in with the flu, we will not have enough health care workers – doctors, nurses, respiratory therapists, etc – to take care of the sickest patients:2. If you are not at high risk for complications, you are not likely to be treated with anything from a doctor except advice, reassurance, and perhaps a prescription that can be called in over the phone:3. You could infect other people sitting in the office or emergency department waiting rooms. The tough part of making this decision is that some patients can get sick enough with influenza – the regular type and the H1N1 influenza – that they really do need to be seen by their primary care provider or the emergency department. How do you know if you, or a loved one, is so sick they should be seen right away, and not stay at home? Well, here are a few guidelines:1. Are you severely ill – too sick to get up and about for food, bathroom, etc.?2. Do you have real trouble with shortness of breath, severe lightheadedness when you are standing, or a severe headache associated with your illness?3. Is the sick person so ill they are less alert that normal, not as responsive as they should be?4. Is the patient too sick to take usual medications?5. If the patient is a child, do they just look ‘lousy’ to you?6. Do they have a significant rash in association with their illness?7. Do they have other health conditions that put them at higher risk of complications from influenza? These include being pregnant, having underlying heart disease (such as congestive heart failure) or lung disease (such as asthma or COPD / emphysema)? If they have any of these problems, call the patient’s physician about the illness and talk to them about being seen, or go to the emergency department if the patient seems too sick to wait.There is also a little questionnaire you can go to on the Web that will help you make this decision. It is available at XXXXXXXXX. You can complete the brief survey, and it might be able to help you with your decision. Don’t bother with the survey if the patient is too sick to wait around. And as always, you don’t have to make this decision alone – if you are uncertain, or worried about the patient (including if you are the patient), call your primary care provider and ask for some help making your decision.
By- Dr. Joan Marie PellegriniIt is that time of year again when we need to talk about hunter safety. Admittedly, accidents from hunting are way down compared with a few decades ago. However, the recent events in the news serves to remind us that this enjoyable activity has some dangers that can mostly be avoided.The Maine Department of Inland Fisheries and Wildlife has a webpage (www.state.me.us/ifw/) that is an excellent source of information on the current laws governing hunting. Below, I have included the ten rules for safety. One of the most important points to make is that many feel the law in 1973 mandating hunter orange clothing and the first hunter safety courses in 1986 (Portland Press Herald Dec 4, 2008) are responsible for the dramatic decrease in hunting accidents. A hunter safety course is not just for the young and new-to-hunting. Although it is not mandated by law, everyone can benefit from a refresher once in awhile. It is easy to become complacent after many years of hunting and being around guns. Hunter safety courses are not just about how to use a gun. There is also good information on the laws, navigation, survival, etc. To find out more about these courses go to the IFW webpage.Source: Maine Department of Inland Fisheries and Wildlife10 COMMANDMENTS OF HUNTER SAFETYGive every gun the respect due a loaded gun.Watch that muzzle and control its direction, even if you happen to fall.Be sure your target is the game your hunting, and identify beyond it before you pull the trigger.Be sure the barrel and action are clear of obstructions and that the ammunition is the proper size.Unload guns when not in use. Carry guns in cases to the shooting area.Never point a gun at anything you do not want to shoot, and never play.Never climb a fence or a tree or jump a ditch with a loaded gun. Never shoot a bullet at a flat, hard surface or water. And use an adequate shooting range backstop.Store guns and ammunition separately, beyond the reach of children.Avoid alcoholic beverages and other mood-altering drugs before and during shooting.
By- Dr. Jonathan WoodThis year, consider using Halloween as an opportunity to discuss a number of global health and safety issues with your children. Yes, several pointed issues certainly all apply to the day itself. But this is also an opportunity to reinforce with your kids that the lessons of Halloween are worth applying to their lives every day of the year.Dental HealthCavities develop as a result of carbohydrates and the associated acids produced bathing the teeth. The total time and frequency of exposure is the key, not necessarily the amount of sugar. The acids remain in the mouth for approx 20 min after a snack or meal. This knowledge supports a number of healthy habits, Halloween-related or not:Candies or foods that bath the mouth for long periods (lollipops, dense sticky candies, etc) engender the greatest riskEating at proscribed meal and snack times, rather than â€œgrazingâ€, will result in a healthier dental environmentTiming your Halloween candy consumption to around meals will reduce the associated risk of cavitiesSuggesting that kids eat little bits at a time and spread their candy consumption out over time will paradoxically increase their cavity riskEvening and Nighttime SafetyAs your kids prepare to wander the neighborhoods this year, use the holiday to remind them about pedestrian safety. It is especially important to stress that the driver visibility is at its worst during dusk, the time when many trick-or-treaters are out and about.Help your children choose costumes that offer adequate vision and mobilityConsider reflective costumes or at least adding some stick-on reflector materialFlashlights! One hand for the candy bag, one hand for the flashlightâ€¦!Review basic road crossing safety and stress the fact that these principles apply year â€˜roundUse sidewalks whenever possible.Food AllergiesFor kids with food allergies, Halloween is a good time to review some of the principles of awareness and avoidance. Teach label reading to confirm that ingredients are acceptableUse the time to review the signs and symptoms of allergic reactions due to inadvertent exposureBe aware that â€œtrick-or-treatâ€ size candies occasionally do not contain the exact same ingredients as the full size versionGeneral Healthy Behaviors and Global Safety Issues With wood stoves fired up and with Jack-o-lanterns on porches, Halloween offers a context for reviewing fire safety. Also, consider fire safety when choosing costumes.Carving pumpkins offers a setting in which to review knife safety with small children and adolescents alike.Use Halloween to gently review stranger safety. Use the trick-or-treating experience to reinforce simple things like not getting in cars with strangers and not going into strangersâ€™ homes unaccompanied. Halloween can be used to emphasize that most people are good people with good intentions, but that this doesnâ€™t negate the value of prudence and being careful.Use Halloween to talk about peer pressure and mob mentality. For example, reinforce the difference between â€œtricksâ€ and vandalism. Especially with older kids and adolescents, Halloween can offer an environment for trouble making. Prepare your kids with the means to identify and avoid inappropriate situations. Offering â€œscriptsâ€ for extracting themselves can be very helpful. Most important, discuss simple common sense with your kids. Nothing will serve them better than that! So, arm those kids with essential Halloween equipment (safe costume, good shoes, candy receptacle, flashlight, cell phone) and some common sense. Theyâ€™ll have fun, learn some things along the way, and have plenty of year â€˜round good habits reinforced!
By- Dr. David PrescottDepression â€“ Progress But Still Undertreated: Great improvements have been made over the past two decades in terms of identifying and treating clinical depression. As with most health problems, early detection and treatment of depression offers the best chance for addressing the problem successfully. Estimates are that just over 16% of Americans will experience clinical depression in their lifetime. Sadly, many of those people never receive treatment. National Depression Screening Day: Each year since 1991, National Depression Screening Day has helped people learn more about depression and provided screening and treatment referrals for any interested person. Screening is now available on-line to make it even more widely available. Types of Depression: As you consider whether or not you ought to take the screening, it may help to review the primary types of depression that have been identified by mental health experts. These descriptions are also available at the national Mental Health Screening website ( www.mentalhealthscreening.org).Clinical depression or major depression is a serious and common disorder of mood that is pervasive, intense and attacks the mind and body at the same time. Current theories indicate that clinical depression may be associated with an imbalance of chemicals in the brain that carry communications between nerve cells that control mood and other bodily systems. Other factors may also come into play, such as negative life experiences including stress or loss, medication, other medical illnesses, and certain personality traits and genetic factors. Dysthymia is a milder form of depression that lasts two years or more. It is the second most common type of depression but because people with dysthymia may only have two or three symptoms, may be overlooked and go undiagnosed and untreated. Seasonal Affective Disorder is a type of depression that follows seasonal rhythms, with symptoms occurring in the winter months and diminishing in spring and summer. Current research indicates that the absence of sunlight triggers a biochemical reaction that may cause symptoms such as loss of energy, decreased activity, sadness, excessive eating and sleeping.Bipolar DisorderBipolar disorder, also known as manic-depression, is a type of mental illness that involves a disorder of affect or mood. The person’s mood usually swings between overly “high” or irritable to sad and hopeless, and then back again, with periods of normal mood in between.Need more Information?Acadia Hospital: www.acadiahospital.orgNational Depression Screening Day: www.mentalhealthscreening.org).Depression Screening Questions â€“ National Depression Screening DaySample Questions: Over the past two weeks, how often have you: Been feeling low in energy, slowed down?a. For none or little of the time. b. For some of the timec. For most of the timed. For all of the timeHad difficulty falling asleep or staying asleep? e. For none or little of the timef. For some of the timeg. For most of the timeh. For all of the timeIf you would like to complete a screening for depression and possible treatment recommendations, follow the link to National Depression Screening Day at:www.acadiahospital.orgAvailable on October 8, 2009
By- Dr. Amy MoviusEastern Equine Encephalitis (EEE) is a very rare, but serious, viral disease that has killed several horses in Maine this fall.Â â€œTriple Eâ€, as it is sometimes called, can be very dangerous and even deadly in humans as well. The Eastern Equine Encephalitis Virus (EEEV) was first seen in Maine in 2005 when it was found in some mosquitoes, birds, and horses.Â Then, in the fall of 2008, a man in Cumberland County died of this disease.This fall, the EEEV has killed horses in 5 different counties of Maine.Â This is significant as horses are infected the same way humans are â€“ from being bitten by an infected mosquito.Â The â€œreservoirâ€ for EEEV is actually in songbirds.Â Mosquitoes, especially those found around hardwood wetlands and costal areas, can pick up the virus from birds and then infect humans (and horses).Â It is seen most often in late summer and early fall.Â Humans and horses infected with EEEV are not themselves infectious to anyone else.Â The increase of this disease in horses means that the virus is, unfortunately, alive and well in Maine in 2009.Â Most people who become infected with EEEV will have a mild flu or no obvious illness at all.Â For some individuals, however, encephalitis develops.Â Encephalitis occurs when there is inflammation around the brain.Â Symptoms can include fever, headache, behavior changes and progress to coma and death.Â Residents of wetland areas endemic for EEEV are at risk for contracting the infection, and persons over 50 and less than 15 years of age are more prone to developing serious disease.Â Sadly, 1/3 of people who develop encephalitis will die and of those who survive, many have permanent brain damage.Â Currently, there is no effective treatment for EEE and no vaccine for humans.Â The key to staying safe is prevention!Â Â Â Â Â Â Â Â Â Â Â 1.Â Always use an insect repellent when outdoors.Â DEET, picaridin, IR3535, and oil & lemon eucalyptus products are effective and should be applied to skin and clothes.Â Clothing may also be treated with permethrin, which will stay effective through several wash cycles.Â Â Â Â Â Â Â Â Â Â Â 2.Â Cover up outdoors with long sleeves/pants.Â Use nets to cover infant carriers.Â Â Â Â Â Â Â Â Â Â Â 3.Â *Limit or reschedule outdoor group evening activities, such as school athletic events.Â Participants and spectators should use insect repellents.Â All of these activities should end at least 1 hour before sunset if the temperature is greater than 50 degrees.Â This is because mosquito bites are most frequent at dusk and dawn.Â Â Â Â Â Â Â Â Â Â Â 4.Â Clean up standing water around your yard: repair any window screens that need it.Maine is full of wetlands and mosquitoes, and this virus is expected to be a problem next year as well.Â We need to use and develop defensive strategies now to protect ourselves while we continue to enjoy our beautiful state.Reference:Â Maine Center for Disease Control and Prevention
By- Dr. Joan PellegriniAlthough anyone at any age can get a concussion, this time of year is particularly important because of the start of the sports season in the schools. A concussion happens when there is a blow to the head that causes either a loss of consciousness, a brief lapse of memory, or a feeling of dizziness or being dazed. Most of us do not consider concussions to be serious and therefore we shrug it off and encourage the athlete to get back on the field quickly. Unfortunately, a concussion is a form of brain injury and this is why it is so important to avoid concussions. People who have a concussion are at an increased risk of having seizures over the next five years. Also, multiple concussions can lead to learning disabilities and some loss of cognition. There is even a theory that multiple concussions can increase your risk of developing Alzheimerâ€™s Disease.Post-concussive syndrome is poorly understood. It is also very difficult to predict. This is a complex disorder that may cause headache and dizziness for weeks or months. There may also be mood or personality changes, diminished concentration, fatigue, nausea, balance issues, and loss of appetite. It is easy to see why this syndrome could cause serious problems with school, work, or family life.The most important thing about concussions is to prevent them. Many high risk sports require helmets. However, there are several sports with high risk that do not require helmets such as soccer and field hockey. Once you or your child suffers a concussion, it then becomes extremely important to avoid another concussion. Certainly, the brain needs time to heal. However, medical professions are uncertain how long the injury may take to heal. Currently, the recommendation is to avoid risky behavior until all symptoms have completely resolved. This may mean keeping your child out of the sport for several weeks or more. If your child had a concussion and then returns to the sport after a time of healing, it is important for the coach to look for signs of incomplete healing such as slow response times, balance issues, etc.If you suspect that your or a family member may be suffering from post-concussive syndrome, your family physician can refer you to a specialist that deals with brain injury. This physician may even refer to very specialized physicians that deal specifically with the neuropsychiatric complications of brain injury.