Please do not get up on your roof to shovel snow if you can avoid it
Two weekends ago was a snowy time and there were public service announcements urging homeowners to clear the snow off of their roofs. Every year as it gets snowier we see these ads and every year we at Eastern Maine Medical Center treat many people with fall injuries. This particular weekend we saw 20 people in the Emergency Room who fell off their roofs and 6 were admitted with serious injuries.
By- Dr. Jonathan Wood
When is someone dead? It seems simple, but clearly it is not.
This is the question circulating the country right now around the case of an unfortunate young girl in California who was declared “brain dead”, but whose family insists that she is not dead. This case is sad and unfortunate, perhaps made more tragic by the girl’s age and by the fact that her brain injury resulted from complications of a seemingly “routine” operation. Unfortunately, the situation has become even more tragic because of the confusion around understanding her death. This confusion is very important to discuss because this type of misunderstanding is more common than many people realize.
Amy Badger, was in for this months Fit Friday. She talked with Wayne about tips on eating and hydration tips for working out.
Amy Badger, was in for this months Fit Friday. She showed Wayne and Joy how to do push ups, and how to modify them to your fitness level.
By- Dr. Amy Movius
Frostbite is something everyone is Maine should know a thing or two about. With single digit temperatures expected this week, it’s a good time to review some frostbite facts. Frostbite is when body tissues literally freeze, and ice crystals form inside cells. If the skin is the only tissue frozen it is “superficial” frostbite. Deep frostbite occurs when all tissue layers are involved. Ironically, frostbite is classified by degrees, similar to burns.
By: Dr. William Sturrock
Osteoporosis is a disease that affects over 45 million Americans, and is found in 55% of the population over age 50. It is found more frequently in women however has been recently recognized as also occurring in men as well particularly over age 65. There has been good research which shows that there are many conditions predisposing to unhealthy bones which can result in osteoporotic fractures to include cigarette smoking and postmenopausal status, long-term COPD or inflammatory bowel disease, heavy alcohol consumption, decreased physical activity, seizure disorders and certain cancers particularly prostate cancer. Recently with the recognition that many men also demonstrate low testosterone levels as they age, it has been shown that a good percentage of these individuals will also have osteoporosis unless treated. There are also studies suggesting that high consumption of carbonated soft drinks and other problems associated with nutrition will increase risk for unhealthy bones.
Because prevention is much smarter than waiting for problem to develop, many experts have recommended increased calcium intake as well as vitamin D, which is essential for bone metabolism.
Experts recommend that at least 1200 mg of calcium with 600 units of vitamin D for adults under 65 and 800 units for older adults should be taken by patients at risk. There is an interesting fact of human physiology that exposure of our skin to sunlight will actually allow us to manufacture vitamin D, and some individuals have tried to increase the vitamin D levels by getting more sun. Unfortunately the American Dermatology Association does not recommend increasing our sun exposure, due to the risk of skin cancer.
Recently our ability to measure vitamin D levels and has added some additional confusion because many individuals living in northern climates can have an abnormally low levels due to the fact they are having much less sun exposure. In addition there have been a lot of suggestive connections between low vitamin D levels and conditions such as fatigue and depression. This has led some clinicians to recommend patients try to take vitamin D for these conditions as well, and there has been much increased vitamin D testing without clear guidelines for treatment. There is a well-known endocrinologist from Bangor, Clifford Rosen MD who has been working with the National Institutes of Health on the issue of what levels of vitamin D are ideal, and whether clinicians should be using it to treat conditions other than osteoporosis. I agree with his previous recommendations that at this point we should not have any false expectations that vitamin D is a primary therapy for conditions such as fatigue or depression. He also has questioned the wisdom of high-dose vitamin D treatment for patients whose levels are close to normal.
By: Dr. David Prescott, Ph.D.
Seasonal Depression Impacts Many People: People who live in areas where daylight hours in winter are extremely short are more likely to be impacted by seasonal affective disorder, or seasonal depression. According to the American Psychiatric Association, 10-20% of people in America feel more depressed with the onset of winter. A true diagnosis of seasonal affective disorder is less common, with estimates ranging from around 1% to 10% of the population during the winter, partly depending on the latitude at which you live.
By- Dr. Amy Movius
Halloween costumes aren’t just for trick-or-treaters. Whether young – or just young at heart – dressing up at Halloween is fun! Cosmetic contact lenses of different colors and designs are a costume accessary that is growing in popularity. These lenses do look pretty cool and the selection seems endless. A Google search of “Halloween contact lenses cheap” returned almost 4 million results! Besides on-line, these lenses may be found in beauty supply stores, costume or specialty stores, and even at convenience stores and flea markets. They can also be quite inexpensive. Great, right?
By: Dr. David Prescott
What is ADHD? Attention Deficit Hyperactivity Disorder, or ADHD, is one of the most common mental health problems diagnosed in children, with lower prevalence among adults. Estimates of its prevalence in children and teenagers typically range from a low of 5% to a high of 10%.
Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death in the United States. The Safe to Sleep campaign aims to change that. TV5 Health Advisor Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to talk about it.
LONG-TERM USE OF PROTON PUMP INHIBITORS
By- Dr. Joan Marie Pellegrini
PPI’s (Proton Pump Inhibitors) is a class of popular drugs used to treat GERD (Gastro esophageal Reflux Disease). Some trade names for these drugs are Nexium, Protonix, Prevacid, and Prilosec. These drugs have been on the market for decades and considered quite safe. They are used to reduce the acid in the stomach. In general, their use is indicated for 2-8 weeks to treat esophagitis, gastritis and other acid-related conditions. However, many patients are on these drugs for years and even decades. PPI’s are the 3rd most commonly prescribed medication at over 100 million prescriptions per year. There does not appear to be any problem with short term use. However, there is rising concern for long-term use.
Data has suggested that long term use can impair absorption of nutrients from the stomach. In particular, calcium and iron are better absorbed in an acidic environment. With long term absorption problems, a patient can develop anemia (low blood counts) and be at increased risk of fractures. Other problems associated with PPI use are increased flatulence, possibly an increase in the risk of some infections such as C difficile colitis and pneumonia, a decrease in effectiveness of some drugs (Plavix is one of these drugs but the data on this is confusing and controversial).
PPI’s have not been shown to reduce the risk of esophageal cancer as was once thought. The PPI helps to relieve the symptoms of reflux but does not actually cure reflux.
Many experts feel that if every patient were to adhere to guidelines to modify their diet, exercise, and manage to lose weight that up to 90% of patients on PPI’s would not actually need the medication.
Clearly there is a role for PPI’s. Since their introduction they have been considered a fantastic drug. PPI’s have dramatically reduced the rate of complications from acid-related disease such as ulcers and gastritis.
Therefore, if you have been on one of these drugs for a long time, it is my recommendation that you have a discussion with your physician about its use. Are you suffering any of the adverse side effects? Is the drug effective for you? Is there another alternative? Do you actually need a PPI? Would now be the time to start a diet and exercise regimen that may help with some of your symptoms (many overall benefits!)?
By: Dr. Anthony Ng
With the recent news of shooting and violence in the news, such as nationally of the young child shot in Chicago, and the mass shooting in Washington, DC, as well as local acts of violence within our local Maine communities, many have been wondering if there is a way that we can tell or predict who will be such likely perpetrator of violence. The hope is that we can prevent such violence from happening, short of the ongoing debate on gun control. The answer is both yes and no.
By- Dr. Joan Marie Pellegrini
Several years ago the National Cancer Institute funded a large trial looking at screening for lung cancer in high-risk patients and the results have been recently released. High risk was defined as amount and length of time of tobacco exposure (1). Patients (2) were randomized to a chest x-ray versus a low dose CT scan annually for three years. The results showed that CT scanning could lead to a 20% decrease in lung cancer deaths. This is mostly because screening patients with CT found many more early stage cancers which could be treated with a cure.
There may be more you may realize to the term “Man’s Best Friend”…By: Dr. Jonathan WoodThe benefits of pet ownership sometimes seem obvious to those of us who have them: pets are loyal, they’re non-judgmental, they reduce our stress, they sense our mood and respond appropriately, and they’re generally just wonderful to have around. But research over the past several years is starting to elucidate distinct medical benefits beyond our qualitative sense that “pets make us feel good”. Research is starting to solidify the notion that our pets actually do make us healthier. For example:A recent report out of UCLA studied 76 heart failure patients and assessed their anxiety levels before and after 3 interventions. One group received a visit from a volunteer, one group received a visit from a volunteer with a dog (with which the patient was allowed to interact), and a control group received no visit at all and remained at rest. Vital signs, stress hormone levels and anxiety questionnaires were evaluated for each patient before and after the interventions.While the blood pressures and hormone levels decreased in both interventions, the apparent positive effect of the dog on anxiety was most dramatic: a 24 percent drop in anxiety levels in the dog group versus a 10 percent drop in the volunteer-alone group and no change in the control group! This study is consistent with a number of studies of the effects of animals and pets on health and disease over the past 15-20 years. This phenomenon has even spawned a new type of therapeutic approach with specific goals and guidelines, known as “animal-assisted therapy” or “pet-facilitated therapy”. What are some of the health benefits of pet ownership or of animal-assisted therapy? Below are a few examples:· Two studies suggest strongly that pet ownership improves 1-year survival after heart attacks.· ACE inhibitors lower blood pressure quite effectively in patients with hypertension, but they have little effect on the increases that occur with mental stress. However, in patients who own pets and take ACE inhibitors, these stress-induced increases are significantly blunted.· Male pet owners have significantly lower systolic blood pressures, triglyceride levels, and cholesterol levels than non-pet owners.· Psychiatric patients with a variety of disorders have been shown to have significantly decreased levels of anxiety following animal-assisted therapy sessions when compared with controls.· Some studies suggest that medication use and cost can be significantly reduced in settings where pets are actively involved in therapy. · Several studies show that pet owners make fewer medical appointments and have fewer minor illnesses. In addition, people who acquire pets show significant improvements in measures of psychological well-being and these effects are maintained over time.· Several aspects of child health are also improved by animal and pet contact on a number of different levels:o The presence of a dog during a child’s physical exam decreases stresso The cognitive development of children appears to be enhanced by pet ownership.o Measures of children’s self-esteem is enhanced by pet ownershipo Children who own pets show more capacity to empathize than those who do not.o Children with autism who have pets seem to exhibit more pro-social behaviors than those who do not.And the list goes on and on. Although these are very difficult studies to perform and invariably there are many factors involved in health maintenance, it seems clear that there are many physiologic and psychosocial benefits of pet ownership and of animal use in therapeutic settings. Many of the effects appear to be the result of decreased stress. As the underlying neurochemical basis for stress-related illness becomes clearer, it will become easier to quantify these effects and allow us to better advocate for using our furry friends to improve health.In the meantime – – enjoy your pets as you always have and revel in the fact that you are probably healthier because of them!For more information on the health benefits of pets, visit some of these web sites:· The CDC’s website on the heath benefits of pets:http://www.cdc.gov/healthypets/health_benefits.htm· The Delta Society – a non-profit group whose mission is “improving human health through service and therapy animals”:http://www.deltasociety.org· The 1987 consensus statement from the National Institutes of Health on this subject:http://consensus.nih.gov/1987/1987HealthBenefitsPetsta003html.htm
By: Dr. Amy MoviusThis week, many schools are starting preseason training for fall sports and the weather has been hot and humid. With these conditions, it is very important to be aware of the potential for climatic heat stress, especially as some of these kids will be abruptly increasing their activity after a leisurely summer break.Heat-related illness happens when the body has increased heat production (as with exercise) and/or a decreased ability to transfer heat to the environment (think uniforms/ sports equipment). It can be fatal and treatment to decrease body temperature should begin as soon as any symptom(s) are recognized. So what are the symptoms? An early one is cramping. Heat exhaustion, which happens when the body has lost too much water and salt, can occur next. Persons with heat exhaustion sweat profusely and have cold, pale, and clammy skin. Heat stroke is the most extreme type of heat-related illness and happens because the body temperature is so high that cells are damaged. Persons with heat stroke are red and hot with dry skin, and confusion. Though heat and humidity are beyond human control, there are lots of other ways to prevent heat illness in child athletes. A summary of recommendations from the AAP (American Academy of Pediatrics) is as follows:1. Everyone in leadership positions for youth sports should emphasize awareness, education, and implementation of heat illness risk-reduction strategies to all staff that oversee/ assist with these sports.2. Capable staff and treatment facilities readily should be readily available.3. Young athletes should be educated on proper sports preparation, prehydration/hydration, honest reporting of any symptoms, and other issues such as getting enough recovery time and rest to reduce their risk of heat stress.4. Athletes should be given an opportunity to acclimatize to preseason practice and conditioning in the heat, typically over a 2 week period. There are specific guidelines for American youth football available.5. Appropriate fluids should be readily accessible to athletes and consumed at regular intervals before, during and after exercising.6. Activity should be modified based on the degree of heat. This can include lowering intensity, shortening duration, and/or increasing breaks during practice sessions. 7. Athletes should avoid or limit participation when ill or recovering from illness.8. Athletic staff needs to receive training in how to monitor athletes for signs and symptoms of heat illness. They should be directed to immediately stop sport participation and start treatment of any individual they suspect may have any of these signs or symptoms. 9. Any athlete with symptoms of heat illness should not resume activity that day.10. An emergency action plan should be clearly in place.11. There should be at least 2 hours of rest between separate events occurring on the same day.12. In extremely hot conditions, sessions should be canceled or rescheduled.For more information on heat related illnesses, please consider the references below.1. Climatic Heat Stress and Exercising Children and Adolescents. Council On Sports Medicine and Fitness and Council on School Health Pediatrics 2011: 128:e741, Luke et al.2. Heat Injury Prevention Practices in High School Football. Clin J Sport Med. 2007:17(6):488-493, Jardine. 3. Heat Illness and Heat Stroke. Pediatrics in Review 2007:28:249-2584. HealthyChildren.org – Heat Related Illness
Eastern Maine Community College is going smoke-free. Faculty, administrators and students came together to make their campus a healthier place.Starting in January, the campus will be tobacco-free.The college wants to reduce second-hand smoke damage and will offer healthy eating and living education.
By: Dr. Jonathan WoodArbovirus infections in Maine?(A mosquito-borne virus is called an “arbovirus”)This week, the Maine CDC released an alert about finding the Eastern Equine Encephalitis virus (EEE) in one of their “mosquito pools” in mid-July. This is the earliest in the season that such a virus has been isolated in Maine. West Nile Virus (WNV) and EEE are two important causes of seasonal mosquito-borne viral encephalitis in the northeast. These viruses which infect humans through mosquitos are called “arboviruses” and are worthy of our attention.In 2012, there were over 5600 proven cases of WNV in the US, about 50% of which affected the nervous system. 60% of “neuroinvasive” cases were hospitalized and 1% died. There was one case of neuroinvasive disease in Maine, which suggests that there were 30-70 non-neuroinvasive cases that were not diagnosed.EEE is much less common, with only 15 proven cases nationally in 2012. However, all of these affect the brain and 9 of 15 occurred in New England. This is a very serious disease with a death rate of 36-70%. Vermont, New Hampshire, and Massachusetts have already isolated arboviruses in 2013. These were mostly isolated from mosquitos, but also from horses and, in the case of New Hampshire, from humans. Again, these viruses can cause severe brain and nervous system disease. Since there is no specific treatment for these viruses, preventing transmission is very important. The Maine CDC suggests the following for preventive measures to protect against WNV, EEE, and other arbovirus infections:• Use an EPA approved repellent when outdoors, especially around dawn and dusk – always follow the instructions on the product’s label • Wear protective clothing when outdoors, including long-sleeved shirts, pants, and socks • Use screens on your windows and doors to keep mosquitoes out of your home • Avoid being outdoors at dawn and dusk when many species of mosquitoes are most active • Drain artificial (non-natural) sources of standing water It has been a bad year for rain and mosquitos, as any walk in the woods or visit to camp will attest. Keep safe and keep the mosquitos away! Be smart!More Information: More information on arboviral illness is available at Maine CDC’s Vector-Borne Disease website at http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml. Information on pesticides and repellents is available at the Maine Board of Pesticides Control website at http://www.maine.gov/agriculture/pesticides/public/index.htm#mosquito.
By- Dr. David PrescottShould You Share Your Problems With Others? People who struggle with excessive anxiety or depression often face a dilemma. Should they talk about their concerns with other people? On the one hand, other people are sometimes able to help us to gain a fresh perspective that helps break up our worry or sadness. On the other hand, talking about a problem over and over may lead a person to conclude that their life is truly sad and that there is no solution. The Argument in Favor of Talking About Problems: One line of psychological research suggests that getting support and encouragement from others helps people with depression or anxiety work through their feelings. Particularly with depression, people often become excessively isolated and withdrawn. Historically, psychologists and counselors have encouraged people to share their difficult feelings and worries. The theory goes that keeping things bottled up inside you will only make things worse. The Argument Against Talking About Problems: On the other hand, telling a friend or family member about your worries and sadness may backfire. Reactions can vary from unsympathetic to critical or harsh. In some cases, repeatedly talking about your unhappiness may reinforce the idea that your life is in tough shape. Recent research suggests that for teenage girls, talking frequently with a close friend about personal worries actually make depression and anxiety worse, through a dynamic called co-rumination. Co-rumination is defined as the tendency to spend too much time talking over problems and dwelling on negative feelings. It appears that co-rumination leads people to feel worse, rather than better. Sometimes, talking repeatedly about a problem or negative situation can eventually drive friends away. Finding A Middle Ground for Talking About Your Problems: Like many things affecting your mental health, the best approach to talking your problems with others is to find a middle ground. People who feel isolated and alone would probably benefit from reaching out to others. However, if you find yourself stuck in a rut, having the same conversation about the same worries or negative events repeatedly, a change in tactic is probably in order. Tips for How to Constructively Talk About Anxiety and Depression: One solution to the dilemma of whether or not it will help to talk with others about your worries or depression, is to strive to have your conversations end up in a constructive or positive place. Characteristics of helpful conversations include: · Identify Small Steps Towards Action: Simply describing negative feelings such as excessive anxiety or depression may not help you feel better. Rather, think of a small step you could take to do something different to cope with your feeling or situation. · Challenge your negative thinking: The feelings we have about others or about an event in our life depend on the lens through which we view them. Challenge your typical ways of looking at other people or other events. Is there a more positive way to view things? · Let go of unattainable goals: Sometimes our frustrations come from setting a goal that is unrealistic or beyond our control. For example, your solution to cope with a person who criticizes you may be for that other person to change their attitude. Changing someone else is usually unattainable, or at least unrealistic. Try to shift your goal to something that you can control. · Distract Yourself From a Problem or a Worry: Try not to have the same worrisome conversation over and over. If you and a friend seem to always end up talking about the same problematic people or situations, purposefully direct your conversations to another topic. Or better yet, go do something to take your mind away from your worries. For More Information: American Psychological Association “Psychology Topics”: http://www.apa.org/topics/depress/support.aspx
By: Dr. Amy MoviusA reality of our increasingly hectic world is the ongoing availability of new conveniences, large and small, directed at “making life easier”. One such – seemingly small – example is laundry detergent pods. Instead of measuring/pouring liquid or powder into a washing machine, a premeasured detergent “pod” can be popped in and, presto, the laundry is good to go.There can be unintentional effects of new amenities and so is the case for laundry pods. Small children, especially less than 5 yrs., have been known to ingest them, presumably because they are colorfully attractive and a size and shape suggestive of candy. Though the membrane of these pods is very sturdy when handled, it readily dissolves when moist – think saliva. When a child puts a laundry pod in their mouth the membrane begins to melt and the pod easily bursts.Laundry pods were first marketed in Europe in 2001 and here in N. America in 2010. The cumulative experience over these more than 10 years has revealed that toxicity from these products is no small matter. The symptoms of detergent pod ingestion have consistently been reported more severe than those of “non-pod” laundry detergent ingestion. Add to that a study from the United Kingdom in 2009-2010 showing that laundry pods were the most common accidental household cleaning product ingestion, and the scope of the problem becomes clearer.So what happens when a pod is ingested? Vomiting often occurs within minutes. This can be followed by difficulty breathing from swelling of the upper airways (mouth/throat) and/or irritation lower in the lungs. Breathing may be affected to the point that a ventilator is needed to breathe for the child until this inflammation subsides. Lastly, for unclear reasons children may become very lethargic or “comatose” following pod ingestion and can require a ventilator temporarily for this reason as well. Eye and skin exposure have also been reported, though ingestion is most common.Prevention is the best tool we have. Awareness of the appeal these pods have to young children is an important first step. As such, these products should be kept both out of sight and out of reach. If a child does have a laundry pod exposure, call poison control or seek immediate medical care if the child has already developed symptoms. References:1. Center for Disease Control and Prevention, Health Hazards Associated with Laundry Detergent Pods – United States, May – June 2012. MMWR October 19, 2012. 2. Williams et al, Exposure to Liquid Detergent capsules: A Study Undertaken by the UK National Poisons Information Service. Clinical Toxicology 20123. Fraser et al, Liquid Detergent Capsule Ingestion in Children: An Increasing Trend. Letter, Arch Dis Child, November 20124. Wood and Thompson, Liquitabs – a Thorough and Comprehensive Review of the UK National Data. Clinical Toxicology 2009
By- Dr. Jonathan WoodHeat-related illness it real. Even in Maine, where thankfully we don’t experience months of extreme heat, we still experience hot days that can be dangerous or even fatal. Last week was a good example of this with daily temperatures repeatedly in the 90′s across the state.People suffer heat-related illness when their bodies are unable to compensate and properly cool themselves. The body normally cools itself by sweating. But under some conditions, sweating just isn’t enough. In such cases, a person’s body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs.Several factors affect the body’s ability to cool itself during extremely hot weather. When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing heat quickly. Other conditions related to risk include age, obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn, and prescription drug and alcohol use.Because heat-related deaths are preventable, people need to be aware of who is at greatest risk and what actions can be taken to prevent a heat-related illness or death. The elderly, the very young, and people with mental illness and chronic diseases are at highest risk. However, even young and healthy individuals can succumb to heat if they participate in strenuous physical activities during hot weather. Gradations of heat-related illness:Heat Cramps – usually associated with strenuous activity and depletion of minerals through excessive sweating and inadequate replacement.Heat Exhaustion – can occur over time even without exercise. It results from ongoing losses without adequate replacement. Symptoms include heavy sweating, paleness, weakness, dizziness, headache, nausea and vomiting, and fainting.Heat Stroke – the most severe form. The body loses its ability to regulate its temperature. The sweating mechanism fails and the body is unable to cool down. Consequently the body temperature rises rapidly, potentially resulting in critical illness and death. Symptoms include all the symptoms of heat exhaustion except the skin is red, hot, and dry. The temperature rises quickly over 103 and confusion or unconsciousness can ensue.What can you do to prevent heat-related illness?Stay Cool· Go to an air-conditioned place if at all possible. (e.g. library, mall, senior center)· Wear loose fitting, light clothing.· Avoid being outdoors and if so, rest in shady areas.· NEVER leave children (or pets) in parked cars, even if it is “not too hot” and even if the windows are cracked. Temperatures rise frighteningly fast in this environment and can quickly result in heat stroke.Stay Hydrated· Drink more water than usual. (during exercise, drink 16-32 oz per hour)· Avoid sugary drinks and alcohol, as these cause you to lose more body fluid.· Don’t wait to get thirsty – – stay ahead of it!Stay Alert:· Know your risk factors. If you are elderly or overweight or have heart disease or high blood pressure, you need to be particularly careful and wary.· Know your medications. Ask your doctor if any put you at particular risk.· Pay attention to warnings about heat waves.· Check up on relatives and neighbors who are high risk.· Pay attention to your body. Seek medical advice early if you experience symptoms of heat-related illness.Knowledge and common sense are the keys to avoiding the dangers associated with extreme heat in the summertime!For more detailed information, visit the CDC’s “Extreme Heat Prevention Guide”