By: Dr. Joan Marie PellegriniEvery parent I know has this problem: how do we come up with healthy snacks for our children that are not too hard to put together and that our children will actually eat? It is so tempting to throw in a bag of chips or cookies. Obviously these are not healthy but they also do not satisfy our hunger for very long. Good snacks will not have a large amount of sugar and are filled with protein and fiber. Sugar and simple carbohydrates tend not to fill us up for very long. Some fat and protein with fiber does a much better job.Here are some ideas: *Yogurt with granola may be a good one but it can be difficult because of the need for refrigeration.*granola with some nuts*carrots or other vegetable with a small container of dressing or peanut butter*popcorn (without any butter or salt)*hummus and chips (these are available in single serving packages but are a bit pricey)*banana and peanut butter or (just a little please!) Nutella*single serving oatmeal with nuts and apples*single serving nuts with cinnamon or cocoa powder (these can be pricey but the more creative of us can put this snack together)*sugar snap peas with tahiniMany of these foods come in single serving sizes. If cost is an issue then it will be helpful to buy a few small reusable containers and fill them with peanut butter or dressing, etc.When we are hungry we tend to eat whatever is available. We can help our children by sending them to school with healthy snacks that are available to them before sports practice or other after-school activities.
How to Recognize, How to CopeBy: Dr. David PrescottTimes of change and transition often mean excitement and anticipation. However, thinking about an upcoming change can also bring on stress, worry, and anxiety. For some children and teenagers, returning to school can bring on such intense worry that they develop an unhealthy avoidance of school. The causes of school phobia often differ between young children and older children or teenagers. In either case, some extra support and help can often help them overcome their fears. When Does Fear of School Become Excessive? It is normal for children and teenagers to worry. A recent study reported that 70% of children say they “worry every now and then.” Worries about school are also relatively normal. But for some children, school worries lead to not wanting to go to school or to a need for excessive reassurance about leaving home. Repeated episodes of trying to avoid school, or even missing school due to anxiety, is usually a sign of a more significant problem. Normal Transition Challenges – Elementary vs. Middle School: Helping your child overcome their anxiety about going to school will work best if you understand the likely cause of the anxiety. For elementary school students, anxiety about school or reluctance to go often has to do with separation from home. A child’s worries about things that are unfamiliar or unknown are often the source of the problem. For middle school students, the transition from elementary to middle school is often accompanied by struggles in keeping up with more difficult work and the focus on peer relationships. Research shows that many students experience an initial academic challenge when they start middle school. And, relationships with peers are often an additional source of anxiety or problems that may lead to a child not wanting to go to school. What Causes School Phobia or School Avoidance? While every situation is unique, some common factors which contribute to school phobia include: Â· Separation anxiety for young children: Particularly for children in their first or second year of school, the primary issue in school phobia is often difficulty with separation from a parent. Â· Fear of the unknown: Transitions to new schools often cause more stress than schools that are familiar.Â· Bullying or problems with friends: If school phobia develops during the middle of a year, it is important to find out if your child is being bullied or having conflicts with others. Â· Social Anxiety for Teenagers: Social phobia, or social anxiety, involves an intense fear of being embarrassed when talking to others. It often emerges in late teenage years, and can contribute to school phobia. What Can Parents Do to Help? A few common sense tips can help your child cope with any excessive fears of school. Â· For children of all ages, show interest: Listen, give encouragement, and ask questions. Â· For younger children, get on the bus with a friend. This can help children not feel so alone. Â· For children entering a new school, visit the school Help your child learn the layout and, if possible, meet their teacher. Â· If your child suddenly becomes stressed about school: Children may suddenly develop worries, resistance, or minor physical ailments once school has already started. Try to find out if something has changed such as problems with friends or a difficult class. Â· Organize the night before. If your child is anxious about going to school, try not to make the trip out the door full of stress and last minute running around. Â· Talk to a mental health professional or school counselor if your child begins missing school or leaving early due to stress or worry.
How Cognitive-Behavioral Therapy Can HelpBy- Dr. David PrescottFor many children, young adults, and adults, the start of school means a change in routine and a change in schedule. Such changes often lead to disruptive sleeping patterns, which if they persist, can cause a wide range of difficulties with health, mental health, and mental sharpness. Psychology has developed specific strategies to help people who struggle with poor sleep to improve their sleep in long lasting ways. These strategies appear to work as well, and perhaps better, than typical sleep medications for many people. Sleep Problems are Relatively Common: Statistics from the National Sleep Foundation suggest that as many as 4 in 10 adults experience daytime sleepiness severe enough to interfere with daily activities. As many as 7 in 10 children have some type of sleep problem a few nights a week. Signs of poor sleep include moodiness, apathy, being more impulsive, and impaired memory. Poor Sleep Means more than Just Being Tired: Research increasingly supports the idea that chronic poor sleep is associated with, or may cause, a number of other health problems. People with chronic poor sleep appear to be at higher risk for high blood pressure or cardiovascular problems. Poor sleep is a symptom, and in some cases a cause, of mental health problems like major depression. While exact estimates are difficult, falling asleep while driving is estimated to cause as many as 100,000 automobile crashes, and as many as 1,500 deaths, in the United States each year. General Strategies for Improving Sleep: Most experts agree that some common sense advice can help improve sleep. While many people are aware of these strategies, it is important to make sure that you truly follow them. Good sleep strategies include: Â· Going to bed and waking up at about the same time each day. Â· Avoid smoking, heavy meals, and alcohol before trying to go to sleep. Â· Get regular exercise. Â· Develop a regular bed time. Cognitive-Behavioral Therapy and Sleep: When general sleep improvement tips do not lead to improved sleep, and people experience long term insomnia, treatment using cognitive behavioral therapy is highly effective, improving sleep for 70-80% of people. Sleep problems may persist even when a co-occurring problem, like depression, has improved. Cognitive-behavioral therapy helps people change thoughts and attitudes about sleep that interfere with getting good sleep. For example, thoughts like “I won’t be able to function if I don’t get to sleep” or “I will never get to sleep without medication” may actually contribute to sleep difficulties. In addition, carefully tracking sleep behavior (what you do before going to sleep, sleep schedules) often reveal important behavior patterns that contribute to problems. With treatment, these thinking and behavior patterns can be changed. For More Information: American Psychological Association: http://www.apa.org/topicsNational Sleep Foundation : http://www.sleepfoundation.orgAmerican Academy of Sleep Medicine: http://www.aasmnet.org
By: Dr. Joan Marie PellegriniWe see it all the time: small children carrying backpacks that seem larger than they are. Teenagers carrying backpacks on one shoulder that are so heavy they are leaning to one side. Is this a problem? It turns out this is the major cause of back and neck pain in school children. Experts recommend that a child’s backpack should weigh no more than 10% of their body weight. Heavier packs and improperly worn packs cause increased curvature of the spine, spine disc compression, and neck and muscle strain. This may not be a serious problem, but it can lead to unnecessary doctor visits, missed sports practices, and may interfere with study habits. There is no study to determine if there is any long term damage to the spine from years of heavy backpack use. However, it just makes sense that we should try to help our children avoid neck and back pain. We should occasionally ask about back and neck pain.When shopping for a backpack, chose one that is smaller rather than larger. This way it will limit the amount that your child can put into it. Also, there should be two padded shoulder straps and a waist strap. It helps if there are multiple compartments so that the load can be evenly distributed. Once your child has their pack loaded, have them put it on. Is it properly fitted? Does it weigh too much? Does it cause your child to change their posture because it is too heavy? Look to see what is in the pack. Can some items be left out? Can some books be left at home or at school? For particularly large text books, perhaps your child can get a copy of the part of the text book that is needed instead of carrying the entire book. Ask the school if there is an electronic version of the text book.
By: Dr. Amy MoviusThe summer Olympics are over but for many children and adolescents the next big event is just beginning: preseason training for school sports. Maine is known for its hot and sometimes sticky summers and this one has been no exception. As some kids abruptly increase their exercise with onset of school sports practice it is important to be aware of the potential for climatic heat stress and how this risk can be minimized. Heat related illness occurs when the body has increased heat production (as occurs with exercise), and decreased heat transfer to the environment (uniforms/equipment). It can be fatal. Cramping is often one of the first signs. Heat exhaustion is more severe and happens when the body has lost excessive water and salt. It is characterized by profuse perspiration, cold and pale and clammy skin. Heat stroke is extreme and occurs when the body temperature is so high that cells are damaged. These patients are red and hot, with dry skin and confusion. Measures to decrease body temperature need to be done as soon as any symptoms are recognized.Heat and humidity, two major risk factors for developing heat related illness, are obviously out of our control. Fortunately, there are plenty of other factors that can be optimized to keep children and adolescents safe while exercising under hot and humid conditions. A summary of the AAP recommendations to reduce the chance of child/adolescent athletes from developing heat related illness is as follows:1. Anyone in any type of leadership position involving youth sports should emphasize awareness, education, and implementation of exertional heat illness risk-reduction strategies to staff that oversee and assist with these sports2. There should be capable staff and facilities readily available for treatment of all forms of heat illness.3. Child/Youth athletes should be educated on proper sports preparation, prehydration/hydration, honest reporting of any symptoms, and other issues such as recovery and rest that can reduce their risk of heat stress.4. Athletes should be given 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 for safety in relation to the degree of heat. This may include lowering intensity, shortening duration, or increasing breaks during sessions. 7. Athletes should avoid or limit participation when currently ill or recovering from illness.8. Staff needs to receive training to monitor athletes for signs and symptoms of heat illness and stop participation of any individual they are suspicious may have any such signs or symptoms. They should be treated immediately and not return to practice/game/session that day.9. An emergency action plan should be clearly in place.10. There should be at least 2 hours of rest between separate events occurring on the same day.11. In extreme 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:e7412. Luke et al. Heat Injury Prevention Practices in High School Football. Clin J Sport Med. 2007:17(6):488-4933. Jardine. Heat Illness and Heat Stroke. Pediatrics in Review 2007:28:249-2584. HealthyChildren.org – Heat Related Illness
Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to discuss pertussis. Also known as whooping cough.
By- Dr. David PrescottHolidays like July 4th is often a time to get together with family, friends, or larger crowds of people. However, for some people social situations like this invoke intense anxiety, worry, and a strong desire to avoid people. Shyness and social anxiety often differ for adults and children, but the underlying fears and causes are basically the same. What Causes Shyness? Shyness is considered a personality trait, and like most traits it seems to develop due to biological, psychological, and social factors. Extreme shyness tends to run in families, and seems related to a personâ€™s temperament. There is some thinking that shy people naturally prefer to remain withdrawn from others, or that they are very emotionally reactive to upsetting social interactions. Interactions in a personâ€™s home environment, such as frequently being shamed or criticized, can also play a role in causing a person to be shy and withdrawn. Or, significant life changes such as moving, changing schools, changing jobs, or changes in family can sometimes be associated with an increase in shyness. When Does Shyness Become Social Phobia? A phobia is a specific fear of a person, thing, or situation. In social phobia, a shy person becomes overwhelmed by the thought of interacting with other people to the point where their fears and avoidance begin to significantly disrupt their life. Symptoms of social phobia include: â€¢ Extreme anxiety about being with other people and having a hard time talking to them, even though they wish they could â€¢ Be very self-conscious in front of other people and feel embarrassed â€¢ Be very afraid that other people will judge them â€¢ Worry for days or weeks before an event where other people will be â€¢ Stay away from places where there are other people â€¢ Blush, sweat, tremble, or feel nauseous around other people What is Unhelpful to People with Shyness or Social Phobia? It is generally not helpful to people who are shy or have social phobia to pressure them about interacting with others. Criticizing or dismissing their fears often makes things worse. Helping the person set small goals, or simply listening to some of their worries is often a good place to start. Should a Person Get Help for Shyness or Social Phobia? Counseling can be very helpful in teaching people who are very shy or who have social phobia how to keep their fears in check so they can do things with others that they truly enjoy. Experts in the area of extreme shyness often use the idea of â€œsocial fitnessâ€ to help explain how people can reduce their worries about interacting with others. Staying Socially Fit: Just as our bodies and minds can quickly get out of shape if we donâ€™t exercise them, experts believe that our social skills quickly diminish if we donâ€™t use them. Thus, treatment models for shyness or social phobia usually involve structured practice being around others. Treatment can help people change negative automatic thoughts about social interactions (for example, â€œI know if I talk to someone I will say something dumbâ€). People can also learn relaxation skills to reduce racing heartbeats or rapid breathing. Sometimes, assertiveness skills allow shy people to better stand up for themselves, which makes social interactions less stressful. For more information: American Psychological Association: http://www.apa.org/helpcenter/shyness.aspxNational Institute of Mental Health: http://www.nimh.nih.gov/health/publications/social-phobia-social-anxiety-disorder-always-embarrassedThe Shyness Institute: http://www.shyness.com
By: Dr. Joan Marie PellegriniIt is summer and now is the time that many people want to burn brush or have a camp fire. However, it can sometimes be fairly difficult getting a fire started when the wood is green or damp, it is windy, or you do not have any kindling. Every summer we see many people in Emergency Rooms across the state who have burns from using a flammable liquid (such as gasoline or kerosene) to get a fire started. The danger in using flammable liquids is there are fumes and gases which also catch fire but are not visible. Often these fumes travel right up to the person who just poured the liquid and so their clothes also catch fire. Please do not ever use a flammable liquid to start a fire.If you or someone you are with does have their clothing catch fire, you must put it out quickly with a large blanket or towel or water if it is available. Then you must remove the clothing. If it is just a small area that was burned, you may use cool water and clean the area and apply an antibiotic ointment. If there is a significant area burned then you must seek emergency medical attention. I most commonly see faces, hands, and arms burned. These are painful burns and can be serious enough to require hospitalization or even surgery.There are several fire starter packets on the market that can be used. These contain various flammable chemicals but do not release a dangerous fume. The problem with these packets is that one must anticipate needing them and therefore have one handy. Another option is to predict you will need help getting a fire started. Fresh evergreen boughs placed at the base of the campfire with some dry paper can be quite helpful. Please make sure you have properly prepared the area for a campfire and that you have the right materials. Please think very carefully before trying to start a campfire or brush fire.
By: Dr. Anthony Ng A phenomenon that occurs in many children is the act of self injury. Such self injury will come in various types. It may range from cutting self to hitting oneself. In a recent article from the journal Pediatrics from the American Academy of Pediatrics, it was revealed that 8% of 665 survey youths had engaged in some form of self injurious behaviors. These youths range in age from 7 to 16. Almost 8% of third graders had engaged in some form of self injurious behavior at some point, vs. 4% for sixth-graders and 12.7% for ninth-graders. Ninth-graders girls were three times more likely then boys to engage in self injuries. Self injury is characterized by a child or an adolescent cutting self, often superficially, on their extremities, such as their arms and legs. They would use knives, razor blades, pen or pencils, paper clips, etc. Other modalities may include punching objects, burning oneselves or hitting their heads repeatedly. In most instances, the intent on the part of the child is not to kill himself or herself. Often, such behavior is a response to stressful situations and negative emotions. They would describe that they are cutting to reduce some psychological pain they are having. Many of these self injuries are NOT suicide attempts, though they may inadvertently lead to greater harm and even risks of death accidentally. It is unclear why a person, especially a child, will inflict pain on themselves to relieve another unpleasant and distressful feeling. It is interesting that other species of animals do engage in similar self injuries in their relief of discomfort. For example, cats and dogs will lick and chew their bodies until they have wounds. There are medical conditions that may lead to self injuries in children and adolescents. Lesch-Nyhan Syndrome is a genetic condition that may lead to some horrific self injuries in children with this disorder. However, in most instances, children and adolescents usually have some sort of psychological distresses who engage in such self injuries. All children like adults are subjected to very powerful emotions with the ability to experience extreme fear and worries. Unlike adults, often children may not have learned a wide array of coping skills or social support to help them cope with such extreme emotions. Children and adolescents who engage in self injurious behaviors may have numerous scars on their bodies. They may also have evidences of other injuries, such as contusions or burnt marks. They may not be able to provide a good explanation for these wounds. More often, the person who self injures often does it in private and may keep their injuries hidden, especially with cutting and burning. They may wear long sleeves or have reluctance to wear shorts or any clothing that may expose scars from past injuries. In addition to these physical signs, the child may also have depression, mood swings, academic difficulties and relationship troubles with family and friends. For some, there may also be evidence of substance abuse issues and some extreme risk taking behaviors. The reason for these self cutting ultimately is complex, with numerous biological and environmental factors. As such, the treatment for such behavior in children is also complex and may include many modalities. The most important intervention is open communication between parents and their children. When parents first learn that their children are cutting, they may be quite stressed by it and take their children to emergency rooms. Unless the injuries are extremely serious, emergency room interventions are likely not the best initial treatment for the children. Parents should not fear that by discussing with their child, the behavior will be increased. Parents need to be direct with their children and let them know that they are there to talk and not force children to talk if they are not ready to do so. They should encourage this communication as being safe for their children and that they do not fear punishment from their parents. For more professional intervention, psychotherapy is often the first treatment of choice. Both individual and group psychotherapies can help children identify what troubles them. Psychotherapy can help children gain and increase their self respect and self esteem. Psychotherapy can help identify triggers for self injurious behavior and help them to develop other types of appropriate coping skills. For example, an often used intervention is a rubber band that the child will snap on their wrists when they have urges to cut. Medication, such as antidepressants, anti-anxiety medication and mood stabilizers, may be helpful if there are significant anxiety or depression that warrants such treatment. In some severe cases, brief inpatient psychiatric treatment may be necessary.The emotional health of children can be a strong determinant of their adult emotional health. Thus, it is important that there be early identification and treatment for such self injurious behavior by parents and guardians to ensure a successful outcome for their children.
Problem Gambling and Pathological Gambling: When Do You Cross the Line? Health Watch – June, 2012David Prescott, Ph.D. – EMMC Behavioral Medicine ProgramProblem Gambling and Pathological Gambling: It is estimated that about 4 out of 5 people gamble at some time in their life. Sometimes, what begins as a recreational pursuit becomes a significant life problem. About 2% of people who gamble have at least one gambling related behavior that causes noticeable problems in their lives. Less than 1% of people who gamble will eventually meet criteria for being diagnosed as a pathological gambler. The average annual financial losses from problem gambling, while varying enormously, average around $5,000 per person per year. What Are Some Signs of Pathological Gambling? People who are labeled as pathological gamblers cannot resist the impulse to gamble. They usually start gambling at a younger age than others, often around age 16 or 17. Pathological gambling is diagnosed when gambling occurs persistently over time, and the behavior interferes with other areas of life functioning such as family or work. Criteria for pathological gambling include: Â· Jeopardize or lose important relationships or career opportunities because of gambling. Â· Spending increasing amount of money on gambling to maintain excitement or thrillÂ· Becoming restless or irritable if person stops gamblingÂ· After losing money, returns to gambling to get even (“chasing losses)Â· Repeated unsuccessful efforts to stop gambling. Pathological Gambling and Other Mental Health Problems: For those few people who develop pathological gambling, co-existing mental health problems are often a part of the picture. People with pathological gambling are more likely to also be diagnosed with bipolar disorder, panic disorder, or substance abuse disorder than the general population. It is not entirely clear what the causal relationship between pathological gambling and these others disorders might be. Types of Gambling Most Often Associated with Gambling Problems: Problem gambling is not strictly associated with people gambling at casinos, although casinos are one venue for problem gambling. The most frequent type of gambling that becomes a problem is lottery type, with bingo games and internet gambling also among the top areas where gambling problems occur. How Can I determine if a Gambling Problem Exists? At either end of the spectrum, ranging from occasional recreational gambling to extreme pathological gambling, it is usually easy to determine whether or not a problem exists. As with many psychiatric disorders, determining the exact line where a problem exists differs from person to person. One place to help you if you, or someone you know, may have a problem is a 20 question survey published by “Gambler’s Anonymous.” The survey can be found at the Gambler’s Anonymous Web Site and includes questions such as: Â· Did you ever lose time from work or school because of gambling? Â· Were you reluctant to use ‘gambling money’ for normal expenditures? Â· Have you ever felt remorse about gambling? Â· After losing, have you ever felt that you must return to gambling as soon as possible to win back your losses? Treatment for Problem and Pathological Gambling: As with most mental health and psychiatric problems, the sooner a person begins to get help, the better the prognosis. Treatment options for problem and pathological gambling include:Counseling using cognitive behavioral therapy (CBT) : Cognitive behavioral therapy examines the thinking and behavior patterns that contribute to problem gambling, and helps a person change these problematic patterns. For example, people with problem gambling often distort their thinking to minimize the chance that they will gamble again, or the fact that the gambling is causing problems. Self-help support groups, such as Gamblers Anonymous. Gamblers Anonymous is a 12-step program similar to Alcoholics Anonymous. Practices used to treat other types of addiction, such as substance abuse and alcohol dependence, can also be helpful in treating pathological gambling.Medications: A few studies have been done on medications for treating pathological gambling. Early results suggest that antidepressants and opioid antagonists (naltrexone) may help treat the symptoms of pathological gambling. However, it is not yet clear which people will respond to medications.For More Information: Gambler’s Anonymous: http://www.gamblersanonymous.orgNational Institute of Health PubMed:
Dr. David Prescott – Eastern Maine Medical Center Behavioral MedicineFetal Alcohol Spectrum Disorders: No Amount of Alcohol is Known to Be Safe During Pregnancy: Disorders caused by alcohol use during pregnancy are termed fetal alcohol spectrum disorders. Fetal alcohol syndrome is one specific type of disorder caused by alcohol use during pregnancy. Children exposed to alcohol during pregnancy may also experience learning disabilities, emotional difficulties, and physical disabilities that do not technically qualify for fetal alcohol syndrome. The exact effects of alcohol use during pregnancy appear to be somewhat difficult to predict, beyond knowing that any alcohol use puts the unborn child at risk. No amount of alcohol has been determined to be safe during pregnancy. How Common Are Fetal Alcohol Spectrum Disorders? Many women do not know when they are first pregnant, or may use alcohol because they do not fully understand its potential impact. Statistics about fetal alcohol spectrum disorders include: Â· Over 40,000 children are born in the United States each year.Â· Fetal alcohol spectrum disorders are more common than autism spectrum disorders. Â· More than 1 out of 10 pregnant women report using alcohol in the last month. Is Alcohol Really That Harmful to an Unborn Child? Alcohol impacts the neural and physical development of a child. According to the Institute of Medicine: “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.What Are Possible Signs of Fetal Alcohol Syndromes? As difficult as it may be to discuss the possibility that a child has a fetal alcohol syndrome, identifying this early offers the best chance to minimize the effects. Possible signs of fetal alcohol spectrum disorders in infants include: Â· Sleeping, breathing, or feeding problems.Â· Small head, facial, or dental irregularitiesÂ· Deformities of joints, limbs, and fingersPossible effects of fetal alcohol spectrum disorders in children include: Â· Overly sensitive to bright lights, sound, or textures of clothing. Â· Balance and motor problems (“clumsy”)Â· Have trouble following multi-step directions. Â· Difficulty with reading, numbers, letters. Is There a Treatment for Fetal Alcohol Syndrome Disorders? Â· Prevention: The only sure way to treat fetal alcohol syndrome disorders is through prevention. Physicians who provide prenatal care are learning that routinely asking about alcohol use during pregnancy, and brief interventions to encourage women to stop using alcohol have a significant effect. Â· Early Recognition: If a child was exposed to alcohol during pregnancy, the earlier that fetal alcohol spectrum disorders are recognized, the better chance of minimizing its negative effects. Â· Focus on Strengths: Children with fetal alcohol syndromes are often friendly and cheerful, like to be helpful, and are often very determined. These strengths can be used to offset areas where life is a challenge. Â· Support for the Family: Having a child with fetal alcohol syndrome is stressful. When families are able to remain intact in spite of the stress, the chances that fetal alcohol syndrome will significantly disrupt the life of the child are greatly reduced. For More Information: Fetal Alcohol Spectrum Disorders Center for Excellence: www.fasdcenter.samhsa.gov
Dr. Anthony NgOne of the toughest experiences we have all faced or will face one day is the loss of a loved one like family or spouse or close friends and colleagues. Such losses may be sudden, as from an accident, victims of violence or sudden illness or such losses may be from chronic illness. When such a loss occurs, those affected experience what is commonly known as bereavement. This is often a difficult time not only for the people who experience the loss but also their friends and families, who often may not be comfortable or know how to help the affected persons deal with the loss. They may worry about what to say or do for fear of making the person feel worse.Most of all, it is important to understand that bereavement is a very normal and common response to traumatic losses. We have developed bonds with people we care about. We may even suffer bereavement from losses of people whom we may not know well but may have some personal connections to. When we grieve, we may have a variety of reactions. They may be emotional, such as extreme sadness, anxiety, with often bouts of crying and tearfulness. There may also be intense anger, either at the individual who died for leaving loved ones or with relationship difficulties in the past when they were alive. This is a common reaction often seen by those who had lost someone to suicide. There may be extreme guilt to those surviving to why they live and the person who they grieved about did not, i.e., victims of a car accident. This is often described as survivor guilt. Individuals who are grieving may have physical complaints, such as stomach upset, headaches or diffuse body aches. There may be loss of appetite and changes in sleep. There may also be concentration and memory difficulties as their thoughts are preoccupied with the memories and thoughts of the person who died. No two individuals will mourn the loss the same way. Some may have more intense reactions then others. Many of the reactions may also be influenced by various factors, such as age and culture. Grief experience by young children may be subdued and very different from adults, but it does not mean their grief is any less. Bereavement is often a temporary response that becomes less intense over time. Most experts feel bereavement may persist for as long as one year, though much of the more intense signs of bereavement usually lessens after two months. Bereavement often ends in the acceptance of the loss of the person. The term resilience has also been used to describe how individuals recover from traumatic losses. There are multiple factors that may influence how one grieves or one’s resilience. This includes our past experiences with losses. The amount of social support or perceived social support may be another factor. Usually, the more support, whether it is family, friends, co-workers or other fellow church members, all serve to enhance an individual’s resilience. If it is a child grieving, family support will be vital in the process. Some individuals who grieve may turn to work or school, or outside activities as a way to cope. Having memorials and gatherings may also appropriate way to deal with the loss. Bereavement responds usually very well to support and grief counseling if need be. However, for some individuals, bereavement may be extremely intense and distressful where professional help may be needed. They may have significant impairment weeks and months after a loss that prevents them from functioning adequately at work, home or school. Some may have marked substance use as a result of the loss. Some may progress to depression, suicidal thoughts and even in severe instances, psychosis. It is important that people with these significant symptoms or impairment seek professional help. Therapy may be helpful and for some, even psychiatric medications may be necessary to treat these symptoms. As I mentioned earlier, bereavement is a very normal part of the grief process of losing someone we care about. While the feelings are extremely distressful and many often feel they have lost part of their lives, many also as part of grieving experience have some sense of growth, renewing their faith, have a different outlook on life, spending more time with family and friends. This has been described as post traumatic growth. Celebration of the lives of those we have lost is often the key.
By: Joan Pellegrini, MDGood news for women: gone are the days of recommending annual Pap exams.So, why did the guidelines change? It turns out that more frequent screening was turning up more abnormal results thus leading to more testing but no benefit. Most of the time, these abnormal results were nothing to worry about. If we screen every 3 years we can still catch cervical disease before it becomes cancer and yet not miss more cancers. If HPV testing is added to the Pap, then screening can be extended to every 5 years.More good news: we no longer have to subject ourselves to screening before the age of 21. Cervical cancer is caused by the Human Papillomavirus (HPV). There are many types of HPV and most of us are infected at some point in our lives by at least one of the types. Only a few of the HPV types will cause cervical cancer. Most women who become infected with the virus are able to fight it off and never have a problem. However, if a young woman who just contracted the right type of HPV has a Pap test early on in the infection, the Pap will be abnormal. But, chances are she will clear the infection and have a normal Pap in a few years. This is mainly the reason why the new guidelines recommend not screening before the age of 21. This is opposed to the previous guidelines which recommended starting screening no later that age 21.The U.S. Preventive Services Task Force website has a more detailed description of the new guidelines.http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancersum.htmThese guidelines are for women at low risk and with no history of an abnormal Pap test. The most important component of screening is that women actually get screened. How long the interval is between screens is less important. As usual, we recommend you discuss your particular situation and concerns with your personal healthcare provider. I started this segment off with the good news. But, the bad news for women is that although cervical cancer rates are down significantly since we started getting Pap exams, there are still over 12,000 cases of cervical cancer per year in this country. And, the vast majority of cancers occur in women who have never been screened. This gives us some room for improvement. So, we can now reduce the frequency of screening but we still need to get every woman to get screened.
Lyme Disease 2012Amy Movius MDHuman Lyme Disease started in Connecticut in the 1970s and hit Maine in 1987. Lyme disease starts as a disease of animals. First, a deer ticks bites an infected animal and â€œpick upâ€ the bacteria that causes Lyme Disease. The infection is then â€œdeliveredâ€ to persons those same ticks later bite. Human Lyme Disease in Maine has been rising every year: more than 1000 cases were reported in 2011. The peak season for Lyme Disease in late spring and summer, BUT, ticks can be active anytime the temperature is above freezing. Last yearâ€™s winter was mild so the medical community is expecting to see more tick bites, earlier in the season. Case in point: a member of my own family has already had a tick bite! May is Lyme Disease Awareness Month so itâ€™s a great time to get ready to NOT get infected. The only fool proof way to avoid Lyme Disease is to have no tick exposure. Since this is near impossible, preventing and quickly detecting any bites is more practical.To this end, the Maine CDC has developed the â€œNo Ticks 4 MEâ€ rules:1. Wear Protective Clothing Long sleeves and pants in outdoor â€œhigh tickâ€ areas are best. Light colored clothing can make ticks easier to see. Tucking pants into socks and taping them prevents ticks from sneaking up pant legs. After wearing clothes outside, wash in hot water and dry on high heat to eliminate any stowaway ticks you may have missed.2. Use Insect Repellent These skin repellents must contain DEET or picaridin to repel ticks. You must treat your pets as well or they may escort Lyme carrying ticks straight into your house. Also, clothing can be treated with permethrin to discourage ticks from attaching to them.3. Perform daily tick checks Yes, daily! Ticks have to be attached at least 24 hours to transmit Lyme disease so finding them promptly keeps you safe. However, these critters are very small and can go undetected if youâ€™re not actively looking for them. Itâ€™s also a good idea to shower as soon as possible after coming indoors for the day. If you find a tick donâ€™t put anything on it! Carefully remove it by pulling it gently and straight out with tweezers. Wash the area and use a topical antiseptic and keep an eye out for any rash around the site for the next month.4. Use extra caution in tick habitats This includes wooded or bushy area, high grass, and areas with lots of leaf litter.Lyme disease most commonly presents with a rash around the bite, which can show up days to even a month after the bite, and is usually not painful. Any rash should be seen by a health provider, even if you feel fine at the time. Antibiotics are effective against Lyme disease and, unfortunately, many people who do not get treatment will develop later symptoms â€“ even months later â€“ that can be quite serious. References:www.maine.gov.cdcwww.cdc.gov/lyme/ www.ncbi.nlm.nih.gov www.lymediseaseassociation.org/
By Dr. Jonathan WoodApril 21-28 = National Infant Immunization WeekChildhood immunization is in the news. Childhood immunization is always in the news. Why? Because it is exceedingly important, likely the single most successful preventative health measure in the history of modern medicine. But also, it is newsworthy because we are still failing to achieve the kind of immunization coverage that an advanced industrialized nation ought to achieve. And why are we failing? â€¢ Sometimes there is a shortage, but that is an infrequent and minor impediment. â€¢ Sometimes cost enters into it, but that has all but been erased in Maine due to the fact that all childhood immunizations now are paid for by the state. â€¢ Sometimes physicians donâ€™t take advantage of immunizing children who need to â€œcatch upâ€ due to misunderstandings about when vaccines can or cannot be given, but that accounts for only a minimal number of the missing vaccines.So why? Myths! There have been genuine concerns about vaccine safety in the past and that has been discussed and re-discussed, researched and re-researched, settled and re-settled. The organizations who look after vaccine safety have been extremely diligent worldwide in evaluating these concerns. Conclusions: our vaccines are exceedingly safe and offer little or no risk, especially when compared with the advantage of preventing the horrible, even deadly diseases which the vaccines are directed towards.Beyond the vaccine safety concern, which I will not address in detail here because it has been done before, what are some concerns that people put forth?1. The vaccines arenâ€™t as effective as everyone says they are?Wrong! These vaccines are amazing and we all need to recognize the profound effect they have had on our society. Examples:â€¢ In 1964-1965, before rubella immunization in the U.S., an epidemic of rubella that resulted in an estimated 20,000 infants born with this disease. The result? 2,100 neonatal deaths. Of those that survived, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded. Due to the widespread use of rubella vaccine, only six cases were provisionally reported in the U.S. in 2000.â€¢ The number of hospitalizations and deaths due to chickenpox (yes, chickenpox!) has dropped more than 90% since its introduction in 1995.â€¢ In the 1980â€™s, the bacteria HIB caused over 20,000 cases of severe disease each year. It was the leading cause of pneumonia, meningitis, and epiglottitis, Most of these children were hospitalized and many died or experienced severe lifelong disability. Since the introduction of the HIB vaccine in the early 1990â€™s, the incidence of invasive HIB disease has decreased by greater than 99%. For those of us who experienced this horrible germ, this is astounding and a godsend!â€¢ The year before the measles vaccine was licensed, there were over 450,000 cases in the US. The death rate is anywhere from 3/1000 to 10/1000, with complication and hospitalization rates much higher. Within 4 years, the incidence was less than 10,000 cases/year. Currently, â€¢ What would we prevent over time if we completed routine immunization of one yearâ€™s worth of children in the US? Over 20 million cases of disease and 42,000 deaths would be prevented! And the money savedâ€¦? Over 13 billion dollars in direct health care costs!2. These diseases donâ€™t exist.Wrong! These diseases most certainly do exist, not only in underdeveloped countries but right here in the USA. And with international travel what it is today, even the less common diseases are increasingly likely to find their way into the US, where our under-immunized children will be at tremendous risk. Just a few examples:â€¢ Pertussis (whooping cough) outbreaks are increasingly more prevalent, including several each year in Maine. Over 21,000 cases of pertussis are diagnoses yearly in the US. A 2010 outbreak in California resulted in the deaths of 10 children.â€¢ Two internationally imported US outbreaks of mumps in 2006 and 2009/2010 resulted in more than 6500 and 3500 cases respectively. Although this is a large number of cases, it pales compared with the over 300,000 cases reported each year prior to immunization.â€¢ Worldwide every year, tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated. Thankfully, the number of reported US cases remains low due to immunization. That said, an increased number of tetanus cases in younger persons has recently been reported, a potentially dangerous trend.â€¢ There are an estimated 45 million cases of measles each year worldwide resulting in more than 800,000 deaths! An exceedingly infectious germ, this disease is easily transported and transmitted via air travel. The recent MMR vaccine â€œscareâ€ which caused decreasing immunization rates has resulted in increased outbreaks throughout the industrialized world.3. The number of vaccines is ridiculous, so many more than we had when we were kids.The number of vaccines has increased, but the purity of these vaccines is so improved and the manufacturing techniques are so advanced, that the actual number of antigens in 2012 is less than the number of antigens than in the 1990â€™s even though the number of diseases prevented has increased. Hard to imagine, but absolutely true!4. Vaccines will traumatize my infant and cause long-term psychological trauma.Childrenâ€™s long term memory has not developed by the time the majority of routine immunization has been completed. Parents may be traumatized, but children are not. There is no evidence to support this worry and it defies common sense. Do kids cry with their shots? Yes. Do toddlers cry when they fall down? Yes. Does either of these things scar them for life? Or even for the day? No! Pick them up, comfort them, and they will bounce back to baseline before you know it. If we were worried about infant psyche from traumatic experiences, we should be worried about their routinely crying when they are hungry or have a diaper rash. Or perhaps even when they pass through the birth canal, perhaps the most traumatic event any of us has ever experienced. All of these are unavoidable and none result in psychological damage. Your kid is very resilient!5. My childâ€™s immune system will be overwhelmed.NO! Wrong! Our immune system is challenged daily by a multitude of antigens. Our diet alone exposes children to many more antigens than immunization will ever do. In fact, it has been repeatedly shown that the introduction of multiple antigens (combined vaccines or multiple shots in one visit) actually increases the responsiveness of the immune system. Our immune system actually does better with multiple doses, not worse!Bottom line:â€¢ These diseases are really bad.â€¢ These diseases are still out thereâ€¦ big time!â€¢ You do not want your kid to have any of these diseases, so donâ€™t pick and choose.â€¢ Immunize your kids.â€¢ Immunize them as infants and young children – – o they will protected earlier, they wonâ€™t remember, and their immune system will like itâ€¢ Donâ€™t be swept up by myths that defy logic and countless years of data
By: Dr. Anthony NgWell spring is upon us and what is the best way to enjoy spring, being outdoors. Many are enjoying the outdoors by bicycling, especially children. As much as it is great fun and great way to have children participate in exercise, this is also an important time for parents to ensure that their children learn bike safety. According to the National Highway Traffic Safety Administration, 618 lives were lost from bicycle accidents in 2010 and this rate has been rising over the past several years. In 2008, 13 percent of those killed were under 16 years old. Each year, close to 500,000 people visit emergency room as a result of bike related injuries. More children between 5 and 14 years old visit the emergency room for bike related injuries than any other sports, with many of these visits due to head injuries. The most important safety tip that parent can teach their children is to wear helmets. Helmets should be worn even by children who may only be biking a very short distance or in the driveway, as this will get children to start practicing bike safety skills. Bicycle helmets should be properly fitted to the childâ€™s head yet comfortable enough for the child to wear. The size of the helmet should be considered, as well as position. A bright color helmet may be more visible to others than a darker color helmet. Parent should buy a new helmet that has been tested and meets the uniform safety standard issued by the U.S. Consumer Product Safety Commission (CPSC). Helmet should be replaced if the child has outgrown it, if the helmet has been involved in a crash or has been damaged. Parents when riding with children should also wear helmets as that will be good role modeling for their children. Remember, it is the law in Maine that any one under 16 years old riding a bicycle must have a helmet. In addition to bicycle helmets, parents should make sure the bicycle is adjusted to fit the child, not too big and not too small for the rider. The equipment should be checked including tires being properly inflated and not worn. The bicycle should also be visible to other riders. This includes the use of reflectors and lights. Children should also be wearing bright color clothing, including fluorescent neon to enhance visibility. Children should be taught to control their bikes, which include having their hands on the handle bars. When riding, children should be mindful of hazards such as potholes, rocks, broken glass, gravel, puddles, tree branches and sticks, leaves, and dogs and other animals. All these hazards can cause a crash. Teach children that when riding with friends, one person can take the lead, yell out and point to the hazard to alert the riders behind him. Avoid riding at night as it is more difficult to see the hazards or for cars to see the rider. Parents should not let children ride in active roadways and young children should be supervised. Placing safety signs by your home to alert motorists that young children may be riding near there may be helpful. For older children, they should still try to avoid very active roadways and to ride on the right of the roadway and always going with the flow of traffic, not against it. Children should watch out for parked cars and should be taught to obey traffic laws, including traffic lights and stop signs. Parents should teach children to yield to traffic and pedestrians. Teach children to use hand signals when turning. Reckless behaviors such as racing in roadways or when there are other pedestrians and riders present should be discouraged. Avoid distractions such as using headphone for music or talking or texting on cell phones as these distractions can increase risks of accidents. Bicycling is a great way to enjoy the outdoors in the spring. It is even better when families can bike with safety in mind. Remember, teaching kids good and safe bike riding habits will help ensure that they will continue to do so as adults.Bicycle Crash Facts. Accessed 4/20/2012. http://www.bicyclinginfo.org/facts/crash-facts.cfmBicycle Safety. Accessed 4/20/2012. http://www.maine.gov/dps/bhs/bicycle-safety.htmlKids and Bicycle Safety. Accessed 4/20/2012 http://www.nhtsa.gov/people/injury/pedbimot/bike/kidsandbikesafetyweb/index.htm
Taking Care of Both Mom and the Baby: Recognizing and Treating Post-Partum DepressionDr. David Prescott â€“ Eastern Maine Medical Center Behavioral Medicine ServiceOne in Six New Mothers have at least Mild Depression: Increasingly, post-partum depression, (depression which occurs within 3-4 months after birth) is recognized as a relatively frequent occurrence that benefits from early recognition and treatment. Just under 1 in 6 women will experience some type of significant depression after giving birth. In some cases these feelings resolve by themselves, often with support from family and friends. However, if left untreated, symptoms of depression can persist for up to a year. Where is the Line Between â€˜Baby Bluesâ€™ and Clinical Depression? Probably the two most important factors in differentiating major depression from â€˜baby bluesâ€™ are the length of time a new mother feels depressed and the intensity of the depression. The benchmark for diagnosing major depression is 2 weeks of persistent depressed or irritable mood. In addition to feeling sad, depressed, or irritable, other symptoms of major depression include: â€¢ Crying frequentlyâ€¢ Feeling hopeless, guilty, and overwhelmedâ€¢ Having trouble focusing or making decisions. â€¢ Withdrawing from friends and family.â€¢ Loss of appetiteâ€¢ Disrupted Sleep or Excessive SleepPost-Partum Psychosis: A less frequent but more severe problem: In rare cases, usually within the first two weeks after giving birth, a woman experiences frequent confusion or disorientation (not knowing where you are or what day it is), hallucinations, or extreme fear and paranoia. This may indicate the presence of post-partum psychosis and warrants immediate attention from a mental health professional or primary care doctor. What Causes Post-Partum Depression? Child birth, while usually very exciting, is also an event which includes most of the major risk factors for depression. Contributing factors include: â€¢ Previous History of Depression: Women who have had previous episodes of major depression are at increased risk for post-partum depression. â€¢ Hormone Changes: The usual post-pregnancy decrease in estrogen and progesterone, as well as a decrease in hormones produced by the thyroid gland, are thought to strongly contribute to risk for post-partum depression. â€¢ Changes in Brain Chemistry: Researchers suspect that pregnancy and childbirth may alter brain chemicals involved in the onset of depression. â€¢ Stressful Life Events: Significant life events, both positive and negative, increase the risk for an episode of major depression. Assessment and Treatment for Post-Partum Depression: Family and friends can provide important help in providing emotional support and caretaking support for new mothers who are struggling with depression. They can also encourage mothers who seem depressed to talk with their doctor or a mental health professional. â€¢ Reducing Isolation: Most mothers, whether depressed or not, find that spending time with other new mothers helps improve their mood and get tips for coping with motherhood. â€¢ Counseling: Simply talking about the adjustments associated with parenthood and the feelings that develop after childbirth usually results in improved mood. Often counselors can make concrete suggestions about a few small steps that will help reverse depression. â€¢ Medications: There are many medications that help with depression or anxiety that can be prescribed by your primary care doctor or a psychiatrist. For More Information: Mayo Clinic Web Site: www.mayoclinic.com/health/postpartum-depression/DS00546American Psychological Association: www.apa.orgNational Institute of Mental Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/
WABI TV5 Healthy Living March 27, 2012By: Dr. Joan Pellegrini A NEW INVESTIGATIONAL DRUG FOR BRAIN INJURED PATIENTSBrain injury is very difficult to treat because there are no effective medications. When someone suffers a serious brain injury the only options for the medical team is to support them through the healing process. Sometimes a neurosurgeon may offer surgery to drain blood or remove part of the brain. However, even after surgery there is only supportive care. Over the past few decades there have been several studies looking at various medications that may improve outcomes from brain injury. Unfortunately the results have not been promising.Physicians who care for these patients noticed many years ago that women tended to have better outcomes. The first study on this involved rats. Male and female rats were subjected to a traumatic brain injury and the female rats had better outcomes (they measured outcome using mazes and testing the ratsâ€™ ability to navigate the maze). It was hypothesized that it might be the female hormones that were helping the brain heal. So, the next study looked at â€œpseudo-pregnantâ€ rats and these rats did even better in functional outcome. More studies were done that led to the hypothesis that it was progesterone that was acting as a â€œneuro-steroidâ€ or as a neuro-protective hormone enabling better healing and functional outcomes.BHR Pharma is a Belgian company that specializes in producing medications that contain progesterone. There have been phase 1 and 2 studies done that give progesterone to brain injured patients. These initial studies have had promising results. In fact, it seems that not only do less patients die but the ones that survive have better functional outcomes. The results are promising enough that the FDA gave BHR permission to conduct a large phase 3 trial. This trial is a randomized, placebo-controlled, double-blinded study that is looking to enroll over 1100 patients internationally. This type of study is considered to be the most rigorous for testing a hypothesis. EMMC is one of the study sites.This is how the study works: when a patient suffers a serious head injury they are almost always transferred to the nearest trauma center (which is EMMC for this part of the state). The emergency personnel and trauma physicians will give all of the standard care that the patient needs. Part of the evaluation always includes a CT scan of the head. If this confirms the presence of a serious head injury and the patient is in a coma, then the patient may be a candidate for the study and the family may be approached and asked for their consent. The study requires that each patient be randomly assigned to either the â€œplaceboâ€ group or the â€œtest drugâ€ group. The drug is a high dose five day infusion of progesterone. All of the other standard treatments and supportive care are still given to the patient. The patient then comes back to EMMC at 3 months and 6 months for a lengthy questionnaire about how well they are doing and whether there is anything they cannot do that they could do before their injury.There are a few things that make it difficult to do this study. First, in order to have the most impact on brain injury, any treatment must be given as soon as possible. For this particular study, the study drug must be given to the patient no later than 8 hours after injury. Also, the next of kin must be present at the hospital in order to give consent to be enrolled in the study.This study is still enrolling patients and will not be closed for another year or so. Therefore, it will be at least another two years before the data is published. It is my hope and the hope of the medical community that this drug turns out to be effective. If so, this would be the first promising new treatment for brain injury.
By Dr. Jonathan WoodSteering Your Way Through Hospitalization(Beware – – potentially rough waters ahead!)Being admitted to the hospital is often scary and traumaticâ€¦ for the patient and for the patientâ€™s family as well.Being critically ill, needing invasive procedures or having a hospitalized child all accentuate this feeling. The medical lingo is difficult to understand, the issues discussed often carry great importance, and there are often unanswered questions. Whatâ€™s more, caretakers often seem to be overworked or in a hurry. Arrgghhhh!And then money is invariably an issue: missed work, inadequate insurance, childcare needs, day-to-day living away from home, etc. More stress.In the end, many people report a sense of â€œloss of controlâ€. What can be done?While I cannot offer a fix for the sometime beleaguered state of modern medicine, I will suggest one central thing that can help with all the above: improved communication. And much of it is within your control.Some suggestions:â€¢ Learn the system (i.e. who are all these people?)Hospitals depend upon a complex system of personnel that is often very confusing and very difficult to understand. Examples:o Primary Care docs (e.g. Internist, Family Practitioner, Pediatrician)o Inpatient Specialists (e.g. Hospitalist, Intensivist)o Specialists (e.g. Surgeon, Psychiatrist, OB-Gyn)o Sub-Specialists (e.g. Cardiologist, Neurologist, Orthopedic surgeon)o Midlevel Providers (e.g. Nurse Practitioner, Physician Assistant)o Nurses (e.g. bedside nurse, charge nurse)o Ancillary Personnel (e.g. Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutritionists, Social Workers, Care Managers)o Trainees (e.g. residents, nursing students, medical students)â€¢ Ask questionso Who are you? Insist that people introduce themselves and explain their role in your care. Where do they fit in the lists above?o Why are we doing this? Insist on understanding why tests are being done and what is going to happen with the information.o May I speak with my doctor? Ideally there is one doctor orchestrating all of your care. Ideally there is excellent communication between doctors and amongst all the participants in the care team. Insist on a team and a good leader.â€¢ Tell your caretakers your worries â€“ donâ€™t be afraid to tell people what concerns you or what would make you more comfortable. Nothing is off limits!â€¢ Leave your biases at homeo Believe in the system â€“ Much of believing is understanding. Work to understand the system (see above) and increased confidence will follow. o Donâ€™t worry about offending â€“ Doctors are people – – you can talk to them like you talk to anyone. Sometimes people feel intimidated, but it is important to move beyond this. Be yourself. Remember: you are the consumer. Be polite and expect the same in return.o Gender â€“ The days of female nurses and male doctors are long over. Do not make assumptions based on gender and treat all your caretakers with respect. Insist on the same in return.o Teaching Hospitals â€“ Much of the best care in the US is delivered in teaching hospitals. No one is experimenting on you. On the contrary, these are often very concerned, very smart, and often less busy students or residents who can be very helpful in you quest for quality healthcare. Take advantage of the opportunity!o Culture Differences â€“ Maine attracts caregivers from all cultures. These people are invariably well trained and very caring. Treat them with respect and expect the same in reverse. If accents are difficult to understand, be frank, polite, and patient.â€¢ Know what is expected of you and your family when you are dischargedo Ask questionso Get to know your â€œcare managerâ€ or â€œdischarge plannerâ€o Be sure you understand your medications and doses (including changes from when your arrived)o Have instructions repeated as many times as it take to understando Know who you need to see after leaving and where and when.While these suggestions wonâ€™t make being hospitalized fun, they may take some of the unnecessary fear and anxiety out of the process. In the end, remember… communication is the key!