By- Dr. Joan Marie PellegriniBecause I am a surgeon, I often have to talk to my patients about managing pain both before and after surgery. As such, I discuss using over the counter (OTC) pain medications with my patients. Many of my patients are confused about how to use the medications and what are the side effects. I also find that many of them think that Tylenol and Motrin are the same. Acetaminophen: This is also known by its trade name as Tylenol. It is sold as just acetaminophen but can also be found in many other OTC medications such as cold/flu remedies and arthritis medications. It is commonly combined with a narcotic as a prescription medication (such as Percocet, Vicodin, etc). It is extremely important to know if your medication has acetaminophen in it and how much is in it because of the risk of taking too much. The maximum dose is 4000 mg a day. The usual dose for an adult is 325-650 mg every 4 hours. Taking too much can lead to severe liver damage. It is not known exactly how this medication works to reduce pain and fever. It can be safely combined with anti-inflammatories and narcotics. It does not usually affect kidney function nor does it cause hypertension often. Also, it does not cause bleeding and is safe to use if you are on blood thinners.Ibuprofen: This is often known by the trade name Motrin. It is an anti-inflammatory and is in the class of medications known as NSAIDs (non-steroidal anti-inflammatory drugs). Other medications in this class are aspirin, Naprosyn (also known as Aleve), and meloxicam (prescription only). Like acetaminophen, there are many different brands of the same medication in the pharmacy and therefore it is important to read the ingredients to know what is in the medication. NSAIDs can cause hypertension, fluid retention, and bleeding disorders. They also can affect the kidney and should not be used in people with kidney disease or on blood thinners. Long-term high dose use of NSAIDs can damage the liver. Ibuprofen has a maximal adult dose of 2400 mg a day. Almost all OTC ibuprofen tablets come as 200 mg. Therefore, the maximum dose is 2 pills (400 mg) every 4 hours, 3 pills (600 mg) every 6 hours, or 4 pills (800 mg) every 8 hours. The prescription strength of 800 mg is just one pill that acts the same as taking 4 pills of the OTC brand. Since aspirin, ibuprofen, and Naprosyn are in the same class these medications should not be combined.If the patient is healthy and on no medications, then a combination of acetaminophen and ibuprofen may be quite effective for pain control. When you talk to your doctor about your pain medication, make sure you write down exactly what you are taking. Also make sure you write down whether you can take acetaminophen or ibuprofen or both and how much your doctor recommends. Neither of these medications causes the side effects that are common with narcotics such as constipation, sleepiness, respiratory depression, or addiction.
By- Dr. David PrescottLack of Willpower is the Number One Barrier to Positive Health Behavior Change: Many people can identify changes in their behavior which would improve their health or mental health. For example, getting support from others rather than staying isolated can help reduce depression. Improving poor eating habits can lower cholesterol or improve your diabetes. Reducing excessive alcohol use will result in better overall health. However, the number one barrier cited by Americans to making positive behavior change is lack of self-discipline. Self-discipline is not entirely pre-determined at birth. By focusing on certain key factors, you can improve your own willpower and self-discipline. The Marshmallow Experiment: Delay of Gratification Really Does Pay Off: Researchers at Columbia University wanted to study how early children can begin to delay gratification, which is a key component of self-discipline. They offered 4-year olds a treat (a single marshmallow) immediately, or told them that if they could wait a few minutes, they would get more than one marshmallow. But more importantly, they kept track of these 4-year olds until they were teenagers. Those teenagers who had been most able to delay gratification had, on average, higher SAT scores, better ability to handle stress, and better ability to plan. Research Supports the Idea that Willpower Wears Down: As people try to change unhealthy behaviors, they often report that the make an initial change, for example not smoking, but that over time stress wears them down. Psychology research actually suggests that this is true! One key to maintaining a healthy behavior is to try to strengthen your willpower. Tips for Building Up Your Willpower: Â· Avoid temptations. In the marshmallow study described above, children who stared at the treat were less likely to resist it than those who closed their eyes, turned away or distracted themselves. “Out of sight, out of mind” works when you’re studying, too. When you need to focus, turn off your phone, sign out of email and eliminate any other distractions from your environment.Â· Make a plan. Having a plan in place may help you resist temptations without having to draw on your willpower, research www.tandfonline.com/doi/abs/10.1080/01443410.2010.506003 suggests. Decide ahead of time how you will react to situations that are likely to foil your resolve. If you need to spend the weekend studying, for example, you might tell yourself, “If someone invites me out, I’ll suggest a Sunday night outing as a reward for studying.”Â· Think you can. How you think about willpower itself is also important. In one study pss.sagepub.com/content/21/11/1686 , researchers found that people who think willpower is a limited resource are more likely to have willpower problems than those who don’t think of it as easily exhausted.Â· Fuel your willpower. Your brain runs on glucose, or blood sugar. But exerting self-control can leave brain cells consuming glucose at a fast pace. Feeding your brain may help restore your willpower, research www.ncbi.nlm.nih.gov/pubmed/17279852 suggests. Eating regular meals can keep your blood-sugar levels on an even keel and may help refuel your run-down willpower.Â· Focus on one goal at a time. The evidence suggests that making a list of New Year’s resolutions isn’t a great idea. That’s because having your willpower become depleted in one realm may reduce willpower in other realms. Instead of trying to adopt better study habits, exercise more and quit smoking all at the same time, take your goals one by one. Once a good habit becomes routine, you no longer need to draw as much on your willpower to maintain it.FOR MORE INFORMATION: American Psychological Association: www.apa.org/helpcenter
Using the Holiday to Reinforce Year-Round Health and Safety HabitsBy- Dr. Jonathan WoodThis year, consider using Halloween as an opportunity to discuss a number of global health and safety issues with your children. Yes, several pointed issues certainly all apply to the day itself. But this is also an opportunity to reinforce with your kids that the lessons of Halloween are worth applying to their lives every day of the year.Dental HealthCavities develop as a result of carbohydrates (sugars) and the associated acids produced bathing the teeth. The total time and frequency of exposure is the key, not necessarily the amount of sugar. The acids remain in the mouth for approx 20 min after a snack or meal. This knowledge supports a number of healthy habits, Halloween-related or not:Â· Candies or foods that bath the mouth for long periods (lollipops, dense sticky candies, etc) engender the greatest riskÂ· Eating at proscribed meal and snack times, rather than “grazing”, will result in a healthier dental environmentÂ· Timing your Halloween candy consumption to around meals will reduce the associated risk of cavitiesÂ· Suggesting that kids eat little bits at a time and spread their candy consumption out over time will paradoxically increase their cavity riskEvening and Nighttime SafetyAs your kids prepare to wander the neighborhoods this year, use the holiday to remind them about pedestrian safety. It is especially important to stress that the driver visibility is at its worst during dusk, the time when many trick-or-treaters are out and about.Â· Help your children choose costumes that offer adequate vision and mobilityÂ· Consider reflective costumes or at least adding some stick-on reflector materialÂ· Flashlights! One hand for the candy bag, one hand for the flashlightâ€¦!Â· Review basic road crossing safety and stress the fact that these principles apply year ’roundÂ· Use sidewalks whenever possible.Food AllergiesFor kids with food allergies, Halloween is a good time to review some of the principles of awareness and avoidance. Â· Teach label reading to confirm that ingredients are acceptableÂ· Use the time to review the signs and symptoms of allergic reactions due to inadvertent exposureÂ· Be aware that “trick-or-treat” size candies occasionally do not contain the exact same ingredients as the full size versionGeneral Healthy Behaviors and Global Safety Issues Â· With wood stoves fired up and with Jack-o-lanterns on porches, Halloween offers a context for reviewing fire safety. Also, consider fire safety when choosing costumes.Â· Carving pumpkins offers a setting in which to review knife safety with small children and adolescents alike.Â· Use Halloween to gently review stranger safety. Use the trick-or-treating experience to reinforce simple things like not getting in cars with strangers and not going into strangers’ homes unaccompanied. Halloween can be used to emphasize that most people are good people with good intentions, but that this doesn’t negate the value of prudence and being careful.Â· Use Halloween to talk about peer pressure and mob mentality. For example, reinforce the difference between “tricks” and vandalism. Especially with older kids and adolescents, Halloween can offer an environment for trouble making. Prepare your kids with the means to identify and avoid inappropriate situations. Offering “scripts” for extracting themselves can be very helpful. Most important, discuss simple common sense with your kids. Nothing will serve them better than that! So, arm those kids with essential Halloween equipment (safe costume, good shoes, candy receptacle, flashlight, cell phone) and some common sense. They’ll have fun, learn some things along the way, and have plenty of year ’round good.
By: Dr. Anthony NgFor those who have had shingles before, it is a very painful and uncomfortable experience. There are many others who have yet to have it and may wonder what it is and what can one do about it. Herpes Zoster, or more commonly known as shingles, is essentially a reactivated viral infection caused by Varicella Zoster. This is the same virus that causes chicken pox. It usually happens to 2 in every 10 people in their lifetimes. Shingles is a painful blistering illness that while it can occur in anyone with a history of chicken pox, it is more likely to occur in individuals over 60 years old. A person, adult or child with no history of having chicken pox or having received the chicken pox vaccine, can contract chicken pox if they come into contact with the shingles rashes when there are vesicles in the skin. Shingles often starts with one sided pain and unusual feelings such as tingling, pins and needles like, numbing and even burning. They may start in one spot and then spread to other areas that are covered by a particular nerve. The pain and numbing can be extremely painful and they usually precede the appearance of any skin rashes. The rashes usually start as reddish patches and then progress to small blisters, sometimes even looking like pimples. The blisters can break. They may have some wetness to them and forming small sores. These sores will dry and crust over, sometimes remaining for 2 to 3 weeks. Shingle rashes may affect a narrow area from the spine to the front of the belly or chest. They can also appear on the face, near the mouth, eyes and ears. Additional symptoms of shingles may include abdominal pain, fever and chills, headaches and swollen glands. If the rash affects the face, there may also be muscle weakness such as drooping eyelids, loss of eye motion and taste problems. The diagnosis of shingles is often done from history and a physical exam by your health care provider. Blood test is rarely needed. Seeking treatment early is the best way to deal with an outbreak of shingles. If one notices possible signs of shingles, they should contact their health provider immediately. The earlier treatment is initiated, such as within 72 hours of outbreak of symptoms, the sooner the symptoms will remit with less discomfort and less risk of complications. Treatment likely would include being prescribed a course of oral antiviral medication, such as acyclovir, famciclovir and valacyclovir, lasting about a week. Sometimes low dose steroids may be prescribed to help lessen the swelling and pain. Over the counter medications in general can help with most discomfort of shingles. Cool compresses can help relieve some of the skin discomfort. An important consideration when one has shingles is to avoid contacting others with no history of chicken pox or vaccine and more importantly, when there is oozing from the blisters of a shingles rash. Someone with shingles should also avoid any contact with pregnant women.It is important to not scratch the rashes as they may worsen the sores. Keep any open sores clean to prevent bacterial infection. If shingles rashes affect the face and eyes, an eye exam by an ophthalmologist may be needed to make sure the virus does not affect the eye. Untreated virus in the eye can potentially lead to blindness. Most shingles resolve by 2 to 3 weeks but some residue nerve discomfort may persist. Shingles can recur but for many, it usually does not. For some, a condition called postherpetic neuralgia may develop. This is when the nerve that was affected has been damaged. This postherpetic neuralgia is pain in the area where the shingles occur and can last for months and even years. This is more likely to occur in individuals over 60 years old. It is unclear what would cause someone to have a shingles outbreak. Injuries, being older than 50 years old, recent medication, illness or stress have all been implicated as reasons for a person have an outbreak of shingles. There is a shingles vaccine which is currently approved for people over 50 years old, though CDC is recommending those over 60 years old receiving the vaccine. This is not the same as a chickenpox vaccine as it is more potent. Side effects for this vaccine may include redness and tenderness at injection site, swelling and headaches. Not all insurance would cover this vaccine so one would need to check with their insurance carrier prior to getting the vaccine. With the shingles vaccine, it lessens the risk of developing shingles or decreases its severity and chances of complications if one does develop shingles. The vaccine offers protection for about 6 years. Shingles is a viral condition that can be very painful and uncomfortable and with potentially serious complications. However, early recognition and treatment will often lead to minimal long term effects. References:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001861/ Accessed Oct 16,2012.Resources:CDC: http://www.cdc.gov/shingles/index.htmlMayo Clinic: http://www.mayoclinic.com/health/shingles/DS00098
By- Dr. Joan Marie PellegriniHardly a week goes by that we do not read about some part of Maine’s narcotic problem. This is a really complex problem. As a surgeon, I prescribe narcotics frequently. The vast majority of patients use as little narcotic as possible. However, there are a few patients who require much longer pain management and may even live with chronic pain. I have noticed that most patients are rather uneducated about non-narcotic options for pain control.The goal of pain management is to reduce the pain enough to allow us to function properly. The goal is not necessarily to completely get rid of all pain. Also, if the pain is due to an acute injury or event, then we need to understand that our expectations should be different during the early course of healing versus the end of the healing phase. Narcotics are certainly quite effective for controlling pain. However, this effectiveness is not without consequences. Narcotics cause drowsiness, slowed motor control, decreased balance, potential for addiction, constipation, difficulty urinating, and respiratory depression. In short, narcotics are a very dangerous class of drugs.There are non-narcotic drugs such as acetaminophen, NSAIDs, tramadol, anti-depressants, anti-convulsants, etc. Acetaminophen is quite safe as long as one does not have liver disease and is careful not to exceed the maximum dose. NSAIDs are anti-inflammatories that are most useful for acute pain and inflammatory disorders. They also are useful as an adjunct to other therapies. They can be dangerous though in that they can cause bleeding, hypertension, kidney disease, fluid retention, stomach damage, and other potentially serious side effects.I have compiled a list of non-pharmacologic techniques for reducing pain. Many of these ideas came from an article that you can access on WebMD.â€¢Exercise: it is a catch-22. Pain makes us not want to move yet inactivity worsens pain. If you live with chronic pain, this becomes exceedingly important. It may not be anything more that gentle yoga excises or walking or swimming. The most important aspect is to move all the joints and muscles and maintain good balance. You may need to start with a physical therapist or personal trainer.â€¢Breathing and relaxation: get into a comfortable position and concentrate on slow, deep breaths. You may even use imagery or soothing tapes of various sounds (ocean, rain, music, etc). Focus on muscle relaxation and not on the pain or the day’s stresses.â€¢Avoid alcohol: alcohol can have a relaxing effect and makes us feel good. However, it will also interfere with sleep. Our sleep is less deep and we can wake up more frequently.â€¢Quit smoking: the chemicals in tobacco will slow healing and will reduce blood supply to an injured area.â€¢Eat healthy. Whole grains, fruit, and vegetables provide many disease fighting nutrients. Over time, our bodies will be able heal chronically injured areas.â€¢Journal: keep track of your level of pain, what activities you did during the day, foods you ate, and level/type of stress. Your doctor may be able to help you learn what some of the triggers are for your pain.â€¢Find a distraction: anything to take your mind off of the pain. Take a class, help a neighbor, find a project.â€¢Accupuncture: this is becoming more accepted and the good news is that because of this, there may be a specialist near you.â€¢Find a massage therapist who does myofascial release. I personally find this very helpful. Unfortunately, it can be painful when it is being done and it is a bit expensive (it is generally not covered by insurance).â€¢Find a sauna/ steam room/ hot tub that you may use. Whole body heat will loosen joints and muscles and make stretching more effective.â€¢Investigate if you have depression and treat it. Depression can cause pain and will certainly worsen any pre-existing pain.â€¢Try singing: this will also help with breathing exercises and relaxation. Along this same line is dancing which helps with movement and balance.â€¢Biofeedback: this is started with an instructor who measures a muscle’s level of tension. The patient then is taught various relaxation techniques and can see the results of the muscle relaxing.â€¢Invasive pain management: a pain specialist may inject certain ares. There are also stimulators that can be implanted. These specialists have many other techniques they may use.â€¢Get a pet: not just any pet. Studies show that petting a cat or dog will lower our blood pressure and our pain level. They also distract us.
TV5 Health Advisor Dr. Erik Steele joined Jim Morris on TV5 News at 5 to talk about meningitis, bacterial meningitis and prevention.
By- Dr. David PrescottSuicide Prevention Efforts Highlighted by U.S. Army: Last week, the United States Army conducted a suicide prevention stand down to focus its efforts on promoting good health, reducing the risk of suicide, and training soldiers in resilience. As has been publicized and acknowledged by the Army, 120 deaths by suicide have occurred in 2012, with another 67 under investigation. Family, Friends and Colleagues are Often the Gateway to Help: One interesting fact was highlighted in the Army’s careful attention to this problem. In the majority of cases where a person considering suicide was identified and helped, the person at risk first talked to a friend, colleague, or family member. Friends and families were able to assist the person considering suicide in obtaining professional help. Thus, early recognition by non-professionals appears to be a critical link in preventing suicides. Suicide Prevention in Maine: In the last year that data are available (2009), Maine had a rate of 15.4 suicides per 100,000 people each year, which is above the national average of 13.7. Maine’s Department of Health and Human Services has put significant effort into suicide prevention in general and youth suicide prevention in particular. Information is available at http://maine.gov/suicide.Possible Warning Signs of Suicide: There is no sure way to predict who is at highest risk for suicide. But, some frequent signs include: Â· Change in Mood or Behavior: Significant changes in a person’s mood or behavior may signify a broader psychological problem. Depression is the mood change most closely associated with suicide. Changes like this shouldn’t be ignored, but should be talked about, preferably with a counselor or mental health professional.Â· Talking about suicide or death: Most people who attempt suicide have talked about it. Becoming preoccupied with suicide or death is often a warning sign of increased risk. Â· Loss, breakup, or high stress event: One factor which increases risk for suicide is a significant loss, such as a relationship breakup. Or, a high stress event such as not getting into a preferred college, bad grades, or trouble with the law is often associated with an increase in thought of suicide. Â· Substance use: Using alcohol or drugs impairs judgment and decision making. Many suicides occur while people are using, or have recently been using such substances. Steps to Take: Talk about suicide, or any of the warning signs, should be taken seriously and brought to a mental health professional. Some steps to keep in mind include: If someone talks about suicide, help them find professional assistance: Counseling and psychotherapy can help work through a moment of crisis, but also resolve some of the problems which contribute to increased risk for suicide. Reduce or eliminate substance use: One step in reducing risk for suicide is to reduce use of alcohol or other substances. Take away ready access to weapons or pills: Families are often asked to help by removing weapons or pills from ready access. In many cases, not having a means available helps the person think the problem through in a different way. Find hope: One key to resolving preoccupation with suicide is to help a person find hope. Often, friends and family can help people keep a sense of realistic hope while problems are worked through. Adult Crisis Line: 1-888-568-1112Youth Crisis Line: 1-800-499-9130Maine Youth Suicide Prevention: http://maine.gov/suicideNational Suicide Prevention Hotline: 1-800-273-TALK (8255)
Psychotherapy is a relationship between a mental health professional and a client that involves talking about problems and concerns in a specific way. Based on scientific research about how to best help people deal with problems like depression, stress, or anger, psychotherapy provides effective long term benefit to over 75% of people who complete a relatively small number of sessions. Most people feel better in as few as 6-12 sessions. How Do I Know if I would be Helped by Psychotherapy? One important question to ask yourself if you are considering starting psychotherapy, is whether problems in your life have gotten better on their own, or through the help of family or friends. If not, for example if you have felt depressed or helpless for several weeks or months, or if you worry so much that you have trouble concentrating on things other than your problems, you would probably benefit from psychotherapy. Myths about Psychotherapy: Many people have inaccurate beliefs about what occurs in psychotherapy, and about its potential benefits. Common myths include: Â· Myth: Psychotherapy is no different from talking with friends: Professional mental health counselors, like psychologists, have learned what types of relationships and what types of self-understanding lead to long term changes that make us feel better. Support from friends is important, but psychotherapy focuses on specific patterns of thinking and behaving that often need to be changed. Â· Myth: Being in Psychotherapy Means that I am Crazy: About 1 in 5 people have a diagnosable mental health problem. Most of these people are not “crazy.” In fact, mental health problems are relatively common. Â· Myth: Psychotherapy is Nothing More than Blowing Off Steam: While being able to talk freely is an important part of psychotherapy, effective treatment is more than just venting. Psychologists and other psychotherapists listen for certain styles of thinking and behaving which actually perpetuate many of our problems. By helping you find alternative ways of thinking and acting, you will begin to improve your mental, and often your physical health. What Happens in Psychotherapy? Most people are quite nervous and more than a little apprehensive before their first meeting with a psychologist or other psychotherapist. What is said when you meet with a psychotherapist is confidential, unless you give permission for your therapist to talk to someone else, like your primary care doctor, about your treatment. Usually, people meet with their therapist once a week, or once every other week, until they begin to make progress. Typical topics during the first few visits include: Â· Telling the Psychotherapist What Brought You Here at This Time: Most people start psychotherapy when they are having particularly difficult struggles. It will be important for your therapist to understand what makes this time so challenging. Â· What Do You Hope to Gain from Psychotherapy? Psychotherapy works best when the therapist and client mutually agree on the goals. You will have an opportunity to tell your therapist what you hope psychotherapy can do for you. Â· Patience and Focus on Lasting Change: One of the primary benefits of psychotherapy is that the changes you make tend to last even after therapy starts. This may make the entire process slower than you wish, but the benefit is that changes in self-understanding, behavior, and attitudes can last a lifetime. For more information:Understanding Psychotherapy and How It Works: http://www.apa.org/helpcenter/understanding-psychotherapy.aspxVideo Clips on Psychotherapy: http://www.apa.org/helpcenter/psychotherapy-works.aspx
By- Dr. Joan Marie PellegriniYou’ve seen those cute little colorful bottles near the cash register. The most popular “shot” is “5 Hour Energy”. If you look at the ingredients there is a listing of B vitamins and then a “proprietary” blend of supplements which includes caffeine. Most of the energy drinks (think Redbull) and “shots” have a mixture of vitamins and a “proprietary blend”. The common ingredient however is caffeine. None of the drinks tell you how much caffeine.Caffeine is a real part of our culture. It helps with alertness, it wakes us up in the morning, it puts us in a good mood, and it enhances our performance athletically. Just one small cup of coffee can give a boost of alertness that will last up to 5 hours. For some people they may stay more alert for up to 12 hours. There may not always be a good cup of coffee available. Or, perhaps, maybe you do not like the taste of coffee. For this reason there are energy drinks (typically 8 ounces or more) or shots (1-2 ounces). The drinks are mostly a sugary concoction that gives energy in the source of sugar with a bit of caffeine on top. There is no danger to these drinks except that some have a fairly large amount of calories. The shots have the benefit of few calories and they are quite portable (can easily fit in a pocket or purse). Because they are meant to be consumed as a shot, there is no need for refrigeration (thus making them even more convenient).All of these drinks contain a variable mixture of vitamins and it is unlikely that the vitamins will give any energy. It is also unlikely there will be any harm though. You would have to drink a lot of these drinks in order to have toxic levels of the vitamins. The dangerous ingredient is the caffeine. Too much caffeine can cause high blood pressure, a fast pulse, headache, stomach ache, and shakiness. If you drink only one of these drinks at a time then there is really no danger.It is very difficult to how much caffeine you are getting in any of these drinks. It is also nearly impossible to know how much caffeine is in any coffee that you may make or buy. Therefore, if you drink coffee and you drink energy drinks, you risk getting an overdose of caffeine. So, although energy drinks are safe they become unsafe if they contribute to caffeine overdose. How much caffeine is needed for an overdose is also difficult to predict. There are genetic factors, tolerance (people who drink caffeine become accustomed to it), and differences in metabolism.Children should not be given energy drinks. Contrary to a popular myth, caffeine does not stunt growth. However, children should avoid caffeine because of the negative side effects that most of them experience. They may become anxious or inattentive in school. They are more likely to have difficulties sleeping and studying. People who do not usually drink coffee (or other caffeinated drinks) should probably avoid these drinks. People who have heart problems and are on medications should also avoid these drinks.I do not believe there should be any concern if you consume an energy drink on occasion. However, if you feel you need an energy drink or shot several times a day then you should evaluate why that is. Do you need to change your sleep habits? Decrease stress? Exercise more? Cut out caffeine completely? Drink less alcohol?
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