Why do you get a beer belly when you drink beer?By- Dr. Joan Marie PellegriniThere is nothing particularly special about beer that makes it cause a beer belly. A â€œbeer bellyâ€ is nothing more than just being overweight. Any type of extra calories will lead to a beer belly although it does seem that alcohol has a tendency to cause fat to accumulate around the midsection. Most people donâ€™t seem to notice the calories in a drink as much as they notice what they eat. A couple of beers will run you on average about 300 calories. But some beers can have as much as 200-300 calories per serving. Now add in the munchies that go along with a beer and you could easily be up to 600 calories or more. That is a dangerous trend when the caloric need of an average sedentary adult is only 2000 calories or less. In general, it takes an extra 3500 calories to store a pound of fat. If you eat your necessary calories each day and then add only one beer (average 150 calories) a day for a year, you will add 15 pounds to your waist if you donâ€™t offset with exercise. A â€œlightâ€ beer has less alcohol and therefore has less calories. However, even a light beer has about 75 calories. All beers have â€œemptyâ€ calories. This is a term that nutritionists use to label a food that does not offer any nutritional benefit such as protein, fiber, or minerals and vitamins.Men are more likely to get the â€œbeer bellyâ€ look because of the way they distribute fat. Men tend to put fat inside their abdomen whereas women are more likely to put fat under their skin. Strong abdominal muscles can help a man â€œsuck inâ€ the abdomen and hide the extra fat that is being stored inside. A beer belly will also become more noticeable as we age because we lose some of our muscle and the skin becomes less tight. People who drink a lot of beer tend to be people who do not exercise. Most of us exercise less as we age and this contributes to gaining a beer belly. There are also some hormonal reasons why we accumulate fat around our midsection as we age.
By- Dr. David PrescottTimes of transition are often both rewarding and stressful. The transition to the new school year, while much anticipated, may bring particular challenges for some children and families. Knowing the early signs of common school adjustment problems can help parents, students, and teachers adjust to a difficult transition without letting a relatively small difficulty grow into a major problem. Three common issues which may require extra attention during the start of a new school year include: 1) anxiety about going to school (â€œschool phobiaâ€): 2) difficulties in peer relationships and bullying: 3) academic difficulties/risk for school dropout.School PhobiaWhat are the signs? It is normal for children and teenagers to worry. A recent study reported that 70% of children say they â€œworry every now and then.â€ In children, phobias or anxieties are often displayed through avoidance, behavior problems like tantrums, or physical symptoms like stomach aches or headaches. Children who have school phobia may say that they are worried about what may happen to their parents while they are in school, or find other reasons that they shouldnâ€™t go to school. They may ask for excessive reassurance about going to school. Suggestions for coping with school phobia 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€¢ 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. Peer Relationships and BullyingWhat are the signs? Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words or more subtle actions. Research suggests that about one in five (17%) of school age children report being bullied sometimes or often. There is no single profile of a bully, such as the stereotypical tough on the outside/insecure on the inside child. Many bullies are extremely popular with their peers and, surprisingly, popular among teachers and other adults.Suggestions for coping with peer relationship problems and bullying:â€¢ Listen to the problem: Many times, listening to your childâ€™s problem in a patient, relaxed manner can help them feel better immediately, and can help your child start to think of solutions. â€¢ Enlist the help of school counselors and administrators: Many schools have worked hard to reduce bullying. A chat with the principal or guidance counselor will help you support your child in a way that is consistent with what they experience at school. â€¢ Provide Perspective and Look for Strengths: Try to help your child keep a long term perspective on peer problems. Things donâ€™t always turn around in a day. While you are figuring out how to make things better, donâ€™t forget to help your child focus on what they do well. Academic Struggles and Risk for School DropoutWhat are the signs? Letâ€™s focus for a moment on children in early adolescence. Research suggests that children normally become more self-critical and negative in their opinion of themselves as they enter their early teenage years. As schoolwork becomes more difficult, young teenagers may be filled with doubt about their abilities and skills. Poor grades may be one sign of this. Sometimes teenagers may express dislike for a subject or teacher partly due to their own self-doubts. Helping them overcome these struggles has significant benefits in terms of future work and self-esteem. Suggestions for Coping with Academic Struggles and Risk for Dropoutâ€¢ Effort matters: Even though it may just sound like a saying, research shows that there is a positive correlation between effort and performance in school. Keep in mind that, at least in this case, hard work does appear to pay off. â€¢ Look for improvement, not perfection: Try to help your child make improvement, rather than perfection, their goal. â€¢ Enlist help: Improving in schoolwork requires both emotional and technical support. Friends, teachers, parents, and siblings can all provide different types of support. Help your child feel like they arenâ€™t isolated in dealing with their struggles. For More Information: Acadia Hospital: www.acadiahospital.orgAmerican Psychological Association Help Center: www.apa.org/healthcare
For millions of american men, with age, hair can thin or fall out and never come back. TV5 health expert Doctor Eric Steele is here to talk about male pattern baldness.
How much cancer risk is there in getting a CAT scan?By- Dr. Joan PellegriniThis is a very difficult question to answer. However, there is a growing concern about what that answer may be because of the extensive use of x-rays in medicine. There is a growing concern that the increasing use of radiologic studies may lead to an increase in our cancer rates. Plain x-rays do not use much radiation but CT scans use much more. Since the 1980′s there has been a rapid rise in the use of CT (Computed Tomography) scanning in the medical field. CT scans use a form of radiation in order to produce images. Doctors order CT scans frequently in order to give us information to aid in diagnosis or to prepare for a surgical procedure. A CT scan can tell a medical professional about what an organ or tissue may look like without actually performing surgery to look. There are obvious benefits to using x-rays and CT scans. Unfortunately, there is also a risk because of the exposure to radiation. The Radiological Society of North America (www.radiologyinfo.org) publishes information on how much radiation exposure happens with various x-ray studies.To put the amount of radiation it in perspective, the average American is exposed to about 3 mSv (a mSv is a measure of a type of radiation) per year of background radiation (basically everything around us is at least a little bit radioactive). Most of our exposure comes from the radon in our homes. In contrast, a CT scan of the stomach exposes a patient to 10 mSv (about 3 years’ worth of ambient exposure). A chest x-ray only exposes us to 0.1 mSv (about 1/100th that of a CT scan). Cell phones have hit the news lately because of the accusation that extended use may cause brain cancer. Cell phones, power lines, computers, microwaves, etc emit a non-ionizing radiation which is less damaging than the ionizing radiation of x-rays because it does not penetrate the skin and cells as easily. Therefore, one cannot easily compare this type of equipment and radiation with medical imaging radiation.Another concern is airport x-ray machines. For the most part, these are used on the luggage and not on the passengers. The new total body scanners do use radiation that amounts to approximately 0.001 mSv (1/1000th of a chest xray). The type of radiation is called “backscatter” and is weak and bounces off the skin. It is not strong enough to penetrate tissues and therefore is no more risky than sun exposure. TSA states on their website that this amount of radiation is equivalent to two minutes of flying on a jet. Metal detectors use a magnet and no radiation. So, from the numbers above, it becomes clear that CT scanning exposes a patient to a significant amount of ionizing radiation. We know that too much ionizing radiation will increase a patient’s risk of developing cancer. What we don’t know is how much is too much and how increased is the risk? Some experts would contend we are seeing increasing rates of cancer in patients who frequently undergo CT scanning. Although this is debatable, I would suggest that caution be used. CT scans should only be ordered if there is likelihood that it will yield useful information and if that information will be used by a medical professional to tailor treatment. In other words, a CT scan should not be done just to see if it shows anything. This is an important concept because many patients and physicians have the mistaken belief that it won’t hurt to order a CT scan and see if it shows anything wrong. One CT scan is probably not worth worrying about. However, it may be concerning if someone has several CT scans over several years. A classic example would be a patient who gets a CT scan every year or two to look for a kidney stone, evaluate for appendicitis, or look for a cause of abdominal pain.The current recommendation from radiologists is that a patient and medical provider discuss why the imaging study is being ordered and what information is expected to be obtained. Also to be discussed is what other diagnostic modalities are available and how will treatment change based on the radiology results. A patient should understand the concept of accumulating radiation exposure and accumulating risk.
By- Dr. Amy MoviusIf youâ€™ve gone sunscreen shopping this summer (and I hope you have!) the options available are mind-boggling. A few years ago, it was rare to find a sunscreen SPF (sun protection factor) rating of more than 45: now there are many products with ratings of 70, 80, 90 and even 100! But what, exactly, do these ratings mean?Letâ€™s start with what the Sun Protection Factor does. An SPF rating refers to the sunscreen productsâ€™ ability to block ultraviolet B, or UVB, rays. UVB rays cause sunburn and contribute to the risk of skin cancer. Now, for what SPF doesnâ€™t do. SPF sunscreens do not block UVA or ultraviolet A rays. About 95% of the UV rays we are exposed to are UVA. UVA rays are closely linked to deeper skin damage (wrinkle causing) and also contribute to the risk of skin cancer. SPF rating measures time. A SPF rating of 10 means you would be protected from sunburn causing UVB rays 10 times longer when using the product than without using the product. As shown below, UVB protection does not increase in direct proportion to the SPF number:SPF UVB rays blocked15 94%30 97%45 98%Accordingly, SPF 15 products are generally fine if used correctly, but few people apply sunscreens as heavily or often as they should. Some providers recommend SPF ratings of 30 or so for this reason alone. No product blocks 100% of UVB rays, so distinctions between SPF 45 to 100 are tiny. In fact, the FDA is working on a new labeling system to limit SPF product claims to 50.Finding a sunscreen that protects against UVA rays is just as important, but a lot harder to do. Many sunscreens that block UVA rays often do so by chemical filters (avobenzone or Mexoryl). However, the protection may be marginal as these chemicals break down quickly and lose effectiveness in the sun, unless stabilized. Few companies have been able to prove they can stabilize these chemicals. Barrier sunscreens containing zinc oxide or titanium are preferred by some dermatologists but many people dislike the thick, pasty and opaque products that are over-the-counter. There are some medical-grade sunscreens that contain these barriers in a micronized form that isnâ€™t so thick or visible.No sunscreen will be effective, however, if not used properly. A water-resistant formula is recommended and should be applied generously about a half hour before going outdoors. It should be reapplied at least every 2 hours, or after swimming, drying off, or sweating. For more information on sunscreens, including specific products, go to www.wedmd.com, High-SPF Sunscreens: Are they Better?
How to Talk About These ProblemsBy- Dr. David PrescottEating disorders continue to be a major concern in America, as people struggle to find a balance between increasing rates of obesity, developing a positive body image, and healthy lifestyles. Friends and family often are the first people to develop concern that a loved one has an eating disorder. The following are some tips for starting a conversation about eating disorders, and helping people with eating disorders get professional treatment.How do I start a discussion about a possible eating disorder? The first time you raise a concern about an eating disorder with a family member or friend, realize that the conversation may be a starting point rather than an ending point. Some useful strategies for having the first conversation include: 1. Learn about eating disorders and treatment options before you talk: Having an understanding of the behaviors, feelings, and treatment options for eating disorders will help you to feel more confident and supportive. 2. Express your concerns without focusing on the eating behavior: Try to express your concerns for the other person without making statements like â€œyou are putting on weightâ€ or â€œyou are getting too thin.â€ Rather, statements about your experience of what it is like to be around them (â€œa lot of times I think you are sad or unhappyâ€) may be a good starting point. 3. Ask if the person has considered that something is wrong, or if they are open to talking with a health professional: Gently asking whether a person has considered that they have a problem, or if they have thought about talking to a health professional will often yield surprising answers. Typically, people with eating disorders have given the issue a great deal of private thought. 4. Take a break if things get too stressful: Remember, control is usually an important issue in eating disorders. Donâ€™t be afraid to take a break in a non-confrontational way. Insisting that a difficult conversation be finished â€œhere and nowâ€ can often lead to a control battle. Coming back to the conversation in a supportive way shows your commitment and willingness to have some give and take. What are the Types of Eating Disorders? There are three major types of eating disorders. 1. Anorexia Nervosa involves having a distorted body image where a person sees themselves as overweight even when they are dangerously thin. People with anorexia have an intense fear of gaining weight, and often develop unusual habits such as refusing to eat around other people. Anorexia usually occurs in women, and is often accompanied by infrequent or absent menstrual periods. 2. Bulimia Nervosa involves eating excessive quantities of food, sometimes in secret, then trying to purge the body of the food and calories by using laxatives, vomiting, exercising or diuretics. People with bulimia nervosa usually feel ashamed and disgusted as they binge, yet also feel relieved of tension once the binge-purge cycle is complete. 3. Binge Eating Disorder involves frequent episodes of excessive, out-of-control eating. However, there is no attempt to purge the body of excess calories. How do I know if I am at risk for an Eating Disorder? Obviously, the determination of when concerns with food, eating and body image cross the line from â€œnormal concernâ€ to â€œpsychological problemâ€ varies from person to person. However, if you answer â€œyesâ€ to any of the following questions, it may suggest that you are at risk for an eating disorder: – Are you constantly preoccupied with weight and intense fear of becoming fat?- Do you believe that your body weight needs to be below what is recommended by physician or dietician? – If you are a woman, have you skipped or stopped a menstrual period when you were losing weight? – Do you frequently feel out of control when you eat? – How much of your eating is secretive or hidden from others? – Have you tried, or strongly considered, trying to lose weight by vomiting, using laxatives, or exercising according to how much you eat? Is Treatment for Eating Disorders Necessary? The sooner that treatment starts for an eating disorder, the easier it is to treat. Eating disorders donâ€™t usually go away by themselves. And, if left untreated, eating disorders can cause serious physical problems (like anemia, tooth decay, and hair and bone loss) as well as severe emotional distress, getting help is vitally important. Treatment often involves working with a licensed psychologist or therapist, dietician, and physician. Where else can I find help? Information about eating disorders is available at:â€¢ American Psychological Association (www.apa.org)â€¢ National Institute of Mental Health (www.nimh.nih.gov)â€¢ National Eating Disorders Association (www.nationaleatingdisorders.org)Information about mental health and substance abuse, including eating disorders is available at: â€¢ Acadia Hospital â€“ 1-800-640-1211 or www.acadiahospital.org
Keeping Your Cool: Understanding Heat Related IllnessBy- Dr. Amy MoviusTourists flock to Maine for the glorious summers: natives wait all year to enjoy it. However, when the temperature cranks up as in recent weeks, we all need to be careful not to get â€œtoo much of a good thingâ€.Heat related illness, often called â€œsunstrokeâ€, occurs when the body has increased heat production and decreased heat transfer to the environment. Heat related illness can be fatal in its most severe form, heatstroke. The body usually cools itself by sweating, but in very hot temperatures it may not be enough â€“ especially when it is also humid (Maine!). Risk factors for getting ill from the heat include being in the heat too long, exercising, being old or young, being sick to begin with, and being overweight. Because the consequences are so dangerous, it is important to recognize when you, or someone else, is developing heat related illness.Heat Cramps. Muscle pain/spasms can be one of the first signs of heat related illness. Stomach, arm, and leg cramps are most common and often happen during strenuous activity. They are most frequently seen in children. If someone develops heat cramps, follow the steps below: 1. Bring person to a cool place. 2. Give him/her water or sports beverage to drink. 3. Massage affected area gently. 4. Insist he/she wait SEVERAL HOURS after cramping is gone before doing any physical activity. 5. If cramps last more than 1 hr, seek medical attention.Heat Exhaustion occurs when the body has lost excessive water and salts from sweating. In addition to muscle cramps, victims will have profuse perspiration, cold and pale and clammy skin, fatigue and weakness, headache, dizziness, fainting, nausea/vomiting, rapid & shallow breathing, and a fast &weak pulse. If someone develops signs of heat exhaustion, follow the steps below: 1. Follow the same steps as heat cramps listed above. 2. Take victimâ€™s temperature (preferably rectal). If greater than 103.1 treat as for heatstroke (section below). 3. Give patient a cool bath (tub or sponge) or shower. 4. If symptoms worsen or last more than 1 hr, seek medical attention. An immediate trip to the emergency room may be needed.HeatStroke occurs when the body temperature rises so high that cells are damaged. It is estimated that 12% of adults with heatstroke die. Body temperature can rise to 105o F or more in only 10 to 15 minutes. Victims of heatstroke cannot sweat well. Symptoms include temp 103.1oF or more, red & hot & dry skin, fast & strong pulse, nausea, dizziness, headache, confusion, loss of consciousness. If someone develops signs of heatstroke, follow the steps below: 1. Immediately call for Emergency Services and begin cooling the victim as described below. 2. Move to a cooler place. 3. Remove clothing . 4. Put cool water on the skin. This can be done by immersing in tub/shower, doing a cool sponge bath, even spraying with a garden hose. 5. Direct fan or air conditioner at victim if available. 6. Take temperature every 5 minutes, continue actively cooling until it is less than 102oF. 7. Donâ€™t give the affected person anything to drink or put anything in their mouth. If they vomit or have a seizure, simply turn their head to the side.As always, prevention is the best strategy. On hot days, drink plenty of fluids, replenish salt and minerals with sports drinks or other intake, and limit time and exertion in the sun – especially during the hottest midday hours.References:1. HeathlyChildren.org â€“ Heat Related Illnesses2. Jardine. Heat Illness and Heat Stroke, Pediatrics in Review. 2007:28:249-258. doi:10.1542/pir.28-7-249
By- Dr. David PrescottBinge Drinking and Alcoholism: Most of us are well aware of the risks associated with excessive alcohol use. Over 14 million people abuse alcohol at any given point in time. More than 20,000 people die each year directly from alcohol related health problems, while many more are killed or injured in accidents where alcohol use is a contributing factor.It can be tempting to think of people with alcohol problems as primarily people who drink every day, develop dependence on alcohol, and begin to organize their lives around drinking. However, recent research suggests that binge drinking may be as much of a problem as chronic alcoholism. What is Binge Drinking? Binge drinking is defined as heavy drinking within a limited period of time: 5 or more drinks for males, 4 or more drinks for females. Obviously, drinking this much puts a person over the legal limit of blood alcohol content for intoxication. It well known that alcohol intoxication puts people at high risk for motor vehicle and other accidents that lead to death and serious injury. But, the risks of binge drinking are not limited to accidents. Short Term Problems with Binge Drinking: Short term problems with binge drinking include: â€¢ Risk of alcohol poisoning: For some people, binge drinking leads to alcohol poisoning and may cause death. â€¢ Impaired Ability to Drive: Recent research suggests that the majority of motor vehicle accidents that involve alcohol are caused by people who binge drink, rather than people who are alcohol dependent (â€œchronic alcoholicsâ€).â€¢ Impaired ability to make good judgments: Not only does binge drinking impair your ability to drive, or do any complex activity, but your own judgment of how well you can perform is impaired when you binge drink. â€¢ Pressure to Binge Drink related to Events or Milestones: More and more research suggests that major events, like 21st birthdays, are increasingly associated with expectations that binge drinking will occur. Long Term Problems with Binge Drinking: â€¢ Binge Drinking Beginning at Younger Ages: One of the most startling statistics about binge drinking concerns the early ages at which binge drinking first occurs. One in ten sixth graders report at least one episode of binge drinking. One in three high school seniors have consumed 4 or more drinks at one time in the past month. These statistics highlight that problem drinking begins well before the legal age to purchase alcohol. â€¢ Increased Risk for Problems In Adulthood: Research suggests that people who binge drink as teenagers are 60% more likely to develop alcohol dependence, 70% more likely to drink heavily as adults, and are twice as likely to have a criminal record. Getting Help for Alcohol Problems: People for whom alcohol has become a significant problem often downplay the role of alcohol in their life. Denial is often viewed as a defining characteristic of alcohol addiction. So, if you try to point out to someone that they have an alcohol problem it is likely that they will disagree with you. Nevertheless, overcoming an alcohol addiction is usually very difficult to manage without help. Some simple tips for getting help include: â€¢ Keep in mind the risks associated with binge drinking and alcohol dependence. These include accidents which occur after drinking, short and long term health problems, and difficulties at school or work. â€¢ Talk with a mental health professional. A psychologist, social worker, or licensed professional counselor can help look at whether or not alcohol use is a problem in your life, and can help you understand better the factors that contribute to alcohol abuse. â€¢ Talk with a doctor or primary care physician. For some people, talking to your family doctor is more comfortable than seeking help from a counselor. Most primary care doctors have basic training in evaluating alcohol related problems, and can help you decide if you need further help. â€¢ Alcohol Addiction may be masking other problems. People who abuse alcohol may be trying to cope with an underlying psychiatric problem like depression or an anxiety disorder. Or, getting drunk may be a short term way to cope with family problems or a troubled relationship. Usually however, using alcohol makes it more difficult to sort out the original problem. Talking with a mental health professional can help you find some other ways to cope. Want More Information? American Psychological Association Help Center: www.apahelpcenter.orgSubstance Abuse and Mental Health Services Administration â€“ Center for Substance Abuse Treatment: www.csat.samhsa.gov/faqs.aspx
CHRONIC PAIN MAY NEED A NOVEL THERAPEUTIC APPROACHBy- Dr. Joan Marie PellegriniMany of us probably know someone with chronic pain. If you do, then you may also be familiar with the difficulty in adequately treating pain in these individuals. Acute pain is the immediate pain that we feel as a warning sign to tell us to stop doing something or to tell us that something is wrong. Chronic pain is pain that continues even when the injury has healed and may be referred to as â€œpathologic painâ€. Often this chronic pain is really a neuropathic pain. Neuropathic means that the nerve is disordered and may be sending pain signals when it should not be. One standard approach to pain is to treat with â€œpain killersâ€. These drugs are known medically as narcotics. Narcotics work on the neuron to dim the pain signal.Scientists have known for a very long time that nerve cells are surrounded by other cells called â€œgliaâ€. The glia are support cells that regulate nerve activity. They maintain the chemical environment surrounding neurons by delivering energy, sopping up the neurotransmitters and releasing healing factors. New research is showing that it may the glial cell that is more important in the cause of chronic pain. This is important because narcotics do not treat disorders of the glia. In fact, glia may be responsible for the narcotics losing their effectiveness over time (a phenomenon known as tolerance). The drugs that have an effect on glia are very different. For instance, one drug is a type of antibiotic (minocycline). Marijuana is not a narcotic and acts on receptors in the glia to dim the pain response. This is part of the reason why marijuana is being used to treat some cancer patients with chronic pain. Research is focusing on several new drugs that are very early in the development phase.This new research will have a very important impact. For one, it will be important not to prescribe narcotics for a neuropathic pain if they are not going to be effective. Narcotics can have serious side effects. Also, there will be many patients who have lived with pain who are in dire need of new and better treatments.
Calcium & Vitamin DCalcium is critical to health through all stages of life. And Vitamin D is critical to maintaining calcium balance.And yet we do not get enough of eitherâ€¦!Calcium Calcium is critical to bone health. Most of us know that. But what other questions might you have?Q: Do our dietary behaviors in adolescence affect such things as osteoporosis in middle and old age? A: Yes. Those behaviors are critical. Adequate calcium intake in adolescence directly influence bone health in later life. Taking calcium through life prevents bone loss in later life. Q: Is calcium important for anything other than “bone health”?Y: Calcium is critical to heart function, nerve transmission, blood clotting, and the function of virtually every cell in the body. Adequate calcium intake may also prevent high blood pressure, prevent colon cancer, and help people diet successfully. This last fact is being increasingly studied in light of our increasing realization that avoiding obesity is critical to overall health.Q: How much calcium do I need?Y: At least 1000 mg/day after age 8. During the critical periods of adolescence and after 50 years old, 1200-1300 mg/day is recommended.Q: Do I need to take pills?A: Not necessarily. Dairy products are an excellent source of calcium – – 8 oz of milk/yogurt or 1.5 oz of cheddar cheese each contain about 300mg of calcium. Other calcium-rich foods include green leafy vegetables, broccoli, fish, almonds, oats, and fortified foods such as orange juice or tofu. If diet doesn’t provide adequate calcium, supplementation is simple. Calcium carbonate is the best: one “extra strength” antacid tablet (Tums or generic) contains 750mg. Or take a multi-vitamin. In both cases, be sure to check the label. % Daily Value is based on 1000 mg/day.Vitamin D We get vitamin D from two sources:(1) through diet or (2) through synthesis in the skin in response to sunlight.Sun exposure is limited by a number of things including skin pigmentation, latitude, sunscreen use, and air pollution. All this make sun exposure an unreliable source of vitamin D. Diet, therefore, is critical. Older children and adults tend to get enough through supplements, but should be aware of the recommended daily intake for all ages: 400 IU/day.Infants are not so lucky. Q: Why is sunlight a particularly poor way for infants to get vitamin D?A: The American Academy of Pediatrics and all other medical societies is clear on the need to avoid sun exposure in infants and children. Sunscreen is uniformly recommended and therefore precludes sun exposure as a means of getting vitamin D.Q: Is there a particular challenge associated with dietary vitamin D in infancy?A: Yes. Â· Breast milk does not contain vitamin D meaningful amountsÂ· Formula is fortified, but intake must be 34 oz/day to meet requirements, an amount rarely reached in infancyÂ· Baby foods do not provide the needed vitamin D.Q: Are infants and children at particular risk?A: Vitamin D deficiency in infancy and childhood affects bone development. In the most severe cases, it can cause softening and weakening of the bones, impair growth, cause developmental delays, and even result in lethargy or seizures.Q: Is there a solution?A: Yes. Infants need supplementation with vitamin D. This needs to be part of a daily routine and not seen as a “medicine”. Despite recommendations to receive 400 IU/day, physicians continue to not provide this for infants. A recent study (April 2010) showed that in breast fed or combined breast-milk/formula fed infants, less than 15% were receiving the recommended dietary vitamin D. And complete formula fed infants were not much better at less than 35%. Supplementation is not happening!Q: Why don’t physicians supplement infants?A: Studies show that many physicians think vitamin D deficiency only happens to dark skinned infants or that breast milk contains adequate vitamin D or that infant receive enough sunlight. All these suppositions are wrong!Parents: you must ask your infant’s physician about vitamin D supplementation. Adequate vitamin D is essential to healthy bone development and to normal childhood development!For more information about calcium and vitamin D supplementation, consult the American Academy of Pediatrics website: www.aap.org
National Drinking Water Safety WeekBy- Dr. Joan PellegriniEvery year the Federal Government, along with organizations such as the Centers for Disease Control (CDC) and the American Water Works Association, kicks off a week-long awareness campaign about our drinking water supply. This week many of us are aware of the issues because of the recent oil spill in the Gulf of Mexico and the water main break in Boston. The motto for this week is â€œOnly tap water deliversâ€. This motto is intended to highlight the importance of public water supply and safety and the need to reinvest in our water supply infra-structure. Americans have the luxury of a very safe and abundant water supply. However, this does not come without hard work and expense. Some of our infra-structure is aging and will require expensive upgrades and repairs. Very few Americans ever have to worry about turning on their faucet and getting contaminated water or not getting any water at all. That is because our local water companies work diligently to provide a clean and safe water supply. As a consumer, though, we need to do our part to protect our water supply and to support funding initiatives to keep our systems in good repair. We can protect our water supply by respecting our reservoirs and aquifers. This means not polluting around them and obeying the laws about land use around the reservoirs. It also means limiting some activities such as fertilizing, spraying pesticides, dumping near reservoirs, and using gasoline or other types of engines on our reservoirs.Tap water is very safe and often safer than well water. It may even be safer than some bottled water. It has the added benefit in most communities of providing a source of fluoride. Bottled water is generally not recommended because of the impact on the environment from the wasted bottles. It also is far more expensive than tap water. There is no data that bottled water is safer or better for you than tap water in the US or Canada. There also is only minimal data that fluoridated water poses any risks. Certainly, we have seen a decrease in dental decay because of fluoride.Up to 20 percent of New Englanders have a well for their water source. The well water is usually tested when the well is first drilled and again if the house is sold. However, it is recommended that the well water be tested more frequently in order to check for contamination. Below, I have an address for Maineâ€™s website on well water information.Below are some websites for further information:This is a PDF put out by the Federal Government to explain many of the issues that affect our drinking water supply. There are also resources listed for obtaining information on water safety.http://www.epa.gov/ogwdw/wot/pdfs/book_waterontap_full.pdfThis is the Center for Disease Controlâ€™s website on drinking water:http://www.cdc.gov/Features/DrinkingWater/Maine also has a website for information on how to get your well water tested and what to do if you think there is a problem with your well:http://www.maine.gov/dhhs/eohp/wells/mewellwater.htm
By- Dr. David Prescott â€“ Acadia HospitalThe Controversy Around Spanking: Arguments about the potential benefits and drawbacks of spanking as a means of child discipline have been ongoing for decades. Research shows that a majority of Americans do not oppose spanking as an occasional way of stopping undesirable behavior. And, most people agree that spanking can cross a line to where it constitutes physical abuse. However, answering the question of whether or not spanking truly causes problems in children has proven to be complex and difficult. Recent Research on Negative Effects of Spanking: A soon to be published study conducted at Tulane University examined the impact of spanking 3-year old children, following them until they were 5 years old. Results showed that children who were spanked more frequently at age 3 were more likely to show aggressive behaviors by age 5. The study was unique in that it attempted to sort out the impact of spanking from other potential factors which could cause aggression, such as levels of aggression/violence between parents, neglect by parents, or stress/depression in the mother. When the impact of these other factors was removed, it still appeared that children who were spanked frequently were more likely to be aggressive. Children who were spanked more than twice a month at age 3 were 50% more likely to commit aggressive acts at age 5. Researchers also found that the differences were not accounted for by childrenâ€™s natural level of aggression. That is, it did not appear that children who were naturally more aggressive were simply more likely to be spanked. Are There Benefits to Spanking? Both research and surveys of parents show that the primary benefit associated with spanking is its immediate effect on undesirable behavior. Spanking is typically highly effective in getting an action to stop right away. The drawback cited by those opposed to spanking is that corporal punishment creates an environment where new learning is unlikely to occur. Stated another way, children who are spanked are typically at such a high level of emotional arousal that they are unlikely to learn more appropriate behaviors. It is only when emotions have calmed that learning â€œthe right thing to doâ€ can occur. What do Professionals Recommend? Most pediatricians and psychologists are in agreement that repeated use of spanking causes more harm than good. The American Academy of Pediatrics takes the following position: The American Academy of Pediatrics strongly opposes striking a child for any reason. If a spanking is spontaneous, parents should later explain calmly why they did it, the specific behavior that provoked it, and how angry they felt. They also might apologize to their child for their loss of control. This usually helps the youngster to understand and accept the spanking, and it models for the child how to remediate a wrong.What to Do Instead of Spanking? Psychologists and other health professionals have developed many techniques to help children learn more appropriate and desirable behaviors without using corporal punishment. Strategies such as using time out, rewarding positive behavior, and teaching non-aggressive ways of coping with anger and frustration have benefitted many parents and children. Many parenting books, as well as the web sites of the American Psychological Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry, offer guidance on these approaches. For more Information: American Psychological Association: www.apa.org/topicsAmerican Academy of Pediatrics: www.aap.orgAmerican Academy of Child and Adolescent Psychiatry: www.aacap.org
Keeping your Facts â€“ and Fats â€“ StraightBy- Dr. Amy MoviusMost of us know that a healthy diet is rich in fruits, vegetables, whole grains, and fiber â€“ and low in fat. In fact, it is recommended that fats make up no more than 25-35% of our daily calories. Keep in mind that fat contains more than twice the calories, gram for gram, than carbohydrate or protein. Then there is consideration of the type of fat in question: trans fats, saturated fats, unsaturated fats, hydrogenated fats, omega 3 fatty acids?? It can certainly be confusing, but the particulars are worth getting to know as the differences can have a huge impact on your health.Saturated Fats (Bad Fats)Saturated fats are perhaps the easiest to understand, since these are fats that come from animals â€“ think meat and dairy. Saturated fats contain cholesterol. There are a few plant sources such as coconut and palm oil.Unsaturated Fats (Good Fats)Unsaturated fats come in two varieties, polyunsaturated and monounsaturated. These fats are found in fish, nuts, seeds, and oils from plants. These fats may help to reduce cholesterol, especially when used in place of their saturated counterpart. Omega 3 is a type of polyunsaturated fat.Trans Fats/Hydrogenated Fats (Good Fats gone BAD!)Hydrogenation is a process, used on unsaturated fats (good fats), that produces hydrogenated or trans fats (very bad fats). Hydrogenation produces products such as margarine, shortening, and cooking oils (partially hydrogenated and hydrogenated vegetable oils). Trans fats are insidious in our diets: they sneak their way into many baked goods as well as fried foods. In a large study of women, the most common sources of trans fat were margarine, beef/pork/lamb as main meal, cookies, and white bread. Though they do not contain cholesterol, they still cause bad cholesterol to rise, maybe even more than the cholesterol-containing saturated fats. To add insult to injury, they may also decrease good cholesterol. It is recommended that trans fat constitute no more than 1% of our diet. Since 2006, trans fat content must be listed on nutrition labels. This can be enormously helpful when shopping: my family discovered a formerly beloved pancake mix contained trans fat. Eating out can still be perilous, however, as there is no labeling requirement at this time. Hydrogenated vegetable oil is typically used for commercially fried foods. Keep in mind these products can still be labeled as â€œcholesterol freeâ€™ and â€œcooked in vegetable oilâ€. One order of fast food French fries easily exceeds the daily recommended intake of trans fats by several times!Now that you know the skinny on different fats, use the following American Heart Association guidelines to keep your family eating and feeling well.1. Use naturally occurring, unhydrogenated vegetable oils such as canola, safflower, sunflower or olive. 2. Avoid saturated fat in your diet. Limit total fat to between 25 and 35% of calories, mostly from unsaturated sources (fish, nuts, seeds, vegetable oils)3. Read labels and select processed foods made with unhydrogenated oil rather than partially hydrogenated or hydrogenated oils, or saturated fats.4. Use soft margarine instead of butter and choose liquid or tub varieties over harder stick forms. Look for â€œ0g trans fatâ€ on label.5. Donâ€™t eat fried or baked goods often as they tend to be high in trans fat. French fries, doughnuts, cookies, cracker, muffins, pies and cakes are examples.6. Limit commercially fried foods and baked goods as they are usually very high in fat in general, and it is often hydrogenated or trans fat.7. Avoid fried fast food. They are usually cooked in hydrogenated products and are very high in trans fat.8. Use fat-free and low-fat dairy products.Again, a diet rich in fruits, vegetables, whole grain and highâ€“fiber foods is also recommended. The American Heart Associated has a lot more great information on keeping you and your family healthy at www.americanheart.org.
By- Joan Marie Pellegrini Irritable bowel syndrome (otherwise commonly known as “IBS”) is a condition of the colon. We do not know what causes it and therefore it is very difficult to know how to cure it. The current most common medical theory is that IBS is a disorder of the nerves that control the function of the colon. IBS causes abdominal pain, bloating, gassiness, diarrhea, and/or constipation. The symptoms can be so severe that it limits one’s activity and ability to work. A doctor may diagnose IBS by the classic set of symptoms and by ruling out other common disorders. The doctor may order tests to rule out a malabsorption disorder such as lactose intolerance or celiac disease. Sometimes a colonoscopy is indicated in order to evaluate for inflammatory bowel disease. Once a patient is given a diagnosis of IBS, there is a four-pronged approach to treatment. The four prongs are: dietary modification, stress reduction, exercise, and (lastly) medications. Dietary modification: A person with IBS should keep a food journal in order to determine which foods cause the most symptoms. Common foods to avoid are milk products and foods high in fat. Also, it is important to add fiber. There are many types of fiber on the market and most of them will cause less gas and bloating than the fiber found in foods. Many people find that the soluble fibers cause the least amount of symptoms. I usually recommend to my patients that they use a combination of soluble (inulin) and insoluble (psyllium) fibers along with increasing the fiber-rich foods in their diet. If someone has diarrhea, then it is usually recommended to avoid or limit caffeine intake. On the other hand, caffeine can benefit the person with constipation. Stress reduction: Just about everyone with IBS notices that their symptoms are worse with stress. In fact just about every disease is worse with stress. There are many components to stress reduction with include psychological evaluation, counseling, breathing exercises, biofeedback, acupuncture, yoga, prayer, etc. Exercise: The colon is fairly responsive to exercise. Many people notice that their constipation is much improved with aerobic exercise. It is not quite understood how exercise benefits the bowel but it is a well known fact that it does. Exercise can also be a source of stress reduction. Medications: This is generally considered the last resort. There are medications that treat the symptoms such as laxatives for constipation, anti-diarrheals or anti-spasmodics for diarrhea, simethicone for the gas, and pain medication for the pain. In general, narcotics are least effective for bowel-related pain. Anti-depressants also may be effective. Finally, there are two drugs on the market for IBS (Lotrenex and Amitiza). These drugs have fairly serious side-effect profiles. If you or a loved one have been given a diagnosis of IBS, the goal is to manage the symptoms and not allow the disease to control your life. There is no cure but there is promise in the future as more reseach is done on bowel motility disorders. Just about every patient who embarks on a well-rounded treatment program will experience significant relief. However, most of the options listed above will need to become part of a person’s lifestyle in the long run. The following is one of my favorite sites for information on IBS:http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106
By- Dr. Jonathan WoodDoes a daily â€œdoseâ€ lower your risk of heart disease and stroke?Why do the Kuna, indigenous peoples from islands off the Panamanian coast, have virtually no hypertension (high blood pressure) and no increase in blood pressure with age? And why do these findings disappear with migration to urban centers like Panama City? This phenomenon has been described in similar isolated populations and usually, when investigated, is connected to a lower salt intake in the native environment. But the native Kuna have higher salt intake than their urban counterparts. So why the extraordinary differences in cardiovascular disease? The answer: cocoa! The Kuna drink an estimated (likely underestimated) 5 cups of a native cocoa drink each day. It is their primary drink and it contains large amounts of flavanols, a naturally occurring antioxidant and blood vessel relaxer. When this â€œKuna phenomenonâ€ was first described less than 10 years ago, a flurry of studies of chocolate and cocoa followed. Could this be the new â€œred wineâ€, something yummy that actually was good for your heart health? Unfortunately, to get the same amount of flavanol contained in the 5+ cups of Kuna cocoa drink, one would have to eat and estimated 4.5 lbs of dark chocolate or 15 lbs of milk chocolate! These amounts are obviously not practical nor advisable to suggest. So studies have been done looking at smaller amounts and trying to account for the other less healthy things (fat, sugar, etc) in commercial chocolate But it has been difficult. And the amounts still have seemed too large to promote without more solid data.But now, once again, chocolate is in the news – – and itâ€™s good news! A German study due to be published tomorrow in the European Heart Journal looked at detailed diet (including chocolate), blood pressure, several known cardiovascular risk factors, and some other demographics in a group of nearly 20,000 men and woman, age 35-65. This group was then followed over 8 years. 300 of them suffered heart attacks or strokes during that time. When controlled for all the other factors, it seems that the lower chocolate diet in these 300 people may be responsible: i.e. the more chocolate eaten, the lower risk of stroke or heart attack. Of note, the effect was more pronounced for strokes than heart attacks.The particularly interesting aspect of this study was the amount of chocolate that seemed to be needed to confer â€œprotectionâ€. The difference between the â€œlowâ€ chocolate group (more strokes) and the â€œhighâ€ chocolate group (fewer strokes) was 6 grams/day. And how much is 6 grams? Not muchâ€¦â€¢ 1Â½ Hersheyâ€™s Kisses = 6 gramsâ€¢ 2 little â€œrectanglesâ€ from a standard Hershey bar = 6 grams (i.e. 1 bar should last 6 days!)â€¢ 11 Nestle semi-sweet morsels = 6 gramsAnd should you choose milk or dark? Clearly, dark chocolate has more flavanols than milk chocolate, so if you like it, dark chocolate is a better choice.So should we all rush out and start a daily dose of chocolate? Probably not – – this study was a retrospective observational design and needs to be repeated in a prospective way. But is a little bit of chocolate okay or perhaps even healthy? Likely, yes. And it seems a very little bit (6 grams) may go a long wayâ€¦if you can control yourself and not eat the whole bar! Remember, our chocolate bars (unlike the Kunasâ€™ drink) have much more in them than just cocoaâ€¦ A good rule of thumb: everything in moderation!
By- Dr. David PrescottMore and more, health care providers are paying attention to the relationship between medical disorders and mental health problems. One the one hand, having a medical event like a heart attack or stroke leads to a greater chance of experiencing a mental health problem. On the other hand, high levels of psychological stress, depression, or anxiety, put you at higher risk for certain medical conditions. No matter which angle you take in looking at the mind/body connection, it is important to take steps to maintain good psychological health.Is there really much overlap between mental health and physical health? Absolutely yes! Several statistics and facts illustrate this point. â€¢ It is estimated that over two-thirds of primary care office visits are due to stress related symptoms. â€¢ 10-14% of people hospitalized for any medical condition have major depression. â€¢ The diagnosis of depression is estimated to be missed in up to 50% of visits to primary care doctors. â€¢ For certain medical conditions, like chronic obstructive pulmonary disease, about 25% of patients have diagnosable panic disorder. â€¢ High levels of hostility have been found to predict heart disease more often than high cholesterol, cigarette smoking, or obesity â€¢ Men high in optimism were less than half as likely to develop heart disease than were the more pessimistic men What are some of the medical conditions most associated with mental health problems?Cardiac Illness and Heart Attacks â€“ Both major depression and anxiety disorders, like panic attacks, are very common following a diagnosis of coronary heart disease or having a heart attack. It is estimated that one in six people who have a heart attack develop panic disorder, and over Â½ (up to 65%) of people develop major depression. Untreated major depression is even correlated with an increase risk of death within 6 months of a heart attack. Cancer â€“ About one in four people diagnosed with cancer develop major depression. Symptoms of depression may be difficult to diagnose during cancer treatment, since poor appetite, weight loss, and loss of energy are characteristic of both depression and treatment for cancer. Diabetes – Rates of depression in diabetes are very similar to cancer (about 25%). Not only is treating depression important in and of itself, but untreated depression may make compliance with treatment for diabetes more difficult. Obesity â€“ The relationship between obesity and depression is complex. In one study, women with obesity had a 37% higher rate of depression than women without obesity. However, it is not clear yet whether depression may cause obesity in some people, or whether obesity may cause depression. It seems likely that both are true! In any case, simultaneously treating both depression and obesity is the best hope for conquering these conditions. Why is it important to treat both medical illnesses and mental health disorders? While clinical anxiety and depression are more frequent in people with significant medical conditions, it does not mean that you are simply supposed to get used to the problem. Getting counseling or medication for anxiety and depression not only helps you feel better, but allows you to focus more energy on recovering from things like heart attacks or cancer. What can I do to make sure that both conditions are treated? Probably the most important step is to tell your doctor or your psychologist/counselor about your concerns with both your emotional and physical health. Donâ€™t think that the fact that you are feeling extremely sad or worried is something you should just keep to yourself, or is something that just happens after a major medical event. Ask your doctor, or a mental health professional, whether what you are feeling is normal, and if there is anything you should do to address the problem. For More Information: Mental Health America: http://www.nmha.org/go/information/get-info/depression/co-occurring-disorders-and-depressionAmerican Psychological Association: http://www.apa.org/helpcenter/mind-body
By- Dr. Amy MoviusSt. Patrick’s Day is Wednesday, March 17th – a lighthearted holiday of green clothes, shamrocks, and (for some) alcohol indulgence. If drinking is a planned part of tomorrow’s celebration, be prepared to distinguish the truths about alcohol consumption from the many leprechaun myths.Alcohol is a Stimulant Nope, it’s a depressant. The initial effects may cause euphoria, and thus seem energizing, but actually, it depresses the brain.It’s Better to Drink With a Full StomachTrue! Though you will still absorb the alcohol you drink, you will do so more slowly with a full stomach and so not feel the effects as rapidly.You can Learn to “Hold Your Liquor”False. Drinking alcohol is not like going to the gym where you can train you body to do more. If the same amount of alcohol doesn’t affect you like it used to, you are developing a tolerance, which is a sign of addiction. It means you need help!Hard Liquor Gets You Drunk FasterNope again. Alcohol is alcohol and you body doesn’t know or care if it was beer, wine or vodka: it’s all processed the same way. What defines “a drink” differs between the three: 12 oz beer, 5 oz wine, and 1 oz of 100 proof hard liquor (1 1/4 oz of 80 proof) are all equal to Â½ oz of pure ethanol alcohol. The person who only drinks glasses of white wine will have the same breathalyzer result as the one who drank the same number of “shots”.Women Get Drunk EasierTrue. Men and women of the same size absorb and metabolize alcohol somewhat differently. This is related to the different proportions of fat to lean muscle between genders as well as a difference in the amount of alcohol dehydrogenase present, the enzyme that breaks alcohol down.Coffee Can Sober You UpCoffee is a stimulant, which may make you feel more alert, but that is not the same as sober. BAC, or blood alcohol concentration (what a breathalyzer measures) decreases at a set, slow rate as the liver breaks the alcohol down. The BAC decreases at about .015 percent/hr. Coffee will NOT affect this. Neither will a cold shower, exercise or anything else. Time alone will sober you up.Drinking Some Alcohol Can Treat a HangoverNo way. The term hangover is derived from the Norwegian word “Veisalgia” meaning “uneasiness following debauchery”. The unpleasant symptoms include headache, nausea, and fatigue (to name a few) and are largely attributed to the dehydrating effects of alcohol consumption. In addition to the “hair of the dog” myth above, MANY products are touted as hangover remedies. They include medications, vitamins, supplements, and foods (bacon, egg and cheese sandwich for one). These products, and even “hangover kits”, can be easily purchased on-line, or at your local drug store. A 2008 article in the British Medical Journal attempted to study the effectiveness of many of these “remedies”. The found the only thing that cured hangovers was time. A better plan may be to prevent the hangover to begin with, by limiting alcohol drinking to moderation.The Younger Children Drink Alcohol The More Likely They Will Have A Drinking ProblemTrue. If you indulge in alcohol during this (or any other) occasion, don’t allow kids to participate. It’s simply not appropriate.If Someone Passes Out From Drinking You Should Let Them Sleep It Off Remember that alcohol is a depressant. It can impair and breathing, blood pressure, heart rate and can be fatal. If someone passes out you would be better taking them to medical attention, not leaving them in alone in a room. References:1. www.uwstout.edu/aod/resources/alcohol/myths_facts.html2. www2.potsdam.edu/hansondj/AlcoholFactsandFiction.html3. BMJ2008:337:a2769
By- Dr. Thomas RajanMarch 7-13 marks National Sleep Awareness Week, and it is a great opportunity to take the time to highlight the importance of getting a good night’s sleep.According to the National Sleep Foundation 74% of American adults experience sleeping problems a few nights a week or more, 39% get less than seven hours of sleep each weeknight, and 37% are so sleepy during the day that it interferes with daily activities.One of the reasons some people may not be getting a good night’s sleep is because of sleep apnea. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. According to the National Institutes of Health, sleep apnea affects more than twelve million Americans. Risk factors include being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age, even children. Yet still because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated, despite the fact that this serious disorder can have significant consequences.Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Moreover, untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Fortunately, sleep apnea can be diagnosed and treated. Several treatment options exist, and research into additional options continues. Please talk to your primary care provider for more information on how you can get a better night’s sleep.
By- Dr. Jonathan WoodParasomnias are “repetitive unusual behaviors or strange experiences that occur in relation to sleep.” These include common occurrences like nightmares, night terrors, sleepwalking, teeth grinding, and bedwetting, but also the more unusual REM sleep behavior disorders and epileptic nighttime wandering. These can be confusing and sometimes quite dramatic. Fortunately, the most common parasomnias are generally the least worrisome. Sleepwalking is one of these common, but benign parasomnias.Who sleepwalks?Sleepwalking or “somnambulism” is common and most occurs predominantly in childhood. Up to 15% of children age 5-12 will sleepwalk at some point. Generally, the episodes become less common in adolescence, with the majority resolving before adulthood. That said, up to 10% sleepwalkers start in adolescence and 2-3% of adults will occasionally sleepwalk. What is the pattern?Sleepwalking occurs in deep non-REM sleep, a stage that occurs in the first third of the night. Eyes are often open and sleepwalkers will appear awake, albeit clumsy and generally purposeless in their movements. If they talk, their speech will often be slow, as will their responses to stimulation. Sleepwalkers generally have no memory of their escapades. These excursions are generally short and harmless, but occasionally have involved more complex and potentially dangerous behaviors like cooking or leaving the house.What predisposes to sleepwalking?Sleepwalking runs in families and there may be genetic factors. There also may be predisposing factors for sleepwalking, especially in teens and adults. These include use of alcohol or sedatives, emotional stress, anxiety, sleep deprivation, obstructive sleep apnea, infection, fever, and occasionally environmental stimuli. Contrary to older teachings, it is now known that there is no association between childhood sleepwalking and psychiatric disorders.What should be done?Be assured of the benign nature of sleepwalking. Be reassured that your child is not ill or disordered. Make the environment as safe as possible by removing obstructions in bedrooms, locking or alarming doors to the outside, etc. Generally, since sleepwalking occurs early in the sleep, parents are often awake when their children sleepwalk and can therefore help them back to bed. If sleepwalking occurs predictably and frequently, awakening your child 20-30 minutes prior to the expected event every night for a several months may extinguish the behavior. This should be discussed with your doctor. Medications are not recommended for sleepwalking. They are sometimes suggested, but the evidence for this is poor and generally comes with more risk than benefit.What should not be done?Don’t try to awaken the sleepwalker! It is rarely successful and can result in the child becoming confused, agitated, or even violent. Waking the child is difficult, counterproductive and unnecessary. The best approach is to let the episode subside and then direct the sleepwalker gently back to bed and to sleep. There is no point in telling children about their sleepwalking episodes: in some children this can cause unnecessary anxiety.What about sleepwalking adults?Sleepwalking in adults, as mentioned, is much less common. If onset is in adulthood, sleepwalking also has a higher incidence of being associated with an underlying neurologic disorder. A physician should be consulted about adult-onset sleepwalking to assure its benign nature. Sleepwalking that occurs later in the night may not be true non-REM somnambulism, but rather a “REM sleep behavior disorder”. This is more of an “acting out of dreams” disorder and is due the patient not having the usual semi-paralysis of muscles that normally accompanies REM sleep and dreaming. This can be dangerous to the patient and his/her sleep partner and needs to be investigated. It is particularly important to not try to arouse an adult from this type of disorder that occurs later in the night’s sleep.Conclusions?Sleepwalking in children and adolescents can be frightening, but does not mean your child is ill or disordered. They will virtually always “grow out of it.” Avoid medications and complex work-ups for this benign condition. Be calm, establish regular sleep routines, make the environment safe, and gently guide your child back to sleep.
By- Dr. Joan Marie PellegriniMost of us know that if we need surgery, we need to choose a qualified surgeon. We then assume that the surgeon and their hospital will do everything they can to prevent any post-operative complications. Unfortunately, the medical community has known for decades that surgical quality is heterogeneous across the country and sometimes even within a state or city. It is not news that some hospitals have lower complication rates than others. There has been quite a bit of research into what these high performing hospitals are doing that may be leading to better results. Fortunately for the consumer, there are now several national quality partnerships aimed at improving processes within the operating room and recovery room to actively reduce post-operative complications.These quality measures are attempting to “hard wire” certain processes. “Hard wiring” means that something will happen based on protocol rather than on individuals having to remember to ask for it to happen. Many industries have proven that protocols lead to better results compared to letting individual practitioners deciding what to do. Getting a patient ready for surgery and then recovering the patient is a very complex process and it is quite easy to forget seemingly unimportant details. We have good surgical results in this country but the goal of these quality initiatives is to have excellent results and to decrease our complications from surgery by at least 25%. Most of these initiatives started several years ago and there has been excellent progress.The quality measures differ somewhat depending on the type of surgery. However, it is now mandatory to do a “time out” prior to making an incision to make sure that everything that needs to be done has been done. Some of the things this” time out” verifies is that the team agrees they have the right patient and the correct procedure according to the consent form, the right antibiotic has been given if indicated and at the right time, that certain medications have been given if indicated, and that the necessary equipment is available and functional. Other measures that are addressed are the patient’s temperature and glucose level. Special warming devices are used to prevent hypothermia during surgery. Also, if the patient’s blood glucose level is elevated, they will be given insulin even if they are not diabetic in order to prevent certain post-operative complications. Extra oxygen is given to all patients after some types of surgery because it has been shown to reduce wound infections. These above measures are why some patients wake up in the recovery room with oxygen and insulin drips even though they do not have lung disease or diabetes.The good news is that there are many national quality measures that are being put into practice and are working to reduce complications as a result of surgery. Because these are national measures, you can be confidant that you will be given the same care no matter which hospital you go to as long as that hospital is participating in these programs. In the future, there will be even more quality programs nationally in an attempt to standardize care across the nation.If you would like more information you may search for SCIP (Surgical Care Improvement Project) or ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program).