By: Joan Pellegrini, MDGood news for women: gone are the days of recommending annual Pap exams.So, why did the guidelines change? It turns out that more frequent screening was turning up more abnormal results thus leading to more testing but no benefit. Most of the time, these abnormal results were nothing to worry about. If we screen every 3 years we can still catch cervical disease before it becomes cancer and yet not miss more cancers. If HPV testing is added to the Pap, then screening can be extended to every 5 years.More good news: we no longer have to subject ourselves to screening before the age of 21. Cervical cancer is caused by the Human Papillomavirus (HPV). There are many types of HPV and most of us are infected at some point in our lives by at least one of the types. Only a few of the HPV types will cause cervical cancer. Most women who become infected with the virus are able to fight it off and never have a problem. However, if a young woman who just contracted the right type of HPV has a Pap test early on in the infection, the Pap will be abnormal. But, chances are she will clear the infection and have a normal Pap in a few years. This is mainly the reason why the new guidelines recommend not screening before the age of 21. This is opposed to the previous guidelines which recommended starting screening no later that age 21.The U.S. Preventive Services Task Force website has a more detailed description of the new guidelines.http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancersum.htmThese guidelines are for women at low risk and with no history of an abnormal Pap test. The most important component of screening is that women actually get screened. How long the interval is between screens is less important. As usual, we recommend you discuss your particular situation and concerns with your personal healthcare provider. I started this segment off with the good news. But, the bad news for women is that although cervical cancer rates are down significantly since we started getting Pap exams, there are still over 12,000 cases of cervical cancer per year in this country. And, the vast majority of cancers occur in women who have never been screened. This gives us some room for improvement. So, we can now reduce the frequency of screening but we still need to get every woman to get screened.
Lyme Disease 2012Amy Movius MDHuman Lyme Disease started in Connecticut in the 1970s and hit Maine in 1987. Lyme disease starts as a disease of animals. First, a deer ticks bites an infected animal and â€œpick upâ€ the bacteria that causes Lyme Disease. The infection is then â€œdeliveredâ€ to persons those same ticks later bite. Human Lyme Disease in Maine has been rising every year: more than 1000 cases were reported in 2011. The peak season for Lyme Disease in late spring and summer, BUT, ticks can be active anytime the temperature is above freezing. Last yearâ€™s winter was mild so the medical community is expecting to see more tick bites, earlier in the season. Case in point: a member of my own family has already had a tick bite! May is Lyme Disease Awareness Month so itâ€™s a great time to get ready to NOT get infected. The only fool proof way to avoid Lyme Disease is to have no tick exposure. Since this is near impossible, preventing and quickly detecting any bites is more practical.To this end, the Maine CDC has developed the â€œNo Ticks 4 MEâ€ rules:1. Wear Protective Clothing Long sleeves and pants in outdoor â€œhigh tickâ€ areas are best. Light colored clothing can make ticks easier to see. Tucking pants into socks and taping them prevents ticks from sneaking up pant legs. After wearing clothes outside, wash in hot water and dry on high heat to eliminate any stowaway ticks you may have missed.2. Use Insect Repellent These skin repellents must contain DEET or picaridin to repel ticks. You must treat your pets as well or they may escort Lyme carrying ticks straight into your house. Also, clothing can be treated with permethrin to discourage ticks from attaching to them.3. Perform daily tick checks Yes, daily! Ticks have to be attached at least 24 hours to transmit Lyme disease so finding them promptly keeps you safe. However, these critters are very small and can go undetected if youâ€™re not actively looking for them. Itâ€™s also a good idea to shower as soon as possible after coming indoors for the day. If you find a tick donâ€™t put anything on it! Carefully remove it by pulling it gently and straight out with tweezers. Wash the area and use a topical antiseptic and keep an eye out for any rash around the site for the next month.4. Use extra caution in tick habitats This includes wooded or bushy area, high grass, and areas with lots of leaf litter.Lyme disease most commonly presents with a rash around the bite, which can show up days to even a month after the bite, and is usually not painful. Any rash should be seen by a health provider, even if you feel fine at the time. Antibiotics are effective against Lyme disease and, unfortunately, many people who do not get treatment will develop later symptoms â€“ even months later â€“ that can be quite serious. References:www.maine.gov.cdcwww.cdc.gov/lyme/ www.ncbi.nlm.nih.gov www.lymediseaseassociation.org/
By Dr. Jonathan WoodApril 21-28 = National Infant Immunization WeekChildhood immunization is in the news. Childhood immunization is always in the news. Why? Because it is exceedingly important, likely the single most successful preventative health measure in the history of modern medicine. But also, it is newsworthy because we are still failing to achieve the kind of immunization coverage that an advanced industrialized nation ought to achieve. And why are we failing? â€¢ Sometimes there is a shortage, but that is an infrequent and minor impediment. â€¢ Sometimes cost enters into it, but that has all but been erased in Maine due to the fact that all childhood immunizations now are paid for by the state. â€¢ Sometimes physicians donâ€™t take advantage of immunizing children who need to â€œcatch upâ€ due to misunderstandings about when vaccines can or cannot be given, but that accounts for only a minimal number of the missing vaccines.So why? Myths! There have been genuine concerns about vaccine safety in the past and that has been discussed and re-discussed, researched and re-researched, settled and re-settled. The organizations who look after vaccine safety have been extremely diligent worldwide in evaluating these concerns. Conclusions: our vaccines are exceedingly safe and offer little or no risk, especially when compared with the advantage of preventing the horrible, even deadly diseases which the vaccines are directed towards.Beyond the vaccine safety concern, which I will not address in detail here because it has been done before, what are some concerns that people put forth?1. The vaccines arenâ€™t as effective as everyone says they are?Wrong! These vaccines are amazing and we all need to recognize the profound effect they have had on our society. Examples:â€¢ In 1964-1965, before rubella immunization in the U.S., an epidemic of rubella that resulted in an estimated 20,000 infants born with this disease. The result? 2,100 neonatal deaths. Of those that survived, 11,600 were deaf, 3,580 were blind, and 1,800 were mentally retarded. Due to the widespread use of rubella vaccine, only six cases were provisionally reported in the U.S. in 2000.â€¢ The number of hospitalizations and deaths due to chickenpox (yes, chickenpox!) has dropped more than 90% since its introduction in 1995.â€¢ In the 1980â€™s, the bacteria HIB caused over 20,000 cases of severe disease each year. It was the leading cause of pneumonia, meningitis, and epiglottitis, Most of these children were hospitalized and many died or experienced severe lifelong disability. Since the introduction of the HIB vaccine in the early 1990â€™s, the incidence of invasive HIB disease has decreased by greater than 99%. For those of us who experienced this horrible germ, this is astounding and a godsend!â€¢ The year before the measles vaccine was licensed, there were over 450,000 cases in the US. The death rate is anywhere from 3/1000 to 10/1000, with complication and hospitalization rates much higher. Within 4 years, the incidence was less than 10,000 cases/year. Currently, â€¢ What would we prevent over time if we completed routine immunization of one yearâ€™s worth of children in the US? Over 20 million cases of disease and 42,000 deaths would be prevented! And the money savedâ€¦? Over 13 billion dollars in direct health care costs!2. These diseases donâ€™t exist.Wrong! These diseases most certainly do exist, not only in underdeveloped countries but right here in the USA. And with international travel what it is today, even the less common diseases are increasingly likely to find their way into the US, where our under-immunized children will be at tremendous risk. Just a few examples:â€¢ Pertussis (whooping cough) outbreaks are increasingly more prevalent, including several each year in Maine. Over 21,000 cases of pertussis are diagnoses yearly in the US. A 2010 outbreak in California resulted in the deaths of 10 children.â€¢ Two internationally imported US outbreaks of mumps in 2006 and 2009/2010 resulted in more than 6500 and 3500 cases respectively. Although this is a large number of cases, it pales compared with the over 300,000 cases reported each year prior to immunization.â€¢ Worldwide every year, tetanus kills 300,000 newborns and 30,000 birth mothers who were not properly vaccinated. Thankfully, the number of reported US cases remains low due to immunization. That said, an increased number of tetanus cases in younger persons has recently been reported, a potentially dangerous trend.â€¢ There are an estimated 45 million cases of measles each year worldwide resulting in more than 800,000 deaths! An exceedingly infectious germ, this disease is easily transported and transmitted via air travel. The recent MMR vaccine â€œscareâ€ which caused decreasing immunization rates has resulted in increased outbreaks throughout the industrialized world.3. The number of vaccines is ridiculous, so many more than we had when we were kids.The number of vaccines has increased, but the purity of these vaccines is so improved and the manufacturing techniques are so advanced, that the actual number of antigens in 2012 is less than the number of antigens than in the 1990â€™s even though the number of diseases prevented has increased. Hard to imagine, but absolutely true!4. Vaccines will traumatize my infant and cause long-term psychological trauma.Childrenâ€™s long term memory has not developed by the time the majority of routine immunization has been completed. Parents may be traumatized, but children are not. There is no evidence to support this worry and it defies common sense. Do kids cry with their shots? Yes. Do toddlers cry when they fall down? Yes. Does either of these things scar them for life? Or even for the day? No! Pick them up, comfort them, and they will bounce back to baseline before you know it. If we were worried about infant psyche from traumatic experiences, we should be worried about their routinely crying when they are hungry or have a diaper rash. Or perhaps even when they pass through the birth canal, perhaps the most traumatic event any of us has ever experienced. All of these are unavoidable and none result in psychological damage. Your kid is very resilient!5. My childâ€™s immune system will be overwhelmed.NO! Wrong! Our immune system is challenged daily by a multitude of antigens. Our diet alone exposes children to many more antigens than immunization will ever do. In fact, it has been repeatedly shown that the introduction of multiple antigens (combined vaccines or multiple shots in one visit) actually increases the responsiveness of the immune system. Our immune system actually does better with multiple doses, not worse!Bottom line:â€¢ These diseases are really bad.â€¢ These diseases are still out thereâ€¦ big time!â€¢ You do not want your kid to have any of these diseases, so donâ€™t pick and choose.â€¢ Immunize your kids.â€¢ Immunize them as infants and young children – – o they will protected earlier, they wonâ€™t remember, and their immune system will like itâ€¢ Donâ€™t be swept up by myths that defy logic and countless years of data
By: Dr. Anthony NgWell spring is upon us and what is the best way to enjoy spring, being outdoors. Many are enjoying the outdoors by bicycling, especially children. As much as it is great fun and great way to have children participate in exercise, this is also an important time for parents to ensure that their children learn bike safety. According to the National Highway Traffic Safety Administration, 618 lives were lost from bicycle accidents in 2010 and this rate has been rising over the past several years. In 2008, 13 percent of those killed were under 16 years old. Each year, close to 500,000 people visit emergency room as a result of bike related injuries. More children between 5 and 14 years old visit the emergency room for bike related injuries than any other sports, with many of these visits due to head injuries. The most important safety tip that parent can teach their children is to wear helmets. Helmets should be worn even by children who may only be biking a very short distance or in the driveway, as this will get children to start practicing bike safety skills. Bicycle helmets should be properly fitted to the childâ€™s head yet comfortable enough for the child to wear. The size of the helmet should be considered, as well as position. A bright color helmet may be more visible to others than a darker color helmet. Parent should buy a new helmet that has been tested and meets the uniform safety standard issued by the U.S. Consumer Product Safety Commission (CPSC). Helmet should be replaced if the child has outgrown it, if the helmet has been involved in a crash or has been damaged. Parents when riding with children should also wear helmets as that will be good role modeling for their children. Remember, it is the law in Maine that any one under 16 years old riding a bicycle must have a helmet. In addition to bicycle helmets, parents should make sure the bicycle is adjusted to fit the child, not too big and not too small for the rider. The equipment should be checked including tires being properly inflated and not worn. The bicycle should also be visible to other riders. This includes the use of reflectors and lights. Children should also be wearing bright color clothing, including fluorescent neon to enhance visibility. Children should be taught to control their bikes, which include having their hands on the handle bars. When riding, children should be mindful of hazards such as potholes, rocks, broken glass, gravel, puddles, tree branches and sticks, leaves, and dogs and other animals. All these hazards can cause a crash. Teach children that when riding with friends, one person can take the lead, yell out and point to the hazard to alert the riders behind him. Avoid riding at night as it is more difficult to see the hazards or for cars to see the rider. Parents should not let children ride in active roadways and young children should be supervised. Placing safety signs by your home to alert motorists that young children may be riding near there may be helpful. For older children, they should still try to avoid very active roadways and to ride on the right of the roadway and always going with the flow of traffic, not against it. Children should watch out for parked cars and should be taught to obey traffic laws, including traffic lights and stop signs. Parents should teach children to yield to traffic and pedestrians. Teach children to use hand signals when turning. Reckless behaviors such as racing in roadways or when there are other pedestrians and riders present should be discouraged. Avoid distractions such as using headphone for music or talking or texting on cell phones as these distractions can increase risks of accidents. Bicycling is a great way to enjoy the outdoors in the spring. It is even better when families can bike with safety in mind. Remember, teaching kids good and safe bike riding habits will help ensure that they will continue to do so as adults.Bicycle Crash Facts. Accessed 4/20/2012. http://www.bicyclinginfo.org/facts/crash-facts.cfmBicycle Safety. Accessed 4/20/2012. http://www.maine.gov/dps/bhs/bicycle-safety.htmlKids and Bicycle Safety. Accessed 4/20/2012 http://www.nhtsa.gov/people/injury/pedbimot/bike/kidsandbikesafetyweb/index.htm
Taking Care of Both Mom and the Baby: Recognizing and Treating Post-Partum DepressionDr. David Prescott â€“ Eastern Maine Medical Center Behavioral Medicine ServiceOne in Six New Mothers have at least Mild Depression: Increasingly, post-partum depression, (depression which occurs within 3-4 months after birth) is recognized as a relatively frequent occurrence that benefits from early recognition and treatment. Just under 1 in 6 women will experience some type of significant depression after giving birth. In some cases these feelings resolve by themselves, often with support from family and friends. However, if left untreated, symptoms of depression can persist for up to a year. Where is the Line Between â€˜Baby Bluesâ€™ and Clinical Depression? Probably the two most important factors in differentiating major depression from â€˜baby bluesâ€™ are the length of time a new mother feels depressed and the intensity of the depression. The benchmark for diagnosing major depression is 2 weeks of persistent depressed or irritable mood. In addition to feeling sad, depressed, or irritable, other symptoms of major depression include: â€¢ Crying frequentlyâ€¢ Feeling hopeless, guilty, and overwhelmedâ€¢ Having trouble focusing or making decisions. â€¢ Withdrawing from friends and family.â€¢ Loss of appetiteâ€¢ Disrupted Sleep or Excessive SleepPost-Partum Psychosis: A less frequent but more severe problem: In rare cases, usually within the first two weeks after giving birth, a woman experiences frequent confusion or disorientation (not knowing where you are or what day it is), hallucinations, or extreme fear and paranoia. This may indicate the presence of post-partum psychosis and warrants immediate attention from a mental health professional or primary care doctor. What Causes Post-Partum Depression? Child birth, while usually very exciting, is also an event which includes most of the major risk factors for depression. Contributing factors include: â€¢ Previous History of Depression: Women who have had previous episodes of major depression are at increased risk for post-partum depression. â€¢ Hormone Changes: The usual post-pregnancy decrease in estrogen and progesterone, as well as a decrease in hormones produced by the thyroid gland, are thought to strongly contribute to risk for post-partum depression. â€¢ Changes in Brain Chemistry: Researchers suspect that pregnancy and childbirth may alter brain chemicals involved in the onset of depression. â€¢ Stressful Life Events: Significant life events, both positive and negative, increase the risk for an episode of major depression. Assessment and Treatment for Post-Partum Depression: Family and friends can provide important help in providing emotional support and caretaking support for new mothers who are struggling with depression. They can also encourage mothers who seem depressed to talk with their doctor or a mental health professional. â€¢ Reducing Isolation: Most mothers, whether depressed or not, find that spending time with other new mothers helps improve their mood and get tips for coping with motherhood. â€¢ Counseling: Simply talking about the adjustments associated with parenthood and the feelings that develop after childbirth usually results in improved mood. Often counselors can make concrete suggestions about a few small steps that will help reverse depression. â€¢ Medications: There are many medications that help with depression or anxiety that can be prescribed by your primary care doctor or a psychiatrist. For More Information: Mayo Clinic Web Site: www.mayoclinic.com/health/postpartum-depression/DS00546American Psychological Association: www.apa.orgNational Institute of Mental Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004481/
WABI TV5 Healthy Living March 27, 2012By: Dr. Joan Pellegrini A NEW INVESTIGATIONAL DRUG FOR BRAIN INJURED PATIENTSBrain injury is very difficult to treat because there are no effective medications. When someone suffers a serious brain injury the only options for the medical team is to support them through the healing process. Sometimes a neurosurgeon may offer surgery to drain blood or remove part of the brain. However, even after surgery there is only supportive care. Over the past few decades there have been several studies looking at various medications that may improve outcomes from brain injury. Unfortunately the results have not been promising.Physicians who care for these patients noticed many years ago that women tended to have better outcomes. The first study on this involved rats. Male and female rats were subjected to a traumatic brain injury and the female rats had better outcomes (they measured outcome using mazes and testing the ratsâ€™ ability to navigate the maze). It was hypothesized that it might be the female hormones that were helping the brain heal. So, the next study looked at â€œpseudo-pregnantâ€ rats and these rats did even better in functional outcome. More studies were done that led to the hypothesis that it was progesterone that was acting as a â€œneuro-steroidâ€ or as a neuro-protective hormone enabling better healing and functional outcomes.BHR Pharma is a Belgian company that specializes in producing medications that contain progesterone. There have been phase 1 and 2 studies done that give progesterone to brain injured patients. These initial studies have had promising results. In fact, it seems that not only do less patients die but the ones that survive have better functional outcomes. The results are promising enough that the FDA gave BHR permission to conduct a large phase 3 trial. This trial is a randomized, placebo-controlled, double-blinded study that is looking to enroll over 1100 patients internationally. This type of study is considered to be the most rigorous for testing a hypothesis. EMMC is one of the study sites.This is how the study works: when a patient suffers a serious head injury they are almost always transferred to the nearest trauma center (which is EMMC for this part of the state). The emergency personnel and trauma physicians will give all of the standard care that the patient needs. Part of the evaluation always includes a CT scan of the head. If this confirms the presence of a serious head injury and the patient is in a coma, then the patient may be a candidate for the study and the family may be approached and asked for their consent. The study requires that each patient be randomly assigned to either the â€œplaceboâ€ group or the â€œtest drugâ€ group. The drug is a high dose five day infusion of progesterone. All of the other standard treatments and supportive care are still given to the patient. The patient then comes back to EMMC at 3 months and 6 months for a lengthy questionnaire about how well they are doing and whether there is anything they cannot do that they could do before their injury.There are a few things that make it difficult to do this study. First, in order to have the most impact on brain injury, any treatment must be given as soon as possible. For this particular study, the study drug must be given to the patient no later than 8 hours after injury. Also, the next of kin must be present at the hospital in order to give consent to be enrolled in the study.This study is still enrolling patients and will not be closed for another year or so. Therefore, it will be at least another two years before the data is published. It is my hope and the hope of the medical community that this drug turns out to be effective. If so, this would be the first promising new treatment for brain injury.
By Dr. Jonathan WoodSteering Your Way Through Hospitalization(Beware – – potentially rough waters ahead!)Being admitted to the hospital is often scary and traumaticâ€¦ for the patient and for the patientâ€™s family as well.Being critically ill, needing invasive procedures or having a hospitalized child all accentuate this feeling. The medical lingo is difficult to understand, the issues discussed often carry great importance, and there are often unanswered questions. Whatâ€™s more, caretakers often seem to be overworked or in a hurry. Arrgghhhh!And then money is invariably an issue: missed work, inadequate insurance, childcare needs, day-to-day living away from home, etc. More stress.In the end, many people report a sense of â€œloss of controlâ€. What can be done?While I cannot offer a fix for the sometime beleaguered state of modern medicine, I will suggest one central thing that can help with all the above: improved communication. And much of it is within your control.Some suggestions:â€¢ Learn the system (i.e. who are all these people?)Hospitals depend upon a complex system of personnel that is often very confusing and very difficult to understand. Examples:o Primary Care docs (e.g. Internist, Family Practitioner, Pediatrician)o Inpatient Specialists (e.g. Hospitalist, Intensivist)o Specialists (e.g. Surgeon, Psychiatrist, OB-Gyn)o Sub-Specialists (e.g. Cardiologist, Neurologist, Orthopedic surgeon)o Midlevel Providers (e.g. Nurse Practitioner, Physician Assistant)o Nurses (e.g. bedside nurse, charge nurse)o Ancillary Personnel (e.g. Respiratory Therapy, Physical Therapy, Occupational Therapy, Nutritionists, Social Workers, Care Managers)o Trainees (e.g. residents, nursing students, medical students)â€¢ Ask questionso Who are you? Insist that people introduce themselves and explain their role in your care. Where do they fit in the lists above?o Why are we doing this? Insist on understanding why tests are being done and what is going to happen with the information.o May I speak with my doctor? Ideally there is one doctor orchestrating all of your care. Ideally there is excellent communication between doctors and amongst all the participants in the care team. Insist on a team and a good leader.â€¢ Tell your caretakers your worries â€“ donâ€™t be afraid to tell people what concerns you or what would make you more comfortable. Nothing is off limits!â€¢ Leave your biases at homeo Believe in the system â€“ Much of believing is understanding. Work to understand the system (see above) and increased confidence will follow. o Donâ€™t worry about offending â€“ Doctors are people – – you can talk to them like you talk to anyone. Sometimes people feel intimidated, but it is important to move beyond this. Be yourself. Remember: you are the consumer. Be polite and expect the same in return.o Gender â€“ The days of female nurses and male doctors are long over. Do not make assumptions based on gender and treat all your caretakers with respect. Insist on the same in return.o Teaching Hospitals â€“ Much of the best care in the US is delivered in teaching hospitals. No one is experimenting on you. On the contrary, these are often very concerned, very smart, and often less busy students or residents who can be very helpful in you quest for quality healthcare. Take advantage of the opportunity!o Culture Differences â€“ Maine attracts caregivers from all cultures. These people are invariably well trained and very caring. Treat them with respect and expect the same in reverse. If accents are difficult to understand, be frank, polite, and patient.â€¢ Know what is expected of you and your family when you are dischargedo Ask questionso Get to know your â€œcare managerâ€ or â€œdischarge plannerâ€o Be sure you understand your medications and doses (including changes from when your arrived)o Have instructions repeated as many times as it take to understando Know who you need to see after leaving and where and when.While these suggestions wonâ€™t make being hospitalized fun, they may take some of the unnecessary fear and anxiety out of the process. In the end, remember… communication is the key!
By- Dr. David PrescottDefining Dementia and Depression: Two common health concerns for seniors are dementia and depression. The relationship between these two conditions is complex and usually requires a careful assessment by a health or mental health professional. However, knowing some of the common similarities and differences can help seniors and their family members know when to ask for help. Dementia refers to significant problems with memory and at least one other cognitive ability such as language or reasoning. As noted by the American Psychological Associationâ€˜s Help Center, dementia can be caused by Alzheimerâ€™s disease or other age-related problems such as stroke or Parkinsonâ€™s disease. Dementia is not an inevitable consequence of aging, although it is age-related and doubles in prevalence from a low rate in 60-64 age group to 40-50% of those older than 85.Depression is primarily a mood disorder, but depression is also marked by difficulties with concentration and short term memory. In fact, concentration and memory difficulties are often the most treatment resistant symptoms of depression in the elderly. In addition to problems with memory or concentration, elderly people often first report signs of depression as physical complaints, such as lack of energy, poor sleep, or increase in minor pain and discomfort. How to Differentiate Dementia from Depression: As mentioned previously, sorting out whether changes in mood and memory are due to depression, dementia, or both usually requires a health or mental health professional. However, certain situations are commonly associated with depression. The following are questions which may help you identify whether or not depression is the underlying factor. 1. Are memory problems brief and variable? Occasional lapses in attention and short term memory, such as forgetting where you put something or forgetting someoneâ€™s name, are common and not usually cause for concern about dementia. These types of problems may become more common when a person is depressed. 2. Was the onset of memory problems associated with a loss or other difficult event? Depression is often associated with a loss of a loved one, a job, or loss of physical functioning. Sometimes the losses are gradual, sometimes sudden. In many cases, if memory problems are associated with some type of loss, they are symptoms of depression rather than dementia. 3. Does the person have persistent hopelessness, discouragement, or sadness? Persistent hopelessness or sadness is a hallmark of depression. If these mood symptoms are present, there is a strong chance of a mood disorder like depression. What Can I Do? Perhaps the biggest common misconception about either depression or memory problems is that there is nothing you can do about it. While there are certainly limitations to treatment, particularly with severe forms of dementia, there are many ways that you can help both your memory and your mood. 1. Engage in mentally stimulating activities: While the exact impact of keeping your mind active is still being researched, there is widespread agreement that staying mentally active helps both your mood and your memory. 2. Find ways to be independent: Independence in the elderly may be different than independence of younger adults, due to physical limitations or general life circumstances. But, finding ways to respect the preferences and self-worth of our senior citizens is a good way to combat depression, and to keep their mind active. 3. Make sure you work closely with health and mental health professionals: The reasons for changes in mood or changes in memory are often complex with seniors, and may involve medications, physical changes, or environmental and social changes. It takes time, and usually professional help, to sort them out. 4. Donâ€™t keep it all to yourself: Neither depression or dementia are inevitable consequences of aging. There are things you can do to cope with depressed mood or mile memory loss. Donâ€™t think you have to go it alone!Additional Resources: American Psychological Association Psychology Topics: www.apa.org National Institute of Mental Health: www.nih/nimh.gov
By- Dr. Anthony NgOne of the most talked about topics in teen health has been the issue of sleep. According to the National Sleep Foundation, their recommended guideline for sleep for teens is nine hours and fifteen minutes per night in order to function at their highest level. Other past studies have suggested children between ages seven to 12 needed 11 hours of sleep. Insufficient sleep for teens has been linked to poor academic performance, as well as health changes and mood issues as well as other task performances such as driving. However, according to a recent study that came out of Brigham Young University, their results seem to highlight that perhaps teens do not need as much sleep as previously thought to see the same level of academic performance on standardized testing. The researchers studied 1,724 primary and secondary school students across the U.S., assessing how much sleep they got and how they scored in standardized tests. In this latest study, the authors noted that in terms of testing best in exams, for age 10, nine to 9.5 hours of sleep is needed: for age 12, eight to 8.5 hours of sleeps is needed and for age 16, seven hours of sleep is needed. What is important about sleep is not how much but more the quality of sleep. Teens may perform better academically if they cut down on lie-ins. Pupils also do better in exams if they have a regular sleeping pattern. While this recent finding highlights that the amount of sleep that teens need to maintain good academic performance is slightly lower than previously thought, additional studies are likely needed to fully assess quality of sleep, rather than duration, how sleep actually affect performance and what variables may affect teen sleep. The amount of sleep needed may be a range instead of a hard number. Also, teens’ lives are busy between school attendance, home work, extracurricular activities, house chores or even paid work. There is significant pressure from parents and society for teens to do well both in and out of school. Such pressure can be extremely stressful. Teen sleep may be compromised as a result. It is important that sleep hygiene or habits are practiced earlier on especially in the teen years. Sleep hygiene include adherent to a regular of schedule of sleep. Avoid long day time naps that can affect one’s sleep at night. The use of stimulants, such as caffeine and nicotine, during the day and especially toward evening should be limited. Teen should try to have some down time for the mind to slow down before sleep. Technology can greatly influence negatively teen sleep. Avoid watching TV, texting or staying on the computer prior to sleep as this may provide ongoing stimulus that may impact sleep. Relaxation techniques such as deep breathing may be helpful. It is also important that teen should not get into a habit of taking sleep medication, both over the counter or prescribed to achieve sleep, as regular use of sleep aids may adversely affect the quality of sleep, thus resulting in not feeling refresh despite the length of sleep. Most importantly, the use of illicit substances such as alcohol or taking sleep medications not prescribed to them is a must to avoid.A take home message is that sleep is important to teens. It is important not only related to school performance but with adequate good quality sleep, teens health can be remarkably improved. Additionally, practicing good sleep habits as a teen will help them continue such habits as adults, thus reducing the potential impact of stress later in life. The Acadia Hospital in The Youth Services Sleep Hygiene Project will be sponsoring Sleep Awareness Month in April. For more information, please contact Sally Carlisle at 207-973-6016.
By- Dr. David PrescottHow is Your New Yearâ€™s Resolution Coming Along? A little more than a month into the new year, and for many of us our New Yearâ€™s Resolution is becoming a distant memory. The most common types of New Yearâ€™s Resolutions are those to improve our health, lose weight and exercise more. So why is this so difficult for many of us?Obesity and the Complexity of the Mind-Body Connection: The relationship between our minds and our bodies is important, but complex. In terms of obesity, psychologists have identified several psychological and emotional factors which play an important role in peopleâ€™s struggle with obesity. â€¢ Obesity and Depression: Depression can be both a cause and a result of being overweight. Particularly with women, the risk of having clinical depression (major depression) increases nearly 40% with obesity. For many people, depression has become such a significant obstacle in their life that they need to address it first before they are able to adopt a successful weight management program. â€¢ Obesity and Eating Disorders: Many fad diets encourage people to avoid food, rather than simply reduce portions. Many experts believe that trying to skip meals actually increases a personâ€™s risk for engaging in binge eating, where large quantities of food is consumed in a short period of time. Binge eating is often present in diagnosed eating disorders such as bulimia or anorexia. â€¢ Obesity and Stress: Stress refers to general feelings of anxiety, chronic worry, and feeling run down. It is very difficult to address obesity while your stress level remains at high levels. Many people hope that if they lose weight they will feel less stressed, but this is rarely the case. Rather, working to balance and reduce life stress is the first step, and then focusing on healthier eating and exercise is the second step. The Psychology of Overeating: Two Potential Factors: Experts in the mind-body relationship and obesity have identified some important factors in the psychology of overeating. Identifying whether any of these factors are important in your own life can be the first step in finding a better way. 1. Not recognizing our own eating patterns: Many, many of our behaviors fall into recognizable patterns. However, in the bustle of everyday life we may fail to recognize these patterns. In terms of eating for example, many people overeat at the end of the day when they are trying to relax and unwind. Others eat reasonable portions at home but oversize portions when eating out. Writing down everything you eat and studying this for patterns helps you determine your own psychology around eating. 2. Recognizing your patterns but not wanting to change: Psychologists have recently started focusing on the strength of our drives to eat palatable food. Said another way, many people who struggle with obesity know their own eating patterns, but simple donâ€™t feel compelled to change them. Psychological theories about why we make certain choices and how we decide between two competing goals offer some direction in cases like this. Psychological Tips for Addressing Obesity (from www.apa.org/healthcenter)â€¢ Think about what you eat and why. Track your eating habits by writing down everything you eat, including time of day and amount of food. Also record what was going through your mind at the time. Were you sad or upset with something? Or, had you just finished a stressful experience and felt the need for “comfort food?”â€¢ Cut down on portions while eating the same foods. Along with making dieting feel less depriving, you’ll soon find that the smaller portions are just as satisfying. This will also give you a platform to safely curb your appetite even more.â€¢ Losing weight is always easier when you have the support of friends and family. Try to enlist the entire household in eating a healthier diet. Many hospitals and schools also sponsor support groups made up of people who offer each other valuable encouragement and support. Research shows that people who participate in such groups lose more weight than going it alone.â€¢ Use the “buddy system.” Ask a friend or family member to be “on-call” for moral support when you’re tempted to stray from your new lifestyle. Just be sure you’re not competing with this person to lose weight.â€¢ Don’t obsess over “bad days” when you can’t help eating more. This is often a problem for women who tend to be overly hard on themselves for losing discipline. Look at what thoughts or feelings caused you to eat more on a particular day, and how you can deal with them in ways other than binge eating. For More Information: American Psychological Association: www.apa.org/helpcenterEastern Maine Medical Center: www.emmc.org
By- Dr. Amy MoviusFor many, snowmobiling is an important part of wintertime in Maine. The deaths and injuries from snowmobiles this past weekend are a sober reminder that care and planning is essential and may be lifesaving for people using these large and powerful machines. Some snowmobiling statistics follow: 1. Victims of snowmobiling injuries or deaths are often young: a. 35% are less than 25 yrs. of age. i. 25% are 15-24 year-olds, ii. 10% in children less than 15yrs. 2. Males outnumber females three to one 3. Head injuries are the leading cause of injury or death, usually from hitting a fixed object such as a tree. 4. Children less than 16yrs are frequently injured from falling off snowmobiles or having them roll over onto them. Children less than 8 yrs of age who are injured or killed are usually passengers or being towed behind snowmobiles. 5. For persons over 16yrs, drowning from falling through ice is a major factor.6. Operator error, speeding, use on inappropriate terrain, snowmobiling at night, and alcohol use are all contributing to snowmobile injuries and deaths 7. Non-accident risks include frostbite, hypothermia, hearing loss, and white finger syndrome.If you want to snowmobile, please do so responsibly. Consideration of the following guidelines can keep you and your family safe, while having fun. 1. Please don’t let anyone less than 16yrs old drive a snowmobile! Though this is not a law, the American Academy of Pediatrics urges you to think of operating a snowmobile as you would driving a car. It requires not only strength and skill, but maturity as well.1 Completion of an instruction and safety course is best. 2. Children less than 6 years should not ride as passengers on snowmobiles because of inadequate strength and stamina.3. A “graduated license” approach is recommended for new operators. This means new operators are limited to snowmobile use during daylight hours and on groomed trails only. Use of a speed limiting governor (limits maximum speed) is also recommended for new operators.24. NEVER use alcohol or drugs before/during snowmobiling.5. Protective clothing is needed. This includes goggles, a waterproof snowmobiling suit, gloves, rubber-bottomed boots and an approved helmet.36. Carry emergency supplies including a first aid kit, a survival kit (that includes flares), and a cellular phone.7. Don’t snowmobile alone.8. Avoid ice is there is any uncertainty about its condition. Conditions can be checked at www.sledmaine.com 9. Carry a maximum of 1 passenger.10. Use headlights and taillights at all times. 11. Never tow or pull someone behind a snowmobile (ex = in saucer, tube, sled, skis) for amusement.References1. Snowmobiling Hazards. American Academy of Pediatrics, Committee on Injury and Poison Prevention. Pediatrics Vol. 106 No. 5 November 2000. Statement of Reaffirmation 2010. www.aap.org2. Maine Snowmobile Laws 2008-09 3. www.sledmaine.com (for current conditions)Footnotes1. Maine state law allows children 10yrs and older to operate snowmobiles without adult supervision and children 14yrs and older to cross public ways on snowmobiles.2. The effect of graduated licensing for teenage snowmobilers has not been determined. However, graduated licensing for teenage drivers has reduced the number of motor vehicle-related deaths in this age group.3. Maine law currently requires persons less than 18yrs to wear protective headgear on snowmobiles being used on public trails funded by the Department of Conservation, Bureau of Public Lands. This applies to both operators and passengers.
By- Dr. Anthony Ngâ€œIt is no big deal.â€ This is often a statement that one may hear when one tells a friend or family member who drinks too much on occasions. This drinking excessively is known as Binge Drinking. Binge drinking is essentially defined as four or more drinks for women and five or more for men over a period of few hours. However, drinking in such excessive amount can be a big deal. In fact, according to a new data from the Center for Disease Control (CDC), a survey of more than 450,000 adults showed adults in the United States binge drink more frequently than previously suspected and they consume more drinks when they do. The CDC data also showed that more than 38 million U.S. adults binge drink an average of four times a month and the most drinks they consume on average is eight. Binge drinking is more common among young adults ages 18â€“34 and of those ages 65 and older who report binge drinking, they do so more often â€“ an average of five to six times a month. Binge drinking is more common among populations in the northern states, those with household incomes of $75,000 or more, but the largest number of drinks consumed per occasion is significantly higher among binge drinkers with household incomes of less than $25,000 â€“ an average of eight to nine drinks, the report said. In Maine, about one in five binge drinks, as compared to one in six nationally. Mainers drink an average of eight alcoholic drinks when they binge drink. It is suspected that much of this data may be an underestimate.The occasional heavy drinking as some may characterize binge drinking is widely accepted, especially in youth population. It is part of youth passage into adulthood as some perceive it. There may also be stigma attached to binge drinking which deters someone from seeking help. There may also be concerns about legal consequences, especially when underage teens are involved. However, alcohol is still among one of the most common drug of choice to abuse. People who binge drink may not be dependent or alcoholics but binge drinking can lead to a variety of public health concerns. When individual binge drink, they often become impaired and with that impairment, bad choices are made. Such choices may include driving while intoxicated, engaging in unsafe sex, risk taking behaviors resulting in injuries or deaths. Drinking too much, including binge drinking, causes more than 80,000 deaths in the United States each year, making it the third leading preventable cause of death, and was responsible for more than $223.5 billion in economic costs in 2006. Over half of these deaths result from injuries that disproportionately involve young people. The most important intervention to binge drinking is education. Communities, and in particular vulnerable populations such as teens and college age adults, are a prime target for such education. People should be informed of the potential for binge drinking and its consequences. Such education can also help empower individuals who are what is called bystanders, parents, teachers, peers, who can help remind individuals who may binge drink. For the individual who binge drinks, they should seek help if they find that their frequency or the amount of alcohol consumes are increasing. They have increased difficulties with school or work because of their drinking. Their moods are altered significantly, with possible depression, mood irritability and anxiety. Help should also be obtained when relationships with friends, families and coworkers become strained because of their drinking. A great resource for individuals is Alcoholic Anonymous. Professional substance abuse counseling may be helpful and in some instances, medication may be helpful to stop binge drinking behavior. So in response to the person who says it is no big deal when they binge drink, you can now tell them that binge drinking IS a big deal.References:CDC Fact Sheets. Binge drinking is bigger problem than previously thought. Accessed online January 13, 2012. http://www.cdc.gov/media/releases/2012/p0110_binge_drinking.html.Farrell, J. CDC: 1 in 5 Mainers binge drink. Bangor Daily News. Accessed online January 13, 2012. http://bangordailynews.com/2012/01/13/health/cdc-1-in-5-mainers-binge-drinks/?ref=latest.
Don’t get fooled by the relatively warm weather. It’s still flu season.TV 5 Health Advisor Dr. Erik Steele spoke on TV 5’s News at 5 with Jim Morris on being pro-active.
By- Dr. David PrescottThe Tragedy of Lost Time: It would be almost unimaginable to think about breaking your leg and then waiting two years before you went to get it fixed. Yet, two years is the average amount of time that elapses before a person showing clear signs of psychosis receives any type of mental health treatment. Similarly, people diagnosed with bipolar disorder report that 9-11 years passed before they first experienced clinically significant mood swings, and the time they were appropriately diagnosed. Increasingly, the need for early intervention in treating mental health disorders is recognized as critical in minimizing the impact of severe mental illness. Here, we will examine early warning signs for three disorders that typically begin in mid to late adolescence: schizophrenia, bipolar disorder, and alcohol dependence. As with any health problem, if you are in doubt, talk to a psychologist, mental health professional, or your family doctor. Early Signs of Schizophrenia or Psychotic Illnesses: The onset of schizophrenia, a mental disorder characterized by disorganization in thinking, excessive suspiciousness or paranoia, or in some cases hallucinations, is typically in the late teens or early twenties. However, warning signs are often present long before the formal onset. These include: â€¢ Withdrawal from friends or family â€¢ Difficulty concentrating, confusion, jumbled thinking â€¢ Suspiciousness, fearfulness or mistrust of others â€¢ Changes in the way things look or sound, seeing or hearing things that aren’t there â€¢ Odd thinking or behavior: feeling odd, like something is wrongEarly Signs of Bipolar Disorder: Bipolar disorder, or manic-depression, is characterized by repeated extreme mood swings. During a manic phase, people have excessive energy, grandiose idea, and elevated mood. These manic phases are often followed by sudden onset of depression, characterized by sadness, lack of motivation, and in some cases thoughts of suicide. While distinguishing normal from abnormal mood swings in teenagers is difficult, early warning signs may include: â€¢ History of biological relative with bipolar disorder. â€¢ Abrupt mood swings lasting from several hours to several days. â€¢ Explosive, lengthy periods of rage. â€¢ Hyperactivity, agitation, or distractibilityEarly Signs of Drug or Alcohol Dependence: Often, drug or alcohol dependence begins as recreational drinking or drug use. Early signs of drug and alcohol abuse or dependence include: â€¢ Frequent episodes of binge drinking (4 or more drinks for women, 5 or more for men)â€¢ Missing school or work due to drug or alcohol use or feeling hungover. â€¢ Spend increasing amounts of time using substances or with people that drink/use drugs with you. How do I seek help? Seeing a qualified mental health professional, like a psychologist, psychiatrist, psychiatric nurse, or licensed social worker is a good start. Help may include counseling, medication, or a combination of the two. If you donâ€™t know a mental health professional, your primary care doctor is often able to make a recommendation. For More Help: Acadia Hospital www.acadiahospital.orgIn Maine: Dial 2-1-1 for agencies that provide counseling.
By- Dr. Joan Marie PellegriniMost of us start thinking about our New Year’s resolution about this time of year. Common resolutions are to lose weight, eat more healthfully, get more organized, etc. The problem with many of these resolutions is that they are too vague and the goals are too lofty. Thus we set ourselves up for disappointment. This year I thought I would compile a list of resolutions that are easy to accomplish.Easy New Year’s resolutions:Advanced directives: On New Year’s day, set a date that you can sit down and address this issue. You will need to decide what you would want done medically if you were unable to make decisions. You will also need to decide who would make decisions for you in that situation. You should address whether you would want to donate organs and tissues if appropriate. You should discuss your decisions and concerns with your doctor at your next doctor’s appointment.Wear a seat belt: If you often forget, New Year’s Day is a good time to put a reminder note on your dashboard.Check smoke alarms: Set aside time on New Year’s Day to do this.Drive more politely: stop when a pedestrian is trying to cross the road. Stop at red lights. Give pedestrians and cyclists plenty of room. If you need a reminder, New Year’s Day would be a good time to put something on your dashboard that would serve as a reminder.Stretch: This cannot be done just on New Year’s Day but it doesn’t require a lot of work. Everyday, either before going to bed or maybe even at work you should do some gentle stretching. Being more limber will help prevent injury and help with chronic back pain.Buy a good pair of shoes: This may require consultation with a shoe sales person who can recommend the right shoe. Poor arch support and lack of appropriate orthotics can contribute to poor posture and back pain.Read my companies safety policies: If you have a job that puts you in danger on occassion, it is always a good idea to brush up on injury prevention.Go through medicine cabinet and throw out old medications: This will help prevent taking the wrong medication or the wrong dose.Update your list of medications: Make sure you have a copy in your wallet in case you need to go to another physician or the Emergency Room. Keep the name and number of your pharmacy on this list also.Check your blood pressure, cholesterol, make appt for checkup: When is the last time you had a health check up?Get vaccines updated for you and your children. This includes the Flu vaccine.Buy and read Unclutter Your Life In One Week: Or, read one motivational book.Go to church this weekend: for some people this can be a stress reliever.Sleep more: Most of us do not get enough sleep. Make sure you get quality sleep. Being well rested leads to bet productivity at work and healthier lives.Be nicer: Studies show that “nice” people are more relaxed and have better performance in their jobs. Being relaxed will help with any health issues also.Eat something healthy each day : I think this is easier than giving up something.Teach children brushing/ flossing: Make is a family routine to have better dental care.Buy a fiber supplement and take it daily: It is easy to remember if it is near your toothbrush or morning coffee. Most of us have inadequate fiber intake. Higher fiber diets help prevent many medical conditions.Take a vitamin supplement: Your physician can help you decide which one is best depending on your other medical conditions. As we head into winter, many of us could benefit from some extra vitamin D.These are just a few ideas. I am sure there are many other good ideas that can be accomplished in just a few days or less.
By- Dr. Amy MoviusKids love toys! And who doesnâ€™t love seeing the excitement and joy of a child playing with a well loved one? Anyone with a child on their holiday list has probably noticed there is a seemingly endless array of toy choices these days. Not surprising when you consider there are an estimated 3 billion toys sold yearly in the United States.Toys arenâ€™t all fun and games, however. Despite mandatory and voluntary safety standards, not all toys are created (literally) equal. In 2009, at least 12 children died from toy-related causes, and more than 250,000 â€“ a quarter of a million â€“ were treated in emergency rooms for toy-related injuries. WATCH (World Against Toys Causing Harm) is an organization devoted to raising awareness and providing information for consumers to use when purchasing toys. They also publish a â€œTop 10 Worst Toysâ€ list yearly. This list is by no means inclusive, but it does illustrate many hazards of currently available toys which unfortunately, are not new. These include (1) choking from small parts (2) strangulation from ropes/cords (3) impact or puncture injuries from rigid/plastic parts (4) electrical injuries and (5) items marketed as toys that shouldnâ€™t be. Some examples follow:1. Choking Hazards 16 of the toys recalled by the CPSC in the last year were because of choking risk related to easily detachable small parts or affixed small parts that easily break. The children most at risk are quite young because they are very oral in their behavior. However these detachable or affixed pieces are not necessarily considered â€œsmall partsâ€ by the toy industry and so may not be labeled as such. 2. Strangulation HazardsThese can result from necklaces, cords, ribbons, etc that can be wrapped around a childâ€™s neck, including items such as guitar straps. The industry standard for maximum cord length for toys designed for cribs or playpens is 12 inches. However there are pull toys (including one of the 10 worst list) marketed for these same very young children with much longer cords.3. Impact/Puncture injuries from rigid partsOne of the toys on the â€œworstâ€ list illustrates this point very well. It is a popular movie figure holding a 4 Â½ inch rigid plastic sword that activates when a lever is pushed. It is marketed to children over 3 and there is a warning of small parts, but no mention of the (obvious) risk of eye/impact injury.4. Electrocution. Sometimes electronic toys, with heating elements, are labeled for children as young as 8 5. Toys that Arenâ€™t ToysAir powered rifles are the prime example. They are actually weapons and not recommended for anyone less than 16yrs. Warning labels, while useful, are not a sole reliable means for determining a toyâ€™s safety. Some warning labels consist of removable sticker labels and others omit some risks or contain warnings that are impossible for the marketed child to adhere to. Examples include:1. A foam bow and arrow, for ages 8 and up, whose warning states bow should not be pulled back at â€œmore that half strengthâ€ and â€œanyone at close distance to the target should be alertedâ€.2. A trampoline, for age 3 and up, whose â€œonly function is for controlled bounce (exercise) in young children.3. An action figure, for ages 4 and up, with a flip open blade up to 2 feet that warns â€œdo not aim toy at anyoneâ€¦do not hit anyone with toyâ€¦do not poke anyone with toyâ€¦do not swing toy at anyoneâ€. How exactly do they envision these toys being used? In some instances, the marketing seems solely targeted at protecting the manufacturer, not the children using it.Likewise, toy recalls are too little, too late. They occur after a marketed toy has been shown to cause harm â€“ i.e. children have already been hurt. Many consumers are never aware a recall notice has been issued for a toy that is in their home. In the past year, there have been at least 28 toy recalls, accounting for over 3.8 MILLION dangerous toys in circulation in the US alone. There are no particularly safe brands or stores either. A quick scan of the CPSC’s list of recalled toys includes items found on the shelves of big-box stores, specialty stores, and dollar stores alike. In the end, families and friends must carefully examine the toys we buy for children, considering the specific toy as well as the nature and maturity of the child for whom it is intended. It is always the season for safety.References1. http://toysafety.org/worst ToyList.shtml2. http://www.cpsc.gov/cpscpub/prerel/catagory/toy.html3. http://www.medscape.com/viewarticle/753842
By- Dr. Anthony NgChristmas holidays are upon us. It is filled with joy, celebration, anticipation of getting together with friends and families. For also many, it is a time of enormous stress, thinking about what to do for the holidays, who to buy gifts for, where do I go to get those gifts, online or waiting in long lines in bad weather as many did for Black Friday. If one is not careful, the stress of the holidays can quickly overwhelm folks and in turn make this holiday season not very fun and enjoyable.First of all, we need to understand what is meant by stress. Whenever we hear the word stress, we only think of negative aspects of it, such as too much to do at work, too many obligations at home, relationship issues, etc., but there are other positive aspects of life that can be â€œstressfulâ€, such as holidays, getting a raise or promotion, going on a first date, or getting married. As joyful and exciting as these events, they are still causing what have been described as positive stress. It is stress that is sustained, uncontrollable and overwhelming, where people canâ€™t figure out options to solve their problems, that is damaging.When a person experiences stress in whatever forms, they may have anxiety, frustrations, happiness and joy or anger. We often tried to cope by various things such as relaxation, reading a book, exercises, spirituality, seeking support from friends and families to name a few. And for those who faces constant stress, they may develop potential negative coping strategies that may include overworking, arguing more with families, friends and colleagues, smoking more, drinking and in some instances using illicit drugs. We process stress in three ways, how we feel emotionally, how we feel physically and how we think. This falls back on the basic principles that human, like all animals, are born with, the â€œFright or Flightâ€ response. When an animal sees a threat from a predator, the brain processes the threat. The brain then attaches an emotion to that threat, such as fear or anger for example. The body then reacts to the threat, either by running away or by fighting it. We humans have evolved enough to now have threats or stresses that are not as visible. Nonetheless, we still behave in a way how our body is genetically imprinted with. We experience a stress. We then interpret the threat in a variety of manners. We then attach emotions to that stress and then our brain instructs our body to respond accordingly. Our body would respond for example by increasing more adrenal hormones to prepare the body for its responses, such as increased heart rate, breathing, muscle tensing to name a few.Our body is designed to handle short bursts of these stresses. We have chemical and hormonal changes to deal with stress. A well know chemical is the stress hormone cortisol which is increased and it leads to an increase of another chemical, adrenaline. The body gears up immediately in the face of stressful stimuli. It goes to our energy stores, and releases glucose and insulin so that our muscles have the energy to deal with the stress.These body chemicals are sustained at high rates to compensate for the stress, and as such, they can impact the body adversely over time. Additionally, the choices we make to handle this stress can influence how those stress hormones affect us. Drugs like alcohol, nicotine and cocaine, and also high-fat, high-calorie comfort foods, are powerful modifiers of the stress system. They will change our stress pathways and affect the way your body is able to control our stress response. And so, after a period of bingeing, our bodyâ€™s stress response system eventually wears out. However, folks will continue to take those drugs and alcohol to compensate a weakened system. This is often what we see in addiction. Research shows that childhood stress can hardwire the brain for a lifetime of higher stress levels. Early traumatic experiences can increase childrenâ€™s susceptibility to a range of high-risk behavior, such as tobacco use, binge eating, and earlier onset of alcohol consumption. It is important to keep in mind that children who see their parents stressed out during the holidays will inherently respond with their own stress and mimic parental stress responses, both good and bad ones.Does that mean we cannot revitalize our stress responses such as the adrenals? In fact, our body is forgiving and they can recover when we take away those toxins. What is not clear is how long that process takes. The problem, though, is that while your adrenals are still recovering, you are more likely to be stressed. And stress affects abstinence and increases chances of a relapse. So then we are caught in a vicious cycle of quickly degenerating health because both the stress and the substances are working together to wear down our body systems and our stress axis, our liver, kidney, heart, blood pressure. All this can also lead to certain types of cancer.We donâ€™t really know which comes first, but we do know that these are all complex multi-factoral diseases. That means they donâ€™t have one single factor that leads to the disease state. And there are factors that can make a person even more vulnerable to stress-related diseases and addiction: early trauma suffered in childhood, cumulative adversity, socio-economic status, education and also things like genetics and personality traits.In addition to the holidays, we live in a society where there are multiple demands on us almost all the time. We need to put greater emphasis on protective factors like sitting down with the family or exercising or putting away all the electronic devices. We also need to focus on mindfulness which we all do in some form or another. Having hobbies is one as well as relaxation. They all provide healthy distractions on stress and allow us to focus on oneself.So as you struggle to find the best bargains, what meals to prepare and who to invite for the holidays, you should take a moment to remember what the holidays is about. It is to share joy with friends, families and others. Make sure you take breathers in your busy schedules to practice stress reductions techniques, such as sitting down at the mall and taking a breather and to relax. Prioritize what you need is an efficient and healthy way to cope. Drink alcohol in moderate amounts. Donâ€™t forget to continue your hobbies and exercises. Remember, your families and friends want you around for many more holidays to share the joy. Happy holidays !!! Reference: CNN Blog: The Vicious Physiology of Stress by Amanda Enayati 11/26/11WedMD Feature: Tips for Overcoming Holidays Anxiety and Stress by R. Morgan Griffin 12/5/2011
Should children with asthma avoid acetaminophen? (Tylenol)By- Dr. Jonathan WoodThe incidence of pediatric asthma increased dramatically between 1980 and 2000. During that same time period, the association between aspirin and the severe neurologic disease, Reye’s Syndrome, became apparent. Consequently, the use of acetaminophen, a non-aspirin pain reliever/fever reliever, increased dramatically.Increased incidence of asthma and increased use of acetaminophen – – is there an association? Perhaps. We, as yet, have no satisfactory explanation for why pediatric asthma incidence has risen and then seemed to level off. The leveling off, by the way, coincides with the leveling off and acceptance of acetaminophen as the primary analgesic/antipyretic in children by the mid-late 1990’s.This coming month, in the journal Pediatrics, John McBride MD, a prominent pediatric lung specialist and researcher has pulled together this data and many other alluring studies to make a strong case that the use of acetaminophen (1) may well be responsible for the increased incidence of asthma and (2) may correlate with increased severity of asthma. The argument is strong and comes from a valid and respected source.For example:Â· An enormous worldwide epidemiologic study looked at more than 500,000 children with asthma and concluded the following:o Children 6-7 yr old using acetaminophen monthly had more than 3-fold increase in asthmao For 13-14 yr olds, it was close 2.5 times the incidenceo For less frequent use (less than monthly, but at least yearly) the increases were still 1.6 and 1.4 times respectively.Â· Other studies have corroborated this data in a variety of cultural, socioeconomic, and geographically diverse settings.Â· Several adult studies apparently demonstrate similar findings These are associations, not proof of causation. Nonetheless, they are worth consideration.And what about asthma severity? Prospective studies have been done comparing acetaminophen (Tylenol) and ibuprofen (Advil) in the context of asthma severity. Again, these suggest an association between more severe pediatric asthma and acetaminophen use: those kids using actaminophen had more severe disease than those using ibuprofen. Unfortunately, no study has ever looked at this with a placebo control, the good standard. Still, while we wait for that, the current data is alluring.What if we could reduce the use of something that would, if eliminated reduce asthma incidence in the population by 35-45 percent? Would we act on this? Yes. How simple would it be for children with asthma to avoid acetaminophen whenever possible? Easy. Are there viable alternatives for most circumstances? Yes. Ibuprofen is one.Would there still be times when the use of acetaminophen is warranted? Yes.My advice? 1 – Keep your eyes open. This issue is going to be discussed more and more.2 – Consider limiting or eliminating acetaminophen use if you or your child has asthmaFever? 1 – Why are we worrying so much about fever anyway? Fever is generally not a bad thing.2 – Review “The Truth About Fever” in the Healthy Living archive.
By- Dr. Jonathan WoodMy work with children and teens with Type I Diabetes Mellitus and its life-threatening acute complications has led me to realize there is quite a bit of confusion about what diabetes is and what the differences are between the two main types. This is important stuff.The confusion is understandable. We use the same word to describe 2 different diseases. Related, yes, but really quite different. Type II or Adult Onset diabetes used to be a disease of older people and generally of overweight people. While it was always a fairly common disease, it has become much much more common in recent years. Many debate the reason for the increased incidence of Type II diabetes, but certainly it is related to some degree to the increased incidence of obesity in the US. And, as we see more and more young obese people, including many children, Type II diabetes has started to occur in younger and younger people. You see where I’m going here – – the terms Juvenile Onset and Adult Onset no longer apply and the crossover has fueled the confusion.Both Type I and Type II diabetes result in high blood glucose or blood “sugar”. That said, the way this happens and the consequences of this is somewhat different in the two diseases.What are the underlying problems in these 2 diseases?Type I Diabetes: lack of insulin. The pancreas stops making insulin. Insulin is critical to the body’s ability to manage and use the fuel glucose. Without insulin, paradoxically, the body tissues can’t “see” all the glucose accumulating in the bloodstream. They therefore turn to different pathways to produce fuel, which causes acute and often severe illness.Type II Diabetes: resistance to insulin. There is insulin, but the body doesn’t recognize it.The body makes insulin, but the tissues can’t “see” the insulin properly. The tissues are partially resistant to the effect of insulin and hence the blood sugar rises.The long-term consequences of high blood glucose (sugar) are largely the same in both diseases. (e.g. eyesight problems, kidney problems, peripheral nerve problems, increased infections)But, additionally, the complete absence of insulin in the Type I diabetics creates a scenario for life-threatening acute problems if day-to-day insulin management isn’t well understood and maintained carefully. This is generally not the case in Type II diabetes.If you have diabetes or a family member with diabetes, learn about their type of diabetes. If you have a young child or teen or grandchild or niece or nephew with diabetes, it is probably Type I. It needs to be well understood to safely provide for that child or teenager.If someone has Type I Diabetes, they need to have insulin given to them at all times. Learn about this! Most of the insulin given is to allow them to handle ingested foods, but a common misconception is that “if they don’t eat anything, they don’t need insulin”. This is a dangerous misconception. Yes, if they are sick or vomiting and not eating, a Type I diabetic needs less insulin, but they still need insulin. To give none is to risk the life-threatening complication of ketoacidosis. The rules governing this important situation are called “sick day rules” – – learn about them.Type I diabetics can lead full and productive lives. They can do all the things that other children can do, but they need to be safe and have family members that understand their disease.A good online review of all this can be found on Wikipedia: http://en.wikipedia.org/wiki/Diabetes_mellitus