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
American men have about a one in six chance of getting prostate cancer and are especially vulnerable as they get older. But a panel commissioned by the U.S. Government recommends against screening for it. TV5 Health Advisor Dr. Erik Steele joined Jim Morris on TV5 News at 5 to talk about it.
Uncontrollable, violent coughing is one of the key symptoms of whooping cough. It’s highly contagious, also highly preventable. TV5 Health Advisor Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to help out.
By- Dr. Amy MoviusThere has been a lot of attention in the press lately regarding a certain vaccine. Unfortunately, what should be a cut and dried health issue can be politicized and otherwise distorted: bluntly stated, politicians and newscasters are probably not the best dispensers of medical advice (sorry WABI!).In approaching the subject of vaccinations, I opted to start with what I believe to be 2 undisputed truths:1. We all want what is best for the children in our lives.2. Doctors and other health providers come from a variety of political, religious and cultural backgrounds.Starting from these two assumptions, there is really very little controversy among medical professionals about the benefit and safety of vaccines. A quick look back in time illustrates the benefits. For example, before vaccine availability in the United States in the 1940s, there was an average of 175,000 cases/year of pertussis (whooping cough) or 150 cases/100,000 population. In the 1980s, there was an average of 2,900 cases per year or 1 case/100,000. In 2008 this was up to 13,278 cases. This is in part due to decreased vaccination rates. Unfortunately, in this example, the youngest among us suffer the most from severe illness and even death. Of the 181 pertussis deaths from 2000-2008, 166 were in children less than 6 months of age. All infants of this age are vulnerable to pertussis as vaccine immunity is not fully established until after 6 months of age (vaccine given at 2, 4, and 6 months). These most fragile among us must rely on not being exposed to avoid disease, which in turn depends on the immunity and vaccination status of the population at large. This does not mean that side effects from vaccines donâ€™t exist. They do, and fortunately most of them are mild (pain/swelling at site). Also, some health problems coincidentally overlap with receiving a vaccination – they are unrelated except in time. However, in the US it is not expected that we vaccinate our children on faith alone. There is an organization that REQUIRES reporting of all possible adverse vaccine effects by health professionals and vaccine manufacturers. However, ANYONE can choose to make a report, including a patient (or a parent). Also, the results are public, so EVERYONE can access this information. The sole function of this organization, VAERS (Vaccine Adverse Events Reporting System), is to constantly process and analyze this data for the purpose of public safety. Because of this process, in 1999 the rotavirus vaccine was removed and then replaced. VAERS receives about 30,000 reports every year: 85% involve mild symptoms, 15% of the reports are more serious. Both of these numbers reflect possible vaccine related events, NOT definite vaccine caused events.Vaccinating yourself and your family is not a small matter. It can be very confusing with all the information â€“ and misinformation â€“available. Consider discussing it with a health provider you know and trust. The goals you share should be simple: to keep you and your family happy and healthy.Referencesvaers.hhs.govwww.cdc.gov/features/pertussisdiseases.emedtv.com/whooping-cough/whooping-cough-statistics
By- Dr. David PrescottAbout 1 in 30 people experience Post Traumatic Stress Disorder (or PTSD) in a given year. That risk increases over a lifetime, with 1 in 10 women, and 1 in 20 men, experiencing PTSD at some point in their life. Sadly, many events the past decade have provided psychologists and other mental health professionals with a number of opportunities to learn more about the causes and treatments for post-traumatic stress disorder, or PTSD. More optimistically, knowledge of how to more effectively understand and treat Post Traumatic Stress Disorder has also improved. How is PTSD Diagnosed? While many people feel temporarily depressed or anxious after a very upsetting or traumatic event, Post-Traumatic Stress Disorder involves a number of characteristic behaviors and experiences. First, the trauma must be outside the realm of normal stressful events. Examples would include being exposed to a situation with a true threat of death or serious injury, or a serious violation of a personâ€™s space and body. Symptoms of Post-Traumatic Stress Disorder are typically grouped into 3 categories: 1. Re-experiencing symptoms: Examples of these symptoms include flashbacks, bad dreams, or intrusive frightening thoughts. Words, objects, or situations that are reminders of the event can trigger re-experiencing.2. Avoidance symptoms: Avoidance symptoms include staying away from places or events that are reminders of the experience, feeling emotionally numb, having trouble remembering the dangerous event, or losing interest in activities which used to be enjoyable. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.3. Hyperarousal symptoms: People with PTSD are easily startled, feel tense or â€˜on edgeâ€™, and often have difficulty sleeping or have angry outbursts. In all cases, to be diagnosed with PTSD the symptoms must persist for more than one month after the traumatic event. Does Everyone Exposed to a Traumatic Event Develop Post-Traumatic Stress Disorder?It is difficult, if not impossible to specifically identify which people exposed to a traumatic event will develop PTSD. What we have learned is that the determining factors in the development of PTSD include some factors which increase the risk, and protective factors which decrease the risk. Protective, or Resilience Factors, Include: â€¢ Seeking out support from other people, such as friends and family â€¢ Finding a support group after a traumatic event â€¢ Feeling good about oneâ€™s own actions in the face of danger â€¢ Having a coping strategy, or a way of getting through the bad event and learning from it â€¢ Being able to act and respond effectively despite feeling fear.Factors Which Increase PTSD Risk Include: â€¢ Having a history of mental illness â€¢ Getting hurt â€¢ Seeing people hurt or killed â€¢ Feeling horror, helplessness, or extreme fear â€¢ Having little or no social support after the event â€¢ Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.What Treatments Are Available for Post-Traumatic Stress Disorder? Many, although not all, people who receive treatment for Post-Traumatic Stress Disorder experience some improvement. Statistically, about half the people with PTSD no longer qualify for the diagnosis after one year. There are both short term and long term strategies for coping with PTSD. Short Term Strategies: Short term strategies, immediately after a traumatic event, are really designed to prevent symptoms of PTSD from occurring in the long run. These strategies include: â€¢ Getting immediate support from friends or family. â€¢ Finding a support with others who had the same or similar experiences. â€¢ Finding a way to learn from the event. Longer Term Strategies: â€¢ Counseling: Focused counseling on managing anxiety and changing thinking patterns which increase or perpetuate fear often help. This type of therapy is often termed Cognitive-Behavioral Therapy. â€¢ Medication: Medications are often used to reduce the symptoms of depression and anxiety that go along with PTSD. â€¢ Group Therapy and Support Groups: Particularly after a traumatic event, being with other people who went through the same thing helps reduce the risk of long term problems. MORE INFORMATION: American Psychological Association: http://www.apa.org/topics/ptsd/index.aspxNational Institute of Mental Health: http://www.nimh.nih.gov/healthNational Alliance for the Mentally Ill: http://www.nami.org/
By- Dr. Joan Marie PellegriniAmericans consume about twice the amount of salt that is recommended in our diets. This is approximately a doubling of the amount we consumed forty years ago. We cannot live without salt. Salt contains sodium which is vital to many cellular functions. However, eating more salt than we need can lead to high blood pressure (hypertension). Hypertension is known as the silent killer because there are rarely any symptoms. Also, we do not check our blood pressure except when we visit a doctor. Over time, hypertension can cause heart disease, stroke, and kidney failure among other problems. It is estimated that even a small reduction in our salt intake will dramatically reduce our risk of these diseases.The New York City Department of Health and Mental Hygiene is coordinating a national effort to prevent stroke and heart attack by reducing the amount of salt in packaged and restaurant foods. Only about 10% of our daily salt intake comes from our salt shaker. About 80% comes in processed foods. The American Heart Association and the American Medical Association are also fully supportive of this national effort and have guidelines for salt reduction. The good news is that many large national companies have signed on to the initiative and have pledged to reduce the amount of salt in their products. What should you do to decrease your salt intake? Most of us can name the obvious offenders: potato chips, salted nuts, soy sauce, etc. Unfortunately, there are hidden sources in the foods we buy. A quick visit to the sodium chart from the USDA will show you that one slice of wheat bread from a national chain may contain almost 10% of your daily allowance. That means that the most important thing we can do is look at labels in the grocery store. Buy the brand of food that has the least amount of salt if you can. There are some items that will have a lot of salt no matter what brand you buy: canned soup or dry soup comes instantly to mind. In general, you should aim for a maximum of 2000 mg of sodium a day. If you are eating out, you will not be able to know which food has the lower salt content unless you ask the chef or wait staff. Even then, they may not know. This is why the national initiative would like restaurants to list sodium content on their menus and also to reduce sodium in their offerings.Even though sodium is ubiquitous and hidden in our foods, the good news is that even a small reduction in our intake will give us benefit. The other good news is that there is a national initiative for food manufacturers to decrease the amount of salt in their products and to provide labels to help us know how much salt we are consuming.References:http://www.time.com/time/health/article/0,8599,1884864,00.html Time Magazine printed this article in March 2009 and it is an easy read. It also has the link for the Sodium chart from the USDA.http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml This site has links for Institute of Medicine report on public health priorities to control hypertension. It also has the link for the journal article that is heavily referenced in the Time Magazine article (Bibbins-Domingo K, et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease in NEJM 1010: 362.)
TV5 Health Advisor Dr. Erik Steele joined Carolyn Callahan on TV5 News at 5 to talk about “Nerve: Poise Under Pressure.” A book written by Taylor Clark focusing on anxiety.
Teething: Not a source of fever and not an explanation for symptoms of illnessBy- Dr. Jonathan WoodTeething continues to be offered as an explanation for fever or as a reason for a variety of symptoms in infants and young children. An important study published in the September 2011 issue of Pediatrics elegantly dispels this misunderstanding. Researchers (pediatric dentists) visited non-daycare infants repeatedly in their homes and gathered data: symptoms reported by mothers, oral exams, and infant temperatures. This was an excellent study for a variety of reasons: the oral exams were performed by experts, the temperatures were taken by the examiner by two different methods, the exams occurred daily over a period of weeks to months and therefore generated detailed data around the eruption of multiple teeth in each child and over 230 teeth overall.The conclusions:Â· Teething does NOT cause fever (before, during, or after tooth eruption)Â· Minor increases in temperature (less than 0.3 degree F) occur on the day of and the day after eruption, but it is negligible and occurs within the range of normal temperature variationÂ· Minor symptoms – sleep disturbance, irritability, increased saliva, rash, loss of appetite, diarrhea – can occur in the day of and day following eruption. But again, these symptoms are not of a severe nature.Why is this important?Â· Doctors and parents should not invoke teething as an explanation for fever, even low-grade fever. Â· Nor should they invoke teething as an explanation for severe changes in activity or behavior. Â· When teething is used as an explanation for these findings, parents and doctors alike can delay the diagnosis of a more serious illness. In young infants especially, this is important: a true fever can be the only signal that a severe illness is developing and the immature immune system of the infant makes prompt diagnosis and treatment particularly important.What can be done about teething?Â· “Teething tablets” and anesthetic gels are not recommended. Parents can inadvertently deliver toxic amounts of the active ingredients and should avoid these products. They have also never been shown to be effective.Â· Teething rings have been shown to be useful and effective.Â· Gently massaging an infants gums often helps and satisfies the infants urge to chew on somethingFor more information of teething and care for a child’s early teeth, visit the American Academy of Pediatrics’ “Healthy Children” website http://www.healthychildren.org/English/Pages/Register-Email.asp It requires a free registration, but is full of much useful information for parents.
A Newer, Safer Permanent Contraceptive Option for WomenBy- Dr. Joan Marie PellegriniWhen a woman is certain that she no longer wants the option to get pregnant, she has a choice of continuing on with her current contraceptive method or considering a surgical option. The most common choice for permanent sterilization is a tubal ligation (getting her tubes tied). A tubal ligation offers the benefit of being highly successful, relatively safe, and permanent. It is immediately effective and allows for a woman to discontinue her â€œpillsâ€. The pill is hormonal based and there are many women who are at risk of complications if they take hormones. These complications include blood clots, stroke, and increased risk of certain cancers. Because a womanâ€™s fallopian tubes are inside her pelvis, tubal ligation would require anesthesia, at least one incision in the belly, and must to be done in the operating room. The recovery time is several hours in the procedure center and then 1-3 days at home. Some women are not candidates for this procedure because of anesthetic or surgical risks.In 2002, the FDA approved a new procedure called Essure. This procedure is done in the doctorâ€™s office and requires no anesthesia. The doctor inserts coils into the fallopian tubes and these coils cause scarring and blockage of the tubes. The woman can drive herself home or to work after the procedure and there is minimal discomfort. Some other form of contraception (pregnancy prevention) must be used for 3 months after the procedure until a hysterogram (an xray using dye of the uterus) is done to confirm that the tubes are blocked. Many experts feel this procedure is safer than tubal ligation and has a similar failure rate. Neither of these procedures is 100% effective however, the failure rate is extremely low and better than that with hormonal manipulation (the pill).A quick look at the Essure webpage reveals that there are at least 6 gynecologists in the Bangor region that perform this procedure. Clearly, this procedure is becoming well-endorsed by the gynecologic community. There is one another hysteroscopic method that is FDA-approved. It is likely that in the future there will be even more options available and your gynecologist will advise you on which one is best for you.Permanent sterilization procedures should be considered irreversible. Studies show that 3-25% of women eventually regret having a sterilization performed. For more information:www.essure.com This site is supported by the company that makes the coils.http://www.uptodate.com/contents/patient-information-permanent-sterilization-procedures-for-women This site is not industry-sponsored and is an excellent source for non-biased information on sterilization procedures. There are also other excellent resources listed.http://www.americanpregnancy.org/preventingpregnancy/birthcontrolfailure.htmlThis site offers information on all of the methods used to prevent pregnancy. This site is not industry-sponsored.
By- Dr. David PrescottProgress Has Been Made on Suicide Awareness: Thanks to efforts of many groups such as the American Foundation for Suicide Prevention and, more locally, the Maine Youth Suicide Prevention Program, public awareness about suicide and suicide risk factors has improved. However, suicide continues to be a leading cause of death in the United States, and helping people cope with suicide continues to be a significant public health issue. Who is Most at Risk for Suicide? Suicide is the 4th leading cause of death in America for people between the ages of 18 and 65, and the 11th leading cause of death overall. Older adults (75 plus) and adolescents/young adults (15-24) continue to have high rates relative to other causes of death. However, the latest statistics available (through 2007) show a recent increase in overall suicide rates. Most people, about 90%, who commit suicide have a diagnosable psychiatric disorder. Most common are the mood disorders like major depression or bipolar disorder. People who have substance abuse disorders (alcohol or drug abuse and dependence) are also at high risk. What are Warning Signs for Suicide? One of the more common myths about suicide is that people who try to commit suicide do not tell anyone of their thoughts and plans. To the contrary, most people who attempt suicide have talked about it. Any talk about a suicide plan should be taken seriously and the person with the plan should be seen by a mental health professional or call a mental health crisis line. Common warning signs of signs of suicide include: Â· Observable signs of depression such as unrelenting low mood, hopelessness, and social isolation. Â· Increased alcohol or illicit drug use. Â· Recent impulsiveness or unnecessary risk takingÂ· Expressing a strong wish to die Â· Making a suicide plan or giving away important possessionsWhat to Do if You Know Someone Who is Considering SuicideIt is important to realize that no one thing that a person does, or fails to do, makes the final determination about a suicide attempt. Try your best to help, but remember that there are many factors involved in a suicide attempt. Good first steps include: Listen Attentively: Just listening to someone can provide important support and begin to help them feel better. Tell them you are concerned, and find out if they see a mental health professional. Encourage Professional Help: If the person is not seeing a mental health professional, encourage them to do so. Types of mental health professionals include psychologists, psychiatrists, social workers, and licensed professional counselors. You may be able to help them follow through on making a call or keeping an appointment. Mental Health Crisis Lines: Maine like most states has crisis phone lines to help people who are considering suicide. You can call 2-1-1 or 1-888-568-1112. Coping with a Completed Suicide: If someone you know has completed suicide, it is important to talk about it. There are support groups available where you will meet other people struggling with the same issue. It is common to immediately feel shock or numb. This is often followed by feeling sad and depressed, guilty, and angry. For More Information: American Society for Suicide Prevention: www.asfp.org Acadia Hospital: www.acadiahospital.org
Lawn mowers are real useful this time of year, but they can also be very dangerous if used improperly. TV 5 Healthy Advisor Dr. Jonathan Wood joined Jim Morris on TV5 News at 5 to help keep your yard work safe.Almost 80,000 times each year people check into Emergency Departments for lawnmower injuries. More than 9,000 of those victims are children, despite the fact that the American Academy of Pediatrics strongly warns against children being anywhere near lawnmowers, much less operating them. Walk-behind mowers result largely in extremity injuries, while riding mowers often include injuries to other parts of the body, including the head and torso.How can you reduce the risk of serious lawnmower injuries to children? Here are a few common sense ideas, as well as some others you may not have considered. 1. A lawn mower is a dangerous tool. The energy of a mower blade is three times the muzzle energy of a .357 Magnum pistol, one of the world’s most powerful handguns. The blade can throw a piece of debris, like a stone or piece of wire, at speeds up to 100 miles per hour. The result – one fourth of all hand and foot injuries caused by mowers include amputations of fingers, toes, hands, or feet. And the injuries are messy and complicated.2. Children should never ride a mower with an adult. Each year a number of children suffer severe, and in some cases fatal, injuries after falling off a mower and then being run over.3. The American Academy of Pediatrics recommends that a child be at least 12 years old before operating a power push mower, and be at least 16 to operate a riding mower. These age recommendations assume that the child is large enough to physically handle the equipment. Careful instructions and review of the operating manuals should be part of the routine of teaching a child or teenager how to use the mower. Ignorance is an accident waiting to happen.4. Children should not be around a yard being mowed. Debris thrown by a mower can easily cross a yard and strike a child. Additionally, mower noise prevents operators from hearing the usual cues that children are near. Subsequently, 5 percent of lawnmower injuries to children occur when the mower backs over them because the operator does not see them. So – – clear the yard before mowing, of both debris and of children. The American Academy of Pediatrics has issued strongly stated advice about how to best prevent injuries from lawnmowers. Please refer to the following web page for a nice synopsis: AAP Safety TipsBe safe! Donâ€™t bend the rules when it comes to lawn mowingâ€¦ the risks are too great!By- Dr. Jonathan Wood
Staying hydrated in the heat it’s something we all need to do. TV5 Health Advisor Dr. Erik Steele joined Carolyn Callahan on TV5 News at 5 to talk about it.
NOISE AND MENTAL HEALTH: Is chronic noise more than just a nuisance? HEALTH WATCH â€“ July 5, 2011David Prescott, Ph.D. â€“ Acadia HospitalWhy Worry About Noise? In much of Maine we are thankful for our ability to step outside of our homes and hear almost nothing. The peace and quiet of the majority of Maine communities is a benefit of living here. But, for many people across the nation and the world, chronic noise is not only a nuisance but a significant hazard to mental and physical health. The World Health Organization recently reported that over 1 million health years of life are lost each year due to ill health, disability, or early death due to traffic related noise. While most research has been done on the impact of noise that is difficult to control, like traffic or airplanes, there is mounting evidence that trying to reduce the amount of everyday noise in our lives can have important health benefits. How much noise is too much? Noise is measured in weighted decibels. The recommended noise level in a bedroom to help with good sleep is no more than 30 decibels. In a classroom, the ideal level of noise for learning is less than 35 decibels. Standing next to a vacuum cleaner is usually rated at about 70 decibels. While studies of American cities are still not completed, recent research found that about 40% of people in Europe live in a place where traffic noises are at an average of 55 decibels. Noise and Mental Health: The impact of chronic noise on mental health is not quite direct, but not hard to follow. Our bodies react to chronic high levels of noise with responses such as: â€¢ Increased production of hormones that are released in response to stressâ€¢ Decreased sleep. â€¢ Increased blood pressurePoor sleep and chronic stress response are clearly tied to increased risk for depression, anxiety disorders, and a variety of mental health disorders. Also, being in an environment with chronic stress, such as high noise levels, make it harder to recover from health and mental health problems. For example, preliminary research suggests that high noise levels in acute care hospitals is associated with slower progress in recovering from an illness. Noise and Development in Children: Exposure to high levels of chronic noise appears to slow the cognitive and learning development of children. Naturalistic studies of children who live near airports shows a decline in reading levels and long term memory associated with chronic noise. Interestingly, a group of children who had chronic noise removed, due to relocation of airports, showed improvement in the same tests of reading and memory. Are there any simple steps that can be taken to reduce the impact of noise? Obviously, people have limited ability to control things like where airports and roads are built. However, becoming aware of noise levels that you can control may have important health and mental health benefits. Some examples might be: o Consider turning off televisions and stereos in your home that are on â€œall the time.â€ o Be sure to reduce noise levels in the house when children, and adults, are sleeping. o If you work at home or your children study at home, consider setting aside agreed upon times for quiet, when radios, movies, and television are turned off. o Simply being aware of reducing your voice level may help, particularly if someone in your home is recovering from illness or mental illness. For More Information: American Psychological Association: www.apa.org/monitorWorld Health Organization: www.euro.who
By- Dr. Joan Marie Pellegrini It is that time of year and the lakes are warming up. As the temperatures rise, we will be spending more time in the water. Because of this, a few of us will get Swimmer’s Ear. This is an infection of the external ear canal that causes pain, itching, a wet and full feeling in ear, pain with jaw movement, drainage from the ear canal, and sometimes neck soreness (from swollen nodes). The CDC estimates that more than half the cases in this country are in adults. So this is not just a problem for children. The most important risk for swimmer’s ear is the duration of exposure of the canal to water that is contaminated. The water from lakes, oceans, and pools all carry risk. I would have thought that a chlorinated pool would be safer. However, this is not true. The chlorine in a pool causes irritation in the canal by accelerating keratin degradation (keratin is found in the protective layer of cells lining the canal) and actually increases the risk of swimmer’s ear (Medscape). So, what can you do to prevent this? First, I should mention some things that you should not do. Don’t try to clear the ear canal before swimming. The ear canal has a natural mechanism of moving wax and dead cells from the inside to the outside. Attempted cleaning can irritate the canal and make infection more likely. Never insert anything into the ear canal. Lots of swimming can wash away the protective wax coating in the canal. In order to protect the skin in the canal, you may use a mixture of vinegar and isopropyl alcohol. Place 2-3 drops in ear canal before and after swimming. If you are particularly prone to this type of infection you may try using ear plugs when swimming. Specialized petroleum coated plugs are available. However, you must avoid getting an accumulation of petroleum in the canal which could block the water that gets in from draining back out. When you get out of the water, try emptying any water in the canal by tilting the head to each side. Pulling on the ear lobe can help empty the water. Also you may use a hair dryer on the lowest setting. Once you have the infection, there are drops that can be prescribed to treat the infection. By no means should you try to clean out the ear canal with anything (including cotton-tipped swabs). If you are on vacation and will need to fly home, you should strongly consider seeking medical attention promptly so that the infection can be optimally treated. This is because the pressure changes in the plane can cause severe pain and some complications. An infection that is left untreated can cause the infection to spread to the inner ear or bone.A useful website:http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001647/
By- Dr. Amy MoviusMedical care is always changing – and not just scientifically. There is a growing appreciation for the “ripple effect” of illness and hospitalization as we understand more about mind and body connection as well as the havoc being sick can wreak on ones life. Perhaps this is most obvious when children are the patients.Providing medical care requires a medical team. Amid the focus on treatment and procedures that surround a child’s illness, the single most important team member to the child, is often the Child Life Specialist (CLS). Most hospitals that provide pediatric care now have a Child Life Program. In the words of the certified CLS I work with daily, her job is to “do everything I can to make (the child) happy and feel better”. This involves more than “getting along with kids” or “liking kids”. Make no mistake, child life specialists are not fancy playmates: they are consummate professionals who have undergone rigorous study and training. This training focuses on the psychosocial needs of children of all ages. They often use therapeutic play to help them cope with and even conquer some of the challenges of being sick or receiving medical treatment that might otherwise be overwhelming. Children process information and experiences differently than adults and so have different needs to help manage difficult circumstances. Even the adults who love these children the most and have only good intentions may not understand or perceive how separate their child’s experience and needs are from their own: much less, how to explain what is happening while coping with their own stress surrounding their child’s condition. The services a CLS provides are many: a few examples of areas of expertise are below:1. Ease a child’s fear and anxiety with play.2. Foster an child friendly environment. 3. Provide medical preparation and support for children.4. Advocate family involvement/presence.5. Consider needs of siblings or other children affected by the illness.6 Support family with grief/bereavement.Feedback surveys leave no doubt as to the high value patients place on Child Life Services. However, it is not only the right thing to do, it is also good medicine. Research suggests that using child life services helps to contain medical costs by reducing hospital length of stay for children and decreasing the need for pain medicine. Lastly, the healthy coping skills developed during such an experience can be built upon for a lifetime.Reference:1. Child Life Services. American Academy of Pediatrics Policy Statement. Child Life Council Committee on Hospital Care, 20062. Child Life Council, Inc. www.childlife.org
By- Dr. Jonathan woodWhat does that mean? â€œExercise is medicineâ€â€¦?We think of medicine as something that:â€¢ You take to makes you feel better when you are ill (e.g. pharmaceuticals, etc)â€¢ You get when pills donâ€™t work to cures illness (e.g. surgery, angioplasty, etc)â€¢ You get to prevent or detect illness or disease (e.g. immunizations, mammograms, etc)What if there was something that was repeatedly shown to do all three? Wouldnâ€™t we call it â€œmedicineâ€?Improving our fitness has been repeatedly shown to do all three! So – – exercise is medicine. This concept is the focus of a recent initiative by the American College of Sports Medicine appropriately called â€œExercise is Medicineâ€. Their goal is to raise awareness of the facts and emphasize the proven benefits of improved fitness on overall health and specifically on the treatment and prevention of chronic diseases. The World Health Organizationâ€™s most recent Global Health Risks data (2004) rates physical inactivity at the 4th leading cause of death globally behind high blood pressure, tobacco use, and high blood glucose. Many feel we are in the midst of an â€œinactivity epidemicâ€, but few in the USA are truly aware of this.Some facts that you might not know:â€¢ Older adolescents and adults spend almost 8 hours/day in sedentary behaviorsâ€¢ 36% of adults engage in no leisure-time activity at allâ€¢ Low levels of fitness pose a bigger risk of death than mild-to-moderate obesityâ€¢ Active people in their 80â€™s have a lower risk of death than inactive people in their 60â€™sâ€¢ Low levels of physical activity expose patients to greater risk of dying than smoking, obesity, hypertension, or high cholesterolâ€¢ Regular physical activity has been shown in several studies to reduce the risk of many chronic diseases by alarming amounts:o Colon cancer â€“ over 60% reductiono Stroke â€“ 27% reductiono Heart disease and high blood pressure â€“ almost 40% reductiono Type II diabetes â€“ 58% reductiono Alzheimerâ€™s disease â€“ almost 40% reductiono and there is much moreâ€¦Additionally, regular physical activity in adolescents has been shown to lead to higher SAT scores and for younger children, it results in improved classroom behavior and less discipline issues in elementary schools.So, again, not only is exercise medicine, it seems to be better than what most of us traditionally think of as â€œmedicine.â€ Use the medicine! It may not always be easy, but it sure seems to be worth it!For more info and some specific suggestions, please visit the Exercise is MedicineÂ® website: http://exerciseismedicine.org
TV5 Health Expert Dr. Erik Steele joined Carolyn Callahan on TV5 News at 5 to discuss when its time to hang up the keys.
When Do You Cross the Line? By- Dr. David PrescottOver half of the adults in America report using alcohol during the past year. Of those, over 14 million people abuse alcohol at any given point in time. One of the most common questions faced by people whose alcohol and drug use is becoming a concern, is when has a person crossed the line from recreational use to problematic drinking? The line between problematic and non-problematic alcohol use is different for each individual, but some common criteria for problem drinking include: Â· Repeated Binge Drinking EpisodesÂ· Driving While Under the Influence of Alcohol or DrugsÂ· Drinking negatively impacts work, health, or important relationships.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. Some people who binge drink quickly become dependent on alcohol. In fact, genetics research suggests that certain people are predisposed to develop dependence very quickly. Alcohol dependence involves developing tolerance, where a person needs more and more alcohol to produce the same effect. Tolerance is a sign that drinking is likely a problem. How young do people start Binge Drinking? 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. Early alcohol use is associated with a far greater risk of developing alcohol addiction later in life. Driving After Drinking: In spite of the public education efforts about the dangers of driving after using alcohol, the statistics on this issue are startling. Almost 1 in 7 adults (13.2%) acknowledge having driven after using alcohol. Maine rates are slightly below the national average, but still above 10%. Driving after using alcohol, particularly if this occurs repeatedly, is obviously a sign of problem drinking. Drinking’s Impact on Work, Health, or Relationships: A third way to address the question of whether alcohol use has crossed the line to become a significant problem, is to think about whether alcohol use has had any impact on work (or school), physical health, or important relationships. Without determining whether or not the impact is large or small, it is helpful to objectively determine whether a person’s alcohol use has ever impacted work (such as missing work due to effects of alcohol use), health (such as injury or contribution to chronic health problems) or relationships. 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· 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. Recent research suggests that brief screening and intervention from primary care providers (SBIRT) is highly effective in addressing alcohol abuse. 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. Want More Information? Acadia Hospital: www.acadiahospital.org American Psychological Association Help Center: www.apahelpcenter.org Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov/recovery/Maine Office of Substance Abuse: http://www.maine.gov/dhhs/osa/
By- Dr. Joan Marie PellegriniGiven Chris Ewingâ€™s weather forecast tonight, it may be a bit hard to fathom needing sun screen anytime soon. However, we are all hoping for a great, sunny summer. Since summer is only a few weeks away, this would be a good time to review some facts about sunscreen.First, letâ€™s review what SPF means. SPF stands for Sun Protection Factor and it is calculated in a rather complex way. There are two types of UV rays: UVA and UVB. SPF refers to protection from UVB. UVA is the type of ray that causes aging of the skin and sunscreen does not protect us well against this type of UV ray. UVB is the type that causes burning and is the type that is absorbed by most sunscreens. Also, there is no linear relationship to the SPF number and how much UV rays are blocked. SPF 15 blocks 93% of the rays and SPF 30 blocks 97% (these numbers are from a WebMD article that I have listed below). Guidelines recommend and SPF of 15 or higher. As you can see from the numbers above, buying a higher SPF screen does not necessarily give you much more protection. More chemical must be added to the screens to obtain the higher SPF and there are some experts who feel that the amount of chemicals in the â€œvery highâ€ SPF screens (over 30) may actually lead to more skin cancers (a very controversial topic). These types of sunscreen protect us because they absorb the UV light. Other sunscreens protect against both types of UV because they provide a physical barrier to block UV rays and usually contain zinc or titanium. They are also heavier and more obvious on the skin (think of the white paste that skiers use on there nose and lips). The WebMD article and the EPA article referenced at the end of this article list which ingredients protect against which type of UV ray.Next, letâ€™s review how the screen is supposed to be applied. Sun screen should be applied to all skin because most summer-weight clothes do not fully protect the skin against the damaging effects of UV radiation. Also, sunscreens that absorb light need to be applied at least 30 minutes before sun exposure because they must be given time to be absorbed into the skin. If you are using one of the sunscreens that provide a physical barrier (they contain zinc or titanium) then you can apply it just before going outside. You will need more than â€œjust a dabâ€ of any of the sunscreens. Sunscreen needs to be applied liberally and often. Therefore, buy a sunscreen that you will not mind using and one that will be easy to apply. The â€œbestâ€ sunscreen doesnâ€™t do you any good if it never gets used.What about vitamin D deficiency? There is some concern that the widespread use of sunscreen may be leading to our widespread vitamin D deficiency however this is quite controversial. I think it is safe to say that the vast majority of national guidelines and experts recommend using sunscreen in an effort to reduce skin cancer rates. If you and your doctor are concerned about your vitamin D level, then it is a pretty simple and safe measure to change your diet to increase your vitamin D intake or to add a vitamin D supplement.Some miscellaneous facts about sunscreen: If you find a sunscreen in your cabinet and you cannot remember when you bought it, it probably is best to throw it away and buy new sunscreen. The active ingredients in the sunscreen may become inactive after 2-3 years. â€œWater resistantâ€ in a sunscreen means that it will last longer in wet conditions. However, it too needs to be reapplied throughout the day (every 2-3 hours). Sunscreens that contain antioxidants offer advantages for skin healing after injury from the harmful effects of the sun.So, to answer the question of which sunscreen is best: buy the sunscreen that is at least SPF 15 and donâ€™t worry about buying the highest SPF you can find. Make sure you get a sunscreen that is easy to apply. If you have a problem with acne, there are sunscreens made specifically for the face that are not so comedogenic (tending to clog the pores). Wear other protective clothing such as hats and sunglasses and remember that sunscreen does not protect against all of the sunâ€™s damaging UV rays. Donâ€™t forget to reapply. These two articles are excellent resources:http://www.webmd.com/skin-beauty/features/whats-best-sunscreenhttp://www.epa.gov/sunwise/doc/sunscreen.pdfThis article addresses the concern of vitamin D levels when sunscreen is used frequently:http://ods.od.nih.gov/factsheets/vitamind/
Improved technology! Increased usage! Is there any concern for long-term radiation effects?By- Dr. Jonathan WoodCT scan usage has increased dramatically in the last 20 years. CT scans are a great diagnostic tool, but what is the risk associated with increased usage? Is there a significant increased risk of cancer in people receiving all these CT scans? Experts are working on the answer to this difficult question and the answer is not as conclusive as we would hope.Medical diagnosis has benefitted greatly in recent years from marked improvements in CT scan technology and the subsequent increased availability of scans. â€œHelical CT scanningâ€ and â€œmultidetectorâ€ scanners have resulted in improved image resolution and a dramatic decrease in the time needed to obtain these images.These changes are cited as the main reason for the impressive increases in CT utilization. In the past 10 years alone, CT use has increased 700%. An estimated 62 million CT scans are done annually in the US today, compared with 3 million done in 1980. And why the focus on CT scans rather than other radiology tests? The answer: CT scans involve much more radiation than simple x-rays or other radiology tests. The numbers illustrate this – – although CT scans account for only 15% of the exams involving ionizing radiation, they collectively account for approximately 70% of the total radiation delivered!An example – – one abdominal CT scan involves a radiation dose equivalent to 250 chest x-rays!Children account for 10-15% of CT scans in the US and the annual number continues to increase. This is important because children are likely more susceptible to the harmful effects of ionizing radiation. The main issues:1. Growing children have more rapidly dividing cells, exactly the cells most affected by radiation. Some estimate that a radiation dose administered to a child has a 10-fold increase in the cancer-causing potential as the same dose given an adult.2. Children have a longer lifetime over which radiation-related cancers could evolve.3. Depending on the location of the scan, CT scanning is not always tailored to the size of the patient, as it should be.So is there a true risk? The answer is a qualified â€œyesâ€.The baseline risk of cancer in the US population is already about 20%. A single abdominal CT in a child is thought to increase that risk over a lifetime by 0.1% to 0.3%. Given that 30% of people who have one CT have additional ones later, this may be a conservative overall risk. The data is difficult to interpret, given all the other factors that contribute to the risk of cancer, but it nonetheless seems quite clear that minimizing the number of CT scans is a good idea. Importantly, any reduction in CT use has to be balanced against the fantastic diagnostic value offered by CT scan technology used in the right situation. The immediate risk of not getting the information is often much higher than the long-term risk of developing a cancer.So what can we do?â€¢ As patients and parents, we need to ask questions and make sure that there arenâ€™t other ways to get the same information. We need to realize that â€œjust checkingâ€ involves real risk and we shouldnâ€™t ask for CT scans that are not going to help with the problem at hand. Many CT scans are ordered because people ask for them!â€¢ As physicians, we need to order these tests judiciously and work with our institutions to perform them in the safest possible manner in children. We also need to continually ask if there are other tests that can offer the same information with less risk – – tests like ultrasound, which donâ€™t involve ionizing radiation. Online Resources:An FDA handout for consumers: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048578.htm An NCI/NIH webpage for docs: http://www.cancer.gov/cancertopics/causes/radiation/radiation-risks-pediatric-CTâ€œImage Gentlyâ€ – a program sponsored by the Society for Pediatric Radiology: http://www.imagegently.orgCNN article on increased CT usage: http://thechart.blogs.cnn.com/2011/04/05/kids-ct-scans-increase-fivefold/