Monthly Archives: December 2010

Study links excessive texting among teens to alcohol, sex, and drugs

How many texts does your child send and receive in a day? Could an increasing number indicate an increasing risk for problems? And, could a certain number indicate your child is more likely to experiment with drugs or sex?

The AP reports, “Teens who text 120 times a day or more — and there seems to be a lot of them — are more likely to have had sex or used alcohol and drugs than kids who don’t send as many messages, according to provocative new research.”

The authors of the study “aren’t suggesting that ‘hyper-texting’ leads to sex, drinking or drugs, but say it’s startling to see an apparent link between excessive messaging and that kind of risky behavior.”

In “Vital Signs,” the New York Times reported that “the study by researchers at Case Western Reserve University, presented … at a meeting of the American Public Health Association in Denver, is based on data from questions posed last year to more than 4,000 students at 20 urban high schools in Ohio.”

Approximately “one-fifth sent at least 120 text messages a day, one-tenth were on social networks for three hours or more, and four percent did both.”

Notably, “that four percent were at twice the risk of nonusers for fighting, smoking, binge drinking, becoming cyber victims, thinking about suicide, missing school, and dozing off in class.”

“The hyper-texters were 3.5 more likely to have had sex than teens who texted less,” the Time “Healthland” blog reported. “The hyper-networkers, however, were not more likely to have had sex compared with the hyper-texters,” but “they did exceed the texters’ predilection for fighting, drinking and drug use,” according to the study authors.

So, here’s a simple tip. If you kid is a hyper-texter (texting more than 100 times per day), it may be time to sit down and have a long talk — before your kid gets into trouble.

Overweight Children Are Affected More By Stress

American kids are really stressed out — not least of all overweight and obese kids, according to a new survey from the American Psychological Association. The report found that children who are overweight or obese feel particularly stressed, more so than their normal-weighted peers. And such stress has a lasting impact on other lifestyle behaviors that negatively affect overweight kids’ health.

Below I have some of the details from a report in Time. If, however, your kids are overweight or obese, you may want to pick up a copy of my book, SuperSized Kids: How to protect your child from the obesity threat. The book is currently on sale in HARDCOVER for $4.99 here (save $18) and in SOFTCOVER for $1.99 here (save $11). The book is chock-full of ways you, as a parent, can help your children make wise decisions about activity, nutrition, and sleep.  

If you have children or teens who are overweight, NOW is the time to make some changes. And, my book has an 8-week plan your family can put into action to start the New Year. The reason to do so is that to NOT act is to doom your kids to a shorter life with lower quality.

The new report, “Stress in America 2010,” found that the majority of Americans continue to live with moderate to high levels of stress, and while they know this isn’t healthy, they say they face obstacles that prevent them from managing or reducing their stress. They also acknowledge that they have trouble adopting other healthy behaviors like eating right, exercising and getting enough sleep. (More here on Study: Parent-Only Education Helps Children Lose Weight)

The effects of all of that appears to be trickling down to their families, particularly in households with overweight or obese parents. Obese parents were more likely than normal-weight parents to have overweight kids, and parents with overweight kids were less likely to report often or always eating healthy foods, compared with parents of thin children. What’s more, thin parents said they engaged in physical activity with their families more often than fat parents.

Along with the tendency toward unhealthy lifestyle behaviors, fat parents and fat children shared higher levels of stress.

For instance, while 31% of overweight children reported worrying about their lives, only 14% of their healthy weighted counterparts did the same.

When researchers asked about specific symptoms of stress and depression, the rates of positive responses in overweight children went up and stayed higher than in normal-weight kids: overweight children were more likely than children of healthy weight to have trouble:

  • sleeping at night (48% vs. 33%),
  • feel angry or get into fights (22% vs. 13%),
  • experience headaches (43% vs. 28%) or
  • feel listless and like they didn’t want to do anything (34% vs. 21%).

Further, children who believed they were overweight were more likely to report a parent who was “always” or often stressed out in the past month (39% vs. 30%). (More here on Do Parents Discriminate Against Their Own Chubby Children?)

Although the majority of parents didn’t their kids were affected by their stress, 91% of all children surveyed said they could tell when a parent was upset about something, and could perceive their emotional distress when they argued, complained or acted worried.

Nearly half of “tween” children aged 8 to 12  and one-third of teens aged 13 to 17 reported feeling sad in response to a parent’s distress, while large proportions also felt worried or frustrated. And while 86% of tweens said they felt comfortable talking to their parents about stressful situations, only 50% had done so in the previous month.

Additional survey data suggested that while overweight kids feel more stress, stress can also lead to additional weight gain.

Most of the children interviewed said they used sedentary activities to manage their stress:

  • 36% of tweens and 66% of teens listened to music,
  • 56% of tweens and 41% of teens played video games, and
  • 34% of tweens and 30% of teens watched TV.
  • Further, 48% of overweight teens and tweens reported disordered eating (either too much or too little) when stressed out, compared with only 16% of children at a healthy weight. (More here on Study: Fast-Food Ads Target Kids with Unhealthy Food, and It Works)

With nearly 1 in 5 children in America being overweight, according to the Centers for Disease Control and Prevention, managing stress as part of a total weight-control plan can only help.

For more data on stress in America, see the full report here.

Adolescent obesity associated with risk of severe obesity in adulthood

Like many physicians who care for children and teens, I’m acutely aware of and concerned about the epidemic, the tsunami, of childhood overweight and obesity. Because of that, I headed a research project at Florida Hospital in Orlando, Florida, that resulted in the book SuperSized Kids: How to protect your child from the obesity threat. The book is currently on sale in HARDCOVER for $4.99 here (save $18) and in SOFTCOVER for $1.99 here (save $11).

SuperSized Kids - .161 MB JPEG copy

If you have children or teens who are overweight, NOW is the time to make some changes. And, my book has an 8-week plan your family can put into action to start the New Year. The reason to do so is that to NOT act is to doom your kids to a shorter life with lower quality.

USA Today reports, “Heavy teenagers are often destined for skyrocketing weight gain in their 20s,” according to a study published in the Journal of the American Medical Association. After reviewing “national data on the height and weight records of almost 9,000 people ages 12 to 21 who were followed for 13 years,” researchers found that “about half of obese teenage girls and about a third of obese teen boys become severely obese by the time they are 30 — meaning they are 80 to 100 pounds over a healthy weight.”

“By the time they reach their late 20s to early 30s, people who were obese between 12 and 21 are more than seven times more likely than normal-weight or overweight peers to develop severe obesity — defined as having a body mass index, or BMI, of 40 or more,” the Los Angeles Times reports. “The result not only confers profound health risks for teens whose excess weight follows them and accelerates into adulthood, it also spells a looming public health disaster in a country where almost one in five adolescents is obese, experts say.”

The CNN “The Chart” blog reported, “The researchers also found that [among] teens who were overweight but not obese when the study started, more than 15 percent of the girls and six percent of the boys went on to become severely obese adults.” In particular, “overweight African-American girls were more likely than their white peers to bump up to the highest weight category.”

HealthDay reported, “Severe obesity … heightens the risk for a number of health complications, including type 2 diabetes, high blood pressure, high cholesterol, asthma, and arthritis. In addition, people who are severely obese can expect significant reductions in life expectancy, according to background information in the study.”

In light of the finding that “teens who were obese at the beginning of the study were 16 times more likely to become severely obese adults compared to normal-weight or overweight teens,” study author Penny Gordon-Larsen, PhD, of the Gillings School of Global Public Health, University of North Carolina-Chapel Hill, stated, “This is really setting these kids up to have significant health challenges later in life.”

According to a report from WebMD, “Gordon-Larsen tells parents of all children to ‘keep an eye on the weight gain.'”

Gordon-Larsen suggested that “parents have a goal of ‘keeping a healthy household.’ That means focusing on healthy food options and building physical activity into the day, encouraging kids to walk more and move more.”

Parents called upon to be role models in helping to fight childhood obesity. In a related article, USA Today reports that “obesity is proving to be a heavy burden for the nation’s kids and teens,” as evidenced by “a study in the Journal of the American Medical Association finds that heavy teens often gain a lot more weight in their 20s,” many of whom go on to become “morbidly obese … by their early 30s.”

Dietitians point out that children watch what their parents each, and that “getting healthier should be a family affair.”

To that end, parents should consider having meals together as a family as often as possible, not keeping soda and an array of snacks at home, becoming more physically active as a family unit, and encouraging the kids to take part in planning healthy meals.

You can find hundreds of practical tips on helping your kids in my book, SuperSized Kids: How to protect your child from the obesity threat. It’s on sale, so get one today and make a life-long difference with your children and their health.

Eating monounsaturated fats boosts heart health

We’ve actually known this fact for sometime. In fact, monounsaturated fats are one of the reasons the Mediterranean Diet is so healthful. Which just shows that the success of a low-cholesterol diet can actually be improved by adding monounsaturated fat, which are commonly found in nuts, seeds, avocados, and oils such as olive oil, canola oil, and sunflower oil. And, now some new research is backing these facts. Here are the details from USA Today:

In the study, researchers randomly assigned 17 men and seven postmenopausal women with mild to moderate elevated cholesterol levels to either a high-monounsaturated fat diet or a low one.

Both groups consumed a vegetarian diet that included oats, barley, psyllium, eggplant, okra, soy, almonds and a plant sterol-enriched margarine. In the high group, the researchers substituted 13% of calories from carbohydrates with a high-monounsaturated-fat sunflower oil, with the option of a partial exchange with avocado oil.

In the high group, levels of “good” cholesterol — high-density lipoprotein cholesterol, or HDL — increased 12.5% while levels of “bad” cholesterol — low-density lipoprotein cholesterol or LDL — decreased 35%, according to the report in the Canadian Medical Association Journal.

People with low HDL levels and high LDL levels are at increased risk for cardiovascular disease, Dr. David Jenkins of the Clinical Nutrition and Risk Factor Modification Center at St. Michael’s Hospital in Toronto, and colleagues said in a news release.

“The addition of MUFA increased (HDL) and therefore may further enhance the cardioprotective effect of the cholesterol-lowering dietary portfolio without diminishing its cholesterol-lowering effect,” Jenkins and colleagues wrote.

Monounsaturated fats are commonly consumed in what is known as the Mediterranean diet, said the researchers, who added that exercise, moderate alcohol consumption, not smoking and weight loss can also help raise “good” HDL cholesterol.

Should smokers get a screening CT scan?

With the news that CT scans — or computerized tomography — can prevent lung cancer deaths, smokers and ex-smokers may wonder whether they should ask for a screening. USA TODAY did a nice job in asking experts for their advice:

Q: How could a lung cancer screening help save lives?

A: Like a mammogram, CT scans can find tumors when they’re small and potentially curable, says the National Cancer Institute (NCI), which funded the $250 million study. Today, most lung cancers aren’t found until people develop symptoms, such as a coughing or shortness of breath. At that point, the cancers are usually incurable.

Q: Should everyone get a lung cancer screening?

A: No. There is a risk of harm associated with the scans, so a patient’s benefits must outweigh the risks.

Q: What study is this all referring to?

A: STUDY: CT scans can reduce lung cancer deaths by 20%. The study only included people at high risk of lung cancer — those ages 55 to 74 who were current or former heavy smokers, says Otis Brawley, chief medical officer of the American Cancer Society, who wasn’t involved in the trial. Everyone in the study had smoked the equivalent of one pack a day for 30 years.

It’s not known whether screenings might help light smokers or those who’ve never smoked, Brawley says.

Q: Are screening CT scans safe?

A: That depends on the patient, Brawley says. For people at high risk of lung cancer, like those in the study, the benefits outweigh the risks. Screening for lung cancer with CT scans reduced lung cancer deaths by 20% during the eight-year study, and cut overall deaths by 7%.

Even so, CT scans still have their risks.

First, they expose patients to radiation, which can itself cause lung cancer, especially in people who have already damaged their cells through smoking, says David Brenner, a professor at Columbia University not involved in the trial.

CT screenings also cause a lot of “false alarms,” in which patients are needlessly worried because of suspicious results on a scan, Brawley says. In the study, about 25% of patients screened with CT scans needed some sort of follow-up, says Harold Varmus, director of the NCI.

In some cases, patients simply had a second scan. But in others, patients needed invasive tests to rule out cancer. Removing a chunk of lung tissue for a biopsy is risky and can be painful, the NCI says. Biopsies can cause collapsed lungs, bleeding and infection.

Some patients with suspicious CT results need a larger operation, in which surgeons open the chest, the NCI says. The operation can cause nerve damage and is especially risky in people with heart conditions or other ailments that are common in older smokers and ex-smokers.

CT scans may detect slow-growing lung tumors that would have never posed a threat, Varmus says.

And CT scans can find lumps and bumps outside the lungs that, on closer inspection, turn out to be harmless, the institute says.

Q: What are radiation’s risks?

A: If half of the USA’s 36 million current and former smokers ages 50 to 74 were to get annual CT screenings until age 75, radiation-related cancers could kill up to 94,000 people, Brenner says. But the screenings could be expected to prevent 380,000 deaths from lung cancer, he says.

The CT scans used in the study provide about 3 millisieverts of radiation, says Denise Aberle, a leader of the study. That’s about the same as from a mammogram.

Q: Can people sign up to get one of these scans today?

A: Maybe. Most hospitals can perform screenings with CT scans, says Bruce Johnson of Boston’s Dana-Farber Cancer Institute.

Although insurance plans don’t pay for lung cancer screening, some people might choose to pay the $300 out-of-pocket cost, Varmus says. Insurance plans generally do pay for diagnostic CT scans, which are used when patients already have other signs of lung cancer.

Johnson notes that screening for lung cancer involves more than one procedure. Hospitals need to be prepared to follow up on patients with suspicious results, performing more tests to confirm or rule out cancer.

New Guidelines for Antidepressants

New guidelines say to select antidepressants based on side effects, other medical conditions, drug interactions, and cost … because they’re all similarly effective. This means the best bets for initial therapy are usually an SSRI, SNRI, bupropion, or mirtazapine … along with appropriate counseling. Here are details from the experts at Prescribers’ Letter:

Prescribing Antidepressants based upon Side effects:

  • The new guidelines recommend prescribers take advantage of side effects when possible.
  • For patients with insomnia, we prescribers should use a MORE sedating antidepressant, such as paroxetine or mirtazapine.
  • For patients with fatigue or sleepiness we should use a LESS sedating drug, such as fluoxetine, bupropion, or venlafaxine
  • For those who have sexual side effects on an antidepressant, we should try bupropion.
  • For those who want to minimize weight gain on an antidepressant, then bupropion or fluoxetine should be prescribed.

Prescribing Antidepressants based upon Chronic conditions:

  • Tricyclic antidepressants can aggravate heart disease … but might help patients who also have chronic pain.

Prescribing Antidepressants based upon Drug interactions:

  • Fluoxetine and paroxetine are strong CYP2D6 inhibitors and therefore can inhibit the metabolism of some beta-blockers, antipsychotics, atomoxetine (Strattera), etc.
  • Some antidepressants may make tamoxifen LESS effective for preventing breast cancer recurrence. Don’t combine tamoxifen with fluoxetine, paroxetine, sertraline, duloxetine, or bupropion.

Treatment duration:

  • Wait 4 to 8 weeks before changing therapy … but keep in mind it can take up to 12 weeks to see the maximal response.
  • Continue therapy for 4 to 9 months after a response to prevent relapse … and even longer for subsequent episodes.

Changing therapy:

  • If the initial antidepressant doesn’t help, try increasing the dose … or switching to another antidepressant in the same or different class.
  • If this isn’t enough, try ADDING an antidepressant from a different class … or adding buspirone, lithium, thyroid, or an atypical antipsychotic (Abilify, etc).
  • Save atypical antipsychotics for add-on therapy for resistant depression … or for patients with bipolar or psychotic symptoms. Don’t use them alone just for depression due to safety concerns.
New guidelines say to select antidepressants based on side effects, other medical conditions, drug interactions, and cost … because they’re all similarly effective. This means the best bets for initial therapy are usually an SSRI, SNRI, bupropion, or mirtazapine … along with appropriate counseling.
Here are details from the experts at Prescribers’ Letter:
Side effects.
The new guidelines recommend prescribers take advantage of side effects when possible.
For patients with insomnia, we prescribers should use a MORE sedating antidepressant, such as paroxetine or mirtazapine.
For patients with fatigue or sleepiness we should use a LESS sedating drug, such as fluoxetine, bupropion, or venlafaxine
For those who have sexual side effects on an antidepressant, we should try bupropion.
For those who want to minimize weight gain on an antidepressant, then bupropion or fluoxetine should be prescribed.
Chronic conditions.
Tricyclic antidepressants can aggravate heart disease … but might help patients who also have chronic pain.
Drug interactions.
Fluoxetine and paroxetine are strong CYP2D6 inhibitors and therefore can inhibit the metabolism of some beta-blockers, antipsychotics, atomoxetine (Strattera), etc.
Some antidepressants may make tamoxifen LESS effective for preventing breast cancer recurrence. Don’t combine tamoxifen with fluoxetine, paroxetine, sertraline, duloxetine, or bupropion.
Treatment duration.
Wait 4 to 8 weeks before changing therapy … but keep in mind it can take up to 12 weeks to see the maximal response.
Continue therapy for 4 to 9 months after a response to prevent relapse … and even longer for subsequent episodes.
Changing therapy.
If the initial antidepressant doesn’t help, try increasing the dose … or switching to another antidepressant in the same or different class.
If this isn’t enough, try ADDING an antidepressant from a different class … or adding buspirone, lithium, thyroid, or an atypical antipsychotic (Abilify, etc).
Save atypical antipsychotics for add-on therapy for resistant depression … or for patients with bipolar or psychotic symptoms. Don’t use them alone just for depression due to safety concerns.

A Christmas story – Part 3

Monday, I began a Christmas story that came from my book Bryson City Seasons. Part 2 was posted Wednesday.

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Here’s the last of three parts. I hope it’s been a Christmas blessing for you and yours:

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“Evan, I know God wants to have a relationship with you. My understanding of the Bible is that it tells us that God loves each of us. Actually, he loves us so much that he sent his only Son, Jesus, not just to be born in a manger but to live a perfect life for us as an example and then to die a torturous death for us—for all of our wrongdoing. Evan, if you’re willing to believe that, God’s willing to begin that relationship with you—today—but only if you want to.”

Evan looked out the window of the ICU. The daylight was just starting. For just a moment, I was concerned he might have been upset, but instead he turned back to me and whispered, “It would be a good day to start.”

I was quiet. The tears began to flow down his face, and he sniffled. I reached out and took his hand.

He gave my hand a squeeze and then looked back at me. “Doc, I’ve done a lot of wrong things. Guess you thumpers would call me a pretty bad sinner, huh?” He smiled as he wiped his tears with his free hand.

I smiled back at him. “Evan, that puts you and me in the same exact crowd.”

He cocked his head and looked at me. “Dr. Larimore, are you …? Are you like me?”

“I am.”

“You are?” he asked.

“Yes, but let me explain. The Bible explains that the sexually immoral and idolaters and adulterers and homosexuals will not inherit the kingdom of God. But, Evan, it also says in the same verse that the greedy and slanderers and swindlers won’t either.”

Evan was quiet in his thoughts, so I continued. “You’re a homosexual. And I’m greedy and a slanderer. I’ve been far more selfish than I should have been, and I’m certainly guilty of gossiping more than I should. So, according to the Bible, you and I are in the same exact crowd.”

Evan smiled and squeezed my hand. I felt an acute sense that God was gently leading my thoughts and words.

“Evan, the Bible describes many names for Jesus. My favorite is that he was known as a friend of sinners. All he requires from us, if we want to have a personal relationship with him—if we want to be his friend—is for us simply to admit that we’ve missed the mark, that we’ve sinned and done wrong.”

“I guess I would qualify.”

“Me too, Evan.” I paused to let him think for a moment.

“I think I’d like to be his friend. That would be nice—especially on Christmas Day,” Evan whispered between labored breaths. “How do I start?”

Dear Lord, I thought, what do I say now?

Then I had an over-shadowing and extremely comforting sense that God had been at work in Evan’s life for a long time.

Evan’s spiritual journey and awakening had, in point of fact, started long before today. I wasn’t exactly sure who had been involved in his life up to this point, but I was sure God now had a small part for me to play in Evan’s story.

“Actually, Evan, it’s pretty easy. You just talk to God—what we thumpers call prayer.”

We smiled, and I continued. “Just let God know you’re ready—invite him into a relationship with you, into your heart, and he’ll come in. First you have to realize that you’ve done wrong. Then you have to be willing to trust him with your life and your choices.”

Evan nodded and closed his eyes. “Lord,” he whispered, “I begin.”

It was the shortest and sweetest prayer I had ever heard.

He looked up at me and smiled.

We were both silent—sitting together after a conversation we had begun as doctor and patient and con- cluded as spiritual brothers.

“Evan, the Bible says that when we admit to God our wrongdoing—just agree with him that we’ve missed the mark— he will instantly and eternally forgive our sins. And based on that forgiveness, he’s willing to become your friend and your Lord and to reserve a room for you in heaven.”

The tears were still flowing down his cheeks. He nodded.

“The Bible also says that when we receive Jesus, when we believe in his name, he gives us the right to become children of God, not like when we’re born physically but when we’re born spiritually—of God.”

Evan nodded, tears still running down his cheeks.

“So, my friend, if you’re a child of God and I’m a child of God, then what does that make us?”

He thought a moment and then smiled. “Brothers?” he whispered.

I smiled and nodded.

“I’ve never had a hug from a brother,” he said quietly.

I slowly pulled him up and felt his arms encircle my shoulders.

He was very, very weak, but his hug was very, very real. After we hugged, I eased him back down.

“Would you like to see a pastor today to talk a bit more about this?”

He smiled, nodded, and squeezed my hand.

We were quiet for a moment as I thought about our extraordinary encounter. I hadn’t been trained to incorporate spirituality into my medical practice, and despite my initial discomfort, my time with Evan had seemed so spontaneous and sincere. Once Evan gave me permission to share all of who I was as his physician, it had seemed natural.

“Evan, I need to go check that X-ray, okay?”

I went to the X-ray reading room, and on my way back to ICU, I saw one of the RTs running toward the unit. I walked quickly into ICU and arrived just in time to see Evan surrounded by nurses and in the process of being intubated by the RT.

“What happened?”

“He just had a respiratory arrest. BP has bottomed out. Bradycardia. Okay to get him on a ventilator?”

I nodded my assent and went to work.

But from there, things went downhill fairly quickly.

Evan’s pneumonia quickly evolved into ARDS—a severe form of respiratory disease that is very difficult to treat—and then he went into kidney and liver failure. He died late that afternoon.

The autopsy report confirmed the pneumonia but blamed it on a bacterium I’d never treated before—Pneumocystis carinii.

The report also confirmed multi-organ failure and a form of cancer—Kaposi’s sarcoma—but said the cancer was confined only to his skin.

I could only assume, with what I knew then, that this unusual infection had overwhelmed his immune system and caused his death.

I called Richard’s shop to give him the results, but the number had been disconnected.

I then called Richard’s home—but, once again, the number had been disconnected.

Ella Jo told me she heard that Richard had closed the shop soon after Evan’s death and left the area. I was never able to find him, but I wondered if he didn’t know, even then, that Evan’s death had in some way been related to their relationship.

For Evan had not died of cancer. Nor would such a mild bacterium have overwhelmed an intact immune system.

I now know he died of a disease that was then unnamed—HIV/AIDS.

So Evan was my first patient with this horrible disease.

But he was also the first patient with whom I shared my personal faith so forthrightly—and the first to so openly ask me to do so.

Looking back over a long career in family medicine, Evan’s case and his decision to give his life to Christ represented one of the high points.

But what his autopsy did not show, and could not show, was that Evan died a new man—spiritually.

He had become a friend of God. He had been born as a son of God on the day we celebrated the birth of the Son of God.

And his life truly began the morning of the day it ended.

I know I’ll see him again one day. I hope he’ll give me—his brother in the Lord—another hug.

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  • Find Part One here.
  • Find Part Two here.

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If you’d like to learn more about beginning a personal relationship with God, check out my blog on the topic here.

Also, here’s more information on the Bryson City series:

Holiday Depression And Stress

Yesterday, my last day in the medical office before Christmas, I saw three patients all suffering from holiday depression. One was a grandmother who had suffered the tragic loss of her first grandchild this summer. Two others were people who had lost dear ones over the last few months. It was a good reminder to me to keep an eye out this season for those around me to whom Christmas may not be a joy, but an emotional roller coaster.

Indeed, the holiday season can be a time full of joy, cheer, parties, and family gatherings. But for many people, it is a time of self-evaluation, loneliness, reflection on past failures and anxiety about an uncertain future.

So, here’s some information on the holiday blues for you and yours from Mental Healthy America:

What Causes Holiday Blues?

Many factors can cause the “holiday blues”: stress, fatigue, unrealistic expectations, over-commercialization, financial constraints, and the inability to be with one’s family and friends. The demands of shopping, parties, family reunions and house guests also contribute to feelings of tension. People may also develop other stress responses such as headaches, excessive drinking, over-eating and difficulty sleeping. Even more people experience post-holiday let down after January 1. This can result from disappointments during the preceding months compounded by the excess fatigue and stress.

Tips for Coping with Stress & Depression During the Holidays

  • Keep expectations for the holiday season manageable. Try to set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the important activities.
  • Be realistic about what you can and cannot do. Don’t put the entire focus on just one day (i.e., Christmas Day). Remember that it’s a season of holiday sentiment, and activities can be spread out to lessen stress and increase enjoyment.
  • Remember the holiday season does not banish reasons for feeling sad or lonely; there is room for these feelings to be present, even if the person chooses not to express them.
  • Leave “yesteryear” in the past and look toward the future. Life brings changes. Each season is different and can be enjoyed in its own way. Don’t set yourself up in comparing today with the “good ol’ days.”
  • Do something for someone else. Try volunteering some of your time to help others.
  • Enjoy activities that are free, such as taking a drive to look at holiday decorations, going window shopping or making a snowperson with children.
  • Be aware that excessive drinking will only increase your feelings of depression.
  • Try something new. Celebrate the holidays in a new way.
  • Spend time with supportive and caring people. Reach out and make new friends, or contact someone you haven’t heard from in a while.
  • Save time for yourself! Recharge your batteries! Let others share in the responsibility of planning activities.

Toy Safety Tips for Christmas Day

As the presents are being opened tomorrow, if you have small children in the house, the U.S. Consumer Product Safety Commission (CPSC) urges gift-givers to keep safety in mind when choosing and opening toys for young children. The CPSC estimates that more than 120,000 children are treated in hospital emergency rooms for toy-related injuries each year. Here are the details from the CPSC:

“Toys are an important part of holiday gift-giving, and CPSC is on the job 365 days a year to make sure toys are as safe as possible,” said CPSC chairman Ann Brown. “CPSC’s goal is to prevent deaths and injuries; unfortunately, each year some children are hurt by toys. By always reading labels and being safety conscious, parents and caregivers can help prevent toy-related injuries.”

CPSC requires labels to be on all toys marketed for children from three to six years old if the toys pose a choking hazard to children under age three. These labels tell consumers two critical things: that a toy is not safe for younger children and why it is not safe. Before CPSC issued these labeling requirements, it was more difficult for consumers to know that certain toys they bought for older children could be a danger to younger kids. CPSC has the most stringent toy-safety standards in the world, and toys on store shelves are safer because of the day-to-day compliance work by CPSC.

Evaluating Toys When they are Opened or Purchased

Parents and gift-givers can help prevent toy-related injuries and deaths by always reading labels and being safety conscious. The following tips will help you choose appropriate toys this holiday season — and all year round:

  • Select toys to suit the age, abilities, skills, and interest level of the intended child. Toys too advanced may pose safety hazards to younger children.
  • For infants, toddlers, and all children who still mouth objects, avoid toys with small parts which could pose a fatal choking hazard.
  • For all children under age eight, avoid toys that have sharp edges and points.
  • Do not purchase electric toys with heating elements for children under age eight.
  • Be a label reader. Look for labels that give age recommendations and use that information as a guide.
  • Look for sturdy construction, such as tightly secured eyes, noses, and other potential small parts.
  • Check instructions for clarity. They should be clear to you, and when appropriate, to the child.
  • Discard plastic wrappings on toys immediately, which can cause suffocation, before they become deadly playthings.

By using common sense and these safety suggestions, holiday shoppers can make informed decisions when purchasing or opening toys for children.

A Christmas story – Part 2

Last time, I began a Christmas story that came from my book Bryson City Seasons.

Covers - Bryson City Series

Here’s the second of three parts. I hope it will be a Christmas blessing for you and yours:

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I passed through the lobby and went first to the X-ray suite. Carroll, the radiology technician, was there. He found the patient’s films and put them on the viewing box.

“Looks like an atypical pneumonia, Walt.”

I nodded. Carroll was as good at reading films as any radiologist I knew.

“I went ahead and did tomograms of the hilum,” he commented.

I nodded again, as Carroll was thinking just what I was—this pneumonia was probably caused by a cancer.

The tomographic X-ray allowed us to look at the area between the lungs—in this case, for lumps of cancer.

Carroll replaced the plain films with the tomograms. “But I don’t see any cancer. Maybe it’s a small-cell carcinoma.”

I smiled to myself. Small-cell cancer of the lung was a name that described a deadly type of cancer—but in no way did the name imply that it didn’t form masses that could be seen.

“Thanks, Carroll. I’d best go take a look at the patient.”

“He’s interesting, Doc, I’ll tell you that.”

Aren’t they all? I wondered to myself.

“Hi, Peggy!” I called out as I entered the nurses’ station. Peggy had been at the hospital for many years. She led the choir at the Presbyterian church when she wasn’t working at the hospital. She was married to Joe Ashley, a longtime ranger at the national park.

“Hi, Dr. Larimore. Here to see the new admit in ICU?”

“Yep.”

Our ICU was really just a former four-bed ward located close to the nurses’ station and converted into the place where we cared for our sickest patients.

“You gonna tell him what he’s got?”

“Guess I’d better figure out what it is first, don’t you think?”

Peggy smiled to herself. It wasn’t unusual for the nurses to know what was going on far before the doctors did, and in this case, Peggy, like Carroll, strongly suspected cancer.

She handed me the chart. The name on the front was Evan Thomas. Could this be the Evan that Ella Jo was talking about? I thought to myself.

As I entered the room, the patient looked worse than I could have imagined. He was fairly emaciated. The oxygen had normalized his color, but instantly I knew this was a very sick man.

Another man was sitting by Evan’s bedside. As I entered, he stood.

“Hi, I’m Dr. Larimore. I’m the doctor on call today.”

“I couldn’t be more delighted!” the man exclaimed. “My name’s Richard White. Evan and I know about you and your partner, Dr. Pyeritz. Ella Jo Shell often visits our shop and has told us so much about you both. We were hoping either you or he would be willing to care for us.”

“Richard, Evan, it’s good to meet you.”

I turned my attention to Evan, taking a complete history and then doing a complete physical. When I was through, I pulled up a chair. I always felt it was better to communicate face-to-face, and sitting with patients helped me accomplish that.

“Evan, I think you know you’ve got pneumonia.” He nodded. “But it’s not a typical pneumonia. It’s atypical. Given your weight loss and fatigue, I’ve gotta be honest with you.” I paused for a moment.

Evan reached out and took Richard’s hand. He looked fleetingly at his partner and then back to me. “Is it cancer?”

I nodded. “To tell you the truth, that’s my guess. We would need to do tests to be sure. But that’s what I suspect.”

“Is it treatable?”

“It depends on the type. But my guess is that it’s probably already widespread. So we’ll just have to see.”

“When can we start?”

“Well, let’s get the infection under control, and then we’ll talk about getting started.” I was quiet and let them absorb the information. When it was clear they didn’t have any more questions, I left the room.

The next morning was Christmas, and I made early-morning rounds—well before our children, Kate and Scott, would wake up to celebrate Christmas.

I found Evan alone but awake. I greeted him and sat on the bed. His breathing was labored and shallow.

“Evan, how are you feeling?”

“Not so good, Doc. Didn’t sleep well.”

“Seems you’re breathing harder than last night. I’d better get Carroll to take another X-ray.”

“He’s already been here—along with Betty the Vampire.”

I smiled at his reference to Betty Carlson, the director of our laboratory.

“Let me go take a look at it and let you know what I see, okay? Anything else I can do?”

“Doc, I’ve been told you’re a man of faith. I’ve also been told you’re a very good doctor. But I’ve got to tell you, I was worried about coming over here to see you.”

“Why’s that?”

Evan didn’t answer for a moment. Then he looked deeply into my eyes. “Doc, lots of Bible-thumpers call people like me evil and nasty things. I was worried you might think the same.”

Now it was my turn to be quiet for a moment. I was trying to think about how to respond to this man’s honesty and transparency. It was an unnerving moment for me. But, cautiously, I continued.

“Evan, my faith teaches me that the most important thing in life is a personal relationship with God. Everything else pales in comparison to that. And I found that when I began that relationship with God, he was fully able and willing to guide me into doing and thinking the right things. So the real issue isn’t what I think or what you think, but what he thinks.”

Evan smiled, and I saw tears forming in his eyes. “When I was a kid, church was important to me. I really enjoyed going—but never did I enjoy it more than on Christmas Eve. But when I grew up I just grew away from it. Do you think your God would even want a relationship with me?”

For a moment I thought about the Bible verse “Always be prepared to give an answer to everyone who asks you to give the reason for the hope that you have. But do this with gentleness and respect.”

I was pleased Evan felt comfortable enough to ask. But I’d always been taught in medical school that it was unethical to discuss religion with patients.

However, Evan had asked—in essence, he had given me permission to share with him. So I decided to proceed—albeit carefully and very uncomfortably.

Spiritual discussions were simply not something I had been trained to provide in the medical environment, but I’d begun to carefully incorporate them into my practice during my first year in Bryson City.

Furthermore, a still, small whisper was encouraging me to harvest this opportunity to share an intimate part of myself with a very, very sick patient.

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  • Find Part One here.
  • Find Part Three here.

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The Bryson City series includes:

Give Yourself the Gift of a Stress-Free Holiday

Here are some steps you can take (if not this year, next) to protect your and your family’s health by keeping it simple during the Christmas season. This was originally published at HealthFinder and I hope it’s helpful:

‘Tis the season to be jolly, not stressed out, and an expert offers some tips on how to take care of yourself during the holiday rush.

While it’s easy to feel overwhelmed by all the shopping, planning and other tasks associated with the season, you need to take steps to keep your stress under control in order to protect your health, said Dr. Gary Kaplan, founder of the Kaplan Center for Integrative Medicine in McLean, Va.

“Stress is the way our body automatically responds to difficult situations. You may feel nervous, irritable and depressed, experience increased aches and pains, or you may just not feel like yourself,” he said in a center news release.

Kaplan offered the following tips to relieve holiday stress:

  • Share the workload. Learn how to say “no” to requests for your time and delegate tasks to others when possible.
  • Keep it simple. Skip the shopping, make homemade gifts and spend quality time with family and friends.
  • Maintain your regular schedule as much as possible. Humans are creatures of habit and feel out of sorts when routines are disrupted.
  • Find ways to burn off physical and emotional tension. Vent to a friend, write about your feelings in a journal, go for a walk or take a bubble bath.
  • Look after your body. Eat a healthy diet, get plenty of exercise and do things that restore your energy, such as meditating or getting a massage.

For more information, the American Psychological Association offers more ways to deal with holiday stress here.

Ten Ways to Avoid Christmas Tree and Holiday Allergies

Here are some nice tips from the folks at Fox News. Of course, by now, some of us have learned the hard way, right?

  • Rule No.1 – Keep your decorations “off season” in enclosed containers, this will reduce dust and mildew from accumulating – and avoid sniffles when opened.
  • Rule No.2 – Avoid artificial “snow sprays” that can aggravate your sinuses, eyes and cause annoying respiratory symptom including cough.
  • Rule No.3 – Watch out for those lovely faux holiday “poinsettias” if you have skin allergies, especially if you have a sensitivity to rubber, it may cause a itchy rash.
  • Rule No.4 – Don’t bring in wood for the fireplace until needed, it may bring mildew and molds into your home, especially when not completely dry or damp.
  • Rule No.5 – Watch out for those pesky mold spores if you have a natural, fresh Christmas tree in your home, especially if you have indoor allergies!
  • Rule No.6 – If you humidify your home, measure the indoor humidity level with a low cost hygrometer, and keep the level of humidity at 50 percent or less.
  • Rule No.7 – It may be best to avoid wood burning stoves or direct exposure to poorly ventilated home fireplace, especially if you have asthma or respiratory problems.
  • Rule No.8 – Stay away from scented candles and potpourri, incense, room fragrance devices that can irritate your eyes and nose as well as your breathing.
  • Rule No.9 – Wash all non-porous holiday decorations, with warm soapy water to clean off dust and mildew, before placing on your tree and other areas of the home.
  • Rule No.10 – A HEPA air cleaner (both a portable room unit and/or central heating/ventilation system can help to reduce indoor allergens and pollutants.)

Read more: http://www.foxnews.com/health/2010/12/20/ways-avoid-christmas-tree-holiday-allergies/#ixzz18g57yIrt

A Christmas story – Part 1

My most popular books, at least based upon sales and letters, are the Bryson City series.

Covers - Bryson City Series

The series includes:

In the second book in this series, Bryson City Seasons, I published an account of caring for my first patient with HIV/AIDS (even before that horrible disease was named). It was in December 1982 and occurred in Bryson City, North Carolina.

This week I’ll be excerpting the story for you and hope it will be a Christmas blessing for you and yours:

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The week before Christmas, I saw Ella Jo Shell for a routine office visit. Ella Jo and her husband, John, were the proprietors of the Hemlock Inn and had become a major source of referrals to our practice. Therefore, I wasn’t surprised when Ella Jo said, “Before you run off to your next patient, I need to tell you about Evan.”

I cocked my head. “Evan?”

“He’s become a good friend. He’s an older man—I’d guess sixty or so—and he and his partner own a shop in a nearby town.”

“I bet Barb’s been there, but I don’t think I ever have.” “Well, it’s a great shop. I like browsing around there.” “Who’s his partner? Do I know her?” Ella Jo smiled. “I would guess not. Evan’s partner is actually a guy whose name is Richard.”

“A guy?”

“Yep. Where they live they’re pretty well accepted—although I’m not so sure they’d be well accepted over here in Swain County.”

I nodded.

Ella Jo continued. “Anyway, Evan is concerned about his health. He’s been losing some weight and has some funny-looking moles developing on his legs. He asked me to look at them. Walt, I’ve never seen anything like it. They look like purplish lumps. Can you think of any sorts of special rashes that occur in homosexuals?”

Frankly, I had never cared for a homosexual—at least none that I knew of—through all of my training in the 1970s.

“Other than the sexually transmitted diseases, I don’t think I know of any.”

I was quiet for a second, developing in my mind what doctors call differential diagnoses—a list of possible diagnoses. Usually I would try to think of the most common diagnosis or diagnoses that would fit the history and exam (and any tests that had been ordered).

But at the same time I’d been taught to always think of the worst possible diagnoses—so that I wouldn’t miss something bad in its earliest stages. In Evan’s case the worst diagnosis I could think of was some form of cancer. For internal cancers to cause fatigue and an unexpected loss of weight, as well as changes in the skin, was not unusual.

“Walt, I told Evan he should get a skin biopsy—for safety’s sake—just to be sure it’s not some sort of melanoma or something like that. Anyway, I told him about you and Rick. I think he’s will- ing to come over here for an evaluation, if you’re willing to see him.”

“Ella Jo, I think it’s a compliment that he’s willing to come over here. Seems like most folks from their town get their care in Sylva or Waynesville—many even travel to Asheville.”

“Yep. But it seems like folks are more willing to stay here for their care. And I think that’s good.”

I agreed. We finished our visit, and I asked her to wish her family a Merry Christmas from Barb and me.

The morning before Christmas, I was on call for our practice.

After I had finished seeing patients for the morning in the office, I was dictating charts when the phone rang. It was Louise from ER. I greeted her with, “Hi, Louie!” when I picked up the phone.

“Dr. Larimore, don’t you start with no ‘Hi, Louie’ to me. You need to learn to respect your elders!”

I grinned as she continued without a breath between sentences.

“In the meantime, I’ve got a patient here with a pretty bad pneumonia. He’s got a temperature of 102, a productive cough, a low white blood cell count, short- ness of breath, and a low oxygen level.”

She paused for a breath and then lowered her voice. “Dr. Larimore, he’s an older white man, and he’s all skin and bones. He looks cachectic, and I bet he’s got ’im a bad cancer. I’ll begin writin’ up some ICU admission orders for him.”

She sighed and then continued. “The respiratory therapist is down here, and I’ve got him on oxygen.”

As Louise paused to take a breath, I couldn’t resist the temptation. “Louise, why is the RT on oxygen? Is he sick also?”

Louise didn’t reply. I was sure she was trying to process what I was saying, so I struck while the striking was good.

“Oh my goodness. Is some plague sweeping over the hospital? The county? Oh dear, Louise! Should I come work at your side, risking life and limb? Or should I flee for my life to Franklin or parts asunder? And if I do come, do you and I need to be on prophylactic oxygen ourselves? And, Louise, what if the hospital runs out of oxygen? Then what? Oh dearie me!”

I paused to chuckle.

However, Louise apparently did not share my sense of humor. “Dr. Larimore, you ain’t funny one bit. This man’s sick, and you best be givin’ me some ICU orders.”

I agreed and gave Louise the admission orders. I wanted him cultured up and started on high-dose antibiotics.

“Does he have family?” She and I both knew this case probably did represent some sort of end-stage cancer.

“Not that I know of. Just a friend who brought him in.”

Loners were not at all unusual in the mountains, and loners who came to the doctor only after their disease process was pretty far along were very common.

You see, to most of the mountain people, the hospital was a scary place. They would tell me that they knew people—friends and neighbors—who would come to the hospital only to die.

The result was that, instead of coming in early in the disease process when treatment and sometimes a cure were at least possible, the locals would often wait to come in until it was too late for us to help them.

“I’ll be up to see him just as soon as I’m done with my patients. That okay?”

“Sounds good, Dr. Larimore. I’ll let you know if you need to get here any quicker. And . . .” Louise paused.

“And what?” I inquired.

“And you can leave your smarty-pants side down there in that office before you come here to my ER!” Before I could respond, she hung up.

When I arrived at the hospital, I paused in the lobby to look at the Christmas decorations. The tree was actually a live tree from Greg Shuler’s Christmas tree farm. The lobby, strung with beautiful lights and freshly cut evergreen garland, smelled exhilarating— it looked like a scene from a Christmas card.

I thought for a moment of how hospitals were places of death, without a doubt, but also places of new birth and healing.

In a very real sense, the events most of us celebrated at Christmas—the birth of the Christ child—and then on Good Friday and Easter— Jesus’ death and burial—were represented in my day-to-day life in the hospital caring for patients.

No wonder, I thought, God calls himself the Great Physician. I suspected that today I’d have to tell an old man of his impending death. I had no idea of the birth that would occur.

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TO BE CONTINUED

Books for those considering the mission field (or praying for missionaries)

My dear friend, John McVay, who is the Chief of Staff at the In His Image Family Medicine Residency and also directs their Medical Missions Program wrote me to say:

I am writing to ask if you would spread the word about the new missions books listed below. The first one I helped put together last spring after ten years of gathering answers.  Perspectives co-editor Steve Hawthorne wrote: “The Ask a Missionary book is like having a dozen missionary friends at your side, coaching you with kindness and clarity. Who knew wisdom could be so encouraging?”

The second book, Where There Was No Church, is by an interagency team that includes an old friend of mine.

And the third book, Operation World, was completely revised recently.

I would add, please forwarding this to others interested in global missions.

1) Ask a Missionary: Time-Tested Answers from Those Who’ve Been There

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If you are exploring doing something extraordinary for the glory of God among the nations, Ask a Missionary will give clarity and answers for a journey into missions. Because they have “been there,” over one hundred missionaries from around the world, including Elisabeth Elliot, George Verwer, Phyllis Kilbourn, and Bill Stearns, share their insightful wisdom and practical advice on everything from making the decision to go, to stepping into a new culture, and everything in between.

  • How can I know if God is leading me to become a missionary?
  • How do I select a mission organization?
  • What type of academic or practical training should I consider?
  • How will I be funded?

To order or learn more click here.

2) Where There Was No Church

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This book brings together stories that show what God is doing through his people among Muslims, and brings to life fruitful practices that have helped followers of Jesus invite Muslims to follow him, too. The principles illustrated through the stories will also be of value to anyone living among other peoples where there is no church.

Questions for reflection are included with each chapter to help the reader further his or her understanding of the chapter, or to use in group study. According to Dr. J. Dudley Woodberry, noted Islamic scholar and Dean Emeritus of the School of Intercultural Studies, Fuller Theological Seminary, “This compilation of true stories is a must read for all who want to learn from the experiences of others. Chapter titles include:

  • Not a Foreign Message
  • Couscous on Sunday
  • Meeting the Savior through the Quran
  • Desperate Enough to Pray
  • The Messiah Is Not a Liar
  • Stoking the Home Fire
  • Uncle, Is It True?

To order or learn more click here.

3) Operation World: The Definitive Prayer Guide to Every Nation (Completely Updated 2010)

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When you hear a country mentioned in the news or in a conversation and you want to more about it and what God is doing there – this book is the definitive global prayer handbook.

With over a million copies of past versions being sold, this all new 7th edition has been completely updated and revised by Jason Mandryk and covers every country in the world, from the largest to the smallest.

Whether you are an intercessor praying behind the scenes for world change, a sender, or an aspiring missionary, Operation World will give you the information necessary to be a vital part in fulfilling God’s passion for the nations:

  • All the countries of the world featured
  • Maps of each country
  • Geographic information
  • People groups within each country
  • Economic information
  • Political information
  • Religious make-up of each country
  • Answers to prayer
  • Challenges for prayer
  • Persecution index

To order or learn more, click here.

The ABCs of CPR Rearranged to “CAB”

Every shopping season we all hear a wrenching story or two of someone who dies of a heart attack at a mall with people standing around but NOT offering help. I think it’s not only because so many have not had CPR training, and don’t know what  to do, but that the definitely do NOT want to do mouth-to-mouth resuscitation on someone they do not know. Well, now even untrained observers can do CPR, except it’s now called “CAB.” Here are the details from MedScape:

Chest compressions should be the first step in addressing cardiac arrest. Therefore, the American Heart Association (AHA) now recommends that the A-B-Cs (Airway-Breathing-Compressions) of cardiopulmonary resuscitation (CPR) be changed to C-A-B (Compressions-Airway-Breathing).

So, if you see someone collapse and they are not breathing and do not have a pulse, (1) have someone call 9-1-1, (2) have another person locate a portable defibralator (all malls and stores have them) or call store security who will bring one, and then you begin chest compressions. No need to do mouth-to-mouth resuscitation at the beginning.

If you remember the Bee Gee’s hit song, Staying Alive, you can time your compressions to the beat as you hum it. Just push down hard (you can NOT push too hard) and fast at a point half way between the top and bottom of the sternum (chest bone). Once 9-1-1 is on the line, the dispatcher will be able to give you further instructions.

Here are the details from MedScape:

The changes were documented in the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, which were published in Circulation: Journal of the American Heart Association and represent an update to previous guidelines issued in 2005.

“The 2010 AHA Guidelines for CPR and ECC [Emergency Cardiovascular Care] are based on the most current and comprehensive review of resuscitation literature ever published,” note the authors in the executive summary. The new research includes information from “356 resuscitation experts from 29 countries who reviewed, analyzed, evaluated, debated, and discussed research and hypotheses through in-person meetings, teleconferences, and online sessions (‘webinars’) during the 36-month period before the 2010 Consensus Conference.”

According to the AHA, chest compressions should be started immediately on anyone who is unresponsive and is not breathing normally. Oxygen will be present in the lungs and bloodstream within the first few minutes, so initiating chest compressions first will facilitate distribution of that oxygen into the brain and heart sooner. Previously, starting with “A” (airway) rather than “C” (compressions) caused significant delays of approximately 30 seconds.

“For more than 40 years, CPR training has emphasized the ABCs of CPR, which instructed people to open a victim’s airway by tilting their head back, pinching the nose and breathing into the victim’s mouth, and only then giving chest compressions,” noted Michael R. Sayre, MD, coauthor and chairman of the AHA’s Emergency Cardiovascular Care Committee, in an AHA written release. “This approach was causing significant delays in starting chest compressions, which are essential for keeping oxygen-rich blood circulating through the body,” he added.

The new guidelines also recommend that during CPR, rescuers increase the speed of chest compressions to a rate of at least 100 times a minute. In addition, compressions should be made more deeply into the chest, to a depth of at least 2 inches in adults and children and 1.5 inches in infants.

Persons performing CPR should also avoid leaning on the chest so that it can return to its starting position, and compression should be continued as long as possible without the use of excessive ventilation.

9-1-1 centers are now directed to deliver instructions assertively so that chest compressions can be started when cardiac arrest is suspected.

The new guidelines also recommend more strongly that dispatchers instruct untrained lay rescuers to provide Hands-Only CPR (chest compression only) for adults who are unresponsive, with no breathing or no normal breathing.

Other key recommendations for healthcare professionals performing CPR include the following:

  • Effective teamwork techniques should be learned and practiced regularly.
  • Quantitative waveform capnography, used to measure carbon dioxide output, should be used to confirm intubation and monitor CPR quality.
  • Therapeutic hypothermia should be part of an overall interdisciplinary system of care after resuscitation from cardiac arrest.
  • Atropine is no longer recommended for routine use in managing and treating pulseless electrical activity or asystole.

Pediatric advanced life support guidelines emphasize organizing care around 2-minute periods of continuous CPR. The new guidelines also discuss resuscitation of infants and children with various congenital heart diseases and pulmonary hypertension.

The 2010 AHA guidelines for CPR and emergency cardiovascular care are available here.

Good Conversation Can Boost Brain Power, Study Finds

As I’ve grown older, I’ve become fonder of sitting and just having conversation with dear friends. I’m privileged to participate in an authors’ group that meets every couple of weeks just to chat. And now, along comes some data showing that thinking skills seem to improve with friendly chats, but not from competitive discussions. So, maybe Paul, Al, Jerry, and Larry are making me smarter!?!?

Here are the details from HealthDay News: Friendly discussions with other people can help you solve common life challenges, but conversations that are competitive in tone aren’t helpful, finds a new study.

“This study shows that simply talking to other people, the way you do when you’re making friends, can provide mental benefits,” lead author Oscar Ybarra, a psychologist and researcher at the Institute for Social Research at the University of Michigan, said in a university news release.

In this study of 192 undergraduates, the researchers examined the effect that brief episodes of social contact had on a type of cognition called executive function, which includes working memory, self-monitoring, and the ability to suppress external and internal distractions. These mental processes are essential in dealing with day-to-day problems.

Engaging in a short, 10-minute conversation in which they got to know another person helped boost the participants’ performance on a variety of cognitive tasks. But when the conversations had a competitive tone, the participants showed no improvement on the cognitive tasks.

The study will be published in an upcoming issue of the journal Social Psychological and Personality Science.

“We believe that performance boosts come about because some social interactions induce people to try to read others’ minds and take their perspectives on things,” Ybarra said. “And we also find that when we structure even competitive interactions to have an element of taking the other person’s perspective, or trying to put yourself in the other person’s shoes, there is a boost in executive functioning as a result.”

The findings suggest that having a friendly talk with a colleague before a big test or presentation may prove beneficial, according to the researchers.

Five ways your cell phone could save your life

Whether you own a BlackBerry, iPhone, Android, or just a cell phone, there are applications and other tools you can use to turn your device into a safety tool. Here are a few suggestions from CNN:

1. Program your cell so people can find you

Cell phone apps can save your life. If you’re lying unconscious somewhere, how would anyone locate you? Verizon, Sprint and AT&T all have locators where you can find members of your family. In addition, you can do a search on iTunes for applications that use your smartphone’s GPS to let you know where you are.

2. Put your “in case of emergency” contact into your cell phone

The trick here is to put your “ICE” information into your cell in as big and obvious a way as possible. After all, emergency workers are busy trying to save you and can’t be spending precious moments browsing through your phone.

Connie Meyer, the incoming president of the National Association of EMTs, suggests putting the “ICE” information into your contact list under “ICE.” “Most EMTs know to look for that,” says Meyer, a paramedic and registered nurse. “And make sure your ICE contact is someone who really knows your medical history.”

Dr. Assaad Sayah, chief of emergency medicine for the Cambridge Health Alliance in Massachusetts, has another suggestion. Many cell phones have a place for information about the owner, such as your name and number, and you can also put your ICE information there.

ICE information is especially important for children, says Sayah, because in many cases, emergency rooms can’t treat a child without consent from parents.

“If someone’s sprained an ankle or something else that’s not life-threatening, we can’t even give pain medication until we get permission from the parents,” he says.

You can put an ICE sticker on your phone to alert emergency workers that your contact is inside.

There’s one problem with all these options: If you password-protect your phone, emergency workers can’t find any of this because your phone will be locked.

3. Put your medical information on your cell

If you have a particular medical condition or are taking certain drugs, emergency workers need to know. You can put that information in the same place as your ICE contact, and you can also get an app that stores it.

Choose an app that puts the information (or an icon leading to it) on the front screen of your phone so it’s easy to find. Jared makes one for your BlackBerry and Polka makes one that goes on the front screen of your iPhone, which will work even if your phone is locked.

However, be aware that an old-fashioned, low-tech approach may be best here. Meyer says EMTs will more quickly notice a medical alert bracelet or necklace than anything on your cell phone.

“We’re focused on the patient, and so wouldn’t be able to spend a whole lot of time looking for information on the phone,” she says. “There are so many various phones out there we wouldn’t know where to look.”

4. Get an app that teaches you first aid and CPR

Several groups, including the American Heart Association, have an app for that.

5. Find help nearby

Several apps, such as iTriage or DocGPS, will direct you to the nearest emergency room.

Vitamin E consumption for stroke prevention may be harmful

In a past blog I told you, “… a spate of high-profile studies published in the last few years shows that a variety of popular supplements — including calcium, selenium, and vitamins A, C and E — don’t do anything to reduce the risk of developing heart disease, stroke, or a variety of cancers.” Also, I said, “In the past few years, several high-quality studies have failed to show that extra vitamins, at least in pill form, help prevent chronic disease or prolong life.” Now there’s some evidence of harm, at least with vitamin E.

Bloomberg News reports, “Taking vitamin E supplements doesn’t reduce the risk of stroke, and may even be harmful, an analysis of previous research found.”

Vitamin E “raised the risk of a severe type of stroke by 22 percent, while it lowered the risk of a milder kind by 10 percent, according to the study,” published in the British Medical Journal. Prior “studies of the vitamin’s effectiveness have produced conflicting results, with some showing a protective effect and others seeing no effect and an increase in the risk of early death, the study said.”

Here are more details from BBC News:

Taking vitamin E could slightly increase the risk of a particular type of stroke, a study says.

The British Medical Journal study found that for every 1,250 people there is the chance of one extra haemorrhagic stroke – bleeding in the brain. Researchers from France, Germany and the US studied nine previous trials and nearly 119,000 people.

But the level at which vitamin E becomes harmful is still unknown, experts say. The study was carried out at Harvard Medical School, Boston, and INSERM in Paris.

Haemorrhagic strokes are the least common type and occur when a weakened blood vessel supplying the brain ruptures and causes brain damage.

Researchers found that vitamin E increased the risk of this kind of stroke by 22%. The study also found that vitamin E could actually cut the risk of ischaemic strokes – the most common type of stroke – by 10%.

Ischaemic strokes account for 70% of all cases and happen when a blood clot prevents blood reaching the brain.

Experts found vitamin E could cut the risk, equivalent to one ischaemic stroke prevented per 476 people taking the vitamin.

Lifestyle check

However, they warned that keeping to a healthy lifestyle and maintaining low blood pressure and low cholesterol have a far bigger effect on cutting the risk of ischaemic stroke than taking vitamin E.

More than 111,000 people have a stroke every year and they are the third biggest cause of death in the UK.

While none of the trials suggested that taking vitamin E increased the risk for total stroke, the differences were notable for the two individual types of strokes.

The authors concluded: “Given the relatively small risk reduction of ischaemic stroke and the generally more severe outcome of haemorrhagic stroke, indiscriminate widespread use of vitamin E should be cautioned against.”

Previous studies have suggested that taking vitamin E can protect the heart from coronary heart disease, but some have also found that the vitamin could increase the risk of death if taken in high doses.

Dr Peter Coleman, deputy director of research at The Stroke Association, said: “This is a very interesting study that shows that the risk of haemorrhagic stroke can be slightly increased by high levels of orally taken Vitamin E, although what is a high level has not clearly been ascertained.

“More research is required to discover the mechanism of action and the level at which Vitamin E can become harmful.

“We urge people to maintain a lifestyle of a balanced diet, regular exercise and monitoring their blood pressure to reduce their risk of a stroke but would be very interested in seeing further research into this study,” he said.

Vicks VapoRub may help ease nighttime cold symptoms in children

My mom, a nurse, used Vicks VapoRub on us boys as we grew up. She believed in it, as did our pediatrician, Gloria Weir, MD. And, Barb and I used it on our kids. Loved it. And, it seemed to work well. Then, it fell out of repute … but, now … it’s back!

The CNN “The Chart” blog reports, “Parents get frustrated with the FDA recommendations not to use cold medicines in kids under the age of four because they are left with few options.”

Thus, “Vicks VapoRub is often used to fight colds and congestion,” but “there has never been proof of how well it works.”

Now, however, research underwritten by Procter & Gamble indicates that the “combination of camphor, menthol, and eucalyptus oils actually does ease cold symptoms and help children suffering from upper-respiratory infections sleep.”

Before reaching that conclusion, Penn State researchers randomized “138 children ages two to 11 to one of three groups for one night – Vicks VapoRub, petroleum jelly, or no treatment,” MedPage Today reports.

“The venerable nasal congestion remedy Vicks VapoRub beat out petroleum jelly and no treatment for easing nighttime symptoms of upper respiratory tract infections in children,” according to the paper in Pediatrics.

Indeed, “improvement was found in each group for all study outcomes, but cough, congestion, and sleep were significantly improved more in those children who used VapoRub,” and “parents slept better when their children used VapoRub.”

Vapor rubs pose very little chance for toxicity.

The study’s lead author, Ian Paul, pointed out that “vapor rubs have been used for a century but in high concentrations camphor can be dangerous, especially for children,” the Chicago Tribune “Julie’s Health Club” blog reports.

“Prior to 1994, before the FDA regulated camphor, there were problems with ingestion, particularly in the form of camphorated liquid oils, said Paul.

But the FDA has since reduced the maximum allowable concentration to below 11 percent, where there is very little chance for toxicity, Paul said.”

So, Mom, here’s to you … and the age old therapy of Vick’s VapoRub.

Regular exercise wards off colds and flu

Earlier this week I discussed how regular exercise can reduce your risk of depression. It can also help you reduce your risk or colds and the flu.

The CNN “The Chart” blog reported, “Working out regularly helps ward off colds and flu,” according to a study published online in the British Journal of Sports Medicine.

HealthDay reported that after collecting “data on 1,002 men and women from ages 18 to 85,” investigators “tracked the number of upper respiratory tract infections the participants suffered” over 12 weeks during the fall and winter of 2008.

Study participants also “reported how much and what kinds of aerobic exercise they did weekly.”

The study authors found that “people who were physically fit and who engaged in exercise five or more days per week were about half as likely to suffer cold symptoms compared to participants who reported less physical activity,” WebMD (11/1, Hendrick) reported.

“What is more, researchers say the severity of symptoms fell by 41% among those who felt fittest and by 31% among the most physically active.”

According to MedPage Today, “In addition to the number of days spent with an upper respiratory tract infection, the severity and symptomatology of such infections was reduced as well, by 32% to 41% between the high versus low aerobic activity and physical fitness tertiles (P<0.05 for all). There were also significant reductions in the middle tertiles.

So, ’tis the season to begin some regular exercise. The benefits are huge!

Kids’ use of electronic media at night linked to problems

More than half of children who use electronic media before bedtime may have mood or learning problems during the day, a preliminary study of 40 young people suggests. The kids in the study, average age 14½, were all treated at the JFK Medical Center Sleep Laboratory in Edison, N.J. About 77% had trouble falling asleep; others had daytime sleepiness. Here are more details from USA Today:

And it’s no wonder: Turns out they sent an average 34 text messages or e-mails a night, according to the study, to be presented today at the meeting of the American College of Chest Physicians in Vancouver, British Columbia. Texts were sent anywhere from 10 minutes to four hours after bedtime.

“Across the board, all of the children admitted to using electronic media — texting, computers, video gaming — after lights out,” says co-author Peter Polos, a physician at the JFK clinic.

Kids texted an average of four people a night. Electronic media woke them up once a night, when they were texted or called by a friend.

Young people who used the most bedtime media — from cellphones to video games — were more likely to have attention-deficit hyperactivity disorder, anxiety, depression and learning problems during the day.

Polos notes that the study has limitations: It can’t prove that late-night media use caused problems such as attention-deficit hyperactivity disorders. He adds that results may not represent all kids; everyone in the study came to the clinic with a problem.

HELP KIDS GET THEIR SLEEP

Parents and kids should talk to each other and find solutions together, says Kim West, a family counselor and author of Good Night, Sleep Tight: Gentle, Proven Solutions to Help Your Child Sleep Well and Wake Up Happy. Her tips

  • Make the bedroom a technology-free zone, with no TVs, cellphones, iPods, computers or video games.
  • Turn off electronic devices at least half an hour before bed.
  • Don’t allow kids to read or do homework in front of a computer screen so they can avoid the temptation of checking in on Facebook or answering an instant message.

Now, one caution about these data. They were presented at CHEST 2010, the annual meeting of the American College of Chest Physicians in Vancouver, British Columbia. Therefore, the findings should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.

Exercise Reduces Depression Risk

In past blogs I’ve told you about how exercise can help both prevent and treat depression. I also discuss this phenomena in my book, 10 Essentials of Happy, Healthy People: Becoming and staying highly healthy.

10 E's

Now, along comes one of the largest studies ever published on the topic (of 40,000 Norwegians), which found that people who take regular exercise during their free time are less likely to have symptoms of depression and anxiety, a study of 40,000 Norwegians has found.

However, physical activity which is part and parcel of the working day does NOT have the same effect. Writing in the British Journal of Psychiatry, the researchers said it was probably because there was not the same level of social interaction. Here are the details from the BBC:

The mental health charity Mind said that exercise and interaction aids our mental health. Higher levels of social interaction during leisure time were found to be part of the reason for the link.

Researchers from the Institute of Psychiatry at King’s College London teamed up with academics from the Norwegian Institute of Public Health and the University of Bergen in Norway to conduct the study.

Participants were asked how often, and to what degree, they undertook physical activity in their leisure time and during the course of their work.

Researchers also measured participants’ depression and anxiety using the Hospital Anxiety and Depression Scale.

People who were not active in their leisure time were almost twice as likely to have symptoms of depression compared to the most active individuals, the study found.

But the intensity of the exercise did not seem to make any difference.

Social benefits

Lead researcher Dr Samuel Harvey, from the Institute of Psychiatry, said: “Our study shows that people who engage in regular leisure-time activity of any intensity are less likely to have symptoms of depression.

“We also found that the context in which activity takes place is vital and that the social benefits associated with exercise, like increased numbers of friends and social support, are more important in understanding how exercise may be linked to improved mental health than any biological markers of fitness.

“This may explain why leisure activity appears to have benefits not seen with physical activity undertaken as part of a working day.”

Paul Farmer, chief executive of the mental health charity Mind, said that lifestyle factors such as diet and exercise are known to have a positive impact on mental well-being.

“Exercise gives you a natural high and is a great way to boost your mood. However, another mental health benefit of physical activity is derived from social interaction.

“So going out with a running club, taking part in a team sport or working on a communal allotment is far better for your mental well-being than a physically demanding job.

“Mind has found that after just a short country walk 90% of people had increased self-esteem,” Mr Farmer said.

Want to Marry Your Soul Mate? Could This Lead An Increased Risk of Divorce?

I must confess: this one surprised me. But, after reading the details, I wonder … After all, Brad Wilcox is one of my favorite researchers and writers. See what you think …

A surprising new study has reported that the idea of marrying your ‘soul mate’ may be a nice idea in theory and in chick flicks, but may not be such a good idea in real life.  Here are the details from Cosmopolitan:

“Couples who believe in soul mates have such high expectations of marriage, and when those aren’t met they’re more likely to enter into conflict or even end up getting divorced,” explains Bradford Wilcox, PhD, Director of the National Marriage Project at the University of Virginia.

He added that these types of couples expect an intense positive emotional connection all the time, which sets them up for disappointment.

On the other hand, couples with a slightly less fantasy-ish outlook aren’t as likely to fight and ultimately throw in the towel.

That may sound like bad news for the two-thirds of Americans who, it is reported, like the idea of soul mates. But if that’s you, there’s no need to change your beliefs. Instead, you can improve your chances of a happy relationship with these tips from Wilcox:

  • Try to be as realistic as possible when it comes to the day-to-day stuff. It’s fine to believe that you’re with The One and Only, but don’t let that turn into bogus expectations (i.e., you must feel 100 percent happy with him All. The. Time.). Keeping things real will decrease the odds that you end up disappointed.
  • Don’t drop your friends and family for your soul mate. “Those who have support from people besides the spouse are better at negotiating the challenges of married life and being successful in the relationship,” says Wilcox.
  • Be willing to make sacrifices. Basically you shouldn’t expect everything to go smoothly without any effort on your part. He may be your soul mate, but that doesn’t mean the relationship won’t take work.

More US adults aware they have hypertension. Do you?

Finally some good news in the recognition and treatment of high blood pressure (hypertension). The AP reports that, according to a report released by the Centers for Disease Control and Prevention (CDC), “more American adults are aware they have high blood pressure, and more are taking medicine to try to control it.”

The report, which included 24,000 adults who underwent blood pressure checks during the period from 1999 to 2008, also revealed that “the proportion of US adults with high blood pressure has actually been holding steady at about 30% for a decade.”

HealthDay reported that “part of the reason that treatment and awareness of hypertension has increased while the prevalence of the condition remains stagnant is the ongoing obesity epidemic and the aging population, both of which tend to produce more hypertensives,” explained the report’s lead author, epidemiologist Sarah Yoon, PhD, of the CDC’s National Center of Health Statistics.

The report also revealed that the percentage of people who were aware of having hypertension “increased from 69.6 percent in 1999-2000 to 80.6 percent in 2007-2008.”

Along with the increase in patient awareness of hypertension, “the percentage of people with high blood pressure taking medications for the condition increased from 60.2% in 1999-2000 to 73.7% in 2007-2008,” WebMD reported.

Yet, although “medication is helping people control blood pressure, the prevalence of adults with the condition has held steady in the past 10 years for men and women, all adult age groups, non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans.

What’s more, “the percentage of people with high blood pressure taking medication to lower it increased for those 18 to 39 and 60 and over, but not for people 40 to 59, the CDC report says.”

So, be sure to get your blood pressure checked at least once a year.

  • If it’s less than 120/80, you’re in great shape. Check it again next year.
  • If the upper number is 120-139 OR the lower number is 80-89, check it a couple of other times. If it stays in this range, you have “pre-hypertension” and need to see your doctor about this (although you likely will not need medicine).
  • If the upper number is 140 or higher OR the lower number is 90 or higher, it’s time to see your doctor about this (and, you may need medicine).

Seniors should get whooping cough vaccine

An across the street neighbor was complaining the other day that her daughter and son-in-law in southern California were not going to let them visit their new grandbaby until they both had their influenza and pertussis vaccines. My comment, “Good for them!”

Our neighbor seemed surprised. I said, “The kids are building a cocoon of protection for their baby. Since a baby cannot get the influenza vaccine until after six months of age, and since a child younger than six months of age is at risk for pertussis, or whooping cough, and several babies have died of it this year, they are making a wise decision for their family.”

The neighbor seemed perturbed by my response … but, my bet is she and her husband will be immunized. And, they should be.

Now, the Los Angeles Times reports in its LA Now blog, “Senior citizens should be vaccinated against whooping cough if they expect to be in contact with newborn infants, a federal health committee in Atlanta said Wednesday.”

Notably, the “vote by the Advisory Committee on Immunization Practices at” the CDC “largely endorsed what California health officials have been saying since the summer: People 65 and older should get the Tdap shot, which protects against tetanus, diphtheria and pertussis, also known as whooping cough.”

The AP says, “The Advisory Committee on Immunization Practices gave the advice Wednesday because of an outbreak of whooping cough this year in California, where more than 6,200 cases have been reported.” Notably, “nine of the 10 infants who have died were too young to be fully vaccinated against the disease.

So, if you’ve not had your influenza immunization this year, or a Tdap immunization, now’s the time.

Warning About Pacifiers Containing Honey

One of the joys of my professional life is serving as a member of the visiting faculty of a Christian family medicine residency, In His Image, in Tulsa, OK. One of the residents recently sent out this note which is a good reminder to parents with children under one year of age.

Hello everyone,

I’m presently doing my rotation in outpatient Peds clinic. I just want to share something that caught our attention when a Hispanic mom brought her child in for a 2 month well child check.

It was a usual normal well baby check until mom said that she gives her child a pacifier with honey on it. As we all know, giving honey to babies less than a year old is a health hazard as it can cause infantile botulism.

Apparently, the honey-containing pacifier is used commonly in the Hispanic community when i did some research about it.

Here in Tulsa, there are several stores known to the Hispanic community that sell this kind of pacifier. One is located in 15th & Lewis called Vickie’s. There is no label in the packet of the pacifier that warns buyers not to give it to babies under 1 year old.

I did not know about the existence of a honey-containing pacifier until I saw that mom and baby at the Peds clinic. It’s good that we should be aware of this because a lot of moms don’t know that giving honey to their babies is a health hazard.

I have attached the alert letter sent by the OKAAP to pediatricians in Oklahoma warning them of these pacifiers, and they have filed a complaint to the Tulsa health department about this.

Blessings,

Joanna

Honey may contain Clostridium botulinum spores that can cause infant botulism, a rare but serious disease that affects the nervous system of young babies (mostly under one year of age). C. botulinum spores are present throughout the environment and may be found not only in honey, but also in dust, soil, and improperly canned foods.

Adults and children over one year of age are routinely exposed to, but not normally affected by, C. botulinum spores — primarily because their more mature gastrointestinal tract, in general, and stomach acid, in particular, can kill the spores.

However, babies, with a less mature GI tract, and less stomach acid to kill the spores, can contract botulism from honey.

Thanks, Joanna. It’s a good reminder not only to parents, but to healthcare professionals who love and care for kids.

Pros and cons of the meningitis booster shot recommendation for 16-year-olds

For a number of years, I’ve been recommending the meningitis vaccine for kids at 10 to 11 years of age. I’ve always told parents, right now it looks like it will just take a single vaccination, but, in the future, we may see a recommendation for a booster. Now, that prediction has come true.

The Los Angeles Times “Booster Shots” blog reported, “A Centers for Disease Control and Prevention advisory committee on Wednesday recommended that adolescents receive a booster shot of the meningitis vaccine at age 16.”

Three years ago, the Advisory Committee on Immunization Practices “recommended that the vaccine be given routinely to children at the age of 10 or 11, primarily in an effort to protect them as they enter college and the military.”

The scientific community had thought that “two popular vaccines against the disease” would provide “10 years of protection,” according to the New York Times.

However, it actually turns out “they may work for only five years or less. That is not long enough to protect teenagers and young adults through the riskiest years,” but a “booster dose at 16 would yield protection through the first few years of college, when outbreaks occur most often.”

That explains the impetus behind the “6-5” vote that led to the current suggestion, MedPage Today reported. But, “some of the panel members opposing the recommendation would have preferred simply delaying the initial dose until age 14 or 15, in part because of the cost.”

Others “at the meeting wondered if it was even necessary to make such a decision,” considering that “cases of bacterial meningitis are at historic lows,” HealthDay reported.

What’s more, “a US Food and Drug Administration official, Norman Baylor, said more studies about the safety and effectiveness of a second dose of the vaccine are needed.”

Nevertheless, “in a news release issued after the vote, the National Meningitis Association said it ‘supports [the] decision to maintain meningococcal immunization at age 11-12 and to add a booster dose to provide increased prevention of disease among adolescents throughout their high-risk years.'”

The AP also covers the story.

My recommendation, if you can afford the vaccine, get your kids immunized against meningococcal meningitis at age 10 and have them take the booster dose at age 16.

Deficiencies Found in B-Complex Supplements

Tests of B vitamin supplements, including B-complexes and shot-sized energy drinks, revealed problems with the quality of 4 out of 18 products selected for review by independent testing organization ConsumerLab.com.

One widely-sold B-complex supplement was found to contain only 17.9% of its vitamin B-12. Another had no detectable vitamin B-6 and was short on both biotin and folic acid. Two energy shot liquid supplements were low on folic acid, respectively providing only 40.4% and 75.5% of the amounts listed on their labels.

Both energy shots displayed B vitamins as their top-listed ingredients and listed caffeine as part of a proprietary “energy blend.” The amounts of vitamins B-6 and B-12 included in these two products were, respectively, 2,000% and 8,333% of the Daily Values of those nutrients.

Taking three of four small bottles in a day (which one product indicated as permissible), would cause a person to exceed Upper Tolerable Intake Levels for niacin, vitamin B-6, and folic acid, representing a risk of toxicity.

Neither of the energy shots listed a specific amount of caffeine but noted the amount to be comparable to that in a cup of either “brewed” or “leading premium” coffee.

According to the USDA, one cup (8 fluid ounces) of brewed coffee contains an average 95 mg of caffeine. The same serving of Starbucks coffee has 180 mg of caffeine.  ConsumerLab.com discovered the amounts of caffeine in the small (2 fluid ounce) energy shots to be higher than one might assume from their labels: 156 mg (64% more than brewed coffee) in one and 207 mg (15% more than a premium coffee such as Starbucks) in the other.

“Consumers need to be aware that some supplements don’t provide all of the B vitamins they claim,” said Tod Cooperman, M.D., President of ConsumerLab.com. “It is also important to recognize that B vitamins won’t increase energy levels if you already get an adequate intake, which most people do. The sense of energy from B vitamin liquid shots appears to come from the added caffeine, which may be at higher levels than you expect.  If you do use energy shots, be careful not to drink more than one or two a day and not to take other B vitamins.  Otherwise you run a risk of toxic effects.”

According to Nutrition Business Journal, sales of B vitamins in the U.S. were $1.2 billion in 2009, second only to multivitamins. Most healthy individuals are not deficient but deficiencies can occur with long-term use of certain medications such as those that reduce stomach acid and strong diuretics, recovery from surgery, alcoholism, and in strict vegetarians.

In addition to treating and preventing vitamin deficiencies, B vitamins are useful in specific conditions.  For example, high-dose niacin can improve cholesterol levels and folic acid can help prevent spinal birth defects. The combination of vitamins B-6, B-12, and folic acid can reduce elevated homocysteine levels — a risk factor for cardiovascular disease, although studies have not shown this combination to reduce cardiovascular risk itself.

In addition to the four supplements that failed testing, fourteen other B vitamin products passed testing as did five products similarly tested through ConsumerLab.com’s voluntary certification program.

ConsumerLab.com also indentified two products similar to one that passed testing but sold under different brand names. The results found in the full report now available online to ConsumerLab.com members.

The report includes test results, quality ratings, and comparisons of B-complexes, energy shots, and single-B vitamin supplements containing thiamin, niacin, vitamin B-6, biotin, folic acid, and vitamin B-12.

Products from the following brands are covered:

  • 5-Hour Energy,
  • Country Life,
  • CVS,
  • FoodScience of Vermont,
  • Freeda,
  • Isotonix,
  • Jamieson,
  • Kirkland,
  • Klaire Labs,
  • Life Solutions,
  • Nature Made,
  • Nature’s Bounty,
  • Nature’s Life,
  • Nature’s Plus,
  • Now,
  • Puritan’s Pride,
  • Schiff,
  • Slo-Niacin,
  • Solgar,
  • Source Naturals,
  • Spring Valley,
  • Stacker 2 – 6 Hour Power,
  • Swanson,
  • Twinlab and
  • Vitamin World.

The report also includes information about the uses, recommended intakes, and cautions for each of the B vitamins.

ConsumerLab.com is a leading provider of consumer information and independent evaluations of products that affect health and nutrition. The company is privately held and based in Westchester, New York. It has no ownership from, or interest in, companies that manufacture, distribute, or sell consumer products

Heavy smoking more than doubles the odds of developing Alzheimer’s

USA Today reports that, according to a study published by the Archives of Internal Medicine, “heavy smoking in midlife more than doubles your odds of developing Alzheimer’s disease.”

For the study, researchers from Kaiser Permanente “evaluated the records of 21,123 men and women in midlife and continued following them, on average, for 23 years.” They found that, “compared with non-smokers, those who had smoked two packs of cigarettes a day increased their risk of developing Alzheimer’s by more than 157% and had a 172% higher risk of developing vascular dementia — the second most common form of dementia after Alzheimer’s.”

The Wall Street Journal reports that smokers who did not smoke so heavily still faced an increased risk for dementia. For example, even smokers who smoked just half a pack of cigarettes daily still had a 37% increased risk for Alzheimer’s.

Bloomberg News points out the public health implications of the study, noting that “about 46 million Americans ages 18 or older are cigarette smokers, according to the US Centers for Disease Control and Prevention.”

The study’s lead author explained that “smoking causes higher levels of inflammation in the body and affects how blood clots.”

In addition, “smokers are … more likely to have strokes, high blood pressure, and cerebrovascular disease — a malady of the blood vessels, particularly the arteries that supply the brain — which are all risk factors for dementia, she said.”

According to the CNN’s “The Chart” blog, people “who smoked between one and two packs had a 44 percent heightened risk, compared to non-smokers.”

However, “this could be an underestimation, because some smokers who would have developed dementia died before diagnosis, said Kenneth Hepburn, associate dean for research at the Emory University School of Nursing, who was not involved in the study.”

What’s more, “the reported risk of dementia among heavy smokers is also likely an underestimation because many of those people will die before they’re old enough to develop dementia, he said.”

“Former smokers and people who smoked less than half a pack a day did not appear to be at increased risk of Alzheimer’s or vascular dementia,” HealthDay reported.

Still, “the associations between smoking and dementia did not change, even after adjusting for race or gender, high blood pressure, high cholesterol, or heart attack, stroke or weight,” the study authors added.

All of this is just another reason for all of you who smoke to talk to your personal physician ASAP about stopping ASAP.

Breast Cancer Surgeon Explains How Abortion Elevates Risk for Women

As breast cancer awareness increases among women, one leading breast cancer surgeon and professor has written a full explanation of one of the risks women need to keep in mind when talking with friends and family about the deadly disease — abortion.

Dr. Angela Lanfranchi is a Clinical Assistant Professor of Surgery at Robert Wood Johnson Medical School in New Jersey. She is a surgeon who, as the co-director of the Sanofi-aventis Breast Care Program at the Steeplechase Cancer Center, has treated countless women facing a breast cancer diagnosis. Lanfranchi was named a 2010 Castle Connolly NY Metro Area “Top Doc” in breast surgery.

In an article she wrote for the medical journal Linacre Quarterly, Lanfranchi talks about why abortion presents women problems and increases their breast cancer risk. Here are some of the details from a report in LifeNews.com:

A growing amount of evidence from quality studies suggests that induced abortion, but not spontaneous abortion or miscarriage, increases risk of breast cancer.

Of course, induced abortion is not the only risk factor for breast cancer. Most women diagnosed with breast cancer have never had an abortion. Most women who have had an induced abortion will not get breast cancer. Like a family history of breast cancer, which is involved in about 15 percent of all breast cancer cases, induced abortion is just another risk factor.

Cigarette smoke is a carcinogen. While only 15% of cigarette smokers get lung cancer, the risk has been well acknowledged. In comparison, induced abortion as a risk factor for breast cancer is somehow not as widely publicized.

Induced abortion boosts breast cancer risk because it stops the normal physiological changes in the breast that occur during a full term pregnancy and that lower a mother’s breast cancer risk. A woman who has a full term pregnancy at 20 has a 90% lower risk of breast cancer than a woman who waits until age 30.

Breast tissue after puberty and before a term pregnancy is immature and cancer-vulnerable. Seventy five percent of this tissue is Type 1 lobules where ductal cancers start and 25 percent is Type 2 lobules where lobular cancers start. Ductal cancers account for 85% of all breast cancers while lobular cancers account for 12-15% of breast cancers.

As soon as a woman conceives, the embryo secretes human chorionic gonadotrophin or hCG, the hormone we check for in pregnancy tests.

HCG causes the mother’s ovaries to increase the levels of estrogen and progesterone in her body resulting in a doubling of the amount of breast tissue she has; in effect, she then has more Type 1 and 2 lobules where cancers start.

After mid pregnancy at 20 weeks, the fetus/placenta makes hPL, another hormone that starts maturing her breast tissue so that it can make milk. It is only after 32 weeks that she has made enough of the mature Type 4 lobules that are cancer resistant so that she lowers her risk of breast cancer.

Induced abortion before 32 weeks leaves the mother’s breast with more vulnerable tissue for cancer to start. It is also why any premature birth before 32 weeks, not just induced abortion, increases or doubles breast cancer risk.

By the end of her pregnancy, 85% of her breast tissue is cancer resistant. Each pregnancy thereafter decreases her risk a further 10%.

Spontaneous abortions in the first trimester on the other hand don’t increase breast cancer risk because there is something wrong with the embryo, so hCG levels are low. Another possibility is that something is wrong with the mother’s ovaries and the estrogen and progesterone levels are low. When those hormones are low, the mother’s breasts do not grow and change.

A woman can use this information to make an informed decision about her pregnancy. If she chooses to abort her pregnancy for whatever reason, she should start breast screening about 8-10 years later so that if she does develop a cancer, it can be found early and treated early for a better outcome.

If she doesn’t have the resources to raise a child or is not ready to be a mother, there are millions of couples waiting to adopt any child, even one with disabilities.

Women need to understand their own bodies so that they can make the best decision for themselves.