Can TV Shows Help Kids? A Neurologist’s View

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by Dr. Heidi Moawad, Neurologist

Television has been scientifically proven to produce many harmful effects on children and adults.1,2 From setting the stage for unrealistic expectations linked to low self-esteem and eating disorders to advertising unhealthy food and presenting unethical behavior as the norm, television can have many undesirable effects.

But some television shows provide entertainment while actually cultivating intellectual or emotional maturity. Some characteristics of these shows teach kids aspects of the real world that can help them understand how to interact with others in a positive way.

The following is a list of popular television shows that, in my observation, help develop a variety of valuable emotional, interpersonal and practical skills for growing children while providing wholesome family entertainment.

Love it or List it

Each episode of this program centers on a different couple – homeowners who are dissatisfied with their home. One homeowner wants to move to avoid making extensive repairs while the other wants to stay because of loved features of the home. The couple agrees to a remodeling and a new home budget while a real estate agent and a home remodeler compete to see who can provide the couple with the best living option. 

There are many great lessons to be learned from this program. The couple agrees to come to a compromise after they each list their wants in a home. They are encouraged to be considerate and compromise with each other. The couple sets a realistic budget, not an extravagant price, thus setting the stage for compromises. The real estate agent and the remodeler compete in a good-natured but genuine competition and accept loss graciously once the couple make a decision at the end. Lessons learned include compromise, good-natured competition and setting a budget.

The Middle

This is a comedy about a working class family with 3 kids ranging in age from grade school to college age. The plots are humorous and often touching, usually highlighting the message that the characters are imperfect but generally honest and kind. The show, unlike most television shows directed towards kids, does not focus on extravagant wealth or superstar kids or superpowers but instead on ordinary kids who lack more talents than they have. The benefits of watching this program include exposure to normal expectations and watching a family work through some typical problems within a half-hour episode.

Chopped / Cupcake Wars

The cooking challenges in this show focuses on the swift creation of a tasty and attractive meals using unusual ingredients. Contestants have to think on their feet, work well with their team, and use constructive criticism to improve as the show progresses through each round. There is some occasional crying but the show teaches poise under pressure, creativity, and compassion for the loser, who is always presented as very human. Many contestants return even after having been eliminated on past episodes, emphasizing the importance of persistence. 

Shark Tank 

This reality show features fledgling entrepreneurs with business ideas that they want to take to the mass market. A panel of potential investors offer varying levels of financing and partnership in the young businesses. Unlike most reality show competitions, every contestant on the show can win. Business offers are made quickly and clearly which emphasizes the importance of strong math skills. Business ideas are praised, criticized and questioned, teaching the importance of self-confidence as well as the importance of keeping an open mind to constructive criticism.  

The Voice 

This show is about talented vocalists who compete for voice coaching and mentorship by celebrity judges. While there is certainly an emphasis on entertainment, this show emphasizes the importance of coaching and reveals that even talented people need to work hard to improve. At the core, this show also demonstrates the tough reality that great raw talent can’t progress to the professional level unless it is packaged for general consumption similar to the message of Shark Tank. 

The Biggest Loser 

This reality show features obese contestants who need to lose weight. An emphasis on health, making positive changes, looking towards the future and not being ashamed of admitting the you need to work on self-improvement are central to the concept. Most importantly for kids, while there is a prize for the winner, the benefits for all contestants lies in the process itself – emphasizing the importance of working hard in daily life. For example, if a student is not number 1 academically or in sports or other extracurricular activities, participation is still beneficial. 

Television, like anything in life, can be harmful, but an also be beneficial if used mindfully. Kids can get some valuable advantages from some television shows that teach realistic and useful life lessons.

 

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Heidi Moawad MD is a Neurologist and a medical writer. Dr. Moawad is a graduate of Case Western Reserve school of Medicine and trained at University of Chicago Hospitals. Dr. Moawad is the author of “Careers Beyond Clinical Medicine” and she teaches human physiology and global health at John Carroll University in Cleveland, Ohio.
http://nonclinicaldoctors.webs.com/ 

 

Sources:

http://www.ncbi.nlm.nih.gov/pubmed/24639016

Early childhood electronic media use as a predictor of poorer well-being: a prospective cohort study, Hinkley T, Verbestel V, Ahrens W, Lissner L, Molnár D, Moreno LA, Pigeot I, Pohlabeln H, Reisch LA, Russo P, Veidebaum T, Tornaritis M, Williams G, De Henauw S, De Bourdeaudhuij I , JAMA Pediatrics, May 2014

http://www.ncbi.nlm.nih.gov/pubmed/25230366

“I Think My Child is Being Bullied: What Can I do?”

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by Dr. Jennifer Caudle, Family Physician

Over the years I have spoken with over 50,000 children, parents and youth about Bullying. This is a topic that I am not only passionate about, but dedicated to helping prevent. In this issue of The Physicians Blog, I wanted to honor “Bullying Prevention Month” (October) by answering your most commonly asked questions about bullying:

1) What are the warning signs that would let me know that my child is bullied?

The following situations should prompt you to ask questions about what your child might be experiencing:

  • If your child has changes in habits, including eating habits (skipping meals), sleeping habits (problems sleeping), or activities (decreased interest in activities)
  • If you notice injuries that cannot be explained
  • If your child has frequent health issues such as headaches, stomach aches, and generally not feeling well
  • If your child has experienced achange in grades (decline), not wanting to go to school or skipping school
  • If he/she has had a change in friendships or avoidance of certain social situations
  • If there is decreased self esteem
  • If your child exhibits sadness or talks about suicide

Any of the above are signs that your child might be involved in bullying behaviors. If any of them occur you should talk with your child. At times (such as in the case of suicide, etc), you should discuss these symptoms with your child and their health care provider as soon as possible.

2) How do I talk with my child about being bullied? Especially if they feel threatened or scared to talk- How do I break the silence? And, what are some tools to help them?

The following are tips to help you talk with your children about bullying and help them:

  1. Ask specific and open-ended questions
  2. Find out what is happening to your child by showing interest
  3. Understand that your child may feel fear or shame about the situation
  4. Talk with your child’s school officials-  including bus drivers, school counselors, teachers and administrator
  5. Encourage your child to get involved in activities they might enjoy-  this can actually be protective for children who are bullied. Encourage your child to spend time with others who have similar interests.
  6. Role play solutions at home
  7. Educate your child about bullying and cyberbullying and monitor online behaviors by following your kids on Facebook, Twitter and Instagram!
  8. Model good behaviors at home
  9. Discuss your child’s feelings and experiences with your child’s physician

3) Is it bullying, or just kids being kids? When will I know that it is bullying and when should I intervene?

Bullying behaviors should ALWAYS be intervened!

The definition of bullying is:

  1. Behaviors intended to hurt or harm someone
  2. There is a perceived imbalance of power between the parties involved
  3. The behavior is repetitive

Research has shown us that children who are bullied or who are bullies often have long-lasting consequences that may be psychological (increased risk of depression and anxiety), behavioral (problems with violence or substance use) or include other health consequences such as headaches, stomach pains, fatigue, etc. Bullying is a health problem that can affect many aspects of a child’s health and intervening should always be a priority!

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Dr. Jennifer Caudle is a board-certified Family Physician. She is an Assistant Professor in the Department of Family Medicine at Rowan School of Osteopathic Medicine. Dr. Jen is the author of “Bullying Among Today’s Youth: The Important Role of the Primary Care Provider” http://www.osteopathicfamilyphysician.org/article/S1877-573X%2813%2900041-5/abstract.

Dr. Jen serves as an on-air health expert for local and national news networks including CNN, The Dr. Oz Show, FOX News, CBS Philly 3 News, The Tom Joyner Morning Show and many others. She is also the creator of The Physicians Blog. Follow her on twitter @drjencaudle and visit her at www.jennifercaudle.com.

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

“Oh, My Aching Back:” Causes and Treatments of Low Back Pain

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by Dr. D’Wan Carpenter

Low back pain is a common stated complaint in most doctors’ offices. Low back pain is in the top 3 list for reasons people miss work in America. So what should you know?

For starters, low back pain has many causes. It can be from a muscular sprain/strain, myofascial pain (tightness and spasm of muscles), facet joints, sacroiliac joints, protruding discs compressing spinal nerves (which give radiating pain down one or both legs), or spinal stenosis (narrowing of the spinal canal which puts pressure on the spinal cord). If you have sudden or rapidly progressing leg weakness, new bowel or bladder incontinence, numbness in the genital area you need to be evaluated immediately by a healthcare professional as this can be the signs of an emergency.

While this list is not all inclusive, it represents the most common causes. The good news is most acute back pain, occurring 3 months or less, gets better on its own in almost 90% of cases although recurrence is possible. The other 10% of cases become chronic and are generally causes by one of three sources:

  1. Intervertebral disc-the disc in between two vertebral bodies in the spine
  2. Zygopophyseal joint (facet joint)-the joint created by the bottom of one vertebra and the top of the next vertebra below
  3. Sacroiliac joint (SI joint)-the joint created by the sacrum (the bottom of the spine) and the ilium (upper part of the pelvic bone)

Low back pain, whether acute or chronic, can limit your function with daily activities, interfere with sleep, and work performance.

Everyone wants to know, what can be done about this pesky back pain?

In most cases, pain medications such as non-steroidal anti-inflammatories (NSAIDs) like ibuprofen can relieve much of the pain. In conjunction, physical therapy for stretches, body mechanics training, and home exercises are often helpful. Osteopathic manipulative treatment (OMT) by an osteopathic physician can help restore the body’s overall function and help promote self-healing. Injections can be indicated particularly in the three main chronic causes. (To find a DO near you http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx) Epidural steroid injections (injections into the spinal canal with anesthetic solution and corticosteroid solution) can help relieve the inflammation caused by a protruding disc. SI joint injections are both diagnostic and therapeutic. Zygopophyseal/facet joint nerve block is diagnostic and can be followed by radio-frequency ablation (procedure where radio-frequency waves create heat that burn the identified pain causing nerves around the facet joint)of the nerve for long-term pain relief. Surgery may be indicated if all of the above measures fail, but keep in mind this should be last resort as surgery comes with its own risks.

Take home message:

  1. Remember when lifting heavy items particularly up from the floor, use the leg muscles and not the back to avoid injuries related to improper lifting
  2. Numbness in the genital area, back of legs and buttocks, bowel or bladder dysfunction, and leg weakness can be signs of an emergency and requires immediate evaluation.
  3. Avoid bed rest, but instead modify activities and decrease activity if necessary as complete bed rest can cause weakness of muscles which may exacerbate the condition.
  4. A thorough exam by your doctor is the best way to diagnose the cause of low back pain. Schedule a visit with your doctor especially if your low back pain is not getting better so that you can get the appropriate treatment you need.

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D’Wan Carpenter, DO is a graduate of University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine (now Rutgers School of Medicine) in Stratford, NJ in 2010. Dr. Carpenter is currently finishing her last year of residency in Physical Medicine and Rehabilitation in Taylor, MI with plans to focus on outpatient medicine to include treatment of joint pain, back pain, and neck pain with use of ultrasound injections, physical therapy, and manipulative techniques.

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

5 Ways To Help Your Child Have a Healthy “Back-To-School”

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by Pediatrician, LaKesha Davison, MD

 

Are you and your children ready for another school year?  Here are 5 tips for a smooth transition:

1. See your pediatrician. If you haven’t already had your child’s annual exam, now is a perfect time to do so. Your child will be screened for obesity, learning disorders, vision problems and several other common problems. Teenagers will also be screened for depression, anemia and scoliosis and can be screened for sexually transmitted diseases. Your pediatrician will be able to fill out any forms needed for school at this time. Health is wealth and your child may have trouble performing well in school if his or her health care needs are not being addressed.
2. Insist on participation in organized activities. Several studies have shown that children and teens who play sports have higher self-esteem and lower rates of obesity. This is especially true for girls, with the additional benefit of lower rates of teenage pregnancy. If your child can not participate in sports, or has other interests, encourage him or her to work on the school yearbook committee, or debate club, or band or chorus. These all provide a sense of achievement for the children and teach them about responsibility to others. These activities also decrease idle time, which is the time when trouble finds kids.
3. Decrease screen time. Children should have two hours or less of screen time once they get home. This includes tablets, TV, smart phones and computers. Their time should be spent interacting with siblings and parents, active play, reading, eating as a family and sleeping. Children in middle school and high school may need to use the computer for school work, but afterwards, they should take a break from the screen as well. Children who have difficulty falling asleep and are hard to wake up in the morning should not be allowed to take electronic devices to bed. These gadgets often stimulate the children and keep them awake instead of helping them to wind down in preparation for bedtime.
4. Encourage healthy habits. Limit sugary drinks, including juice, to less than 8 ounces a day. Encourage your children to drink water. Remind your children to wash hands after using the bathroom, even if they just went “number 1”. Your children should also wash hands after touching their mouths, after sneezing, and after using school computers. If they can’t get to a sink, pack hand sanitizer in their backpacks to help reduce the spread of germs. The beginning of the school year is when we see a huge number of outbreaks of strep throat, colds, stomach flu and other infections.
5. Be Nosey. This may be the most important thing you can do for your children. They should expect you to know about almost everything in their lives. Ask questions about what they learned in school, about what homework they have, about their friends’ names, about their favorite teacher, about how they feel about their body’s changes as they go through puberty and more. You should also know how they spend their free time and time between classes. There are several dangerous games that kids are playing, including lighting themselves on fire and hyperventilating until they pass out. Middle schoolers are especially at-risk as they are trying to learn some independence but lack insight. This is also the time that many children are first exposed to drugs, alcohol and sexual images/conversation. If your child knows that you are aware of or will quickly find out what they are up to, they are less likely to engage in dangerous activities. In addition, if your children know that you are interested in their lives, they are more likely to talk with you before making important decisions such as whether to use drugs, when to engage in sexual activity and what they will do with their lives after graduation. You will be your child’s greatest advocate. Your children might not realize it, but they need you. Don’t let mood swings or perceived disinterest dissuade you from giving them the attention they require to help them successfully navigate the challenges of obtaining their high school diploma. Always remember that your pediatrician is around to help you through this time as well. Good luck!
Dr Lakesha Davison
LaKesha M. Davison, MD, FAAP
Pediatrician
Decatur Pediatric Group, PA
Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

“The Last Kiss. Saying Goodbye:” Thoughts Of A Doctor/Mom After The Death Of Her Son

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by Dr. Joyce Scott, Family Physician

 

“Death is going to be an awful big adventure,” Peter Pan.

And just like that the one you love is gone.
The only ones that know about death are those in the grave and they are not talking. There is a sense of mystery and wonder about death. Like death, grief is a personal and individual experience. The very moment that you experience the death of a loved one, and the grief that follows, will forever be etched in your heart and mind. Years may pass marking another anniversary of their death, but the memory is as fresh as the day it happened.

At the tender age of 19 years my son died. While sitting at his bedside the noise of the ventilator and medical equipment broke the silence of fear. I would talk to him and whisper “I love you.” I probably prayed more during those two days than all the rest of my life combined. I found hope and comfort in other families in the waiting room that were experiencing similar problems. Strange but the doctors never gave us hope. The first time that I met the neurosurgeon he shook my hand and then told me, “Your son has zero chances.” Once when I saw a tear fall from my son’s eye I became overwhelmed and said, “He heard me.” The nurse scowled at me, “That is not a tear. That is fluid from where his brain is swelling. He can’t hear you.” I gently wiped the tear from his eye and whispered, “Rawlin, it’s mom. I love you.”

 
Hope is personal, providing comfort and softening the blow for bad news to follow. Taking away someone’s hope is like a thief in the night stealing a precious treasure. People look to the sky and search for a loved one. Somehow that sense of a Heaven above is where we might find them. Someone said to me “Rawlin is in a better place.” I looked at her, stretched out my arms and replied, “What better place for a child than in the arms of his mother that loves him.” Longing to see, feel, touch or just to sense their presence one more time lingers. I still believe my son heard me. Even if he didn’t, I would still want the last words that I spoke to my son to be “I love you Rawlin.”

 
I often heard phrases “time heals all pain”, “you will get over it,” and “you have two other children to take his place”. Once I replied, “Time does not help. It only reinforces that Rawlin is not coming back. You can get over a fence but you will not ‘get over “a death”. “No one, not even one of my other children will replace Rawlin.” To suggest that he can be replaced is to say in essence that he really didn’t matter anyway, his life was of little value, with no purpose because another can take his place. As the mother of three, each child occupies their own space and place in my heart and the family. People have said, “I know just how you feel.”  But, how can anyone ‘know’ another person’s thoughts and feelings? I’ve also heard, “It could have been worse.” I find it strange that during grief we have to imagine some horrible incident that could be worse so that death doesn’t seem so bad after all.

 
In this day of mass communications, internet frenzies, viral sensation, most trending events, tweeting, blogging, and even Facebook it is easy to get swept away in a cloud of confusion. We feel the pressure to say something. “I am sorry” or “I am sorry that this has happened to you” are simple ways to convey sympathy. Often, a gentle caress, sincere hug and even a tearful gaze from another can comfort and show compassion and sympathy. Sometimes you say it best when you say nothing at all.

 

“And all the king’s horses and all the King’s men couldn’t put Humpty Dumpty together again.” Powerless over death. We hear phrases like, “I would drown saving my child. I would die saving my child.” All of my medical training and education could not save my own child’s life. It is difficult to not feel like a failure. I did not swim fast enough to save my son. “No man is an island, we are all a part of the main.” Death and grief changes who we are. I told my daughter, “I will never be the woman that I was before Rawlin died.” My daughter now had two mothers: the mother she knew before Rawlin died and the mother she lives with now after he died.

 
I heard this advice, “Stop living in the past.”  That is where my son is….in the past. The only way that I can be with him is to return to the past. Move on.


How can we ease the pain and try to assemble the pieces to our shattered heart and life after the death of our loved one? Is there hope and peace beyond the grave? The answer is yes. It may take more effort and energy than required by Atlas while holding up the weight of the world, but it is doable.

 
1. Throw away all the misconceptions and misinformation from standardized grief processes. Avoid getting caught up in rules, steps to climb, stages to successfully pass through. The path of grief is a long and winding road that takes us on a journey for the broken heart.
2. Thrown down your armor and weapon along with your shield from pain. Loss makes us vulnerable. Realize that it is okay to be sad. It is okay to cry. One sincere listener can ease much pain. Allow the sympathizing heart of others to share the sorrow. It may be becoming weak that we survive to be strong.
3. Find strength in others while making time for being alone. Sometimes it is normal to seek our own solitude and quiet in order to appreciate the relationship shared with the lost loved one. As a mother I am reminded that I was not the only one that lost a son. My husband did also. My other children lost their brother.
4. Allow yourself to have freedom from pain without feeling guilty. It is okay to smile again; to laugh again; to rejoin life again.
5. Take care of yourself. Maintain nutrition and sleep. Try to get some form of physical exercise such as walking. Often our physical body suffers along with our emotional self.
6. If the time continues without going toward a healing process, there are professionals which can be instrumental. Counseling provides a safe time to ventilate feelings while receiving a sense of trust and unconditional caring support.
7. Although there is no such thing as a ‘miracle pill’ or remedy, there are many new medications available which also have added benefits to assist through emotional turmoil and situations. Symptoms of sleeplessness, anxiety, sadness, and lack of motivation for routine daily living can be improved with medication. Speak to a healthcare provider with concerns and possible prescription medication.

Joyce E. Scott, D.O.
Board Certified Family Practice,  author and motivational speaker

Twitter:  @JoyceEScott1

http://www.drjoycescott.com/
https://www.facebook.com/joycees1

 

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

“Don’t Eat the Alfredo, Sweetheart.” How to Prevent Food Poisoning

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by Dr. Lenny Powell

The evening of July 31, 2011 was lovely – my wife and I went to an Italian restaurant for dinner. She ordered pasta with marinara sauce, and I had the fettuccini Alfredo. We were sitting outside and the temperature was a balmy 95 degrees. We took our time eating our meals, picking at them while we gabbed and laughed about our day.

Then, it hit me – a grumbling and gurgling in my stomach about an hour after I finished my meal. “Hmm, that’s odd.” I thought. My stomach didn’t really hurt but it felt kind of annoying. I excused myself to the bathroom and came back a few minutes later, feeling somewhat better. Then it happened again- not cramps, but stomach pangs. I thought to myself, “this isn’t going to be a fun night.” By the time I got home I realized that I had food poisoning!

Foodborne illnesses strike about 1 in 6 Americans (48 million) every year; 128,000 people are hospitalized, and 3,000 people die from complications. Food poisoning can be caused by bacteria, viruses, toxins, or chemicals. Foods most commonly associated with foodborne illnesses include raw foods such as meat, poultry, milk, shellfish, eggs, and raw fruits and vegetables (1).

Food poisoning is caused by eating foods that are contaminated with bacteria or other pathogens. The good news is that most of these infections are largely preventable, and there are simple steps that can be taken to minimize exposure to these pathogens.

Safe food preparation is a key to avoiding foodborne illness. According to the CDC (1), it’s important to “Cook, Separate, Chill, and Clean” foods to prevent food poisoning:

Cook meat, eggs, and poultry thoroughly. Use a food thermometer to make sure you meat is cooked properly and use this chart as a guide: http://www.foodsafety.gov/keep/charts/mintemp.html. Make sure your eggs are cooked until the yolk is firm.

Separate foods so that they do not cross-contaminate one another. Keep produce separate from meat, poultry, seafood and eggs. Use separate cutting boards and plates and keep these foods separate in the refrigerator as well.

Chill promptly fruits, vegetables, milk, eggs, and meats. Bacteria can start to grow as quickly as after one hour unless foods are refrigerated. A cooler in the car with ice may be a temporary fix but the best thing to do is to get your food home, especially on a hot day, and into the refrigerator. It is also important to thaw or marinate foods in the refrigerator and never on the counter or in the sink.

Clean your hands, your surfaces, your utensils, and your fruits and vegetables. Clean your hands for at least 20 seconds with soap and warm water, your utensils and small cutting boards with soap and hot water, and surfaces as well as larger cutting boards with a bleach/water mixture. Wash fruits and vegetables before peeling to prevent bacteria from creeping inside and causing contamination.

Those who are most at risk from foodborne illnesses include pregnant women, the elderly, and those with weakened immune systems. Additionally, bottle-fed infants should be provided with clean and disinfected bottles with each feeding.

Symptoms of food poisoning include abdominal pain, nausea and vomiting, diarrhea, and fever. You should see your doctor if these symptoms progress to any of the following (1):

• Diarrhea, particularly if you notice blood, that lasts longer than 3 days
• Persistent abdominal cramping or pain
• Nausea and vomiting that is prolonged and such that you cannot keep liquids down
• Fever (greater than 100.4 ºF, measured orally)
• Decreased urination

Symptoms can range depending on the cause of the food poisoning. The goal of treatment is to replace fluids and, if warranted, provide antibiotic therapy. Not all foodborne illnesses require antibiotic therapy, as many diarrheal illnesses are viral in nature and will not be affected by antibiotic therapy. In some cases antibiotics may be more harmful than helpful.

“Don’t eat the Alfredo, sweetheart,” my mother warned me sternly at an outdoor wedding we attended shortly after this episode, “you don’t want to go through all that again!” I nodded in agreement, realizing that food safety and handling is of paramount importance and that with appropriate measures, illness can effectively be prevented.

Dr. Powell

Dr. Lenny Powell is a third-year Family Medicine resident at Rowan University School of Osteopathic Medicine. He presently has the pleasure of rotating with Dr. Jennifer Caudle (@drjencaudle) on a Medicine in Media rotation exploring the media communicates health information to the public. Follow Dr. Powell on Twitter @drlennypowell.

Reference 1:  http://www.cdc.gov

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

 

Do You Worry? The Breakdown of Anxiety

 

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by Dr. Lenny Powell

 

I admit that I worry.

I worry about many things – waking up on time to start my day, getting to work after driving through rush hour traffic, seeing my patients in a timely manner, completing my office notes, and presenting my patients to Dr. Jen when I forgot to write down a patient’s medication list or recent labs.

If you happen to catch me in the middle of a shift, I might seem rushed or panicked, constantly on the move to my next destination, my mind racing as fast as my feet can take me. In the mix of all this is a silent rumination of trying to manage all the details of whatever I’m working on or whom I’m seeing. Do things sometimes go awry? Yes. A series of calamities that others might look at and say, “That’s nothing, don’t worry about it” often does not strike me the same way.

“I’ve got three more patients to see and it’s already 3:30! Did I really spend 35 minutes of a 15-minute visit talking to Mrs. Smith about quitting smoking? How can this be? What if I don’t go back and check that box on that screen? What if I don’t add that line to my assessment and plan? What about this, or that? ” This can be a lot sometimes, but most of this worry dissipates when I manage to finally complete all of my tasks for the day.

I worry, yes – but does this make me anxious? Do I have an anxiety disorder?

Worry is a normal response to uncertainty.1 When this worrying becomes excessive and unable to be controlled, our state moves beyond worry into anxiety. Anxiety is defined as excessive and unrealistic worrying about everyday tasks or events. Anxiety may be specific to certain objects or rituals.2

Anxiety disorders – of which there are several – are the most common mental health problems in the United States2. Anxiety is an umbrella term used to encompass disorders such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and obsessive-compulsive disorder. These disorders often co-exist. Let’s look at each of these1,2. Generalized anxiety disorder is best described as constantly worrying. Panic disorder is having the sudden surge of overwhelming fear that may occur without warning or reason (panic attacks). Post-traumatic stress disorder may develop after witnessing or experiencing extremely traumatic events such as military combat, a criminal assault, or a car accident. Social anxiety disorder is an overwhelming fear of being scrutinized by others. Obsessive-compulsive disorder is characterized by recurrent and ritualistic behaviors to reduce anxiety such as excessive hand washing. Of these, generalized anxiety disorder is the most common.

The National Institutes of Mental Health estimates that 40 million Americans aged 18 or older have an anxiety disorder and women are twice as likely as men to develop anxiety.

What are signs that you may have an anxiety disorder? Here are some questions to consider2:

  • Do you feel nervous, anxious, or on edge?
  • Do you find yourself unable to stop worrying or controlling your worrying?
  • Do you worry too much about different things?
  • Do you have trouble relaxing?
  • Do you find it hard to sit still?
  • Do you become easily annoyed or irritable?
  • Do you feel afraid that something awful is going to happen?

If you’ve answered yes to two or more of those questions and your symptoms have persisted for at least one month2, you may have an anxiety disorder. Even if you don’t have these exact symptoms, but you are concerned about what you are feeling, make sure to keep a diary of your symptoms and discuss these with your physician.

There are many great treatment options for anxiety and it is possible to live a very full life with a diagnosis of an anxiety disorder. Counseling and medications have been shown to be almost equally effective. Other tips included making sure to get enough sleep, managing your time by prioritizing your activities, and avoiding alcohol, caffeine, nicotine, and sedatives which can make your symptoms worse. Make sure you see your doctor because anxiety can be caused by other underlying medical conditions.

If untreated, anxiety can lead to fatigue, muscle tension, restlessness, and a decline in your ability to do things you need or want to do. In addition, untreated anxiety has been shown to cause an increased risk of alcohol or drug abuse. But, there is hope and there are good treatments. What is most important is to discuss your symptoms with your physician.

“Okay!” I tell myself, standing outside the next patient’s room. “Take a few deep breaths. This will be fine,” I tell myself. As I knock on the door, I start my usual line as I enter the room, “Hello, I’m Dr. Powell, …”

Dr. Powell

Dr. Lenny Powell is a third-year Family Medicine resident at Rowan University School of Osteopathic Medicine. He presently has the pleasure of rotating with Dr. Jennifer Caudle on a Medicine in the Media rotation exploring how the use of various media (television, radio, internet, and print) disseminates medical knowledge to the public. Follow him on twitter: @drlennypowell at http://www.twitter.com/drlennypowell

References:

  1. http://www.aafp.org/afp/2006/0315/p1049.html
  2. http://www.aafp.org/afp/2009/0501/p785.html
  3. http://www.cdc.gov/cfs/management/treating-symptoms.html

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

 

Still Awake? 11 Ways to Get the Best Sleep Ever

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by Dr. Jennifer Caudle

If you’re  like most Americans, you have spent some days feeling tired and sleepy. Adults should get seven to eight hours of sleep each night (NIH), but more than 25% of the U.S. population report occasionally not getting enough sleep, and 10% experience chronic insomnia (cdc.gov).

Don’t be fooled into thinking that you can function on a smaller amount of sleep than normal and not have it catch up with you. Even if you don’t keep track of the sleep that you are missing out on, your body does. Sleep debt is the term used to describe the amount of sleep you are deficient. For example, if last night you received one less hour of sleep than you normally require, you have a sleep debt of one hour. If you then miss out of two hours of sleep tonight, you then have a combined sleep debt of 3 hours. The need for those 3 hours of sleep does not go away and your body still requires that you obtain that deficient sleep. Sleeping in on weekends may not be enough to repay your sleep debt and prevent the effects of lost sleep.

Daytime sleepiness could be a result of stress or environmental factors, or it could be the result of a more serious condition. The following are the most common sleep disorders:
A. Insomnia – difficulty falling asleep or staying asleep.
B. Obstructive sleep apnea- the upper airway is blocked intermittently throughout sleep. Symptoms can include loud snoring, gasping or choking during sleep.
C. Restless legs syndrome- urge to move the legs, often in response to pulling, crawling or tingling sensations.
D. Narcolepsy- excessive daytime sleepiness, often with sudden muscle weakness, the inability to talk or move upon falling asleep/awakening or hallucinations.

Other medical conditions that cause daytime sleepiness include bronchitis, asthma, heart failure, sickle cell disease, and rheumatoid arthritis among others. Environmental factors such as fluctuating work schedules, prescription and over-the-counter drugs, caffeine, alcohol, and nicotine can all cause disrupted sleep patterns and daytime sleepiness.

Sleepiness can have serious consequences.  Drowsy Driving is related to at least 100,000 motor-vehicle accidents and more than 1,500 deaths per year in the United States (nhtsa.gov). In addition, work-related accidents have been identified as a result of a lack of sleep. The Accreditation Council for Graduate Medical Education established standards in 2003 to limit the number of hours medical residents can work to “promote quality education and patient care” (acgme.org). Sleep is helpful for creating memories and learning information. Decreased sleep has been shown to hinder school performance, concentration and memory. Lack of sleep can also negatively impact mood and behavior.

If you want a good night’s sleep, try the following “Sleep Hygiene” tips (yoursleep.aasmnet.org) :

1. Use the bed for sleep and sex only (don’t pay bills, do work or other activities in bed)
2. Get into bed only when feeling sleepy.
3. If you go to bed and are unable to fall asleep after 20 minutes, get out of bed, do something relaxing until you become drowsy and then return to bed.
4. Get out of bed at the same time every morning (even on weekends)
5. Avoid naps (limit naps to 30 minutes for the elderly).
6. Don’t exercise too close to bedtime
7. Avoid caffeine and nicotine
8. Avoid alcohol before bed
9. Make your bedroom conducive to sleep: keep the temperature on the cooler side, keep your room dark, and minimize distractions such as electronics, cell phones and computers
10. Avoid large meals late at night.
11. Take time to wind-down before bed

These tips can help daytime sleepiness caused by insomnia. If your daytime sleepiness is caused by a condition other than insomnia your treatment may be different. Make sure that you visit your doctor for proper diagnosis and treatment. Best wishes for a great night’s sleep! -Dr. Jen

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Dr. Jennifer Caudle is a board-certified Family Physician and Rowan U. Assistant Professor. She is an on-air health expert who appears/ed on CBS3 Philly, Fox29 Philly, CNN, the Dr Oz Show and many others. Visit her at http://www.jennifercaudle.com and follow her on Twitter: @drjencaudle, Instagram: @drjencaudle and Facebook: http://www.facebook.com/drjennifercaudle.

 

Information in this article is for informational and educational purposes only and is not intended to provide medical consultation or serve as a substitute for medical advice provided by a physician or qualified medical professional.

Mother’s Day Edition: “Liquid Gold: The Benefits of Breast Milk”

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by Dr. Tomeka Day

 

Have you thought about breastfeeding ? Have you read, or heard the pros or cons to breastfeeding. Make sure you don’t miss one of the most valuable opportunities in your life to give your beautiful baby the absolute best! Here are some of my top reasons why you should breastfeed your baby and some of the reasons why some women choose not to breastfeed.

The top reasons why you should breastfeed your newborn baby:

1. Your baby will be much healthier. Breastfeeding is one thing that you can do to support your baby’s health. You see, breast milk not only contains nutrients and proteins, but also antibodies. These antibodies help protect your baby from horrible bugs that can cause ear infections, pneumonia and diarrheal illnesses. This is one of the reasons that many women refer to their breast milk as liquid gold, because it is so very precious. So if you are a working mom, or a stay at home mom, you will certainly appreciate your baby having fewer illnesses during their first year of life.

2. Breast milk is very gentle. You and your baby will appreciate the ease in which breast milk will be digested. Because it is easily digested, your baby will have less gas, colic, constipation, and spitting up episodes. Breast milk also decreases the risk of asthma, food allergies, and eczema.

3. Breast milk will enhance your baby’s brain development. Breast milk is excellent for developing the nervous system. Because of the special nutrients that breast milk contains, it enhances the development of your baby’s brain, thereby, making your baby smarter.

4. Breastfeeding strengthens the bond between you and your baby. Your newborn will only be a baby once, and this is the perfect time to enjoy giving your baby the best nutrition possible. This precious time with your baby will allow him or her to spend time focusing on their beautiful mom and you on your precious baby.

5. Breastfeeding can be very convenient. You won’t have to worry about carrying around multiple bottles for feedings. Nighttime feedings can be actually quite simple once mastered. You won’t have to worry about spending extra time preparing a bottle, simply pick your baby up, and begin breastfeeding. Once your baby has finished breastfeeding, simply burp your baby, and place him or her back into their bed for rest. Now you can return to your bed for rest.

6. Breastfeeding can delay the return of your menstrual cycle. Most women will appreciate not having to deal with the “period”. This means one less thing to worry about during this time. And for a time in your life, you can enjoy this added benefit of breastfeeding.

7. Breastfeeding can help you lose weight. Not only does breastfeeding help your womb get back to its normal size quicker, but it can help you burn more than 300 calories daily, which will help you get back to your pre-pregnancy weight much faster. The amount of calories that you burn breastfeeding daily may be equivalent to an hour-workout.

8. Breastfeeding can save you money. Parents can easily spend $1,000 during the first year of life on infant formula alone. Because you are feeding your baby the absolute best, breast milk, you don’t have to purchase infant formula. So, you can put that money into your baby’s savings account for their college education.

 

Despite these wonderful benefits of breastfeeding, here re some barriers that may prevent a woman from breastfeeding.

1. Lack of support. Initially after birth, this can be a very emotional time for the mother. For the first time mother, it can be a stressful trying to get the baby to latch on, wondering if the baby is eating enough, or even experiencing some pain from incorrect breastfeeding. However, I want to encourage you, that you can be successful at breastfeeding and your baby will thank you for your endurance. Your milk may not letdown until 48 – 72 hours after birth, but during this time, your baby will still be getting nourishment, which is your colostrum. If you are experiencing some pain with breastfeeding, it may be because the baby isn’t latching on properly. If your baby is born in a hospital, most hospitals have very supportive nurses and even lactation specialists that can assist you and show you the proper way for your baby to latch on. Your doctor can also be very instrumental in this area. Furthermore, once you and your baby are discharged home, if you have any additional questions or concerns, don’t hesitate to call your doctor for advice. Some lactation specialists will make home visits once you leave the hospital; so make sure you check to see if that is a possibility.

2. Some medical conditions can prevent breastfeeding. There are certain illnesses that the mother may have which are not safe for breastfeeding. Some of these conditions are HIV, active tuberculosis, drug addiction, or medications that the mother is taking. If you have any concerns about this, ask your doctor if it is safe to breastfeed your baby. It is my hope that you will choose to breastfeed your precious baby. You have been blessed with your bundle of joy, and I hope you give your baby one of the best things that you have to offer, your breast milk. Some refer to breast milk as liquid gold, because it is such a precious substance. You will be helping your baby be the healthiest, smartest, and happiest baby possible by simply breastfeeding.

 

Tomeka Day photo

Dr. Tomeka G. Day, M.D. is a physician who practices pediatric medicine in NC & VA. She is committed to improving the health of children and young adults. http://www.facebook.com/tomeka.day.54

I’m forgetful, do I have Alzheimer’s?

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by Amit M. Shelat, D.O., F.A.C.P.

 

Fear of losing one’s memory is certainly a significant concern. Many people fear that memory loss usually represents onset of Alzheimer’s Disease. This fear becomes even more prominent when there is someone in the family who has been diagnosed with Alzheimer’s Disease. Although this fear is very valid, it is not always justified since the most common reason for memory loss is not Alzheimer’s.

 
So what are the most common reasons for memory loss? Many patients who complain of memory loss are also individuals who also complain of poor sleep or feeling unrested when they get up from bed. Sleep and memory (more specifically short-term memory) are very closely linked. In order for a person to feel well-rested after sleeping and allow the brain to store memory, the brain has to be permitted to enter a stage of sleep called REM. REM or Rapid Eye Movement is a stage that makes up 20-25% of the total sleep that a person receives in one night. People who suffer from sleep apnea (have trouble breathing during the night) are not able to get adequate REM sleep. Inadequate REM sleep may lead to disturbances in concentration and memory. Most people with sleep apnea are diagnosed by their spouse long before they see a doctor as they often feel the business end of their spouse’s elbow routinely throughout the night. Many people with sleep apnea have a tendency to snore, but this is not present in all cases of sleep apnea. People with sleep apnea commonly wake up feeling tired. As this condition worsens, memory problems begin to arise and worsen to the point where sufferers become very absentminded and have trouble functioning during the day. People who feel this way should consult their doctor about having a sleep study.

 
When someone complains of memory problems, physicians will commonly order a panel of blood tests that evaluate thyroid function, look for deficiencies in Vitamin B12 and Folate, and look for infections such as Syphilis. It is important to note that vitamin deficiencies in B12 and Folate are commonly seen in those who follow a vegan or vegetarian diet. Supplementing these diets with these missing vitamins can help prevent memory problems. Additionally, those who have a long history of alcohol abuse can also suffer from deficiencies in Thiamine which can also lead to memory problems in addition to a host of other issues.

 
Abnormalities in functioning of the thyroid can not only lead to memory problems but also cause weight changes, hair loss, as well as abnormal heart beat. Those suffering from thyroid problems can also complain of depression, anxiety or restlessness. These feelings often go hand-in-hand with problems with sleep which can further exacerbate issues with memory as discussed earlier.

 
Finally, those who suffer from primary depression, bipolar disease, or anxiety disorders are very prone to developing memory problems. However, in the case of these conditions, the memory problems are part of a group of symptoms that lead to a condition called pseudodementia which as the name implies is not really dementia. Patients with pseudodementia have complaints of: poor short-term memory, problems with decision-making, poor attention, lack of concentration, abnormal sleep patterns (either too much or too little sleep), and appetite abnormalities. In these cases, treating the underlying problem will also lead to an improvement in the memory complaints. Many people who suffer from depression or anxiety are often not aware that they are suffering from these conditions. Still yet, many are in denial that they are suffering from depression. Personal and/or professional stressors can have significant impact on one’s ability to function normally. These stressors can lead to insomnia and in severe cases to depression which can cause one to feel incompetent at even the most basic tasks. Seeking attention early is the best intervention in cases that involve depression.

 
I hope that the above has been helpful in understanding some of the complexities of treating problems with memory. If you are having trouble with the things that we discussed above, I encourage you to speak to your primary care doctor and to do it sooner rather than later. The earlier you seek attention, the more likely it is that your doctor will be able to help you and the faster you can get back to yourself and enjoy life to its fullest.

 

Dr. Amit Shelat

Dr. Amit M. Shelat, D.O., F.A.C.P. is an Attending Neurologist in the Department of Neuroscience at Winthrop-University Hospital in Mineola, New York. Dr. Shelat is Assistant Professor of Clinical Neurology at Stony Brook University School of Medicine. He is board-certified in Neurology by the American Board of Psychiatry and Neurology (ABPN) and the American Osteopathic Board of Neurology and Psychiatry (AOBNP). Connect with him on LinkedIn.

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