50 years after the first report warned us about the dangers of tobacco, the current Surgeon General has issued a new report, telling us it's even more dangerous than we realized.
- eye degeneration
- birth defects
- a higher risk of tuberculosis
- ectopic pregnancy
- erectile dysfunction
- liver and colorectal cancer
- rheumatoid arthritis
- immune problems
- Talk to your kids, early and often, about the dangers of all forms of tobacco and nicotine. Have rules and expectations--and consequences if they use any. Find out if their friends smoke, because it makes it more likely that they will start. For more information and for ideas on what you can do, visit the Smoking and Tobacco page of the website of the Centers for Disease Control and Prevention.
- Support any legislation or initiatives that make it more difficult for people to smoke, especially youth.
- Support funding for anti-tobacco initiatives. Whatever they cost, it's going to be way less than $289 billion.
- Create a comprehensive definition of tobacco products. It's not just e-cigs--there are all sorts of "emerging tobacco products" that sometimes sneak under the legal radar.
- Restrict sales to minors. Seems like a "duh" thing to do, but until you make the law, anybody can go buy the stuff.
- Restrict manufacturers from distributing samples of tobacco products. E-cigarettes come in flavors like chocolate and bubble gum. Handing them out could be like handing out candy...and a bad habit is begun.
- Prohibit the use of smoking and electronic cigarettes in places where the smoke-free workplace law applies. Let's get rid of the loopholes. And truly, we don't know that the vapor from e-cigarettes is safe, even if it isn't the same as regular cigarette smoke. For all we know, it's got its own set of toxins.
Did you know that Martin Luther King is the only non-president to have a day commemorating him?
- A show about kids who smoke a lot of weed, drink, or use other substances. I have various patients who experiment with this stuff, thinking that they can handle it and that it's not such a big deal. I think it would be really useful for them to see how lives can unravel.
- A show about teens who have experienced unhealthy dating relationships. I once saw a survivor of domestic violence talk to a group of high school students, and they were clearly mesmerized--and visibly shaken--by her compelling story of how what seemed like a perfect relationship with the perfect guy went terribly wrong. If we could get more teens to hear these stories, we could help them see the signs, and ask for help, before it gets dangerous.
- A show about victims of bullying. Lots of teens think of bullying as drama, no big deal, and think that the victim should just, well, ignore it or get over it. Maybe if they could really see and understand what it feels like to be bullied, they would think twice before they made that mean offhand comment. And maybe they would be more willing to stand up to bullies.
A study recently published in the journal Pediatrics says that actually, we do need to worry.
Researchers looked at information from emergency room visits across the country. They found that between 2001 and 2008, more than 7 million children ages 5 to 19 were treated for injuries they got at school (about 12 percent of all injuries in that age group). But here's what's scary: 10 percent of those injuries were intentional--the kids were hurt by someone on purpose, not by accident.
The injuries aren't all minor, either. Some are just bumps and bruises, sure, but there were a significant number of fractures--and brain injuries.
These intentional injuries are more common in boys--and, what is particularly scary is that boys are more likely to get beat up at school than outside of school. (Girls are more likely to be hurt intentionally outside of school). This is especially true of middle school students--which reminded me of the time when my daughter's middle school friend was taken under the bleachers and beaten because he is gay.
We talk a lot about cyberbullying, and it's true that it's a dangerous thing and on the rise--but this study makes it clear that plain old schoolyard bullying is still happening.
So what can we do?
Well, all schools should have anti-bullying policies and programs--and good supervision on school grounds. If parents don't know what the policies, programs and supervision are at their child's school they should ask--and if they aren't in place, they should speak up and make sure they get put into place.
Parents also need to work with their own children to help prevent them from becoming either victims or bullies. A lot of that has to do with how children are doing emotionally and socially, and parents should always talk to their pediatrician if they have any concerns. But there are also strategies we can teach children to help them handle those dicey school moments. The American Academy of Pediatrics (AAP) suggests that parents teach their children to ACT CALM.
If they are mad, they should:
Acknowledge angry feelings
Calm down (breathe deeply, count to 10, listen to music)
Think and Talk (think about the problem and ways to fix it, talk with someone about how they are feeling)
If someone starts a fight, the child can be the one to stay calm:
Calm down (keep a safe distance away, take deep breaths, stay alert)
Avoid (avoid returning insults, avoid other kids who may want to fight)
Listen (to what other kid is saying, try to understand what they really want)
Move on (find a way to solve the problem without fighting, or just walk away)
To learn more about the study and for links to other resources about violence against children and keeping kids safe, visit healthychildren.org.
How smart are you when it comes to being safe in the cold? See how you do on this quiz:
True or False: When going outside in cold weather, it's best to wear multiple layers of loose-fitting clothing, rather than one layer of heavier clothing.
Answer: True (starting you off easy here). Layers help keep the heat in. For inner layers, wool, silk or polypropylene are better than cotton. Hats are key, mittens are better than gloves, and it's important to have a scarf or mask for your face.
True or False: If you are sweating when you are outside in the cold, that's good--it means you are nice and warm.
Answer: False. Perspiration is how your body cools off--you'll just end up colder. Ditch a layer.
True or False: If your kids are bundled up, it's fine to let them play outside.
Answer: Depends--on the temperature, and wind chill. I'm all about getting kids outside, even in the winter. But frosbite can set in very quickly--and exertion in really cold weather can stress the body further. When the weather gets very cold (it's hard to give an exact temperature, because the wind chill affects it as well), you should really limit the time your children spend outside. If they go out, bring them in as soon as they start shivering--and if they get wet.
Which of the following are signs of frostbite?
a. Very red skin
b. White, gray or yellow skin
d. Pain and stinging
Answer: b and c. Certainly if the skin is getting really red (or there's any pain) it's time to get out of the cold, but frostbitten skin is pale and numb. It's the numbness that can be a problem--sometimes people don't even realize they have frostbite!
Which of the following should you do if you suspect frostbite?
a. get somewhere warm immediately
b. rub the skin
c. use body heat to warm the area, or run it under warm (not hot) water
d. use a heating pad
Answer: a and c. Don't rub the skin, as it can do more damage--and using a heating pad when skin is numb can lead to burning. If you are worried about frostbite you should also call your doctor for advice.
Which of the following are signs of hypothermia?
b. drowsiness, less energy
d. slurred speech, memory loss
e. all of the above
Answer: e. Remember, it doesn't have to be extremely cold for hypothermia to set in, especially if a person gets wet. And the confusion/drowsiness part can make it hard for people to realize that they are getting into trouble.
If you suspect hypothermia, you should:
a. Get somewhere warm immediately
b. Take the person's temperature
c. Stick the person in a tub of hot water
d. Use warm blankets and give them something warm to drink.
e. Warm up their hands and feet first.
Answer: a, b and d. Obviously, getting out of the cold is the first step. But for warming, think dry--which also includes getting the person into dry clothing if they are wet. So warm blankets are good (an electric blanket is great if you have one), maybe lots of them. While hands and feet may feel really cold, you want to warm the core first--and drinking something warm, like cocoa (stay away from caffeine) can help warm the insides too (one big caveat: don't make people who are extremely sleepy drink--they might choke). The reason taking the temperature is a good idea is that if the temperature is 95 or below that's dangerous--and a reason to get medical attention. If you ever aren't sure what to do, call your doctor.
To learn more about cold weather safety, including lots of great information about how to prepare for storms and keep your pipes from freezing, check out the Center for Disease Control and Prevention's Extreme Cold guide.
I saw a child with the flu in clinic last week. At the time I wasn't thinking too much about whether it was the flu or another viral illness; I was thinking more about whether to hospitalize the child, which we did. But when I heard about the positive flu test, I thought: of course.
- Fever, sometimes high (not everyone with the flu will have a fever, but most do)
- Runny nose/stuffiness
- Sore throat
- Muscle aches
- Feeling tired
- Sometimes: vomiting and/or diarrhea
Medicine is changing all the time; we learn new things every day. And each new discovery spawns more discoveries; there are times when I feel that what we know, and what we are learning, is literally exploding. I do a lot of reading to keep up, but I could read all day every day and not know everything. Medicine feels different than it did 23 years ago when I was pregnant with Michaela.
At the same time, we are in an age where access to information is exploding too. News travels nearly instantaneously. When I was pregnant with Michaela in 1990, the JAMA study would have been reported in the papers, where I might or might not have read about it. My obstetrician might or might not have heard about it quickly, depending on how much time he had to read journals. Information, especially medical information, moved more slowly and was less widely accessible.
There were downsides to this, obviously. Getting good health information out to those who need it quickly can make all the difference, and well-informed patients can better advocate for themselves (and often get better care when they do). But there were upsides, too. Information had a time to sit, get put in context, get tried out, be interpreted and better understood. Sometimes, in the process, we realized that it didn't make sense. Doctors had a chance to explain things. We don't necessarily get that anymore.
So often these days, parents ask me questions that puzzle me. They puzzle me because I haven't heard anything about it (I am not the only doctor who has had to Google something because a patient heard about it before I did)--or because it would never have occurred to me to ask the question, let alone worry about it. But the way information get spun these days, it's hard not to worry--and react.
See, that's the thing: without medical training (actually, without specific medical training--even parents who are medically trained come to me with puzzling questions outside of their area of specialty) it's really hard to interpret information--and know if it has anything at all to do with you. And when information has to fit into the paragraph next to the picture on the website and be condensible into a 140 character Tweet, well, there's lots that gets left out.
Like nuance. Like the fact that so little in medicine is completely certain, that there is so much more gray than black or white. Like the fact that risks are relative. Eating Brie cheese during pregnancy doesn't mean that you will get Listeria (the risk of contamination is 0.7%, or 7 per 1000 servings)--which is good, since I was blissfully unaware that I wasn't supposed to eat soft cheese during pregnancy and ate it nearly daily. We need to be aware of risks, but we need to keep perspective, too--after all, crossing the street or driving a car and other ordinary acts of daily life can get risky too. Sometimes the big picture is the most important one.
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