Guns Or Mental Health?

On February 9, Acadiana’s regional EMS Council had it’s latest meeting, representing local ambulance services, Emergency Departments, and disaster coordinators.  First we congratulated ourselves on providing tourniquet training to 105 Sheriff’s deputies, to stop life threatening bleeding from gunshot wounds. Our next consideration was to provide this training to schools.  We all shook our heads: the world’s come to this, that schools need tourniquet training?  Five days later, another school shooting, this time in Parkland, Florida.

This latest shooting reignited national debate on preventing these tragedies.  Is it a lapse in mental health care; or is access to assault rifles, designed to kill large amounts of people, too easy?  I see lots of kids in the ER with suicidal and violent tendencies. Occasionally they threaten to shoot up their school, and can get a gun.  When we hear that, we admit them to a psychiatric facility for evaluation.

However, there’s limited treatment options for these kids.  There’s not enough mental health beds or outpatient services for all the teens who need help. When it comes to pre-teens, it sometimes takes days to get them into an appropriate hospital- there’s not that many beds for that age in Louisiana.  The closed option for younger kids from our area is Alexandria.  If that hospital’s full, it’s Shreveport or New Orleans.  That’s far for impoverished, working families to visit, and far for those hospitals to coordinate outpatient care for patients returning home.

Obviously, mental health needs more money for doctors, therapists, and beds.  Like roads and schools, when it comes to quality, you get what you pay for.  There’s also a need for finding lonely, bullied kids and support them before they become risks.  The Huffington Post recently reported on a teacher who uses surveys in her fifth grade classes, asking who wants to sit with whom for the following week, and asking for nominations for the week’s exceptional class citizen.  But instead of using those surveys to see where kids want to sit and their nominations, she’s finding out who’s not getting requests to be sat with, or nominated.  She’s looking for lonely kids who needs friends.

The sun is about to come up, the woods quiet and dark.  My son, my brother-in-law, and I stand in knee-deep water, listening.  The birds start to chirp, the frogs croak, the sky lightens. Alas, no ducks show up, and when the dawn is over, we unload our shotguns and head home.  Another morning where, instead of “hunters,” we’re just “heavily-armed nature lovers.”

As mental health care has again become a national issue after the latest school shooting in Florida, as we discussed above, gun control has also resurfaced.  As many are vilifying the National Rifle Association for it’s gun access advocacy, we learn there’s actually two NRAs.  The historical NRA, and majority of members, are hunters like us, nature lovers with shotguns.  This NRA is about spending time outdoors with family, gun safety, and how to cook your deer or ducks.  For most of the 20th century the NRA actually helped write some gun control laws, including restrictions on “crime” weapons like submachine guns.  It’s only in recent history that there’s a political NRA, lobbying for access to all types of weapons.

Like them or not, the NRA has important safety advice for parents.  After all, most gun injuries and deaths happen in the home, from suicide, domestic violence, or accidents.  Keep guns unloaded and locked, and ammunition locked up separately.  When your kids get curious about guns, teach them gun safety, to take away the mystery and desire to “play with guns.”  If kids find an unsecure weapon, they should run from it and and report it to a responsible adult.  With little kids, or depressed teens, don’t have a gun in the house at all.

Finally, no one needs an assault rifle, especially the mentally ill.  They’re no good for hunting ducks.  The high energy, tumbling action of their bullets, designed to inflict maximal damage to soldiers, destroys deer meat.  Like I mentioned above, our regional EMS council was considering providing tourniquet training for our local schools, even before the latest school shooting.  But prevention, by regulating these weapons, or their ammunition, is way better than having to treat pediatric gunshot wounds.  The only animals that should be at risk are those that are good in gumbo. 

Beware of UFOs!

This week’s guest columnist is Dr. Alex Wolf, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

It’s Sunday afternoon, you’re prepping dinner and keeping an eye on the kids.  You catch a fleeting glimpse of your youngest casually shoving something up his nose.  Did that just happen?  What’s he put up there?  You grab his head to look, and see something- let’s call it an Unidentified Foreign Object, a pediatric UFO.

Besides the obvious question- what the heck did he stick up there- there’s others.  Is this dangerous?  Does he need to go to the Emergency Room?  Often, parents decide the answer is yes, I need a professional to remove and identify this thing.  But you don’t need the ER with every UFO sighting.

Most objects in the nose are benign, and since they irritate, eventually get sneezed out.  If it’s close to the nasal opening, you can often grab it with tweezers.  However, if it’s big, round, slippery, and far up there, you may need help getting it out.  Also, if it’s a disc battery, it needs removal now.  Mucus in the nose sets up a current between the battery’s terminals, heating it up and burning the inside of the nose.  UFOs that are far up there pose other risks.  If they clog a sinus passage, mucus and debris can accumulate in the sinus and cause infection.  Also, the back of the nose opens into the throat, and occasionally UFOs can fall back and be breathed into the lungs.

Ears are another popular place children hide things.  Dr. Hamilton once had a kid put orange seeds in each ear to block having to listen to his sister. Usually there’s less reason kids do this besides, that they can.  Ears are trickier for UFOs- it’s harder to get objects out of that skinny, sensitive canal.  Also, there’s the ear drum back there.  If you hit that while trying to get a UFO out, it really hurts!  And you might injure the drum and affect hearing.  Ear UFOs that aren’t tiny enough to fall out on their own require us, or an ENT specialist, to remove.

Back to our toddler from above, casually shoving random objects up his nose.  Let’s say he does another common toddler move- putting things in his mouth and swallowing them.  Again you panic, rush over to look, and wonder what was that Unidentified Foreign Object (UFO) he just scarfed?  Is this bad?  You see some coins lying around, was that it?  At this point, many families rush to the Emergency Room.

Most ingested objects are benign. They simply pass through the gastrointestinal tract and out the other end.  If the UFO landed somewhere more concerning, like in the airway, or in the esophagus on the way to the stomach, your child lets you know.  UFOs in the upper airway or lungs irritate, causing coughing and obvious distress.  If stuck in the esophagus, kids feel that too, and will gag and squirm and have trouble swallowing.  These kids certainly need the ER.

Another emergency situation is if your child swallows toy magnets.  Even though these go down easily and he toddles off to get into more mischief, magnets can cause serious internal injuries.  Two magnets can cling together, trapping intestinal lining between them.  When that lining is compressed, it’s blood supply is squeezed out, it perforates, and gut contents can leak out and cause life-threatening abdominal infections.

Another stat scenario is disc or button batteries stuck in the esophagus.  Like the battery in the nose from above, the esophageal mucus makes a current between the battery’s + and – sides, heating it up, and causing burns.  If the esophagus burns through, it’s a risk for another life-threatening internal infection, inside the chest.

Understandably, having a UFO in your child’s ear, nose, or throat is alarming.  But stay calm.  Becoming upset also upsets your child, and when she’s crying, you can’t tell if it’s because you’re crying, or she’s in true distress.  No parent wants their child to become the next Area 51, but if he’s not coughing and choking, and you’re sure the UFO was something inert like a coin or lego, it’s cool.  If in doubt, call your doctor for advice.  A UFO is scariest because it’s unidentified, but really, they usually come in peace.

Too Many Tests, Too Many Meds

I remember that first time- a parent insisting on antibiotics despite my advice.  The girl clearly had a virus- cough and runny nose for two days.  I explained to the father that antibiotics don’t kill viruses, she’ll get better regardless.  “I still want the antibiotic,” he answered.  No doctor likes to disappoint, but I didn’t give in.  Better to anger a parent than prescribe unnecessary medications; as I explained to him, medications have risks.

In the past two decades, medicine has been touting “Antibiotic Stewardship.”  As more antibiotics are prescribed, bacteria develop resistance to them.  ”Super-bacteria” that resist all antibiotics sometimes infect patients.  Scientists worry that one day, bacteria will win the battle, they’ll all become resistant to all antibiotics.  The age of these miracle medicines will have passed, and a new medical dark age begun.

Antibiotics also are not entirely benign.  They can have side-effects.  Kids can get allergic reactions, sometimes just itchy hives, sometimes more severe.  Antibiotics can cause diarrhea and yeast infections.  Kids come to the Emergency Department for antibiotic reactions, and I sigh when the antibiotics were prescribed “for a cold.”  Unnecessary medications can lead to unnecessary ER visits.

Since the Antibiotic Stewardship campaign hasn’t really changed prescribing habits, there’s now a program called “Choosing Wisely.”  This new push is for doctors not only to prescribe medications carefully, but also stop unnecessary testing that can be potentially harmful, like unnecessary CT scans.  All the major medical academies, like the American Academy of Pediatrics, have Choosing Wisely goals for their specialties.

Why are campaigns like Choosing Wisely and Antibiotic Stewardship necessary?  Usage of medical testing and medication has skyrocketed, without improvement in health.  The most stark example is the opioid epidemic: more Americans are now dying of narcotic overdoses than from car accidents.  Part of the problem is consumer demand. We think that more is better, and that more tests, more medications, lead to better results.  Also, everyone knows a story of someone who suffered or died because the doctor didn’t order this test, or give that medication.  Then when their kid’s sick, they want it all.

Many people aren’t aware that tests can be harmful.  When I discuss the risks of CT scans, I sometimes talk about this experiment:  In August 1945, the Army Air Force dropped atomic bombs on two Japanese cities, Hiroshima and Nagasaki.  The physicists knew how much radiation the explosions would put out for each given distance from ground zero.  After the war, scientists followed the radiation effects in the victims.  From this data, we know from those that got a radiation dose equal to a CT scan, that dose increases your risk of cancer a small, but real, amount.

Besides radiation risk, CT scans can also cause other problems.  Often we need to give medical dye to “light up” inflammation for the scan, and that dye can cause allergic reactions.  Also, scans carry the risk of “too much information.”  Sometimes the scan shows not only what we’re interested in, like the appendix, but also shows other weird things we can’t explain.  Usually those weird things are normal, but sometimes we can’t be sure.  Then doctors are faced with a dilemma: do we spend more time and tests to prove that thing is cool, or do we just assume so and move on?

When people want more tests, like we discussed above, they’re often unaware that tests usually don’t declare the diagnosis, but only provide more clues.  What’s not well known to the public (and some doctors!), is that most diagnosis, as much as 85%, is made from the medical history alone.  The medical history is the “story” of the illness that doctors elicit from the patient.  Taking a thorough history if far more important than tests.  A good history also helps point to the best tests to do, or can eliminate the need for tests.

When the family wants a test or medication that the doctor is wary to order, there should be a clear conversation.  The doctor needs to explain why the risks outweigh the benefits, that the test or medication may harm the child more than help.  If the parents still insist, then the doctor either cedes to the parent’s request, if the harm is minimal, or must stand firm for the good of the child.  Sometimes we make parents angry, in order to Do No Harm.


Two Peds In A Pod

This week’s guest columnist is Dr. Rachel Kumar, a Family Practice resident at University Hospital and Clinics here in Lafayette.  

We see lots of kids with abdominal pain in the Emergency Department.  They’ll maybe have cramps or sharp pains, sometimes diarrhea, or have hard stools that hurt.  We’ll ask “what did you have for dinner last night?”  A common answer: Taco Bell.  Or McDonald’s.  Or “rice and gravy.”  Few families make the link between their greasy, fatty diets and their kids’ grumpy guts.

It’s no secret that feeding kids can be challenging.  You may want them to eat a healthy diet, but when they get old enough, kids can be fussy about what they like.  They have more control over what they eat as well.  Toddlers can be stubborn and refuse what you make; meals become battles.  School-age kids just go to the kitchen and snack when they’re hungry.  Teens hop into cars and drive to fast food joints.

Eating well is important for all ages, but particularly for children, who require adequate nutrients for their growing bodies.  Lucky for parents, they really have a great deal of control over the evolution of their kids’ taste buds, and can steer food preferences to healthier choices.

Taste development actually begins in the womb.  Amniotic fluid contains flavors based on mom’s diet.  After delivery, breast-fed babies get flavors of mom’s food through her milk.  To illustrate, after someone eats garlic, their breath still smells the next morning, no matter how much they brushed their teeth.  That’s because garlic is suffused through their bodies, and the smell is exhaled out their lungs, not their mouths.  For pregnant and nursing moms, that includes the placenta and breast milk.

So to all pregnant and breast-feeding moms out there, a well-balanced, healthy diet is not only important for you, but for baby’s developing tastes.  These women need to be good about what they eat- low fat, high-fiber, lots of fruits and vegetables, and whole grains.  That way their bodies are the best incubators for babies, and so babies also prefer healthy foods for themselves.

I know of one toddler whose parents fed her a variety of foods, and she learned to eat lots of things.  She also liked to put each of those foods on top of her head while she ate.  She did it for fun, smiling and enjoying her parents’ reactions, as peach juice ran down her forehead.

When babies reach the age of 6 months, taste preferences start to flourish- that’s when they start solid foods.  Introducing pureed vegetables before fruits is a great way to acclimate your child’s taste buds to low-sugar foods.  Giving many different baby foods is crucial; as many pureed vegetables, fruits, meats, and grains as you can.  This will make transition to a toddler diet easier, as they will have already been exposed to almost all flavors and will therefore be less likely to react adversely to a taste.

It’s also important to remember to introduce only one new food at a time at that age.  That way, if baby has an allergic reaction, or doesn’t digest that food well (has vomiting or diarrhea), you’ll know it’s the new food that caused it.  If a particular food is tolerated after 4 days of eating it, move on to the next new thing.

Toddler-hood is when routines and healthy eating can be challenging.  These kids  vocalize food preferences, and can be stubborn refusers.  Stock your kitchen with a variety of healthy choices, with no junk food choices that he can focus on.  Avoid buying the 20-count pack of chips, no matter how cheap.  If your toddler sees that, good luck getting him to eat his peas!

It’s important to establish routines: the family should sit down together for meals, three times daily.  These meals should feature most food groups, and toddlers need to try each one, if only one bite.  It can sometimes take fifteen tries before a kid decides they like a food.  If they refuse a bite, no treats!  If a toddler refuses to eat anything at all, don’t give into the fear that they’ll starve and make them something else.  We’ve never seen a child starve from refusing food.  When they’re hungry, they’ll eat.  Parents who fix their children different foods than they’re eating, catering to the child’s preferences, are creating diet monsters.   

Teens, Pregnancy- Never Mix The Two!

The 15 year-old had what she thought were gas pains for the past several months.  Then one day the pains became terrible, she came to the Emergency Department, and delivered a baby.  Then the doctors and nurses had their usual debate- did she really not know she was pregnant?  The missed periods?  The growing mass in her abdomen, that moved?

Yes, sometimes teenagers can be pregnant and not know it.  Some have periods so irregular they skip them.  Some are overweight enough to hide pregnancy.  Baby movements are interpreted as gas cramps. Then there’s that all powerful denial: Pregnant?  Nah, not me!  I remember going into a room to tell a teenager that her pregnancy test was positive.  She was so insistent, even pleading, that she didn’t have sex, that it was impossible for her to be pregnant, that I began to doubt it myself.  But she was pregnant in the face of the obvious- her missed periods, her morning sickness, and that positive test.

These teens evoke lots of other emotions in the adults around them, besides  bewilderment that they didn’t know they were pregnant, all the way until delivery.  Parents can be angry and frustrated.  We warned her about using birth control!  How could she make such a terrible mistake!  The doctors and nurses often just sigh about it- another teenage mishap, they’ve seen it before.  

Unfortunately, many teens are hard-wired to make such mistakes.  Teens are like toddlers, in that they like to explore.  But instead of toddling around the house looking for trouble in a 2 1/2 foot-tall frame, they are adult-sized, with raging hormones.  They want to try all the risky behaviors- drinking, driving, sex- with no thought to consequences.  It’s just the way they are.

Here is a short list of those consequences of teen pregnancy.  They visit the ER often, for the abdominal pains that accompany pregnancy, for morning sickness, for fatigue.  Their infants are born prematurely more often than for adult moms, giving the newborn a whole host of it’s own medical complications.  And pregnant teenagers may be at higher risk of death during childbirth than adult women.

Here’s a common conversation I have with teenage girls in the Emergency Department:  “Do you want to get pregnant?” I ask.  “No!” she replies.  “Are you using birth control?”  “No,” she answers.

As we discussed above, teenagers are bad at prevention.  They don’t consider the consequences of actions like unprotected sex.  They just do stuff, like drinking or driving too fast, and worry about the fall-out later.  After the crash.  Or the positive test.

Also, teens are under-prepared for pregnancy prevention.  Besides not getting enough sex-education, the education often doesn’t dispel common myths about how to avoid pregnancy.  Many teens think that if they have sex in certain times of their menstrual cycle, they’re safe.  Some have even more magical-thinking: that drinking Mountain Dew or doing jumping jacks afterward works. Many parents are uncomfortable discussing sex and birth control with their teens, for religious reasons, or denial that their “little girl” would ever do that, or just plain embarrassment.

However, discussing birth control with your daughter is way easier than if she actually got pregnant. Besides risking those medical complications we discussed above, teen pregnancy often comes with depression.  Then there’s that baby to raise.  Babies cost a lot; babies equal poverty.  Read the years of columns I’ve written on child care, remember all the foibles you experienced raising your own kids; then imagine your teen in that position.

Step one in preventing pregnancy is to teach kids BEFORE they’re teens.  Effective sex education begins in the pre-teen years, while kids are still good listeners, before the eye-rolling age, while they still think about consequences.  They should learn that pregnancy can happen any time in their cycle, with any single encounter.  They should learn about birth control and Sexually Transmitted Disease prevention. HIV rates are rising- you don’t want your kid getting that life-long, life-threatening disease!

Finally, teach them about the Plan B pill.  As teens often do, they have sex and then worry about pregnancy after.  That’s the time for Plan B, as soon as possible, within 72 hours.  Plan B is available in pharmacies without prescription, without needing an adult to buy it.  It may just save her life, and the life of a future, premature baby. 

Merry Christmas/Happy New Year!

This week’s guest columnist is Dr. April Weliever, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

In the past weeks Dr. Hamilton reviewed Christmas safety issues.  Christmas must be pretty dangerous, because there’s more to talk about this week!  Dr. Hamilton talked about choking hazards with toddlers putting things in their mouths, and last year he saw a toddler who put a Christmas tree light bulb in his mouth and chewed it up!  Fortunately the baby didn’t get cuts in his mouth or swallow any glass.  But toddlers like to explore with their mouths, and bulbs look pretty tasty, all smooth and brightly colored.

Christmas also comes with fire hazards.  Natural trees look and smell great, but if the needles become dry, a spark can start it aflame.  Add hot lights, an overloaded power socket, and your risk increases.  If you get a natural tree, stand it with the trunk sitting in water, and keep that water replenished.  Your tree will suck the water up and need more, to stay hydrated and fire-resistant.  Keep space heaters and other hot sources (time to upgrade to LED bulbs?) away.  In the old days, people used to put lit candles on their trees, and not surprisingly, fire departments had busy Christmases.  Don’t try this at home!

Fireplaces are another hazard.  In many homes they’re dormant until the family wants a Christmas eve fire in the grate.  If you light a fire, have your chimney inspected beforehand by a chimney sweep.  Birds can nest there, old soot can build up, and these can either catch fire in the chimney or block the flue, filling your house with smoke. Also have a fire screen, so that sparks and flaming logs don’t roll out and set carpets, presents, or trees alight.

Last Christmas tip, and it’s those pesky toddlers again!  Keep holly, mistletoe, and poinsettas out of reach.  Kids rarely eat enough of these to get poisoned, but don’t chance it!  If your child does ingest something potentially toxic, call Poison Control (1-800-222-1222) to see if he needs to get seen.  Don’t leave alcoholic drinks lying around either- toddlers love to imitate their parents, but you don’t want them emulating you that way!

So if you’ve gotten safely through Christmas with no conflagrations or toddler poisonings like we discussed above, now it’s time to talk about New Year’s.  New Year’s is traditionally a time for reflecting on the year past and planning for the year ahead.  It’s also a time of year for family and friends to get together, drink a lot, and then attempt to blow some fingers off with fireworks.

Seriously though, many celebrations will include fireworks displays in the community, and also in many backyards.  Though fireworks are lots of fun, festivities can get out of hand, and every New Year’s we see several kids with burns and blast injuries.  According to the National Fire Protection Association, Emergency Departments treated nearly 12,000 individuals for firework-related injuries in 2015 alone.  Over 3000 of those were kids.

Drinking and fireworks make a bad combination.  Have a “designated shooter” who is not drinking, to handle the fireworks and matches or lighters, so that safe decisions are made, and kids are well watched.  Light only one firework at a time, and have a bucket of water or ready garden hose to put out flames.  Never try to re-light duds, or light broken fuses.  Stick those guys in a bucket of water and forget about them!  Avoid buying fireworks packaged in plain brown paper.  These can be commercial-grade fireworks, and maybe too hazardous for backyard use.  Nothing spoils New Year’s like a house fire.

Sparklers are another child hazard.  They seem safe enough, but the hot tip actually gets to 1200 degrees, hot enough to melt glass!  And when they throw sparks, little kids’ arms are too short to keep them far enough away, and can get a spark in the eye.

New Year’s time is terrific for kids to zip around on the cool toys they got for Christmas- bikes, scooters, skateboards and ripsticks, dirt bikes and ATVs.  Make sure Santa also brought the helmets!  And for those skates, skateboards, and ripsticks: wrist guards.  Don’t start the New Year with a broken wrist- it hurts a lot, and puts the toys back in storage until the cast comes off. 

Christmas Out Of Control

When I was growing up, my Christmases were chronically overbooked.  Mom was a violin teacher, and since I played too, I got roped into every pageant, every church program mom could sign us up for.  It paid some bills for our family, but it wasn’t exactly peace on earth, barreling through the snowy county to the next gig.

My wife has her own version of holiday spiraling-out-of-control.  Early in December she starts buying gifts for our three kids, determined to hold the presents to a sane amount.  Then about two weeks before the big day, she realizes the crucial gift ratios are off: one kid getting 3 presents, the other 5, the other 7.  So more agonizing about how big the piles will look on Christmas morning, more spending.

When you make Christmas crazy, not only does it stress you, but it stresses your kids.  When kids get stressed, they get sick.  Then they come see us in the Emergency Department.  For our sake, for your sake, and for your kids’, here’s some tips for keeping a lid on things.

First, kids don’t care about Christmas volume.  Few children worry that their house is more decked out than the Griswold’s, or that their stack of presents exceeds the GDP of Botswana.  Kids typically want only a few presents, but they care that they are the right ones!  They know what they want, will let you know, and then you need to shop early, before things sell out.  Now’s the time (as you’re reading this!) to get their Christmas lists and get the shopping done.  Then later, if you need to even out the piles, you can get the “secondary” presents (clothes, socks,etc)

Also, more pageants, more shows, more activities won’t amp up your childrens’ Christmas spirit.  Too much running around can exhaust them, make them grumpy, and make them prone to getting sick.  Kids would rather spend time alone with their parents, than in crowds.  Good family holiday activities are things like hikes, kayaking, playing games together, cooking together, watching movies at home.  These are where kids’ favorite holiday memories are made, not at the Christmas Spectacular for $50 per ticket.

Here’s a not-so-heart-warming Christmas story.  Last week we saw a baby with a month of coughing, occasional vomiting, but otherwise looked well.  My colleague seeing the child decided to do a chest x-ray, given the long-standing cough, to be sure he wasn’t developing a pneumonia.  While the x-ray showed no pneumonia, it did show the quarter lodged in baby’s esophagus!

Occasionally babies and toddlers will grab an object when no one’s looking.  Since their mouths are their most sensitive parts, they’ll put new things in there to explore them.  And occasionally swallow the object.  Kids swallowing “foreign bodies,” as we call them, is especially a concern at Christmas.  More toys strewn about, ornaments on trees, spare tree bulbs, are temptations toddlers can’t resist.

As we discussed above, keeping Christmas low-key and simple helps decrease holiday stress for you and your kids.  It also decreases the amount of foreign bodies they can ingest.  However, you will want to decorate some, so it’s a time to be extra vigilant.  Small ornaments that baby can fit in his mouth should be high on the tree, out of reach.  After decorating the tree, put all the boxes away and crawl around the area yourself, like a toddler, searching for anything she may be able to reach and eat.

Buy only age-appropriate toys. Toys will have an age category on the box, so you know if there’s lots of pieces that could be ingested.  Keep the little ones away from the older one’s toys with small parts. Be especially careful to not leave out any magnets, button or disc batteries, or balloons- these can be deadly.

Finally, as always, it’s better to give than to receive.  Studies have shown that people are happier the more they give, and not just presents.  One really good giving idea this holiday is to donate blood.  There’s always a shortage of blood in December, as people are so busy they feel they don’t have time to give.  But we always need blood, for premature babies, for heart surgeries, for accident victims, and more.  Making time to give blood will bring you a whole lot more holiday cheer than spending that time looking for parking at the mall.

Play ‘Til It Hurts

This week’s guest columnist is Dr. James Hyatt, a family practice resident at the University Hospital and Clinics here in Lafayette.

“Winning isn’t everything, it’s the only thing.”  This quote, made famous by Vince Lombardi, is a mantra for generations of athletes.  This attitude permeates all sports, even at the youngest level.  If you watch Esquire Network’s “Friday Night Tykes,” you’ll understand how intensified kid sports and sport-related injuries have become commonplace.  You’ll see football coaches yell at children like they’re college phenoms, and then watch the kids get seriously hurt.

Every year, more than 3.5 million children under age 15 require treatment for sports injuries.  This evolution from mere games to full-on quests to turn kids into tomorrow’s superstars has caused a rise in injuries.  What are the perils of youth sports today, and how can we avoid sports-related Emergency Department visits?  One peril is concussions, particularly when kids are charging at each other with extra zeal.

Bailey was a 14 year-old soccer player.  In one tight game she came head-to-head with not another player, but her greatest opponent, the ball itself.  She took her eye off of it for a split second and it struck her in the forehead.  As she lay on the ground, all she remembered was the brightness of the lights and the hush of the crowd.  She tried to stand up but felt too dazed, and began having a headache and nausea.  The coaches were worried she had a concussion, so her parents took her to the ER.  Hours later, after a CT scan of her head, she was discharged with instructions to not play or even work out for at least a week.  Intense play resulted in a long time on the DL.

The American Academy of Pediatrics recommends kids who sustain a concussion be evaluated by a doctor before returning to play.  They need “brain rest,” to resolve the symptoms and let their brains heal.  This means physical rest and “cognitive” rest, relieving the thinking part of the brain.  Cognitive exertion, like homework, video games, or school work may worsen headaches, nausea and fatigue, and make them last longer.  Some kids need weeks or months for these to go away.

12 year-old Bradley was at bat.  Bases loaded, bottom of the ninth, he envisioned his  hit sailing over the outfield wall.  Instead he took the pitch to his ring finger.  He missed the post-game festivities, finding himself in the Emergency Department getting x-rays.  The finger was broken.  

Besides broken bones, or concussions like Bailey’s story above, kid sports injuries often happen less dramatically.  While Bailey and Bradley’s mishaps could happen in sports at any level, the intensification at youth level often leads to overuse injuries we used to see only in college or professional athletes.

Take Little League Elbow.  This didn’t exist when I was young, but now happens to kids who throw too much.  It mostly affects pitchers, but anyone who throws baseballs or softballs a lot can get it, stressing the ligament on the inside of the elbow.  The ligament becomes inflamed, swollen, and hurts.  In extreme cases the underlying bone can come apart, or kids can develop arthritis.

To prevent Little League Elbow, everyone’s now aware of the pitch count.  There’s tables to tell how many pitches children are allowed by their age, but coaches need to be careful.  The school coach may hold his pitchers under their counts, but does he factor how many pitches the kids are throwing at private lessons, or with a select team?  The sum of all those should be under the safety number.

Better prevention of overuse injuries, and more fun, is to vary children’s sports.  If a kid loves sports, she should do a variety- soccer one season, running another, baseball another, etc.  Also, parents and coaches need to dial back the intensity.  The science is clear- too much training is more likely to lead to an injury, rather than to a college scholarship. Kids should learn injury prevention skills like hydration, warm-up exercises, warm-down stretches.  They shouldn’t be pressured to play hurt, but instead encouraged to speak up when in pain.  Then they need adequate rest and rehab.

Preserving young athletes’ health is everyone’s responsibility: coaches, teammates, parents, and physicians.  It’s a balance between keeping kids out the ER, and heeding the call to ”Put Me In Coach!”

Killing Time Constructively

A friend’s son wanted help picking out his sister’s Christmas gift.  “What are her hobbies?” the son asked.  My friend was stumped: “Buying clothes?  Talking on her cell?  Eating at Whataburger?”  After a good laugh, they got serious.  She liked to run, and she loved to cook.  Get her something for the kitchen?  A kit for baking something extravagant maybe?

Everyone’s busy, kids too.  My own daughter in college is stressed with school work, her campus job, and sorority duties.  I worry that when my kids are adults, will they be too busy to have fun, to re-charge and enjoy the world, rushing through life and wondering where it went?

Hobbies are fun things done for their own sake, and they’re important for being healthy.  It’s time spent forgetting worries, doing something only for the sheer joy of it.  I see many kids in the Emergency Department with anxiety and depression, who have no fun.  To be fair, they aren’t unhappy just from a lack of hobbies; they have plenty to be miserable about.  There’s bullying, in-born mental illness, living in abusive households.  But even for them, maybe if they just had something to escape to….

Developing hobbies is important for kids. Video games and other screen times don’t count.  I also in the ER see the consequences of too much sitting still- obese kids, some already with adult-type diabetes and high blood pressure.  I’m talking about activities where the brain and the body are engaged, rather than the computer.

There’s various sports to try, but kid sports can be too highly organized.  Super-competitive school and select teams often become another chore for kids, organized and run by adults.  Maybe something less regimented, like skiing, hiking and geocaching, biking, fencing, surfing.  There’s other non-sport things to consider- sewing, gardening, bee-keeping, carpentry, car repair.

Trying things doesn’t always mean success.  It took several activities for one of my daughters to find her fun thing, suffering through hours of soccer and piano lessons before she discovered karate.  My other daughter slogged through years of violin before she and we gave up, and left her to what she really loved- soccer and softball.

Some people readily take to hobbies, loving everything.  That was my father: cycling, bee-keeping, sailing, model trains, carpentry, cross-country skiing.  We all were included in his activities, so we could spend lots of time with him.  He was so busy playing, I’m surprised he got any real work done, though he did have a lauded career as a professor.  Some guys have all the luck.

Fortunately for our appetites, mom did the cooking, an activity not on Dad’s list.  She didn’t grow up cooking, but learned later in life, and enjoyed it.  She most liked the gardening that put fresh food on the table, and baking desserts.

We discussed the importance of hobbies above, and one that will apparently never lose popularity is playing in the kitchen.  There’s now whole cable networks devoted to cooking, with competition shows about making food with weird ingredients under eccentric conditions.  Kind of like mom used to.

“Eating in” is now what many call cooking.  In the last century, eating at restaurants or bringing home prepared foods was a luxury few could afford.  Dining out was too expensive.  Even birthdays, when I was a kid, were a home activity, including a scratch-made cake.  For mine and most families, going out to eat was a once-per-year treat, if that.

But then McDonald’s and the rest of the fast food industry made eating out inexpensive, and wildly unhealthy.  Now this cheap, fatty food has made obesity the new sign of poverty, rather than thin, underfed kids.  And fast food has made my job harder.  I see lots of obese kids coming in to the ER with complaints of belly pain.  When I ask what they had for their last meal, it’s invariably “Burger King” or “Taco Bell.”

So get your kids interested in the kitchen, and yourselves too.  When you cook, you know what goes into your food.  You control the ingredients, the fat content, the portion sizes.  Kids learn a life skill, have fun, and get to eat!  Also consider this when shopping for Christmas gifts for your kids.  My kids used the heck out of their Easy Bake Oven, and they still love the kitchen.

Having a Hard Go

This week’s guest columnist is Dr. Justin Pratt, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“Something isn’t right.  My baby only poops every three days, and all my friends’ babies go every day.  What’s wrong?” -First time mother of a four-month old in my clinic.

Constipation is common: Whew!  You’re not the only one with a constipated kid!  Almost one third of children have constipation some time in childhood.  The definition of constipation varies with age.  For the baby above, skipping three to four days between stools is normal.  Straining to poop may mean constipation, maybe not.  However, passing hard stools that hurt, that’s constipation for sure.

Besides not stooling for days, moms worry that when their infants strain and grunt, they’re having a hard time (literally?).  However, if baby finally goes and it’s soft, that’s normal.  Consider this: babies must have bowel movements while lying down, so it’s going to take some straining.  You probably haven’t tried since you were that age, but it is!

Older children can suddenly have constipation, after going regularly and easily. There’s some times in life this commonly occurs.  The first is when one year-old’s transition to solid foods and cow’s milk.  The new toddler can get constipated from too much milk, which has no fiber, and not eating enough fiber-containing foods like fruits and vegetables.  Moms think: milk is good, give him all he wants.  This kills baby’s appetite for other foods, and then comes the painful consequences.  Thus, at one year babies should only get three or four 4-ounce sippy cups of milk per day.  This lets them be hungry for more fibrous food.

The next common constipation “milestone” is potty training.  When confronted with the unfamiliar potty, toddlers often get stage fright: “You want me to do that, there!?”  Sometimes they’d rather just hold it until you give up and put the diaper back on.  If this stubbornness goes on for more than two weeks, maybe she isn’t ready yet, and should go back to diapers for another few months.

“I”m really uncomfortable and haven’t had a BM all week.  I started a new construction job, don’t get to go in the morning, and can’t use the homeowners’ bathrooms.  I’m in the heat all day and probably don’t drink enough water.” -17 year-old in the Emergency Department.

Another time children get constipated is when they start school.  They’ve been using their nice, private bathroom at home.  Now they have to get out of the house early, often skipping going.  Then at school, they have to share the bathroom with other kids.  Many aren’t respectful of bathroom privacy, sometimes out of curiosity, sometimes to be mean.  Who could go in those circumstances? So these kids hold it all day, waiting to get back home.

When you don’t poop for a while and don’t drink enough water, your body scavenges extra water from stool.  The rectum absorbs the water, poop dries up, and compacts. Then it hurts to pass.

Fixing constipation depends on age and cause.  As above, babies who skip days pooping or strain, but it comes out soft, aren’t constipated.  If baby has hard poops that hurt, the easiest remedy is fruit juice, an ounce or two twice daily.  It takes a few days to work, but the fruit sugar is a laxative, and after passing the last “rocks,” baby should go smooth.  Babies over 4 months old can have strained foods with fiber, like cereals, vegetables, or fruits, to prevent constipation.  Also, breast milk prevents constipation compared to formula.

Babies transitioning to cow’s milk, like we said above, should get only three to four 4-ounce cups of milk per day.  More than that can constipate, and kills appetites for fiber-containing foods.  Kids should eat at least three fruit and vegetable servings per day, preferably more.

For potty-training kids, if you’re fighting to get your kid use a toilet, put him back in diapers and wait a few months.  Have foot rests for your adult toilet, or a toddler toilet.  It’s harder to go without a little leverage!

If your child is having hard painful stools, and you’re thinking about a suppository or enema, talk to your doctor first.  She can help you pick more effective, less traumatic fixes for constipation.