Pearly Whites

My brother-in-law was in a bar on a cruise ship.  A woman from ”coal-mining country” liked him so much she exclaimed, “Ain’t you pretty- you got all your teeth!”  Teeth are important for good looks, and good health.  Listen to this week’s guest columnists: Drs. Libby Going and Rati Venkatesh, Family Practice residents at the University Hospital and Clinics here in Lafayette. 

In the Pediatric Emergency Department, we see lots of coughs, fevers, injuries of all sorts, and concerns about kid’s teeth.  While infrequent, parents sometimes come to ask about tooth care.  And we see lots of visits for tooth and mouth trauma.

We saw a precious two year-old girl recently, with big brown eyes a red bow in her hair, and a runny nose.  She was bubbly and fun but when she smiled, her teeth took away some pizazz.  They were brown stubs, an obvious case of “bottle rot.”  Her parents had been putting her to bed with a bottle, the milk sitting in her mouth all night, destroying her teeth.

Dental care is important early in life.  Start good habits for both baby teeth and permanent teeth.  Even before baby has teeth you should gently clean his gums with a wet washcloth.  When you see that first tooth and document it in the baby book, it’s time to start cleaning that tooth.  Use a soft baby toothbrush and a very tiny smear of toothpaste.

When you celebrate that first big birthday, baby enjoys her first cake, and you get that picture with icing all over her face and high chair.  Then it’s time to schedule a dentist appointment.  The first visits to the dentist are for a check-up, and to get the child used to the dentist. Dental visits aren’t the horror we feared when we were kids- children should learn early that dentistry is pretty painless.

What your child eats is also important for healthy teeth.  Sippy cups filled with juice or milk (or worse, soda!) lead to tooth decay.  Limit juice or milk to meal time only, with water offered the rest of the day.  And again, no bed time bottles after you have gently brushed those pearly whites.

Falls, sports injuries, and plain horsing around cause all sorts of injuries, but one of the scariest is a knocked-out tooth.  There’s screaming, blood, and an ugly gap.  What to do depends on whether it’s a baby tooth, or a permanent one.  Baby teeth usually start coming out in the first two years, and fall out on their own about age 6.  They are then replaced by the permanent teeth, which need to last the rest of the child’s life.

The best way to handle knocked-out teeth is prevention.  Mouth and face guards are very important for sports at risk for tooth injury- those with regular impacts, sticks, and flying objects- like football, baseball, hockey, softball, and lacrosse.  Cheering too- cheerleaders are often flying objects themselves!

What to do when a tooth gets popped out?  If it’s a baby tooth, don’t worry, just call your dentist.  Your kid may have a gapped-tooth picture for awhile, but her permanent tooth should grow in fine.  If it’s a permanent tooth, that’s more trouble.  It’s important to get that tooth back in so it won’t die, but take root and live.

First, pick up the tooth by the whitest part (the crown)- don’t touch the root.  If it’s dirty, rinse it for 10 seconds only.  Then match it to it’s hole and push the root into the socket.  Have your child bite down on a cloth to hold it in place, and call your dentist.  Put that tooth in with the outside facing out- backwards teeth make for future orthodontic trouble.

Scared to put that tooth back in?  Many are, with all that blood and crying.  Have your kiddo spit into a cup, and put the tooth in the saliva.  Or put it in milk.  Then immediately see your dentist.  Teeth re-implanted within one hour have better chances of surviving.

Mouth and dental emergencies can be scary, so it’s important to have a dentist by the first birthday.  Then you have an expert to call when things get hairy, and you can keep your child’s smile pretty.

The Good Ole Days Weren’t Always Good…

My father-in-law, Howard Fournet, grew up on a farm during the Great Depression.  The farmhouse was on Johnston St. (a gravel road then) in Lafayette, where the Albertson’s now stands.  The University of Louisiana’s athletic fields were the Fournet’s cow pastures.  It was hard living: the boys woke before dawn to milk cows, shared one bathtub’s water for ten, shared beds, and ate what they grew.  One year the boys all failed school because of sleep-deprivation, when times got so bad they had to let the hired hands go and do all the work themselves.

For Howard, going to Army Boot Camp in World War II was a vacation.  He got to sleep all the way to 6 am!  Three meals per day, daily showers, clean clothes, his own bed! And “work” was playing soldier all day.  He had never had it so easy.

As Billy Joel sings, the good ole days weren’t always good.  As far as health goes, there were fewer vaccines, so kids got more bad infections- more meningitis, blood infections, pneumonias.  Cars were less safe- no car seats or even seat belts, so kids got more horrific injuries in crashes.

While it wasn’t heaven when I was a kid either, many things were healthier.  With fewer TVs and only a few channels, we spent lots more time outside playing.  We had more recess and P.E. at school, more art, more music, less homework. We had more freedom to explore by foot and bike- the world was less crowded and our parents weren’t afraid of kidnapping. Eating was healthier- more home-cooking, and less junk food and prepared food.  With all that exercise and good food, there was much less obesity.

In the old days there were some good child-rearing choices and some bad ones. This raises the question- what choices do we make now when it comes to diet, exercise, and other facets of child-rearing?  What’s good, what’s bad, and what don’t we know yet?

When my friends complain about how hard we had it as kids, I think of the Monty Python skit about four guys who trade stories about their childhoods, trying to one-up each other about how rough it was.  In Python style, the tales get progressively more absurd, until they are saying things like “We lived in a brown paper bag in a septic tank,” getting up at 3 am to clean the bag, eat “a handful of cold gravel” for breakfast, go to work at the mill for 14 hours per day, and once back home “Dad would thrash us to sleep with his belt!”

I didn’t have it quite that bad growing up, but like we mentioned above, many things are better for kids today than in the “good ole days.”  There are more vaccines to protect kids from deadly diseases.  Cars are safer and car seats protect kids better.  We know more about healthy diets: cooking with less fat, high-fiber foods, buying foods grown locally, and eating less processed food.

However, we are unsure of some new things in child-rearing.  One is organized sports. When I was growing up there was little league baseball and football, but most of our exercise was running and biking the neighborhood.  Today kids spend way more time in super-organized sports- select soccer, baseball, volleyball, softball.  Those kids are getting lots of exercise, but we don’t know if the injury toll from repetitive practices and increased intensity is worth it.

Another unknown is the price of kids having phones.  It’s easier to stay connected with kids when they are away, and they can access lots of information from the net. But all that time texting and talking instead of experiencing the world around them- is that bad? And if they’re less bored because there’s always a phone game to fill idle time, is that good?  Or is some boredom maybe better, forcing kids to play and think creatively, rather than playing the phone?

These are important questions for we parents as we raise kids.  Choosing foods and vaccines and car seats is easy; life-style choices like sports and phones are harder. These are the Advanced Parenting choices not available in the Good Ole Days.

Junior Springs A Leak

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

Kids get a lot of bloody noses. While they’re usually only a mild inconvenience, nosebleeds freak out some parents.  They get alarmed at the blood- it looks like a lot! However, kids rarely lose a worrisome amount of blood. Another myth about kid nosebleeds: they are caused by high blood pressure, and are a harbinger of complications like stroke.  Finally, kids don’t choke to death on blood trickling down their throats.

Many nosebleeds seen in the Emergency Department are from minor injuries- bumps on the nose from balls and siblings, and nose picking.  Nosebleeds also happen in dry climates, because of allergies and colds, and because of some medications.  While dry climate is not a Louisiana issue, air-conditioning removes humidity, causing dryness indoors.  However, allergies are common here, and with that comes allergy medication. Allergies make for runny noses, then allergy medicines dry out the nose and mucus.  The dried-out inside of the nose and mucus get cracked, a crack runs through a vein, and pow!

Regardless of cause, the initial treatment for nosebleeds is the same.  Apply pressure to stop bleeding and allow clotting.  Applying pressure means gently pinching the nostrils together without causing pain.  We have all been told growing up to lean the head back. This does very little to stop the bleeding, but very effectively causes blood to drain down the back of the throat.  While saving her shirt from blood stains, for the kid it only leads to gagging and coughing and nausea.

Gently squeeze the nostrils closed for ten minutes.  It takes that long to make a clot. Don’t keep checking to see if the bleeding is done during that time: letting go interrupts the clotting process.  Hold for the whole time, watching a clock.  Sometimes when parents let go and bleeding continues, they really get nervous.  Don’t panic!  Again, no kids bleed to death from nosebleeds. Close the nostrils for another ten minutes and hang on. Sometimes a few drops of Afrin help slow bleeding.

Injuries cause lots of nosebleeds, besides dry noses and allergies that we discussed above.  Misplaced elbows, thrown toys, a wall that leaps in your child’s way, all these cause bloody noses.  Then there’s many children’s favorite pasttime- picking (many adults enjoy this too).  Nose picking is a double whammy on nose tissue.  It often starts with itchy noses from allergy and dry air. Then when your kid scratches that itch, his fingernail tears the already dried out, cracked, and fragile tissue, nicks a vein, and it’s off to the races.

Like we said, stopping nosebleeds is usually easy.  Squeeze the nostrils closed gently for ten minutes, not letting go to check if it’s stopped until time is up.  If that doesn’t work, do it again.  But what if after all that your kid’s nose is still bleeding and you’re out of decorative dishtowels, and your furniture and carpet look like a Jackson Pollock nightmare?

If the bleeding won’t stop after a couple of tries at direct pressure, then it may be time to bring your child in.  Another issue is if an injury caused the bleeding, should the nose be looked at for other problems besides the bleeding itself?  If there is a large amount of swelling around the bridge of the nose, or every time you touch your kid’s nose they pull away and let out a howl, then maybe it should be looked at.

After a nosebleed, there are often some “aftershocks” of bleeding.  If nosebleeds are recurrent you might put a humidifier in the bedroom, and run the air conditioning less.  If bleeding continues on and off for more than a week, it’s time to see an Ear/Nose/Throat (ENT) specialist.  Sometimes kids get a raw spot inside their noses that just won’t heal, and the ENTs have the tiny scopes to look inside, find the raw spot, and cauterize it.

All in all nosebleeds are a side effect of growing up.  They are rarely dangerous, and cause more alarm than real trouble.  Remember not to panic, and you can always call the people who are trained to help when you are concerned.

You’ll Put Your Eye Out!

It was a mystery to mom: her 10 year-old, autistic boy suddenly was rubbing his eyes and crying.  When she pried his hands away, she saw that his eyes were red with swollen lids, and he obviously hurt.  Was it allergies?  Did pink eye come on this fast?

She checked him over to see if he had gotten into anything, felt a lump in his pocket, and pulled out the pepper spray canister that she kept in her purse!  Mystery solved.  She ran his eyes and face under cold water and brought him in.

Eye illnesses and injuries often freak people out.  Sight is important, and many fear losing it.  Eyeballs themselves are kinda freaky.  No haunted house is without missing eyeballs, misshapen eyeballs, or eyeballs in a bowl.  Eyes can be mysterious- movies and TV enhance drama by highlighting or shading an actor’s eyes. Emotional response to eye problems makes for a lot of Emergency Department visits.

The most common eye problem in the ED isn’t an emergency: conjunctivitis. Conjunctivitis is what many call “pink eye,” where the eye is red, watery, and itchy. Sometimes the eyes water clear, sometimes the discharge is green and gooey.

Most conjunctivitis is from infection, usually viral.  Like most viruses, pink eye lasts only a few days and goes away on it’s own without antibiotics.  Contrary to popular belief, pink eye is not terribly contagious, and the American Academy of Pediatrics doesn’t consider it a reason to skip school or daycare. Pink eye can also be from allergies to pollen or pet hair exposure.  This “allergic conjunctivitis” lasts as long as the child is exposed, and tends to stay watery and not get gooey and discolored.

Swelling around the eye also worries parents.  Usually baby wakes up with one eyelid dramatically swollen, and is rushed to the ER.  Baby seems fine, cooing away and not sick, but it LOOKS bad!  These are usually due to insect bites, and swelling around the eye is more dramatic than bites to other areas because of loose skin and abundant blood supply there.

In the iconic movie “A Christmas Story,” 9 year-old Ralphie Parker yearns for a Red Ryder BB gun.  A running gag is Ralphie’s subtle and not-so-subtle begging to his parents and Santa for the gun.  He is invariably turned down with the line, “You’ll put your eye out!”

At the end (spoiler alert!), Ralphie gets his BB gun and promptly shoots himself in the eye, or actually, shoots his glasses off.  Fortunately for Ralphie, his glasses saved his eye.  Unfortunately, in real life BB guns can “put your eye out.”  I’ve seen too many BB injuries to eyes and faces of kids, and too many real gunshot wounds there too.  Despite advances in eye surgery, eyesight and/or the eye itself are often lost.

Therefore, preventing eye injuries is the best way to preserve vision.  If your child is doing something with potential injury, have them wear safety glasses.  Basketball great Kareem Abdul Jabbar turned geeky protective glasses into cool.  During a college game he got his cornea (the clear dome in front of your iris and pupil) scratched.  Corneal abrasions are intensely painful, and after that he wore glasses.  Corneal abrasions can come from flying particles while woodworking, weed-eating, shooting, and from many sports.

Eye strain is another form of eye injury.  In my childhood, parents warned that watching too much TV would “strain” our eyes.  Not knowing what that meant, we ignored them.  It turns out eyestrain is real and much more prevalent today, with smaller screens that have more detail than old TVs, and kids spending way more time looking at them.  Growing up we had one TV at home, and you could tell who the rich kids were because they had two!  Now most kids have a screen in their pocket, or more likely in their faces.

Symptoms of eyestrain are watery and itchy eyes, blurry vision, headaches, and light sensitivity.  Eyestrain can be reduced by keeping screens clean, enlarging text, and rest from screen time.  Put off getting your child a phone.  Get their phone when they NEED it, not because they want it for entertainment.

Like with the Red Ryder BB gun, you don’t want them to put their eyes out!

Baby Fall, Go Boom!

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

Bumps, scrapes, and bruises can be found on the scalp of any active child, some so much they look like a scuffed shoe.  Kids explore and lead with their big heads, so it comes with the territory. Usually it’s easy to know when a scalp bump can be cured with a mommy’s kiss.  These are the minor boo-boos from flying soccer balls or cups thrown by grumpy siblings.

It’s also not hard to know when a more traumatic blow requires an Emergency Room visit. It’s an easy decision if your child gets knocked out cold by a baseball bat, or is in a high-impact traffic collision. These obvious ones you bring to the hospital.

What about those in-between injuries:  the short falls on the head from a tree branch, the heavy tackles at football practice, the head-on sprints into an invisible glass door? Even if toddlers cry for a couple of minutes after a smack to the crown, or teens seem a little confused after a soccer ball to the head, they’re usually soon skipping around like nothing happened. However, every parent has heard stories from someone they know, or about a celebrity, who seemed fine after a head injury, didn’t go the hospital, and then didn’t wake up the next morning.  These tales will make any parent rush the kid in with the teensiest knock on the noggin.

Fortunately we now have scientifically valid criteria to evaluate those in-between cases, to decide who needs a brain scan and who doesn’t:

-Does your child complain of a really bad headache, or seem confused?

-Was he knocked out?

-Is she vomiting?

-Did he fall from over 5 feet up, or have another high-impact injury to the head (like a thrown baseball)?

These are the kids who need to get seen, but these criteria apply to kids 2 years-old and up.  What about the smaller fry?

Babies and toddlers fall a lot.  Even before babies can sit up, they will roll.  Off the bed. They tumble out of car seats and strollers.  Then when they first start walking, toddlers look like high-wire artists, weaving about with their arms out for balance, everyone around wondering, will he fall, won’t he?  Then the toddler learns to run, and is not deterred by walls or coffee tables.

Like minor head injuries in older kids from above, it’s usually easy to tell which baby or toddler is okay.  She bonks her head on the coffee table, cries for a minute, and then gets up and runs after the cat.  Baby flops out of the car seat that is on the floor, scrapes his forehead, then goes back to wiggling and cooing, and nurses fine.

So when do we worry?  Our high-risk criteria for older kids we discussed above don’t seem to apply to the littler ones.  How can you tell if baby has a bad headache, or is “confused?”  And many babies vomit daily, whether they hit their head or not.  For these reasons we have separate rules for head injuries involving kids under 2 years-old:

-Does baby have a large bump anywhere on the scalp, except the forehead?  Forehead bumps are allowed, since that is where the skull is hardest, designed for the most common, front-end impacts.

-Did the child lose consciousness for more than 5 seconds?  Many toddlers are temporarily dazed after smacking their heads, so we give them 5 seconds to recover their wits.

-Is the child acting normally, or is he more sluggish or more fussy?

-Did baby fall from more than 3 feet, or have a similarly traumatic blow?

Note that vomiting is not on the list for babies and toddlers.  Some toddlers will vomit when they cry really hard, and many babies spit up randomly.  Vomiting doesn’t correlate with bad head injuries in the littler ones- many toddlers who end up in Pediatric Intensive Care don’t vomit, and many babies who are fine vomit all day anyway.

So when baby falls and goes boom, you will initially freak out and want to rush to the doctor. Then take a breath, think about the above, and use your own noggin to decide!

A Tale Of Two Teenagers

Ben grew up with asthma, but at 15 he seemed to have outgrown it.  Then this fall he began to cough and feel tight.  His mom took him to a quick-care, where he was prescribed an inhaler. A few weeks later he caught another cold virus, began to cough and wheeze again, and started using the inhaler he had left in his school bag.

Ben was a busy teenager, and didn’t use his inhaler regularly.  He took puffs only when when he felt tight.  He began to get more tired and out of breath despite the inhaler, but he didn’t tell his mom.  He felt this was his business, and his mom nagged him enough as it was- about his grades, his phone use, his messy room.  He didn’t need more nagging about his medicine.

Then one evening he suddenly couldn’t breathe.  It was a struggle to pull in a breath, and he had to tell his mom.  When she saw that he couldn’t speak and was so air hungry, she called the ambulance. After an hour in the Emergency Department and lots more medicines, he was put in Intensive Care, still wheezing.

Ben’s story is common with teenage asthmatics.  Teenagers generally get poor health care, even those with chronic, potentially life-threatening conditions like asthma or depression.  Littler kids see the doctor a lot, given all the vaccines they need.  They get sick a lot more too, meaning more trips to the office.

When they get to be teens, there’s less reason for kids to go to the doctor.  The vaccines are fewer and far between.  Teens stay pretty well.  When they do get sick, rather than fight to get into their regular doctor, parents sometimes opt for more convenient walk-in clinics.

However, losing contact with your child’s doctor is a problem.  Sure the vaccines are fewer, but when you don’t go to your “medical home” to get seen, you don’t get reminded the important teen vaccines and may miss them: the meningococcal vaccine against meningitis, the tetanus booster, and the cancer-preventing HPV vaccine.  And a walk-in doctor is less likely to ask about your teen’s chronic conditions which need surveillance, like asthma, or depression.

Ashley, 14 years-old, was always a glum kid.  She kept to herself, rarely smiled, had few friends.  About a month ago she broke up with her first boyfriend.  This made her feel even more worthless than usual, and she lately has been thinking that the world would be better without her.  Today she told a friend that she was thinking of taking a lot of pills.

Ashley’s friend, burdened by this knowledge, stewed through several periods at school, and then told a counselor.  Though this made the friend feel like a tattle-tale, she actually saved Ashley’s life. The counselor called in Ashley and her parents, Ashley admitted her suicidal thoughts, and she was brought to the Emergency Department for evaluation.

Depression, like asthma, can be a chronic condition in teenagers.  Like our asthmatic teen from above, teens don’t like talking to parents about their condition.  They are embarrassed by it; they feel like freaks, with their asthma or depression making them different than others.  They also don’t like being nagged.  Throughout her childhood Ashley’s parents harped on her about her depression, and she had been to counseling several times.  She didn’t like counseling: who wants to talk about their feelings when their feelings are so negative?

Having a regular doctor is one way to keep tabs on depression.  At well visits, besides vaccines and school physicals, doctors should be asking teens about their feelings.  If kids seem depressed, their doctor isn’t afraid to ask the harder questions: do you want to kill yourself?  Why are things worse now: is it problems with your parents, your friends, your school?  The ”medical home” is all about prevention, unlike an Emergency Department or walk-in clinic, where it’s about fixing the kid’s immediate problem and moving on.

If you are worried that your teen is depressed and may be suicidal, fortunately Lafayette has the Jacob Crouch Foundation, a suicide awareness and support group.  You can visit their website at to learn suicide facts and myths, how to recognize signs, and how to get help.

Even better, get help earlier by sticking with your kid’s doctor!

Avoid a $100,000 Medical Bill

This week’s guest columnist is Dr. Michael Johnson, a Family Medicine resident at the University Hospital and Clinics here in Lafayette.

In the Sportsman’s Paradise, enjoying the great outdoors means most of us have encountered a snake.  I remember when my father and I were squirrel hunting one evening on a creek bank.  I was following, literally in his footsteps, when he suddenly stopped.  He turned to me and said firmly, “Son, back up now.”  I looked down and saw he was standing on a snake he had accidentally walked on, and he wouldn’t move until I was safely away.  He then pinned the snake behind the neck with a stick, stepped off, and let it slither away.  This was the start of my lifelong hatred of snakes.

Between snakes and mosquitoes, it’s sometimes hard to enjoy Louisiana outdoors. Every year about 8,000 people are bitten by poisonous snakes in the United States, with 10-12 deaths.  Louisiana is home to four species of poisonous snakes: the rattlesnake, water moccasin (a.k.a cottonmouth), copperhead, and coral snake.  Most bites happen during summer and fall.  How can we keep children safe during this time of year without confining them to the prison of “inside the house?”

Parents can start by keeping kids from playing in tall grass or around large rocks.  These are the preferred environment for snakes.  It’s another incentive to mow the lawn, besides keeping up with the Jones’s.  Children shouldn’t play in vacant lots.  Use extreme caution when moving firewood or stacked lumber.  When outdoors, examine and then designate safe areas before fishing in ponds or swimming in lakes or creeks.

Never teach your kids that it’s alright to handle snakes.  This includes not letting them see their crazy uncle (we all have one) catch a snake to remove it, or worse, play with it. Dr. Hamilton had one partner, a life-long swamp rat, who did just that after his son found a snake in the yard.  Instead of staying away, he decided to show his son how to “walk” a snake with a forked stick.  He led the snake just far enough to get himself bitten.

What if you or your child fall prey to a poisonous snake’s fangs? We’ve been educated by John Wayne, the Duke himself, on wrapping a belt around your arm, cutting the bite with your bowie knife, and sucking out the venom.  In the movies this always saved his life, yet it’s another case where Hollywood shows us exactly what NOT to do.  Here’s what we SHOULD do.

After being bitten, first remove the victim from the snake’s territory. Snakes don’t always bite and slither away; sometimes they stick around and bite again.  Next, don’t panic.  Up to 25% of poisonous snake bites are “dry” bites, where the snake bites but doesn’t inject venom.  If you do get injected, it’s still okay.  The chance of dying from a snakebite is nearly zero in the United States because of high-quality medical care.

After calming the victim (and yourself), keep him or her warm and quiet.  Immobilize the injured part with a splint and remove watches, rings, or tight clothing from the affected extremity.  Swelling around these might cut off circulation.  Do NOT apply tourniquets or tigtht dressings.  Loss of blood to the bitten part causes more damage than good. Clean the wound with water.

Attempt to identify the snake, as long as that doesn’t endanger anyone. Take a picture from a safe distance.  Don’t handle the snake even if it’s dead, since dead snakes can still bite reflexively.  Don’t try to kill the snake. Many snake bites are from non-poisonous snakes, and killing them gives the rats one less predator to worry about.  And if you try to kill it and get bitten yourself, that’s one more victim to worry about.  Most of all, don’t delay transport just to identify the snake.  Lay the patient down and get going!

How does this add up to a $100,000 medical bill?  If anti-venom is needed, treatment takes 6-10 vials, each vial costing about $7500.  Add that to the cost of a hospital stay. I’d rather spend that hundred grand on a yacht or a round-the-world trip.  So don’t be that person who plays with snakes; be the safer, more educated person with a yacht.

Guns or Dogs?

With the recent Grand theater shooting, I realized I hadn’t written about gun safety, so it’s overdue.  But I don’t like talking about gun tragedies since I spent a week on the trauma team in third year of medical school.  That week we had three incidents of children coming into the trauma room, dying of gunshot wounds.  The third child was the 5 year-old son of a DEA agent, who had come home from an overnight stake out.  Exhausted, he tossed his pistol on the kitchen table and crashed in bed.  The son woke up sometime later, and you can guess the rest.

I don’t like talking about guns and kids, but as my priest said this past Sunday, a real conversation on guns is overdue. Pediatric firearms deaths aren’t a single event like at the Grand either, but an ongoing problem.  Twice as many children and teens die from gunshots as die from cancer.

Preventing firearm tragedies begins at home, where most deaths occur.  In the past I have discussed how to best prevent your child from drowning in a pool- don’t have one.  Same with guns- it’s best just not to have one in the house.  I own a shotgun, but while my kids were growing up I kept it at my father-in-law’s.

If you must have a gun in the house (we’ll discuss the statistics of that further on), keep it locked in a gun safe, unloaded, with the ammunition locked separately. Regardless of your position on the National Rifle Association (NRA), they advocate this. The NRA has another good idea about safety- teach your kids about guns, to take away the mystery. Teach them to not touch, and even run away from, unattended guns (like at a friend’s house) and immediately tell an adult about unsecure guns.

The American Academy of Pediatrics advises doctors to discuss gun safety at office visits, just like above.  Except in Florida, where the legislature and governor passed a law forbidding pediatricians from doing just that.  You would think that that’s unconstitutional, given the right to free speech and a doctor’s duty to ensure child safety. Discussing gun safety is akin to discussing safely storing ant poison.  Inexplicably, two courts have ruled in favor of the law, which illustrates how far afield the gun debate has gone.

Fortunately we’re in Louisiana, so talking gun safety is okay.  As we discussed, it’s best not to have a gun in the house at all.  When my kids were little I kept my shotgun at my father-in-law’s.  When my son became curious about guns, his uncles and I took him hunting to teach him firearm safety.  Our favorite memory is of Uncle Tommy taking him on a squirrel hunt.  They rode the four-wheeler through the woods, zigzagging in the brush for so long that my son thought he was clear to Bunkie, though they ended up only 100 yards from the house.  My son never even touched the rifle, but he learned all about it.

If you have a gun in the house, keep it locked in a gun safe, unloaded, with the ammunition locked away separately.   But keeping it locked doesn’t make sense, some will say. What if someone breaks into my house- the gun won’t be ready!  The statistics are clear: violent home invasions are rare, and guns in the house are much more likely to kill the owner or a family member than an intruder.  Accidental deaths and suicides from home firearms are far more common than successful home defenses.  It’s better to get a dog with a deep, loud bark.

Finally, as any responsible gun owner will say, you must know the laws of ownership and use.  Particularly, as Seth Fontenot unfortunately found out, it’s illegal to use a firearm to stop a robbery.  One of my nurses who is an ex-marine and hunter puts it this way: if someone goes into your garage and starts walking away with your stuff right in front of you, you can’t use a gun to stop them.  You can call 911, and start taking stuff out of his car and putting it back in your garage, but no guns!

Again, better to have a big loud dog.

Bad News Bears

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

In the first week of medical school my class was split into groups of ten students with a professor.  The groups met weekly, between anatomy lessons and biochem lectures, to discuss doctor things like “how to use an otoscope,” and “how to scrub into a sterile OR.”  These were fun little breaks from the monotonous all-day lectures and hours spent studying.

One of these forums was a little different. It was on “Breaking Bad News,” how to tell patients something terrible, like that they had cancer.  We role-played scenarios acting as patients and doctors, nervously laughing, as we practiced giving each other bad news.  We learned tips like “before giving bad news to a patient, turn off your phone,” and “don’t sugar coat anything, tell the whole truth,” and “allow the patient ample time for questions.”  It was an important exercise, and one we would revisit throughout training.

Unfortunately there’s no handbook to prepare parents for receiving Bad News.  If only we were discharged from the hospital with our new baby in one hand and an indexed, tabbed, parenting handbook in the other.  I yearned for such a handbook when I was 20 weeks pregnant and on the parent side of Bad News.  My husband and I learned that our baby would be born with a complex heart defect that would require surgery.  Suddenly we were no longer researching car seats or deciding what color to paint the nursery.  We were talking about at which hospital to deliver this sick baby and planning for open heart surgery.

Thankfully, in the Pediatric Emergency Department, the bad news usually goes: “Gage did, in fact, break his arm,” or “Liza looks like she has Hand, Foot, and Mouth disease, so no daycare for a few days.”  Occasionally the bad news is more serious, and here are some tips I’ve learned in my own experience.

When presented with bad news, the most important thing to do is to select a “captain of the ship” for your child’s care.  You are wading into very unfamiliar and rocky waters, and you’ll want a doctor experienced in those seas.  When our baby was diagnosed with a heart defect, that doctor for my husband and me was our cardiologist, Dr. B, who could write a chapter on “breaking bad news.”

When Dr. B made the diagnosis he made sure we were the only family in the office.  He sat us down, took out a sheet of paper, and drew her defect.  Then he wrote down two lists: one with an explanation of the defect, and the second on “where to go from here.”  It was our plan to refer to when we were confused or stressed.  Finally, we scheduled an appointment in a month to discuss further questions.  No matter what, you will need a good, reliable captain for the journey ahead.

Another tip: resist the temptation to troll internet blogs; avoid late night Google searches.  My mom always told me in high school: “Nothing good comes from being out on the road after 10 pm.”  The same goes for Google!  Don’t get me wrong, there’s lots of good, useful information out there, but there’s a lot of bad information and horror stories too.  And while knowledge is power, I refer you to my first advice- ask your captain to give you good information and websites so you can properly educate yourself and advocate for your child.

Try to meet other families facing similar diagnoses.  These days, social media is a wonderful tool to find support groups and families who are walking your same path.  Meeting others and knowing that you are not alone is a huge help.  You’ll be surprised how many locals are in a similar situation.

Lastly, have a support system at home.  Lean on your spouse, family, and close friends.  If you live away from family, find a counselor, priest, or minister.  It’s imperative that you pay attention to your own needs in order to be able to take good care of your children.  And then when things go well like they did for us, you can celebrate good news!


What? What?

The rock band Pink Floyd was known in its day for being loud.  Legend was that at a concert in 1971, the noise was so bad that it killed the fish in a pond next to the stage. Probably more truthfully, the fish went belly up due to fans dancing in the pond, smoke bombs, and the giant inflatable octopus on the water (Pink Floyd was also known for eccentric decorations).  But fish dying because of loudness is a better story.

Many rock stars have hearing loss due to the chronic and loud sound of their profession. Phil Collins, Neil Young, Eric Clapton, and Pete Townsend of the Who are just some of the victims of their own success.  The listening apparatus inside our ears is delicate, and can be injured or permanently damaged. We’ve all come home from rock concerts to lie down and hear ringing in our ears. That ringing is the sound of acoustic injury.  Usually the ringing goes away, the hearing organ heals up.  Sometimes the ringing doesn’t go away.

William Shatner, who played Captain Kirk on Star Trek, has permanent ringing in his ears. This condition, called Tinnitis, started when a special effects explosion went off too close to his head.  Since then he has been tormented by what he calls a “hiss-static,” night and day. Many military veterans also have Tinnitis from rifles, grenades, naval guns, and rocket launches.  Besides pounding targets, these explosions also pound the ear drum, the delicate bones behind the drum that transmit sound, and the fragile nerves that receive the bones’ signals.

Kids are vulnerable to hearing loss too.  Remember when the Saints won the Super Bowl? Remember Drew Brees holding his infant son, Baylen, and Baylen’s earphones?  Baylen had them to protect his hearing from the roar of the crowd.  Your kids need to be wearing those too, when they are hunting, mowing lawns, or going to rock concerts.  Well, no kid who wants to be cool is wearing those to a show, but consider other protection: fewer concerts, more subtle ear plugs, quieter venues.

I married into a loud family, and they laughingly admit it.  Thanksgiving can be deafening , with 50-plus Fournets packed into a house.  It’s like the movie My Big Fat Greek Wedding, except with pork roast instead of lamb, and conversation sprinkled with french instead of greek.

Part of the noise is due to hearing loss in my in-laws.  They have to shout to be heard.  My father-in-law ran a service station, flew airplanes, and hunted.  His sons worked in the station and also hunted.  And the sons went to plenty of rock concerts. All those roaring engines, shotguns, and guitars while growing up took a toll.

When considering hearing injury, we think of the really loud noises mentioned above- guns, explosions, amplifiers.  But sustained moderate noise can cause hearing loss too. Just like too much running can lead to overuse injuries in knees and feet, chronic intense sounds can also hurt ears.  Mowers, blenders, hair dryers, TV, car radios, and ipods all contribute to hearing loss.  Even cell phones glued to your kids’ ears can be too much.

Some people are more susceptible to hearing loss than others.  The Fournets have a family history of hearing loss, and the youngest son had some warning to start wearing headphones while hunting, woodworking, and mowing the lawn.

Are you worried about your child losing his hearing?  Parents usually worry about hearing loss when their kid seems not to hear them: they shout and shout and get no answer. Fortunately this deafness is usually due to them tuning you out rather than true hearing loss.  Kids get lots of hearing screening at school.  Lafayette Parish schools screen in kindergarten, first grade, and every other year after that to eleventh grade.  But if you are worried, your doctor can recommend testing at audiology and ENT offices.

Better still, worry about your kids hearing ahead of time and take action.  Keep the phones, car radios, and MP3 players dialed down.  Turn down (heck, turn off) the TV. Set limits on the number and intensity of concerts, and get them headphones for chronic noise makers.  Then maybe they’ll hear you when you call them to do the dishes.  Or not.