Lassie, Get Help!

In January 2019, 911 dispatcher Antonia Bundy answered a call from a 9 year-old boy.  He said “Hi, um, I had a really bad day….,” told her he had a “ton” of homework, and was stumped by a math problem involving fractions. Instead of giving him a grumpy lecture on proper use of 911, she helped him solve the problem. The boy thanked her, and when the news story came out, Ms. Bundy’s police chief lauded her for her kindly service helping the boy with his homework. Of course, the chief recommended against this use of 911 by anyone in the future.

Last month the journal Pediatrics published a study titled “Children’s Ability to Call 911 in an Emergency: A Simulation Study.” Emergency dispatch has come a long way from the days when Timmy would send his dog Lassie for help when trapped in the old abandoned mine. As emergency calls have increased over the past 50 years, the 911 system was developed to enhance efficiency and ease getting assistance in a crisis. The question in this study: can kids Timmy’s age use it properly?

The researchers started by enumerating the necessary steps. First, can children recognize an emergency is happening? Then can they find a cellphone, bypass the password, dial 9-1-1, and answer the dispatcher in a meaningful way? They videoed simulations where an actor pretended to choke and collapse unconscious on the floor. With the video running, the scientists checked off each step the study child got right.

As you might expect, younger children had more difficulty. Kindergartners and first-graders were pretty bad at it; second and third graders a little better. The main problem for littler kids was recognizing that an emergency was happening; even though before the simulation began, the child was told there would be a pretend emergency for them to respond to, and s/he agreeing to participate.

This study raises many questions about how kids might learn emergency response. For example, many schools teach kids how to use 911, but demonstrate with land-lines, which fewer households have now. And how do you use a cellphone if you don’t know the password?

When I was 7 years-old, I had my first emergency. I came home from school to find smoke coming from our windows. I went inside into the kitchen, coughing and calling for mom. I found chicken burning in a pan, shut the stove off, and went back out. Mom arrived soon after, having gone on an errand and forgotten about the chicken. I was a hero for saving the house. Any wonder I’d grow up to be an emergency guy for a living?

Of course, I shouldn’t have gone into a house with smoke pouring out- I could have been overcome by fumes and suffocated. Maybe I should have called 911, but the service wasn’t invented yet. With no cellphones either, I’d need to go a neighbor’s to call the fire department. In the study discussed above, “Children’s Ability to Call 911,”  pretend emergencies were used to see if kids could use a cellphone to call 911 and report it successfully to a dispatcher.

In the study, kids were videotaped in simulations where actors pretended to choke and collapse. They had to find the cellphone, bypass the password prompt, dial 9-1-1, and answer the dispatcher in a helpful way. Less than half the 7-and-under kids even recognized an emergency was happening. As for finding the cellphone, the researchers cheated: they had the actor first pretend to be on a call, then put the cellphone down in view of the child. A more realistic test would have had the phone somewhere else. After all, how many times per day do you misplace your phone? Try finding it when someone’s choking to death!

While schools often teach kids how to call for help, it’s usually lecturing and demonstrations with land-line phones. When’s the last time kids used one of those? Thus schools and parents need to better drill kids how to respond to an emergency, particularly if they stay with grandparents, who might actually keel over sometime with only the child to help. They should see demonstrations of what ailing adults look like, be taught how to find the tiny “Emergency Call” button on the password screen, practice dialing 9-1-1, and rehearse what to say to the dispatcher. Just in case it’s their turn to be a hero.

Poisoned by Grandma?

This week’s guest columnists are Drs. Chris Johnson and Traci Bourgeois, Family Practice residents at the University Hospital and Clinics here in Lafayette.

When I was three, a fun trip to my grandma’s became a trip to the Emergency Department. I found insecticide spray in her kitchen, tasted it, and brought it to mom saying it was yuck. The active ingredient was probably allethrin, a compound synthesized from crysanthemums.  Sounds all-natural, right? Except when it causes vomiting, muscle spasms, coma, and even death. In the ER they “pumped my stomach,” which means putting a tube down my throat and flushing saline solution in and out. I remember screaming for my mom (back then parents were kicked out of the room for such unpleasant procedures). To this day I get panicky when laying down for medical stuff. Worse, we always got gumbo at grandma’s, and I missed lunch!

While most parents are strict about home safety, this doesn’t always go for other places  a child might visit, like grandparents’, babysitters’, or in-home daycares. Even our own homes that we think are safe may not be with exploring, clever toddlers. Kids have been home more during the Pandemic, and if parents are working at home, they’re often concentrating on work, not the children. Poison Control Center calls jumped up 18% in March 2020.

While most parents keep cleaners locked up, some haven’t thought that hand sanitizer was a hazard, and we’ve all been using tons of that. Cleaner poisonings rose 35% from March to May 2020, and ingestions of surface disinfectants and hand-sanitizers rose 108%!  Toddlers eating sanitizer may sound like an innocent taste test, but they often contain 70% alcohol or more. That’s equal to the strongest liquors, like grain alcohol, that occasionally kill unfortunate fraternity pledges.

The lessons are clear: lock away all toxins, including medications, hand cleansers, and other chemicals so that even the smartest toddler can’t pry in. Crawl around your house on hands and knees, pulling on every door and cabinet, pushing every chair and step-stool to a counter or bathroom cabinet. If you can get at these hazards with reasonable ease, so can they!

Some toddlers just aren’t good about taking medicine. Unlike Dr. Bourgeois’s story above where she drank Grandma’s insecticide, some kids spits out medicines, hosing down mom with ibuprofen or amoxicillin. Sometimes to entice the child to take it, parents will say the medicine’s candy or juice.  After all, these are sweet things all kids like to eat, so why not try to fool them?  Which makes us wonder- what toddler gets candy? What kind of lousy diet are these kids on, that they know what candy is?

Besides being unnecessary for kids, invoking candy as an incentive can lead to anything colorful being regarded as candy or juice.  Including that poison under Grandma’s kitchen sink. Furthermore, toddlers usually can taste the difference between juice, candy, and medication.  Parents still end up wearing the Tylenol.

How do we get resistant children to take medicine? Drug companies and pharmacies make pediatric stuff taste as good as possible, but that’s a two-edged sword. The better it tastes, the more likely children will want to drink it when they’re not supposed to, leading to overdoses or kids taking other’s medication. Some medicines come as suppositories to put in the butt. They’re absorbed by the intestines, just like swallowed medicines, and they’re harder to spit out! Ultimately, medication can be injected, though you need to go to the pharmacy, doctor’s office, or hospital for those.

If your child takes something they shouldn’t, don’t panic.  First, call Poison Control at 1-800-222-1222. They’re easier to get on the phone than your doctor, and can tell you if what the kid took is dangerous. They’ll tell you if you should call the ambulance, drive to the hospital yourself, or stay at home and not worry. Things like baby shampoo or most antibiotics, no sweat. Grandma’s insecticide- come in!

Prevention is the best medicine. Like we advised above, toddler-proof your house. This goes for parents, grandparents, babysitters, in-home daycares, anywhere that’ll host mobile children. They’ll slip out of sight and into stuff quicker than you think, even if it’s just an afternoon visit. Get on your hands and knees and explore the potential hazards before they do.

He Who Hesitates…

With the Pandemic, no one’s wanted to be in tight spaces with others who might be shedding deadly Coronavirus. California’s Disneyland has been closed because of that concern. Being squeezed into lines and rooms at Disney is unavoidable, to get as many people through the rides as possible- after, all everyone wants their turn to be immersed in the magic. But in 2015, some Disneyland visitors were unlucky enough to also be immersed in measles.

That year an unvaccinated 11 year-old visited the park. The child was infected with measles, not symptomatic yet, but already shedding virus. 110 people caught the virus, most of whom were unvaccinated. 20% had to be hospitalized; luckily, no one died. Like COVID, measles is highly contagious. When an infected child coughs, virus-laden droplets can hang in the air for 2 hours, waiting to be inhaled by others. That makes for lots of exposed people if that cough is in the elevator in the Haunted Mansion- how many people shuffle through that ride in two hours!?

Vaccine hesitancy has been growing in the past twenty years, and is now an issue again with the COVID vaccine roll-out. Parents want their kids to be as safe as possible, and some are confused by competing voices in the media and online about vaccine safety. Medical experts know vaccines are safe and important to prevent deadly infections. However, their voices are sometimes drowned out by anti-vaccine folks who frankly don’t know what they’re talking about.

Vaccines have been around for centuries. Smallpox inoculation began in the 1700s, and has saved millions of lives since. Most vaccines kids get these days have been around for 50 years or more. We have lifetimes of experience with these medicines to know they’re safe.  They’re also the most administered medicines- the vast majority of kids get them. Thus we have plentiful opportunities to detect side-effects.  Finally, vaccines are some of the most studied medicines. Anti-vaccine hysteria has driven some of this research, and any serious worries about safety have been thoroughly investigated. Mission accomplished: vaccines are some of the safest medicines available.  Oh, did I mention they save children’s lives too?

My friend Brent has a sheep farm in Georgia. The farmers around him are mostly older, taciturn types.  Brent got his first COVID vaccination, and tried to talk his colleagues into doing likewise, but they’ve decided to wait and see. To goad one farmer into getting his shot, Brent offered, “How about, if I feel fine after my second shot, you get yours?  Deal?” The farmer replied, “Well, let us know how it goes.”  Note the non-committal response- talk about giving nothing away!

As we mentioned above, small pox inoculation is centuries-old, and we’ve had modern vaccinations for over 50 years. Vaccine hesitancy is that old too. In the 1800s, governments mandating smallpox inoculation met with popular resistance. After all, inoculation meant taking fluid from a cow’s pox blister and scraping it into the skin of a child- doesn’t sound very clean or safe, does it?  The Leicester (England) Demonstration March of 1885 had over 80,000 participants, opposing forced vaccination.

Fast forward to 1998, Dr. Andrew Wakefield published a study that supposedly linked the Measles/Mumps/Rubella (MMR) vaccine to autism in children. Despite the revelation that Wakefield falsified his data and lost is medical license for other ethics violations, the anti-vaccination movement was off and running. Besides bad data interpretation, vaccine hesitancy is also fueled by complacency. In the 1950s when polio was epidemic, killing and crippling thousands of children yearly, people clamored for a vaccine. Now vaccines have been victims of their own success: few parents experience the horror of children dying from vaccine-preventable diseases, and wonder why all these shots matter.

Conspiracy theories have also eroded confidence in experts and vaccination.  Conspiracies are inherently attractive to human thinking (they’re so exciting to contemplate, like UFOs!), and have been grafted onto vaccines. From microchips and DNA manipulation in Coronavirus shots, to good-old-fashioned drug company corruption, conspiracy theories make saving kids from vaccine preventable disease harder.

Rest assured, vaccine makers aren’t dastardly villains poisoning kids for fun and profit. They’re nerds and careerists who live for good data and publishing well-researched papers. They’re nice folks doing good science to save kid’s lives. What more could a parent want for their child?

COVID and Kids

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

A 16 year-old boy came in with three days of fever, vomiting, and diarrhea. He didn’t have anything left to throw up- he could only dry heave; but he still managed six bouts of diarrhea that morning. His blood pressure was down and he looked beat. You’d think he had dehydration with a bad bout of stomach virus, except his eyeballs were red? Could this be COVID?

After his first liter of IV fluid, he perked up.  He sat up, smiled, and even his lips were less cracked. An hour later he was back down, pale, tired, with borderline blood pressure. Despite receiving two more liters, he quit rallying. While his COVID PCR came back negative, his antibody test was positive. This means he wasn’t shedding Coronavirus now, but had antibodies to previous infection. Mom confirmed that after Christmas he was with cousins who tested positive. He hadn’t had symptoms like fever back then, but many kids don’t with their initial infection. He was our first case of Multisystem Inflammatory Syndrome in Children (MIS-C).

MIS-C is a rare complication of Coronavirus. Many elderly and sickly adults get rampant inflammation from their infections- in their lungs, hearts, kidneys, and just about any other organ. They have respiratory failure, heart attacks, and spend weeks in ICU. Kids don’t have these problems, except a rare few like our boy. Something about COVID irritates the immune system after the main infection, and while you’ve recovered from the initial bout, your immunity goes haywire against your own body.

Besides his eyeballs, our patient had heart inflammation, called myocarditis, which  affected it’s ability to pump blood.  Hence his low blood pressure. It also attacked his GI system, causing all that vomiting and diarrhea. MIS-C is diagnosed when the child has fever, looks really sick, and inflammation in two or more organ systems; our patient’s inflammation blood tests were sky high. He spent 3 days in the ICU for blood pressure support, immunoglobin therapy, steroids, and more fluids, and eventually got better.

A 14 year-old female came in last week after feeling tired for 2 days. She had fever, headache, and cough. Though she denied sick contacts, she had been in school and out shopping. She had also attended a family reunion. Given all those exposures, we weren’t surprised when her COVID test came back positive. Dad wasn’t happy she caught Coronavirus, but since he had also attended the reunion, he had no moral high ground to stand on!

Though few kids get severe disease like our 16 year-old boy from above, they can still get sick and pass the virus to others, including older loved ones. As of February, the CDC reported only 204 deaths in ages 0-17 years. Those above 50 years-old make up 95% of deaths. COVID is now the leading cause of death in the US; heart disease second, cancer third.

Other bad things about Coronavirus: our 16 year-old from above had myocarditis. A competitive athlete, his weakened heart put him out of sports for at least 6 months. Though he was likely to regain his strength, that wasn’t guaranteed. Also, kids with “regular” COVID like our 14 year-old are out of school and sports for two weeks. Those restrictions were terribly disheartening for our two patients.

A second problem is delayed procedures for positive patients. This affects adults who need diagnostic and therapeutic interventions for heart disease and cancer. It also impacted a teenager with lymphoma- he had swollen lymph glands, night sweats, and terrible pain. He needed chemotherapy to shrink his cancer and relieve the pain.  However, he couldn’t start chemo without a biopsy to identify the cancer and choose the best regimen. And he couldn’t have the biopsy because he was COVID positive, and anesthesia would expose the OR team to his virus. He was finally admitted to the hospital when his pain couldn’t be controlled at home, and eventually got his biopsy.

Though states, parishes, and towns are easing restrictions, don’t you and your family!  Continue mask-wearing and distancing, particularly with the advent of more highly contagious variants. No teens going on spring break! The end of the Pandemic is near, if we can all hang in there a little longer.

Who’s Medication?

This 16 year-old boy hurt his knee playing basketball, banging it into another player’s knee. He was brought in limping by his mom. “Did you give him anything for pain?” I asked. “I gave him one of my prescription ibuprofens,” mom replied. I gave a little jerk inside: you did WHAT?  But I checked myself from berating her, because mom actually did right- ibuprofen is safe, good for her son’s injury pain, and he was big enough to tolerate that dose. She chose right, but I had instinctual alarm because some parents don’t.

Parents give their kids all kinds of medications- old prescriptions, over-the-counter (OTC) meds, herbal supplements. Using someone else’s prescription is fraught with danger. Those medications are available only by prescription for a reason; their misuse can harm. OTC medicines are typically safer; thus the FDA allows people to buy them without a doctor’s okay. But sometimes they can be dangerous if used improperly.

Among the safest, most effective, and most under-used medications are OTC fever and pain relievers. It’s hard to hurt kids with Ibuprofen and acetaminophen (Tylenol), and they work great. However, some parents are afraid to use them, or give enough. I’ll ask “how much Tylenol did you give?” Mom will indicate a tiny portion of the dropper, and I’ll say “no wonder her fever didn’t break, she didn’t get near enough!” Mom’ll look sheepish and say she was afraid to overdose her child. We laugh, and then have a conversation about effective dosing.

Sometimes parents worry these’ll make their child too sleepy, as if they’re narcotics. However, no one’s ever seen drug dealers pushing ibuprofen or Tylenol: “Psst, over here! This’ll get you high!”  Some kids do sleep after these medications, but not because of narcosis. It’s because their pain or fever’s relieved, and they can finally rest!

Other safe OTC medications include Peptobismol and Imodium for diarrhea, and laxatives for constipation. Except when parents give laxatives when they think their kid’s cramps are from constipation. If they’re actually from a stomach virus, the ensuing diarrhea from the virus plus the laxative is really bad!

Even doctors make mistakes with medications and their kids. During my residency, one of the pediatric oncologists rushed his toddler into the Emergency Department. He’d  been brushing his teeth at the bathroom sink, and looked down to see his boy sucking on a bottle of Visine eye drops. The doctor’s eyes bugged out, and he scooped up the toddler and zipped in. After several days in the Pediatric Intensive Care Unit, the boy’s heart rhythm quit hiccuping in scary ways, and he went home. I remember thinking: why did he buy Visine in the first place?  It’s not even good for eyes, much less exploring children.

Above we discussed safe and helpful over-the-counter (OTC) medications. Conversely, most OTC cold medicines are bad for children: they don’t work, and they’re not safe. They’re not deathly harmful, or the FDA wouldn’t allow their sale. They also get a pass from the FDA because they’ve been around for decades. But they’re not good: they can  make kids jittery and irritable. One time I gave a kid a prescription version of a cold medicine, the mom was so desperate for relief. The next time I saw her in the Emergency Department, she had dagger-eyes for me. I asked, what’s wrong?  She told me after giving her child that medicine, he screamed all night. That’s why we don’t  prescribe cold medicines. And they don’t relieve coughs and runny noses either.

Asprin is another OTC medicine kids shouldn’t get. In the 1970s they found that children who got Influenza or Chicken Pox viruses, and aspirin for their fevers, had liver damage. Thus for your child’s fever and pain, Tylenol and ibuprofen only. Beware, aspirin comes in forms you may not recognize as aspirin, like BC Powder or Goody”s.

Above we also mentioned not using old prescriptions. They’re available only by prescription for a reason- their potential harm. Certainly don’t give your kids old narcotics. If you get the dose wrong, they could stop breathing. Never give children old antibiotics either, since each antibiotic has a specific use and probably won’t work for this new illness.  Also, they have side effects like allergic reactions or yeast infections. Leave the prescribing to us!

Teen Depression in the Pandemic

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

A 16 year-old girl saw me in clinic after she’d told mom she was feeling down. Prior to the Pandemic, she’d been a spirited teenager, involved in student council, the Welcoming Committee, and intramural sports. After school closed last spring, she went from being busy every day to having nothing to do for months. She started isolating in her room, sleeping more, eating less, and becoming irritable with family.

Since the beginning of COVID, we’ve seen an uptick of patients with depression. Some  are having symptoms for the first time in their lives. Scariest of all, in the past month we’ve had an epidemic of adolescent overdoses. Every day at least one teen’s come to the Emergency Department having taken whole bottles of their medication, or someone else’s. One girl took fistfuls of several of her grandmother’s medications, any one of which could have been lethal.

My 16 year-old patient had a more common presentation of depression. Her world was turned upside down, like everyone’s this past year. Stuck at home with only social media and family, she felt trapped in four walls, and trapped in her own mind. She went from wanting to be with everyone and involved in everything, to closing herself in her room and even minimizing social media interactions with friends.

When we see kids like this in clinic or the ER, one first thing we do is check for metabolic causes for depression, like thyroid disease or drug use. We also ask questions to assess the symptoms and severity. His he feeling like a failure?  Has he lost interest in favorite activities? Trouble concentrating or sleeping? Appetite changes?  Moving more slowly? Even more worrisome: has he had suicidal thoughts or worse, attempted suicide in the past and not told anyone?

We set my patient up with a counselor and started an anti-depressant. She slowly improved with video counseling and the medicine, and mom saw a positive change. She began to feel like she had her daughter back.

Once my 16 year-old patient was doing better, mom brought in her 13 year-old brother. He was always an introvert, keeping to himself and never having many friends. However, recently he began sleeping poorly and barely eating. In clinic, he stated that he felt like nothing he could do was good enough. During my interview, he was slow to answer questions, mumbled, and wouldn’t make eye contact.

We knew his sister had depression, and counseling and medication had worked for her, so we tried that with him. Just one month later when he returned for a check-up, I could tell he was a new boy the moment he walked in. He looked all around and asked a million questions, and when he sat down he didn’t slump like a sack of potatoes; he sat straight up, looked me in the eye, and smiled! His sister was excited too, because earlier that week he spontaneously hugged her, which he hadn’t done for over a year.

Both my patients are so far having happy endings to their depression. Unfortunately, not all kids have that. As we mentioned above, we’ve seen a spate of suicide attempts by overdose recently. While some of those teens have had life-long depression and even admissions to psychiatric facilities, we’re seeing more and more with no previous histories.

It’s sometimes difficult to know what’s on a child’s mind. Knowing was less of an issue when they were going to school five days per week, interacting with teachers and schoolmates, and busy with school work and extracurriculars. And early in the Pandemic children could coast along with electronic interactions. As things linger though, they’re getting just as fed up with it as adults are. Many are also dealing with illness and death in loved ones and friends.

If you’re suspecting a child’s depressed, seek help immediately. Your kid’s doctor, your priest or pastor, the school, or counseling centers have resources to help. At home, restrict access to medications, lock away guns or keep them out of the house, monitor your kid’s on-line activities, and just talk to them about depression. Depression, and the Pandemic, aren’t quite going away just yet.

Gumbo On Call

When my wife was in college, years before we met, Saturday mornings boys would knock on her door: “Make us a gumbo!” This was in Wyoming where gumbo was rare, and she and her roommate, also from Lafayette, were popular for their cooking. And  after a night of partying, apparently gumbo was what was needed. Bleary-eyed themselves, the girls set the conditions: “Go to the store, get a chicken and some sausage, and we’ll see.”

Cooking is an important skill kids should learn. This winter there’s no better indoor activity. They’re home from school more, and it’s sometimes too cold to play outside. Eating home-cooked food is healthier for the whole family too, rather than eating take-out or processed food from a box. Of course, if the parents are lousy cooks, maybe kids should learn from another family member. My mom was an average cook, but an excellent baker, so that’s how I turned out. My wife’s mother was solid in the kitchen, and so is she. Now my son is a better cook than I, having his mom to teach him gumbos and etouffees.

Learning to cook goes hand-in-hand with learning which foods are better (fruits and vegetables, low fat, high fiber). Children are also happier, stronger, less sick, and less overweight when they eat three meals per day: breakfast, lunch, and dinner. Some kids  don’t like breakfast; their stomachs and heads aren’t awake before they go out the door to school. However, children learn better with fed brains, so get them up earlier to eat something, like at least half a banana, a small muffin and a glass of juice. Some other kids don’t like to eat at school, where many get their breakfast and lunch. These kids should take food with them- granola bars and fruits to keep them going.

We see lots of issues in the Pediatric Emergency Department due to poor diet. Constipation and gas pains result from low-fiber foods. Not eating three meals daily contributes to headaches, fatigue, and depression. Snack-filled diets cause obesity, leading to leg and back pain, among other problems. Gumbo to the rescue?

On the TV show Chopped, four chefs compete to make gourmet meals from “Mystery Baskets,” with time limits to cook each course. The baskets contain regular ingredients like fish or lamb, but also whacky items like gummy worms. It’s fun watching the chefs try to make tasty food as time ticks down. Then they stand there as judges critique their dishes and decide who gets “chopped.” Pressure really ratchets up when a chef slices himself with a knife, and precious seconds waste away while his wound is dressed.

Kitchens can be dangerous places for kids. There’s knives and whirring blades in blenders, pots and microwaves full of boiling liquids, and lots of traffic to bump children into these hazards. On Chopped chefs call “behind you” to each other as they pass, lest they collide and get burned. Few teens yell “behind you” when going to the fridge while parents are dicing vegetables.

However, like we discussed above, it’s important for children to be there, where they learn the life-long skill of cooking and families hash out the day’s events, and other important life issues. Besides learning how to feed themselves in a healthy way, kids also need to be safe when kitchens get frantic like on Chopped.

The most common kitchen injury we see in the Pediatric Emergency Department is burns from microwaved liquids. Those big, clumsy microwave doors are targets for passers-by, bumping the child who’s retrieving a bowl of hot noodles, scalding her in the face, chest, and hands. When this happens, immediately remove burning clothes and run cold water on to stop the burning process. Better still, closely watch kids when they use microwaves.

Knives injuries are second. Kids should learn how to use them, but with supervision, ensuring they cut away from themselves. It seems obvious to not hold the object you’re cutting in your hand, putting it on a cutting board instead, but it wasn’t obvious to that kid we saw last week. A final checklist for toddlers: keep pot handles and electric cords out of reach, and lock cabinets with poisoning hazards like detergents. Kids shouldn’t get chopped in real life.

Residency During The Pandemic

This week’s guest columnist is Dr. Hanh-My Tran, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

I recall one elderly patient I took care of in the ICU. He had COVID, which in turn caused multiple organs to fail. Inflammation was killing his kidneys, his liver, and his lung capacity. After two weeks on the ventilator he continued losing ground, and his family agreed to switch from life-saving measures to comfort care for the end. The worst part: I had to tell the family that visitors weren’t allowed. Coronavirus is rampant enough, and no one wants other family to get sick, maybe die, and compound the tragedy. I gowned up in full PPE, took in an iPad, and Facetimed the family. Devastated, the children and grandchildren said their goodbyes, crying in the camera.

This last year of residency was supposed to be seeing more patients, honing procedural skills, and broadening my experience with different diseases. Instead, my fellow residents and I have learned to tackle a pandemic. Early on we were designated for more adult floor and ICU shifts to shore up personnel for that first surge. As the attending doctors and hospitals have gotten more efficient at COVID care, we’ve resumed a mostly normal schedule.  In pediatrics, we’ve not had anything near our usual volume of patients, since with COVID precautions kids have been pretty healthy, not passing colds to each other. But kids have suffered other ways.

As adults, we tend to understand what stressors make us feel overwhelmed, angry, sad, anxious, and depressed. Children learn how to respond to stressors as they grow and develop. COVID has forced them to grow up a little faster this year. Isolation, social distancing, and fear of family and friends getting sick are taking their toll.

Anxiety and depression are rising in children and teens, and counseling services were scarce in the best of times. So besides your own stress, watch your kids for the subtle signs of depression- changes in mood and appetite, unusually defiant behavior, self-isolation. Respond to these sympathetically now, so your kids can learn to cope too.

I have a condition that weakens my immune system, so I follow guidelines on COVID prevention religiously. I’m always masked, wear PPE with patients, and of course wash my hands until they’re red and raw. But COVID-19 is highly contagious and sneaky, and I contracted it nonetheless. My first symptom was fatigue, but since residency is a 60-70 work week, that wasn’t abnormal. I had no fever, cough, or trouble breathing. However, my partner got sick with cough, fever, and aches, and tested positive. He works from home, so he probably got it from me. “What’s mine is yours, what’s yours is mine” didn’t  have that poetic ring when I tested positive too.

The worst part for me was the loss of taste and smell for two months. I l dropped weight, but don’t recommend COVID as a weight-loss plan. No taste or smell takes a lot of fun out of life, and is a major depressor in affected patients. However, both my adults and children in clinic have drastically gained weight since COVID started. Trapped in the house, they’ve increased snacking and eating. Physical activity is also down, with limited school, sports, and outdoor time. Obesity has been escalating globally, and is now an epidemic within the pandemic!

Overweight kids have more trouble looming than just achy feet. Obese kids become obese adults, and have a head start on the attending heart disease and cancer risks. They also get sleep apnea, joint pain, and diabetes. High blood pressure in children, and thus risk of future strokes, is also rising. “Curing” obesity is harder than treating cancer. Medical attempts at weight loss lag behind cancer cure rates.

As we discussed above, more children have depression and anxiety due to the pandemic, and obesity compounds depression. Feeling achy, being bullied, and social isolation are a trifecta of misery. The lessons are clear: keep your kids to routines: three healthy meals daily, limited and healthy snacks, regular bed-times. Get them moving! Less screen time!  Besides masking and distancing, you’ve got to fight Coronavirus at home as well as in public. For our kids’ futures, it’s a battle we must win.

Long Dark Winter

Yesterday my wife and I were walking our dog on a grey, wintery day. Though only 45 degrees, it was a damp chill that felt like 39, what my wife’s Cajun family calls “dat wet cold.” She was grumbling about it, having grown up in Lafayette and hating winter. I reminded her that we met in Maine, regularly walking and skiing in worse cold and snow, with even shorter days and longer nights. “So this isn’t so bad, right?” I offered. Her response to my profound wisdom: “I wanna go to the Bahamas.”

Unlike my wife, grey winter days make me happy. I grew up in New Jersey, which like Maine, has long dark snowy winters. But winter has it’s own fun: as kids we got “snow days” off of school when the roads were too slick for school buses. Unlike days off for hurricanes where you must shelter, snow meant having snow-ball fights, sledding, and cross-country skiing in the woods. You’d come home wet and cold, peel off the soggy clothes, and have hot chocolate before a roaring fire. Some pundits are predicting a “long dark winter” of COVID. They seem to think, like my wife, that long dark winters are a bad thing?

Winter is typically difficult for kids’ health. Cooped up indoors with each other at home and school, children pass around cold viruses, influenza, and RSV. Those cough/congestion viruses in turn can cause asthmatics to have attacks, and some babies can wheeze from RSV. Kids with skin conditions like eczema will have flairs with prolonged exposure to cold dry air. They’ll itch, scratch, and have crusty flaky rashes.

At least we in Louisiana have shorter winters than most of the country, given our early spring warmth and longer days of light. Kids (and adults) will get outside sooner. Also,  schools’ protocols for mask-wearing, distancing, and alternating attendance has cut down not just COVID, but those other viruses that make kids sick on the regular. And the vaccine’s coming! So stock up on skin moisturizers, your kid’s asthma medication, and get those flu shots. There’s light at the end of the long dark winter tunnel.

I grew up cross-country skiing, but hadn’t been for 20 years since moving to Lafayette. Last March my wife and I went to Quebec with friends to try it out again. Three days of going up and down hills, the old reflexes were working, and I didn’t fall down once.Then that last day, skiing back to the lodge, they were cheering me in! I threw up my arms in triumph, lost my balance, and POW!  Nordic Scott eats snow.

As I mentioned above, long dark winters don’t get me down. However, this time of year when the days are shortest, the nights longest, and it’s grey and cold, many people get depressed. Add the post-Christmas blues: the holiday’s over, no fun between now and spring. Finally, with COVID, we can’t get together to share the misery like usual, under threat of life-threatening illness that we could catch; or worse, give to loved ones.

Depression from COVID issues is real. Isolation brings loneliness. Fear oppresses as friends and family get sick, some fatally. There’s nowhere to escape- any vacation spots you might visit are risky. Finally, most of us are poorer to some degree. Nothing takes the fun out of life like poverty and money worries.

Teenagers particularly get depressed easily. Puberty often makes them hyper-emotional, hyper-sensitive. If there’s depression to be had, they’re buying in! It’s thus a good time to keep an extra eye on your teenager’s mood. Are they more sullen or argumentative? Are they isolating more in their rooms? Are grades slipping? If so, ask them if they’re depressed or suicidal. Don’t tiptoe around the subject: asking if they’re  suicidal won’t put the idea in their head, and you need to know if they are. Not being proactive could prove fatal!  If you get the usual eye-rolling at your over-protectiveness, then good.  Better to be over-cautious than making funeral arrangements.

Meanwhile, stay positive. Spring and vaccines are coming. When the sun shines, get out of the house and get some sun on your faces. Do some charity- helping others often makes kids and adults feel better. The long dark winter will soon be past.

 

My Big Fat Cajun Wedding

On December 8, 1990, I got married. It was my first trip to Louisiana, and my staid protestant family met my new loud, fun catholic in-laws. Like the movie My Big Fat Greek Wedding, my stiff northeasterners got swallowed up in merry-making, and had a blast. First, the rehearsal dinner speeches started with the restauranteur welcoming everyone with a dirty joke. Wary looks were exchanged, but fortunately none of my family understood his thick Cajun accent (enhanced by a few drinks). Except it had something to do with ducks and condoms.

For our 30th Anniversary this month, there’s no Big Fat Events. COVID in Acadiana’s hospitals is up to apocalyptic volumes, added to our usual winter big numbers of patients. This new bump started with pre-Thanksgiving gatherings. For example, some parents rented party buses for Homecomings, finding the distancing, outdoor events planned by schools too nerdy. Those unmasked teens spread the virus to each other, then on to their families. Then Thanksgiving happened, and it’s a bump on top of a bump.

Fortunately for children, they aren’t getting as sick as adults with Coronavirus. There’s some coughing and fever, maybe a headache, and recovery in a few days. Many fewer children get as gravely ill as adults do.  Unfortunately, Emergency Departments, Intensive Care Units, regular beds, and even ambulances are clogged by the sheer numbers of very sick, even dying, grown-ups.

It doesn’t seem to be the schools’ fault. They’ve been careful with their protocols,  enforcing mask-wearing and distancing. It’s parents not following the basic containment rules: teaching kids to wash hands and wear masks properly (cover BOTH nose and mouth). Their violation of distancing rules in allowing, even arranging, spreader events, has been responsible for the current calamity. Maybe enough of them and their elderly parents have gotten sick now, that we’ve all learned our lesson.

So please, from all of us working at hospitals, please plan a Quiet Christmas: no parties, no big family events. Just you and your kids at home opening presents, virtual church, and grandparents at a distance, preferably on facetime. Thus we can have as merry a Christmas as possible.

Another event during my Big Fat Cajun Wedding 30 years ago was the Thursday Gumbo. My family of stiff protestant Northeasters wondered, what’s “A Gumbo?” A gathering? Brown soup? But they were swept up in the milling, laughter, and noisy chatter, and even calling for seconds on the brown soup. I get misty-eyed watching the video; so many of our parents and family have passed on.

Also when I watch that video, I first wonder “Why is everyone so close together?” Then I remember: oh, that was life before COVID. Hopefully, no one’s planning any Big Fat Events for this Christmas. Too many friends and family have been in the hospital, in ICU, or died, to risk making more Christmas tragedies.

As mentioned above, Coronavirus cases have ramped up since October, with too many kids and adults having big risky gatherings. Acadiana’s hospitals are clogged with cases, adding to the usual winter high volume. Being careful, not succumbing to “COVID fatigue”, is key to survival. It’s a sneaky virus, being so contagious and spreading through asymptomatic kids and adults. We’ve got to cinch up on the mask-wearing, distancing, and hand-washing; to get through the next few months as the vaccine rolls out. Fortunately for us in Louisiana, we get to go back outdoors in February or March. My unlucky Northern family will still be shoveling snow.

As for vaccine safety, I’m not worried; I’ll happily start mine in the next few weeks!  The vaccines have been carefully studied and well-scrutinized. Mythbuster: there’s no microchips in the injection. Nanotechnology is amazing, but just isn’t there yet, so don’t worry that Government will track you through the vaccine. Like they want to watch me anyway: “Hey, look, Scott’s driving to work. Now he’s napping. Wow, he’s mowing the lawn.” If they really wanted such information, it’s much cheaper and doable to spy on us through our phones.

So again, plan a Quiet Christmas. Fewer people, no parties, fewer presents. Just you and your kids at home, and visit other family on-line. That way next Christmas can be a happier one, with no melancholy watching of this year’s videos.