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.


Curing Asthma, With A Fish?

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

My great-grandmother Regina Thomassie, born in 1897, lived in the small farming town of St. Amant, Louisiana.  Because doctors and medications were scarce, she used many home remedies.  While her hot toddies and thrush salves have stood the test of time, her asthma treatment has been, well, superseded.  She would first have the asthma patient inhale over steaming hot coffee and then sip it- fair enough.  But then she sent the patient out to catch a fish, then breathe into its mouth, to transfer the asthma to the fish.

Luckily for both humans and fish, our treatment of asthma has improved beyond trout and coffee.  Asthma is an over-reaction to things inhaled from the environment, like dust, viruses, smoke, cockroach droppings, and other allergens.  The muscles in the airways constrict to keep out the offending agents.  Unfortunately, too much constriction also keeps out the air!  After more irritation, the airways become inflamed; swelling and producing mucus to wash away the irritants.  This swelling and mucus production further clog air passage, and breathing becomes labored.

To prevent airway inflammation (and visits to the Emergency Department!), we have several tools. One is daily inhaled steroid to keep the inflammation and mucus down.  It’s important to use this medicine every day before your child is sick, even if they feel great.  If you begin the medicine when your child’s already coughing and wheezing, it’s not strong enough to fight inflammation, only to prevent it.  Another daily prevention medicine is montelukast (Singulair), which also inhibits inflammation.  Again, prevention means using this every day, before your child gets sick!

The best prevention is avoidance.  Dust is the most common airway irritant that triggers asthma, and is partly why asthma is so bad in winter.  When kids are trapped indoors in school or by bad weather, they breathe more indoor dust.  Dust is hard to avoid, requiring minimal carpeting, curtains, and bedding, which collect and hold dust; and lots of mopping. Cockroaches are also hard to avoid- it’s Louisiana after all!  So keep your exterminator busy.

Back to my great-grandmother Regina Thomassie from above, who treated asthmatics by having them transfer their asthma to a fish by breathing into it’s mouth.  During the  20th century when she practiced, more effective asthma treatments were developed. Injection of adrenaline, the hormone responsible for our fear reaction, proved effective in relaxing muscles in constricted airways, opening them up.  For eons humans have known the effects of adrenaline: when confronted by a sabre-toothed tiger, the human would develop a racing heartbeat, muscle tremors, and wide-open airways, to prepare for a foot race with its predator.  About when Regina was born, 1897, scientists isolated the compound, and by 1914 had demonstrated its usefulness in asthma.

Today’s mainstay of asthma treatment, albuterol, acts like adrenaline but with less agitation.  Albuterol relaxes muscles in airways that have constricted to keep out irritating agents like dust, smoke, and viruses; with less tremoring and racing pulse.  Adrenaline, a.k.a. epinephrine, lives on in other important treatments: injected for severe allergic reactions (the “epi” in your epipen), cardiac arrests, and severe asthma attacks.

Another mainstay of treatment, steroids, was developed in the 1940s.  Steroids decrease inflammation, like the airway swelling in asthma.  As discussed above, supersensitive lung tissue in asthmatics is easily irritated by dust, pollen, smoke, and viruses. Steroids soothe this irritation, decreasing swelling that narrows airways and occludes air passage.  Mythbuster: steroids don’t work faster when injected. “Cortisone shots” don’t take effect sooner than pills or liquids.  In the Emergency Department we give it to kids orally, unless they’re breathing so hard they can’t swallow. Then it’s given IV.

Of course the best asthma treatment is prevention; don’t get an attack!  Besides avoiding asthma triggers, it’s important to get flu vaccine every year.  Flu virus is particularly hard on asthmatics, is highly contagious, and the season is coming fast.  Get your asthmatic that vaccine!

Another important, often overlooked, prevention is exercise.  Getting kids outdoors and moving not only decreases dusty interior air exposure, it somehow makes lungs stronger.  Though it seems paradoxical, given that exercise sometimes triggers asthma, in the long run (get it?) activity makes kids less susceptible to attacks.

When Bears Attack!

As a Pediatric Emergency Physician, I’m calm in medical emergencies.  But good at one kind of emergency doesn’t translate to all emergencies.  One summer my family was hiking in Grand Tetons National Park.  The path ran along a lake, and nearby boaters began to shout, “There’s a bear coming towards you!”  We should have turned back, but someone nearby said, “My husband knows bears, he encounters them all the time.”  Since most bear encounters are fine, there were 10 of us in this group (bears are intimidated by numbers), and we DID want to see a wild bear, we strode on. I also had a can of Bear Repellant spray on my hip.

Soon enough, a brown bear came loping down the trail.  “Okay,” said our ‘bear guide,’ “everyone in the water.”  We stepped aside into the shallows of the lake, me ending up between the bear and everyone else, struggling to get the can off my belt.  Finally, it jerked free, I accidentally hit the trigger, and a 20 foot spray shot out towards Yogi.  He ambled on, unmindful of us.  “You weren’t supposed to spray unless he came at us,” chimed my daughter.  “I didn’t mean to,” I mumbled, embarrassed that I wasn’t more cool facing wild beasts.

Emergency situations are scary.  By definition, they’re life-threatening; we naturally get shaky when in danger.  Also, emergencies are rare, so we don’t get any practice knowing what to do. They can require unfamiliar skills, like CPR, or getting bear spray off your belt with trembling hands.

Everyone should have some idea how to handle common emergencies, particularly for their kids.  The three leading causes of death in kids are car crashes, firearm injuries, and drowning.  The best emergency preparedness is avoiding the injury in the first place: seatbelts and car seats, no cell phones while driving, swimming lessons, have a sober kid-watcher at pool parties, and locking up guns with ammunition locked up separately.  But if something bad does happen, having taken CPR and a first aid course really helps.  If kids are around grandparents or other elderly relatives, teach them how to dial 911, and be able to tell the dispatcher their address, and who they need (Fire, Police, or Ambulance).

On September 11, 2001, John Pelletier was the manager of Corporation Service Company’s office in the World Trade Center.  At 8:46 am he heard a rumble and saw flames from the tower next door.  Though the PA announced that their building was fine, he thought otherwise and ordered his office evacuated.  His 100-plus employees were on their way down the stairwell when the second plane struck his building.  If they’d stayed, they would have been trapped above the impact site, and perished.

Survivors of that day recall co-workers waiting for Emergency personnel to get them. In mass casualty situations, like hotel fires and airplane crashes, it takes time for Police and Fire to get to the scene and rescue people, and whoever waits for them may be too late.  For those who can run- run!

Above we discussed people’s unreadiness to respond to emergencies, because they happen so seldom.  No one gets to practice what to do.  So when you’re on a plane, do the practice. Read the safety pamphlet, watch the demo, identify your nearest exit, and rehearse in your mind: unbuckle, move to the exit, open the door.  When staying in hotels, find your nearest exit, go out it and down the stairs.  It’s good exercise, it’s fun to explore, and it may save your family’s lives.  Rehearsing prepares you to evacuate when necessary; those who wait do so at their peril.

We also already discussed being ready for personal emergencies.  Again, for kids this means preparing to avoid, or deal with, their most common threats- car crashes, firearms injuries, and drowning.  Buckle them  into their car seats or seatbelts.  Many times I see kids hurt in crashes who didn’t buckle up because they were “just going down the block.”  If the car is moving only 15 miles per hour and crashes, the child’s impact will be equal to a 15 foot high fall.

Firearm injuries often happen when exploring kids shoot themselves or playmates accidentally.  Lock up guns unloaded, with ammuniton locked up separately.  To prevent drowning, get kids swimming lessons, and swim where there’s life guards.  Finally, make sure kids know how to dial 911, tell the dispatcher who they need (Police, Fire, Ambulance), and their address.

Unsociable Media

This week’s guest columnists are Drs. Meghan Gaddis and Mark Carreras, Family Practice residents at the University Hospital and Clinics here in Lafayette.

I’ve been thinking on how things have changed for kids in recent decades.  It seems  the days of riding bikes to friends’ houses, playing outside until the street lights come on, and having water balloon fights on hot summer days, are gone.  Parks and playgrounds in my hometown that were once packed are now empty wastelands.  Kids no longer rely on their imaginations for play, some even repulsed by the thought of going outside and getting dirty.

As adults, we’re witnesses to a generation growing up not doing the same things we did. One of the culprits that’s robbed our kids of such adventure is the advancement of technology.  Kids don’t have to deal with the disappointment of riding bikes to a friend’s house only to find him not home- they just text to communicate.  No waiting for Christmas or birthdays for a toy they’ve been yearning for- just a few clicks and Amazon brings it to the doorstep.

Of couse there’s good and bad sides to technology.  While computers have taken over a large part of children’s play, they’ve also enhanced parts of our lives.  Modern medicine relies heavily on technology and its advancements.  It was an old joke about doctors’ bad handwriting in their notes and prescriptions, which was sometimes a medical risk if a pharmacist mis-read instructions.  Now it’s all printed and legible.

A hidden risk for kids is the accessibility of a potentially dangerous side of modern tech- social media. In the United States, 77% of the population has a social media profile, on Facebook, Instagram, Twitter, etc.  Social media is taking over a large part of our lives.  We’ve all enjoyed social media’s benefits.  I’ve connected with many old friends and family I haven’t seen in years.  I’ve also been able to network with other professionals with similar interests.  But just as we’re able to access a world of others, so can our kids.

Imagine letting your child wander through the worst neighborhoods in a big city, all alone.  She might be threatened by strangers, certainly would be scared, and bad things might actually happen.  Modern technology has made this nightmare more possible for kids, in social media.  Kids can be bullied by scores of schoolmates, and strangers too.  Predators may lure them into unspeakable situations.

We see lots of victims of social media in the Pediatric Emergency Department.  Besides injuries and illness, we take care of psychiatric emergencies- depression, aggression, suicide. Often the bullying that finally drove the child to the despair of contemplating killing herself started online.  Consider these statistics:

-88% of teens have seen someone be mean or cruel to another person on a social networking site.

-15% of teens say they were a target of online cruelty.

-8% of teens got into a physical fight over something posted on social media.

–29% of sex crime relationships were initiated on social media.

These are the victims.  But any kid on social media is at risk if they have unregulated access.  More stats: 

-67% of teens know how to hide their online activity from parents.

-22% of teens log on to social media site more than 10 times per day.

-85% of parents with teens report that their child has a social networking profile

-29% have been stalked or contacted by a stranger

The best way to avoid this is to closely monitor your child’s online activity.  Frequently talk to them about what they’re seeing, and with whom they’re communicating.  Ask them if they’re being bullied, or recieving messages from stangers.  Get them used to talking openly about it, and see for yourself what they’re reading and writing.

Some teens argue that this is an invasion of their privacy, and fight monitoring tooth-and-nail.  And as we just stated, most teens know how to hide their activity.  The best way to avoid this is to early in their lives, before they’re teens, let them know that there’s no such thing as online privacy.  Explain to them this contract: from the first day they get access to a screen, if you’re paying for the access, you get to see it all.  And just like you wouldn’t let them wander through the city lost and alone, you wouldn’t leave them all alone in the online jungle either.


Scary Times

When I was a kid, instead of handing out store-bought candy to trick-or-treaters, my mom made halloween cookies, iced to look like jack-o-lanterns, with raisins for eyes and a grin.  The neighborhood kids loved them- “Mrs. Hamilton’s cookies!” they’d yell.  I could eat a dozen myself (as if she’d let me). The cookies had to be eaten right away.  Otherwise they’d get smashed by other goodies in the treat bag. Then successive generations of kids, who didn’t know mom and my family as well, became leery of cookies made by strangers.  By my teen years, mom had switched to packaged candy.

Halloween fun has been undermined by fear; not the exciting fear of ghosts and skeletons, but unnerving fear of poisoned treats, or with needles inserted.  Parents are afraid to let kids out into a neighborhood where unsavory strangers may lurk.  A generation ago trick-or-treaters flooded the streets.  These days, not so much.

Many halloween fears are unfounded.  Reports of candy tampering are quite rare.  In previous years some hospitals offered to x-ray candy.  However, no hospital ever reported finding metal in treats.  Given the hassle of families going to the hospital, radiology departments tied up with this extra service, and the low yield of found objects, no one bothers anymore.

The damage to neighborhood trick-or-treating volumes has been done.  But in response to these fears, some good things have happened.  Parents accompany trick-or-treaters more.  Some churches, schools, and families hold halloween parties, where kids’ safety is assured.  My church has a trunk-or-treat party, where parishioners scatter their cars about the parking lot, and kids go from trunk to trunk to gather goodies.  Keeping a closer watch on kids these ways, knowing what goes into their bags, isn’t a bad thing at all.

But what about those elementary school kids, too old to want to be watched, yearning to be out with their friends, away from hovering parents?  Young enough to still love dressing up and collecting free candy- what about their trick or treat?

After my kids got home from trick-or-treating, they’d shout “Candy Market open!”  The three of them would sit in a circle, still in costume, empty their bags onto the floor, and begin bartering.  My oldest daughter didn’t like chocolate, and her younger brother and sister did.  So the horse-trading would begin- so many skittles for so many m&ms, does a Laffy-Taffy equal a Butterfinger, etc.

Halloween is supposed to be fun. Choosing and making costumes weeks in advance, the anticipation of halloween night, is part of the joy.  Then the night itself: roaming the neighborhood at night with friends.  Parents often enjoy halloween too, delighting kids with hand-outs, chatting with neighbors, maybe dressing up and having their own parties.  And of course for the kids, the big bonus: a bagful of free candy.

We discussed the perceived hazards of Halloween above- candy poisoned or spiked with sharp objects, and creeps lurking in the dark.  Though these dangers are actually rare, trick-or-treating has taken a hit.  It’s still safe to send your kids out into the neighborhood, but be aware of the real hazards.  The most important concern is getting hit by a car.  Kids are hard for drivers to see at night.  They’re small and often wear dark costumes.  And excited children run in and out of the street as they go from porch to porch.

Thus kids should travel in packs, to make them easier for drivers to see as well as having safety in numbers.  Costumes should have visibility aids- reflective tape or shiny parts (metallic stars on wizard costumes), and kids can carry flashlights (or light-sabers).  Another hazard is not of candy that’s been tampered with, but stomachaches from wolfing it all down in one go.  Parents should encourage their kids to ration their goodies.  It’s more fun, and better for them, to make the treats last for weeks, instead of just one night.

The true fix for halloween fears are having better neighborhoods for trick-or-treating.  Get to know your neighbors.  Have a pre-halloween neighborhood meet-and-greet, to plan for a safe trick-or-treat, and make halloween a block party.  Talk to city hall about blocking the streets, or having signs and monitors to slow traffic.  Welcome kids visiting from neighborhoods where it’s not so safe.  Finally, inspect your kids’ treats when they get home, if only to allay your worries.  Then, let the Candy Market begin!


Many days in the Pediatric Emergency Department at Lafayette General, I am joined by a Family Practice resident.  Residents are apprentice doctors, graduated from medical school, who spend the first years after school in “residency,” programs that teach new doctors their specialties, like Family Practice, Pediatrics, Surgery, or adult Internal Medicine.  Our Family Practice residents learn a lot of their pediatric care on my unit.

Every weekday their lunch hour is Noon Conference, usually a lecture.  Sometimes Noon Conference is a business meeting involving schedules, preparation for upcoming exams,  or new training requirements.  Last week, the Tuesday conference was about what happens If University Hospital and Clinics (UHC), the residents’ base hospital, closes.

If you haven’t heard the news, the Louisiana Legislature has an upcoming $692 million budget shortfall.  The current plan is to make drastic cuts in state spending, particularly to Louisiana healthcare expenditure.  These cuts would close many hospitals around the state, including UHC.  With less than two months before the deadline (June 30), the Legislature still has no plan to save UHC.

Besides being a base for resident training, UHC sees about 50,000 patients in it’s Emergency Department per year, and has 116 beds for hospitalized patients.  It also has outpatient general and specialty clinics.  But it’s biggest mission, with the assistance of units like mine at Lafayette General, is to train Acadiana’s next doctors.  That’s the “University” in UHC.

Most residents, in Lafayette and around the country, stay in the community where they trained.  A good 75% of Family Practice residents at UHC get a job in the Acadiana area.  That’s lots of new doctors.  They’re needed to replace doctors who retire, and there’s already a shortage of doctors to see all the patients in need.

If UHC closed, that’s no more new doctors for the Lafayette area.  The shortage of doctors seeing patients would get worse. Imagine having to wait months to see your doctor.  And what if you got sick?  What would happen if you needed to go to the ER, or be hospitalized?

Here’s what would happen.  It’s mid-June (a month from now!), and the state Legislature still hasn’t budgeted to save Louisiana’s healthcare system, with it’s doctors, hospitals, and training programs.  It’s looking like the worst will come.  Hospitals around the state, like UHC here in Lafayette, that train doctors and medical students and see the poorest and sickest patients, will close.  

Since resident doctors, those apprentice doctors we discussed above, start their academic years on July 1, they’ll have to be placed elsewhere.  The surviving programs in New Orleans and Shreveport will absorb as many residents as they can.  Those they can’t take will have to go out of state.  The residents and their families will make moving plans.  As we discussed above, that’s it for new doctors for the Lafayette area.

When the resident programs close on June 30, they can’t reopen if the Legislature suddenly decides to come up with the money on, say, July 10.  It takes years to get a residency program accredited, and if the doors close, there’s no re-opening them days later and saying “just kidding!”  Training doctors is serious business, and those who regulate it don’t tolerate poor planning, and capricious closing and opening.  Whosever fault it is, Legislature or elsewhere, residencies require stability and competency.  So if the UHC residencies shut down, that’s it.

Now it’s July 1.  UHC is shuttered, the lights out, the residents gone to programs in other cities.  The patients in the hospital have been transferred to the other area hospitals.  Lafayette General Medical Center and Lafayette General SouthWest, UHC’s sister hospitals, fill up first.  Then Our Lady of Lourdes, Heart Hospital, and Women’s and Children’s are next.  With the beds all taken, their Emergency Departments begin to be populated by patients who are “boarding,” awaiting room in the hospital upstairs.

Then the patients who would be served by UHC’s ER and clinics begin to come to those other ERs, already full of boarders.  Wait times to get seen in those ERs skyrocket.  Waiting rooms and hallways overflow.  Ambulances stack up at the ER entrances; the paramedics can’t get their patients off their stretchers and back in service.  It starts to look like an apocalyptic movie.

Go to saveUHC.com, push the Take Action button, and let your legislators know.  We must save UHC.  Or else.

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. 

And They All Came Tumbling Down

This week’s guest columnists are Drs. Anna Malesky and Alicia Ortiz, Family Practice residents at the University Hospital and Clinics here in Lafayette.

It was our sixth shift in the Pediatric Emergency Department when we began to notice a theme.  On the Adult side of the ER, we saw falls in the elderly- on the Pedi side, we saw even more in kids.  Usually the mother can barely tell the story while clutching her infant tight to her chest.  Parents often blame themselves, or each other- who was supposed to be watching?

On one shift we saw a three-month old who fell out of her car seat on to the street, while the seat was being transferred from the car to the stroller.  She had been unbuckled after the car stopped, mom assuming belts were only necessary when it was moving. In the next room was a six-month old who had rolled off his parents’ bed.  Both kids had fallen from high enough to warrant head CT scans, to insure they had no brain bleeding or skull fractures. Both CTs were normal, and the parents were relieved.

It’s important to keep infants strapped in their car seats anytime they’re in them, not just in the car. It drives our nurses crazy when parents bring a baby into the ER, swinging them in their car seats, unbuckled- an accident waiting to happen.  Also, never leave babies on beds.  It’s no fun to discover that they can roll over by hearing a thud and a shriek from the bedroom you left “for just a minute.”  In that vein, babies should never sleep with parents on couches or beds either.  Not only could they roll out while you’re sleeping, but it’s also a risk for SIDS- babies can smother to death in bed or on couches with adults.

Infants also shouldn’t be carried around by younger children.  Kids in their pre-teen years and younger just aren’t strong enough, or reliable or careful enough, to be trusted with such a precious cargo.  Heck, even many teens can’t be trusted either.  Ask yourself, would you let that child or teen carry around your favorite 15 pound china bowl?  How much more valuable is your baby?

Keeping kids safe from falls is not limited to infants or toddlers.  Last week we had a pediatric trauma case, a nine-year old, who was riding on the back of a bike.  A seventeen year-old was steering, not looking where he was going, and ran them into a parked car.  Both kids flipped onto the car roof.  Neither were wearing bike helmets. Fortunately the nine-year old, after a lot of x-rays and CTs, ended up only with some cuts and scrapes.  Others aren’t so lucky.

According to the U.S. Centers For Disease Control (CDC), “injuries due to transportation were the leading cause of death in children” for 2016.  This includes kids killed in bike accidents, many of which would be prevented by bike helmets. Louisiana regularly ranks as the top second or third state for bicycle accident deaths. Earlier this summer Dr. Hamilton was showing friends from Maine around New Orleans. They were appalled at how no one was wearing bike helmets- apparently everyone in Maine does.

The other important tip to avoid injuries from falling off bikes, is not to fall off them! When they first start riding, children should be taught the rules of the road for bikes- riding with traffic, staying in bike lanes, obeying the same rules as cars. This means stopping for red lights and stop signs, and checking both ways before crossing, unlike our kids above. Supervise your kids on their bikes until you’re confident they’ll be safe. Make it a “family ride” when you do this, to bond with your kids, get in some exercise, and keep them out of harm’s way.

Finally, your kids will eventually turn 16 and get a learner’s permit.  While this affords them some independence and frees you from chauffeur duties, it’s important that they know that motor vehicles are dangerous, and can cause significant harm to others.  You don’t want your teen making other bicyclists and pedestrians fall- by being hit by your car!  When riding with your teen, besides enforcing the rules of the road, teach them vigilance for pedestrians and bicyclists.  Of course, vigilance means no texting and driving- ever.

Drama In Real Life

April 29th was a bad day in Lafayette.  Around midnight at Festival Internationale, two people began arguing.  Possibly fueled by alcohol, the fight escalated, someone pulled a gun, and one person ended up dead, and two injured by stray shots.

Interpersonal drama brings many kids to the Emergency Department too, particularly teenagers. Someone says the wrong thing, feelings are hurt, punches are exchanged, and we see the ensuing facial and head injuries.  Teens are particularly vulnerable to these escalations.  Already at an emotional age, with hormones surging, feelings are raw and easily chafed. Teens are also often in the early stages of learning conflict resolution. They are unskilled in managing feelings and arguments without resorting to shouting and violence.

Several outside forces can inhibit teens from maturing into rational adults too.  A lot of media these days portrays immature behavior as something fun to watch and emulate. Reality TV consists of knuckleheads gossiping about each other on camera, making wars out of simple disagreements.  Then the assailants confront each other and scream obscenities for the enjoyment of the TV audience.  And the combatants are always so good-looking, just like teens want to be.  

Social media amplifies drama as well.  When I see fights brewing at festivals, it’s not just two teens having a tiff.  There’s usually a crowd of “friends” swirling around, egging them on, joining the shouting.  With social media, the crowd is even bigger, with unlimited gawkers available through screens and sites, taking sides, trading barbs. Simple arguments become electronically-enabled riots.

Some teens learn poor conflict resolution at home too.  When some parents fight, their negotiating skills look like the Jerry Springer show. Rather than a calm discussion of differences, these parents try to intentionally hurt the other’s feelings, verbally “aiming to kill,” instead of speaking respectfully.  When kids grow up living with such behavior, they rarely learn a better way for themselves. 

Like we discussed above, social media can fuel conflicts between people.  Once on Facebook, I saw a picture of a friend’s teenage son at a party.  His round smiling face, his arms draped around two friends, reminded me of actor Jonah Hill  (a cute Jonah Hill, not the overweight creep he sometimes portrays). So, bonehead that I can be, I said so in a comment. The backlash from he and his parents, and my wife, still makes me cringe with embarrassment.

Thus one problem with social media: it’s easier to commit a social faux pas with a keyboard.  When you’re face to face with a person, you naturally edit what you say, to not offend.  There’s non-verbal cues that help you to not say dreadful things. This in-person behavioral check doesn’t operate when interacting online.

Secondly, when you’re angry at another person, this social media disconnect makes it easier to intentionally wound.  In World War II, fighter pilots were rarely troubled by killing their enemies, though viciously machine-gunning each other in one-on-one combat.  This was because they concentrated on the other plane, not the pilot inside. Likewise today, it’s easier to say the meanest thing that comes to mind online, because you’re saying it to a machine. But screens are like fighter planes- there’s a real person hidden inside that gets hurt.

So how can you counter the forces of Reality TV and on-line depersonalization, that turn your teen into a screaming drama king or queen?  Begin before your child’s a teen. In pre-teen years, games should be played less on screens, and more face-to-face. Board and card games, tag and backyard ball, are all conflict-resolution exercises for kids. Negotiating the rules, playing fair, keeping friends, all happen in those arenas, not in video games.

You must also model good behavior yourself.  Parents should have arguments that aren’t death matches, but calm settlings of differences. Feeling wronged and needing vengeance are innate human traits- show your kids how you bypass those cruder motivations, to stay friendly.

Finally, texting and messaging are certainly convenient, but elementary school kids should spend more time together in person than on screens. Phone and computer time should be limited, like limiting how much candy kids eat. And explain that there’s real people on the other side of the screen, not computer-generated enemies.  Then it’s easier to avoid comparing someone to Jonah Hill.  

2016- The Worst of Times?

My son came home from college, shaking his head. His fellow millennials were lamenting that 2016 was the worst year ever: “David Bowie and Prince died!” My son’s response: “Worst year ever?  What about 1939?”  Nazis starting World War II was a lot worse than some celebrities passing away.

As a pediatrician, I saw many good things about 2016. While preparing for my yearly mission trip to Honduras, I’m reminded of positives for even the most impoverished U.S. citizens- clean water, with no risk of cholera.  And while some American kids go hungry, there isn’t the abject starvation of the third world.

Though we worry about the environmental impact of coal, oil production, and car exhaust, we enjoy pretty clean air compared to the third world.  Their vehicles and factories have unregulated emissions, families cook inside over open fires, and farms often practice slash-and-burn techniques.

In fact, Americans suffer from too many good things.  Too much food and too much sitting around looking at screens leads to obesity.  2016 has highlighted another rising glut- too much information.  The recent presidential race has revealed growing anxiety about which information is real, which is made up.  Is this candidate telling the truth?  Where are they getting their facts?  What are the facts, and where to find them?

There was a recent political cartoon depicting two people looking at cellphones, wondering if the news they were reading was real or fake, and how they could find out. Standing behind them was a newspaper stand.  A subtext of the joke is that many no longer trust information from traditional sources, like newspaper and TV media, government, or science.  Too many conspiracy theories, too many scandals, have undermined faith in these traditional institutions.

As a doctor, my decision-making relies on good data.  It’s a professional duty to find facts for the good of the patient. Newspaper and TV media and government scientists are the same.  The vast majority of journalists and scientists are professionals, diligent about getting facts right.  You can trust them for the best information, better than random websites. When looking for medical information, like about vaccines, go to the Centers for Disease Control or the American Academy of Pediatrics, rather than some un-credentialed crank.

Besides cataloging the year’s best and worst, a favorite new year pastime is making New Year’s Resolutions.  I’m not big on resolutions myself. Doctors have to continually make new good habits and throw out old ones, as medical knowledge evolves. Nothing’s special about New Year’s when it comes to medical innovation.

I don’t encourage New Year’s resolutions in others either, as humorist Dave Barry wrote, “so that you can become a better you- a more-attractive you, an organized you, a you that is…well, less like you.”  This column is always about making good habits all year, throughout your childrens’ growing-up, so they are safer and happier.

Good habits aren’t actually hard to make when there’s quick results. New Year’s resolutions, the good habits that we continually fail to make, are the ones that require persistence to get to the pay-off.  Losing weight or exercising are commonly failed resolutions because it’s months before you look or feel better, while you suffer through cravings and pain.  Quick pay-off habits, like always putting your car keys in your left pocket so you never lose them, are easy to develop.

Here’s an easy habit to keep your kids happy, healthy, and safe: get them a doctor and dentist.  Many kids I see in the Emergency Department don’t have these. Some kids don’t get sick much, so their parents stopped taking them for yearly check-ups. When the kids do get sick, they get taken to a walk-in clinic or ER.

However, doctor and dentist practices help you keep good habits.  At yearly check-ups, they discuss how to keep your kids well, appropriate to their age and development.  If your kid’s a toddler, they discuss tooth-brushing and toddler-proofing the house.  For teenagers, it’s about acne, wearing seat belts, and not getting pregnant.

My dentist’s office books my next appointment before I leave.  Six months later I get two phone calls to remind me when to come. That’s a slick outfit- they keep their patients coming in, and my my teeth stay clean.  Get your kids a dentist and doctor with such a well-run office.  They’ll do your New Year’s resolution work for you.