Tuesday, June 30, 2009

I'm not fat! Are so, fatso!

A study from 2005 in the Journal of Adolescent Health reported about appearance-related teasing among middle school age girls. The study was conducted among 372 girls in one school in Tampa Bay, Florida.

First, what did the girls say about how often they are teased? Twenty-three percent of participants in the study reported appearance-related teasing by a parent. 13% were teased by mothers and 29% by siblings, according to the survey.

This teasing was a significant predictor of body dissatisfaction, depression, lowered self-esteem, bulimic behavior, and restricted eating.

Middle school is a time when the average male body is becoming longer and lanky (if it is changing yet at all) and the average girl's body is becoming thickened around the middle. It is this midriff thickening that many girls complain of. And it is just at this time that an insensitively placed comment can ignite an eating disorder. One of my patients once told me she started her diet that became full-fledged anorexia nervosa the day the boy at the locker next to hers called her "Sara Lee."

Doctors, nurses, teachers, coaches, parents, and brothers and sisters need to know that words CAN hurt. Each patient should have the opportunity to discuss any bullying, teasing, harassment or worse that she is experiencing in her environment before a self-destructive response has a chance to flare up.

Thursday, June 25, 2009

Plan B Goes Generic

The Food and Drug Administration announced today that Plan B, the revolutionary morning after pill will be sold as a generic drug after August 24, 2009.

What is Plan B again? Plan B is the most commonly prescribed emergency contraceptive on the market. It was designed and marketed by Barr Laboratories to meet a demand for a simple, effective, safe, and relatively side-effect-free alternative to previous versions of the morning after pill. Only recently the FDA approved its sale over the counter to people under 17.

This new announcement is a good thing if it results in less expensive alternatives to the brand name. In my experience the $35 cost of Plan B can be a stumbling block for teens who need to pay out of pocket in order to protect their privacy( I always warn my patients that insurance companies do not seem to follow the same ethics about confidentiality that the medical profession does and if their privacy is paramount, they need to fork over the cash for their Plan B).

We owe a debt of gratitude to Women's Capital Corporation and Barr Laboratories for the enormous effort and investment they put into developing this product and working to acheive its FDA approval for over the counter use for teens. Hooray!

Friday, June 19, 2009

ADHD and Medication: cause for alarm?

Just when the calls about Swine (H1N1)Flu started to abate, the phone and email box filled up this week with concerns about children taking medication for Atttention Deficit Hyperactivity Disorder.

That’s because it was big news across all media this week. A study, "Sudden Death and Use of Stimulation Medications in Youths"* has parents and providers everywhere scrutinizing the results. It is generally agreed that somewhere near 5% of the general pediatric population has a diagnosis of ADHD, so that means this information has the potential to affect at least one kid in every classroom. In addition to legitimate use of medication one needs to consider the current fad of students buying or borrowing the prescribed medications of their friends to use as study aids. The results of this current research ask us to sit up and pay attention.

What is the brouhaha about? This epidemiological study from Columbia University and the New York State Psychiatric Institute published in the June issue of the American Journal of Psychiatry examined the risk of sudden unexplained death(SUD) in young people taking stimulant medication (eg Methylphenidate (Ritalin).

The study used official vital statistics from across the US and identified 564 cases of SUD in children ages 7 through 19. They were compared with 564 youth who died as passengers in motor vehicle accidents. Data was collected and studied for the years 1985 to 1996. Without going into exhaustive detail, suffice it to say that there is very little criticism about the methodology in this ambitious work. The control group was well matched, the methods of inquiry and verification were excellent, several confounding factors (like underlying diseases in victims) were accounted for, and the results appear to be reliable and statistically significant.
Results showed that ten children (1.8%) of the SUD group showed evidence of stimulant use (almost all methylphenidate, the generic name for Ritalin) as opposed to only two (0.4%) of the motor vehicle fatality group.

Here are some of the most fundamental concerns and questions raised by this new information:

  • The data in this study was collected from records more than twenty years ago and the newer formulations of longer acting medications (eg Adderal XR, Concerta) were not prescribed yet.
  • A statistical association does not prove causality. For instance, it is possible that the genes that code for ADHD in an individual also put that person at a slightly higher risk of a sudden cardiac event.
  • The numbers of exposed children was extremely small. Although the data showed a statistically significant difference, we need to remember that the percentages still remain extremely low.
  • In a misguided haste to dismiss medications for ADHD as unsafe, we must not forget the very high likelihood of harmful and unhealthy behaviors associated with untreated ADHD. Alcoholism, motor vehicle accidents, school failure, antisocial activity and other accidents are many times higher in adolescents who are not on medication when it is indicated.
  • This study makes people want to do something (like an EKG) before prescribing medication even though the study does not at all address whether there is any way to predict who might be at risk from the medications.
  • A statistical nugget to underscore the rarity of the problem was pointed out by Dr Laurence Greenhill, a child psychiatrist in practice in Mamaroneck, one of the lead authors in the study, and the President-elect of the American Academy of Child and Adolescent Psychiatry. It would be necessary to treat 250,000 children before one might expect to encounter SUD associated with stimulant treatment. On the other hand, it would only take treating two children with medication for their ADHD to see beneficial effects on the symptoms.


What is the current advice for kids already on medication?
Most clinicians have been alerted to the statistical increase in SUD over the past few years. The current recommendation by the FDA, the American Academy of Pediatrics, and the American Heart Association is to have a careful assessment of family cardiac history done before prescribing medication. Only when such a positive history exists is an electrocardiogram or other test recommended. For others, no screening cardiac tests are necessary. If there is any question of a family history, it should be discussed with the prescribing doctor.

Although it is fair to downplay the risks in diagnosed patients who need the medications in order to function well, it is also fair to point out to those who might abuse stimulants that every medication has risks, known and unknown. When an otherwise healthy college sophomore combines Adderal with Red Bull, coffee, alcohol, insufficient sleep and stress, any number of side effects are possible, including cardiac ones.

Monday, June 15, 2009

Two Birds with One Stone: Pregnancy and HIV?

How cool is this?

Imagine how the world could be a better place if a simple, non-invasive device could prevent pregnancy and HIV at the same time. Researchers at Weill Cornell Medical College (my alma mater!) have come up with such a thing. It is a small vaginal ring (I am not sure how similar to the popular hormonal Nuvaring it is) that is impregnated (funny word choice in this context) with non-hormonal chemicals that not only prevent pregnancy but also prevent HIV and possibly other sexually transmitted diseases. The study was published in the journal AIDS in May of this year.

Researchers note that in addition to this Two-for-One, such a method leaves the power in the hands of women who are the ones most likely to be affected by pregnancy and HIV through vaginal intercourse. If the new device is similar in size and shape to Nuvaring, the vast majority of men are not aware that a woman is wearing one in her vagina. One can only imagine the number of situations around the world where such a device could be life-saving and life-enhancing for all involved.

Thursday, June 11, 2009

Just Say NO is not enough

Today Mamaroneck High School held a day of speakers, workshops, and fun for graduating seniors. I was there because I led two workshops on "Avoiding the Freshman Fifteen". Attendance seemed good, in no small part because of the dreary weather, I am sure. But those of us who went, were lucky enough to hear Bernie McGrenahan give his rolicking routine on the perils of college partying.

Standing on the auditorium stage with only a water bottle and a mike for props, Bernie took us on a roller coaster ride through his blurry, high, highschool years and then on to college where he partied and drank excessively, and was arrested for DWI twice. His storytelling is brilliant, and people laugh, sometimes embarassed at laughing at such a terrible tale.

Bernie painfully tells about his younger brother's struggle with alcohol and depression and ultimate suicide. And about his other brother, Sean, who is mentally retarded and completely lovable. After a six month jail term for a third DWI, Bernie gave up drinking and drugs and has been clean for 21 years.

The power in Bernie's story is in its humor but also in his keen awareness of what adolescent drinking is really like. He sends caveats to kids about drinking and driving (Don't even think of it!), how to plan ahead on how much drinking to do, how to get home and with whom("No means No when it comes to the ladies") and about warning signs that they might be troubled drinkers (you cannot stick to your plan for the evening, you are skipping class, you are losing friends, you cannot stop drinking once you start, you get angry at the suggestion that you should cut down, and you lose track of what is "normal" drinking).

Bernie is spending the summer talking to the military overseas about decision making and I am sure just making them laugh and feel appreciated. In the Fall he will resume his gig at colleges and high schools around the country. His website is HappyHourComedy. I highly recommend him to any school or college administrator or counsellor trying to reach adolescents and young adults.

Tuesday, June 9, 2009

Twitter: Guiding parents and others of us in the dark

The enormous advantage to having signed up for Google alerts about all things "Teen" is that everyday a new blog or website pops up with fun, useful, new, or even ridiculous information. Today I want to share with you a site that explains Twitter and its impact on teens in the simplest of terms. Click here to access this concise article by Sarah Newton who writes the blog, Teen Coach/GenY Guide.

As with all new steps in technology evolution, there are sure to be aspects of Twitter no one has thought of that will emerge with time. If you have experience with your teens or young adults and want to share a Twitter story, please comment at the end of this post. And please don't feel hemmed in by 140 characters!

One thing I have already heard from parents in my community is how quickly a house party can go "viral" because of Twitter. Something new to be aware of!

Tuesday, June 2, 2009

Why Blog?

Thanks for clicking through to my blog. I am new at this and hope to make a small contribution to the daily discussions on line. As many of you know I have been writing in the Larchmont Gazette for many years, trying to make adolescent news relevant to a local audience. In addition I send a newsletter from my office quarterly. These endeavors will continue.

However, with more and more social networking, our world necessarily and impatiently expands into the world beyond our small communities. There are many people to hear from and there are even more listening out there.

So, why would I decide to do this? Blogging satisfies my need to teach satisfies my wish to filter the news bombarding all of us helps me focus on medical news that can help parents and professionals do a better job will contribute to my platform as I work on a book on parenting teens will hopefully add a voice of experience and reason to the blogosphere!

I hope you will join this adventure with me. Become a follower; make my blog an RSS (what is that anyway?) feed; or make it a favorite. But above all, please send it along to friends and family and COMMENT! Comment by clicking on "comment" at the end of each blog entry.

If all else fails, ask one of your children to show you what to do!

Thanks for coming along!

Monday, June 1, 2009

Parenting Teens-adjective or verb?

About a month ago I signed up for any new books or blogs on "parenting teens." My email inbox is crowded now with these Google Alerts. What has come in is most interesting and unexpected. What I was hoping to find was all news related to books on parenting of adolescents. I am getting plenty of that, including Beth Harpaz' funny book 13 is the New 18 and other things my children taught me while I was having a nervous breakdown being their mother. Check it out for a light, fun read.

But I am also getting a look at a number of publications, blogs and books that address "parenting teens"--meaning "teens who parent"! Bristol Palin's publicity for her new baby and her ironic trumpeting of "do as I say not as I do" is only the most public example of teenagers who are parenting. As of 2006, the birth rate for 15-19 year olds started to rise whereas it had fallen steadily by over 30% over the previous 14 years.

The easily accessible internet can be a tremendous resource for teens most in need of information. I will be following with interest to see where advice is coming from and how supportive bloggers actually are of these young, vulnerable parents.