Thursday, July 23, 2009

Heads Up: You CAN"T walk and text at the same time!

This week the media have focussed on the dangers of multi-tasking while driving. A resurgence of some old data shows that the risk of an accident while talking on a cell phone is far greater even if one is using a "hands-free" system. In my experience, hands free is rarely so--either because the earpiece needs adjusting or because hands are required for dialing. Recent work has shown that using a cell phone increases the poor coordination and concentration necessary for driving to the equivalent of a blood alcohol level of 0.08, the legal limit!

A 2009 study in the professional journal Pediatrics highlights another danger of cell phone use among young people worth considering. It really is no surprise that crossing the street while talking or texting has its own risks. While the study was done in kids, I think the lessons apply to all of us who have a hard time clamping off the technological umbilical cord.

In this study middle schoolers were tested in an ingenious interactive virtual environment. The kids who were on the phone were less likely to look both ways before crossing the street. They were more likely to be hit by a car or have a close call when crossing.

Since phone use has become second nature for so many of us, we need reminders that we should adjust our bad habits. Here are a few suggestions:

  • Crossing guards in our communities should warn kids about crossing and cell phone use.
  • Tell your kids to remind you while in the car together that you should get off the phone or let them take the calls!(Kids love to reprimand their parents)
  • Put a sticky reminder on your child's dashboard.
  • Remind your spouse to set a good example.
  • Ask your taxi driver to hang up if he is driving you.

Monday, July 13, 2009

Yuck! Doctors' Cell Phones Are Gross!

I was recently at Montefiore Hospital with a patient and noticed a sign on the spotless waiting room wall: "Have we washed our hands? It's ok to remind us!" I though how mortified I would feel if a patient had to remind me to wash my hands before doing a physical exam. And now there is something new to remind your physician about in order to keep you healthy.

A recent study published in the Annals of Clinical Microbiology and Antimicrobials was conducted in Turkey. Two hundred health care workers had their hands and their mobile phones swabbed and cultured. Fully 95% of the phones were contaminated with bacteria. We would not expect them to be sterile. However, over half of the phones were contaminated with Staphylococcus aureus, of the variety called MRSA that has acheived notoriety recently because of its resistance to more common antibiotics.

So imagine if your doctor has greeted you, washed her hands, begun to chat with you then interrupts to answer her cell phone. What usually happens is that she would then snap the phone shut, apologize (you hope) and resume her conversation or exam with you. OOPS, bacteria have now been transferred to you from the phone. Can you be courageous enough to remind her to wash again? Can she be gracious enough to accept your observation, new-found knowledge and chutzpah?

I suggest you try if the situation ever arises. It would be a true litmus test of a doctor's compassion, conscientiousness, and ability to learn. And maybe this message should go VIRAL!

Thursday, July 2, 2009

Do campers need Tamiflu for "Swine Flu"?

Several calls have come in this week from parents who are inquiring about swine flu (novel H1N1) virus. The story is usually something like this: a few kids have been "definitively diagnosed" with Swine Flu and the camp has sent home an email letting parents know their children, in spite of their best efforts, have been exposed. They are being asked to call their pediatricians and ask if they would like the exposed (but not yet ill in any way) children to have prophylactic Tamiflu, the most commonly precribed anti-viral drug for prevention and treatment of novel H1N1 influenza.

My philosophy and that of numerous other experts(American Academy of Pediatrics, Centers for Disease Control, and New York State Health Department) is that prophylactic medication is not indicated for the vast majority of patients. If a child has labile asthma, or heart disease or is on chemotherapy or is otherwise in a weakened immunologic state and particularly at risk for complications of the flu, prophylactic medication may be indicated.

If a child comes down with typical symptoms of the flu (fever, headache, body aches, cough, and cold symptoms) Tamiflu can be given within 48 hours of the onset of symptoms. Even then, it only mitigates the illness by about 24 hours. And although this is anecdotal, this year's H1N1 flu seems to be fairly mild, causing illness for only a few days.

My personal feeling is that for the majority of people this flu is a fairly mild illness and I would just as soon we allow our children to develop some natural immunity. Natural immunity is the reason that most people born before 1957 have not had this flu. The flu virus from those years had some genetic resemblance to this current H1N1 and most adults over age 52 are actually partially immune due to exposure in childhood.

Another reason that prophylactic medication (usually given for 10 days) does not make sense is that exposure will not cease after ten days. Are we to give Tamiflu all summer long to campers as more and more kids turn up with the illness?

Fortunately this "Pandemic Flu" has not had the scarey consequences that were originally feared. It is unfortunate that the concern and planning that so many school districts went through this Spring is now transferred to camps. And of course the extraordinarily rainy weather has not helped any of us. Campers are huddled together indoors in relatively unsanitary environments because lightning could strike at any moment outside! If only it meant we saw more of the "Dear Mom, Dear Dad" a result.