Tuesday, July 27, 2010

Book Review: Girls on the Edge

From time to time it is valuable for me to browse the aisles of the library or bookstore to see what is new on the "parenting" shelves. Girls on the Edge:the four factors driving the new crisis for girls by Leonard Sax, is a fresh look at some of the problems I see in my office every day. Sax who is a family physician and a psychologist singles out four issues that he believes contribute to what he sees as an epidemic of angst and an ill-defined sense of self among US girls. These four are:
  • confusion over sexual identity or how girls are confusing sexuality with premature sexualization
  • the cyberbubble or how excessive social networking replaces real friendships
  • obsessions or how the pusuit of thinness, a fit body, or other notions of perfection lead to disaster
  • environmental toxins or how chemicals in our midst may be contributing to early puberty and sexualization.
To me this is a waste basket of current hot-button issues, and the book moves quickly from interesting and helpful observations to unproven speculation. One strong aspect of the book is Sax's discussion of the impoverished souls and spiritual lives of many teenage girls. This is a common theme among the prolific evangelical Christian writers for parents, but it is interesting to see Sax handle similar issues from a more ecumenical perspective. He discusses the "anorexia of the soul" of many of the driven, over-achieving, stressed and fragile girls he describes.

I would give this book a Bminus, but would say it is worth a quick read (from the library) and may galvanize parents to be more and more aware of the cultural pitfalls that await teenage young women.

Wednesday, July 21, 2010

"Meet my Sister, Ana Rexia"

In Spring and Summer it sometimes feels to those of us in adolescent medicine as if patients with anorexia, bulimia and other eating disorders simply come out of the woodwork. These patients are enormously consuming of time, energy, effort and empathy, not to mention their parents' funds. Many of them take months if not years to recover and during this time their parents are often forced to focus on the patient to the exclusion of themselves and their other children.

In the Journal of Adolescent Health this Spring, four clinicians from Toronto Sick Children's Hospital conducted a survey to evaluate the experiences of the siblings of twenty siblings of adolescents with an eating disorder (AED). Following are quotations from their interviews with these 10-18 year old siblings that illustrate some of the key themes they discovered. Anyone who has lived with a friend, child or sibling with ED will recognize the issues:

the struggle to understand:
"Yeah it's like, when people are saying 'what is wrong with those people;why don't they just control it', you feel kind of defensive but you're thinking the same thing."

acute awareness of ED behaviors and thoughts:
"I hear (people saying)'I'm fat' a lot more than I used to and I hear 'I need to go on a diet'...a lot more."

challenges in understanding non-eating-related obsessive behavior:
"When she is ready to go to school, she would tap the pencil on the table. When she's brushing her teeth she has to touch the tap. Once I tried to stop her from doing this and she said, 'no I have to do it.'....Why do they do those things?"

increase in family conflicts and arguments:
"My parents fight if she doesn't eat and she doesn't want to eat. So it's kind of weird because all you hear is yelling and stuff just because she's not eating."

compassion and concern for the AED:
"...you can't not think about it. How can you not think about it when someone who you love is just suffering?"

overwhelming sense of responsibility for the AED:
"...I blamed myself for that. I don't know, I just thought 'what did I say?' or 'what did I do that made her feel she wasn't good enough?...Maybe I should not have said, 'those pants are too small."

pervasiveness of the ED in all aspects of the siblings' life:
"sure it does affect the way I see myself and it does affect the way I see the world; the way I see my sister, our relationship; how we used to talk and how we used to laugh. We don't do that as much anymore."

The conflicts, pathos and compassion in these comments is often forgotten in the intensive programs organized around the AED. As with any sibling of a chronically ill patient or of a special needs child, their special concerns need to be elicited expressly since they are often left out or left home while the parents and patients' needs are addressed. What this study shows is that these collaterally affected siblings could be some of the strongest allies in the therapeutic team. But it's clear that we need to specifically address their own needs too.

photo credit: www.hypericum.wordpress.com

Monday, July 19, 2010

Extreme Sport/Extreme Heat

These days you hear bits of advice everywhere about staying hydrated and exercising in this hot and humid environment. So here is a bit of advice I solicited from my son, Justin Merolla, who completed the New York City Triathlon yesterday.

For those who don't know, a triathlon means the athletes complete a 1,500-meter swim(in the Hudson River), a 40-kilometer bicycle ride and a 10-kilometer run, ending in Central Park, all executed as quickly as possible, moving from one event to the next in a seamless, organized way.

The photo at the left is Justin running in the New York City triathlon exactly one year ago when it was 97 degrees at 11 am! Yesterday was barely different. So from someone who knows and has trained extensively and intensively are some words of advice on hydration. This advice holds especially for endurance athletes but any tennis, football, soccer or field hockey player who is training now (or later in August when this weather is even more common) should listen up:

  • there IS such a thing as drinking too much water-hyponatremia (or a low concentration of sodium in the blood can be potentially lethal).
  • hydrating properly does not only mean 'drinking water' - it also means replacing salt lost through sweat (sodium and potassium). One way to tell if you sweat a lot of salt is simply to compare the taste of your sweat to the taste of tears. Hmmm (hard to do).
  • cold drinks are better - most of the calories burned during exercise go towards body temp regulation, especially in July!!! Drinking cold drinks will bring down the core temperature faster and preserve internal body fluids which otherwise would be lost in sweat, the body's cooling mechanism.
  • hydrate to prevent dehydration - which is self explanatory, but by the time you feel thirsty, you're already in trouble
  • you sweat more than you think - you can lose up to 1 liter of sweat per hour during exercise.

Any coach, trainer, player or parent who thinks it's ok to overdress (eg in football gear) and decrease the ability to cool by sweating should be advised of his or her error. When sweating profusely an electrolyte drink such as Gatorade is the way to go.

The human body can adapt to incredibly harsh conditions. But there is no substitute for training, nutrition, focus and willpower. And then those shoes from JackRabbit in New York!

Please send up three cheers for Justin's accomplishment!

Wednesday, July 14, 2010

A Doctor Takes a Look at Bad Kids

Ghetto parenting? Ouch.

Apparently the Chicago Sun-Times writer Mary Mitchell who is African American has caught some flak for her recent article about poor parenting. “Ghetto Parenting Dooms Kids: Deck Stacked Against Those Who Were Raised in the Streets" describes horribly poor parenting such as leaving kids with neighbors so that you can go hang out on the street or cursing at or around kids, or brawling with your spouse. These behaviors are obviously not limited to the African American or the urban/ghetto community and for this perceived assumption, Mitchell has had some serious feedback and scorn. It makes common sense to most of us that this kind of parenting is likely to lead to unleashed kids with school troubles and ultimate failure.

I am intrigued that in the New York Times this week, Dr Richard Friedman wrote about good parenting that results-in spite of best efforts- in offspring who behave as "bad seeds." His article poignantly tells of his professional experience with a family whose son just turned out "badly" in spite of what seemed to be "good enough" parenting and a loving environment.

Even though Friedman's article is encouraging and expiating for the thousands of families who are pained by the antisocial, disruptive or even criminal behavior of family members, Mitchell's nearly simultaneous article reminds us of the balance of nature and nurture. In the end we must be humbled by our childrens' success as much as by their misfortune or mistakes. How we adapt, how we carry on, and how we keep our balance without punishing ourselves or renouncing our ongoing responsibilities to ourselves, our partners, and our other children is what really matters in the end.

photo credit: http://www.independent.co.uk/multimedia/archive/00147/pg-14-teenagers-ala_147614s.jpg

Monday, July 12, 2010

Shame on them!

Just when I was thinking about which subject to blog on this afternoon I got a call from a patient. She is twenty and after a year of severe anxiety attacks and many ER and office visits, she has been stable and working at a well known sandwich chain.

She called me because her health insurance is terminating since she is no longer working "full time." "How many hours are you working?" I asked. Turns out she is working thirty eight hours a week, and they won't let their employees work any more because "Guess What?" They would be obligated to pay health insurance!

My anemic suggestion to my patient was to try to see if she can be covered under our state health insurance plan since she is not 21 yet. I'm not optimistic. It seems to me that when corporations want to hold on to money that they should be spending for the welfare of their employees (in the case of my patient) or their clients (in the case of insurance companies) they do a really good job of not paying out.

There ought to be a law. Laws are needed when people and their companies don't do what is right on their own. It's no wonder young adults can't move out of their parents' homes. They simply cannot afford it. Shame on someone.

Tuesday, July 6, 2010

The End of Men?

In this summer's issue of The Atlantic Hannah Rosin makes the case that we are close upon a major change in the roles women and men play in our world. Armed with facts such as "according to the Bureau of Labor Statistics, women now hold 51.4 percent of managerial and professional jobs--up from 26.1 percent in 1980...and (women) make up 54 percent of all accountants and hold about half of all banking and insurance jobs" she describes a "role reversal" that is troubling even to a feminist from the 70's.

There is a change afoot that Rosin argues is primarily a fundamental shift in the economy. She notes that more mens' jobs have been lost during this recession. Traditional male jobs--construction, manufacturing, and finance are slipping away. Rosin argues that women have better communication, multi-tasking and team working skills. These are all skills that are prized now in the era of Internet transactions and rapid global information exchange and business.

Unfortunately she paints a gloomy picture of women ruling the world and the home, leaving incompetent, lazy, unmotivated men in their dust. As the mother of young men and the doctor to many young men and women, I have absorbed Rosin's ideas and pledge to look with renewed commitment at ways we can bring the boys, young men, and men along on this journey. Maybe women are temporarily better suited to the challenges of our new world but let us continue to believe that this pendulum shift of power and influence will eventually bring all of us to a happier middle ground for all.