Saturday, December 31, 2011

New Year's Resolution to Diet?


With 2012 only hours away, many are scrambling to assemble their resolutions and for millions of us, teens and adults alike, this list includes renewed efforts to improve diet and exercise more.  While obesity is a growing international problem, we all know that weight watching can lead to serious health problems, both mental and physical. 

Following are a few warning signs that a diet may be misguided or inappropriate:

  • The desire to lose weight seems more motivated by emotional than health factors. “I’m not popular because I’m fat.” Or “If only I could get rid of my stomach I’d be happy.”

  • A person signs on to a drastic change in lifestyle. " I’ve decided to become a vegan in 2012.” Not only is a vegan diet (void of all animal products, including cheese and eggs) very difficult to do in a healthy manner, it is usually high in calories and hard to maintain.  

  • You are quite sure that your daughter is at a normal weight and do not think dieting is necessary or safe. If any degree of struggle or disagreement arises between you over this issue, it is best to turn to a professional who can assess the teen’s weight and health status and explore the psychological and emotional motivating factors in order to provide guidance.

  • You see evidence that your teen, young adult or friend is using caffeine, laxatives, diet pills or is even vomiting to control intake and weight. These are obvious signs of an eating disorder, which can quickly become a chronic and recalcitrant disease. Intervene as soon as possible.

  • You see a marked increase in concern over fat content of food, accompanied by scrutiny of food labels, avoidance of previously favorite foods, and “fear of fat.”

  • You note an uncharacteristic and perhaps unsustainable level of physical exercise that accompanies someone's new resolution. In an era when most Americans are not getting enough exercise and spending too much time in front of various screens, there are still many who use excessive exercise as a tool for weight loss and body changes that may not be appropriate. 
These concerns apply equally to girls, boys, women and men.  The latest issue of Contemporary Pediatrics in fact, discusses "Disordered Eating in Boys," and points out that a desire to gain weight (whether in the form of muscle or bulk) can signal an unhealthy attempt at body modification just as much as a wish to lose weight might.

With respect to this resolution, there is no more apt wish than to  "Have a Happy and Healthy New Year."

image from richardwiseman.files.wordpress.com

Tuesday, December 27, 2011

Home for the Holidays


Whatever we are asked to call this period of time at the end of December, whether it's religious or festive, in my family we try to make a bow beyond just the secular to both Christmas and Hannukah.  However, as the kids get older and the precious time together seems more and more compressed, we spend less and less time with the traditional prayers, stories, and services than we do with the catching up and laughing, making merry, reveling in the special lights, and treasuring moments together.

For a long time, I like many moms before me, have made a ritual of cooking and preparing and creating a vast reception for the hungry appetites I know will land on my doorstep.  So over the years, I have worked to accommodate the expanding dietary rules, limitations, limits, and experiments that my growing brood requests.  This year I scoured Epicurious.com as well as my shelf of cookbooks for the perfect dishes that would accommodate the vegetarians, the kosher-observant ones, the meat eaters, and the simple gourmets among them.   With apologies to the lactose intolerant in the group, the baked Alaska "took the cake" this year with its drama and elegance and in the end, once we got over our disbelief and anxiety, its simplicity.

But no matter how hard I try and no matter how grateful and simply full everyone is, coming home brings  certain culinary calls.  Among them are the local sandwich shops that generate a debate among sibs over which has the best wraps or cranberry sauce.   The homing phenomenon was clear late on Christmas Day when the tired and overfed group decided to honor a Jewish tradition and order Chinese food.   From the very busy and stalwart restaurant right around the corner, they ate one of our long time standards: Chinese cold noodles with sesame sauce.  One of my adult kids gratefully announced: "The great thing about cold noodles is that they still taste just like they did in sixth grade."  Nostalgia strikes again.

No matter how sophisticated their palates might have become through travels and experiences beyond imagining, the tastes, flavors and happy experiences at home mingle and linger a long while in our minds.  And that is the blessing of togetherness no matter what's on the menu. 

image from zazzle.com via Googleimages

Tuesday, December 20, 2011

One in three teens and young adults arrested?


Usually, I can trust the New York Times to report accurately and scientifically about stories and research they pick up in the media.  I have not been alone in the past few days in feeling shocked by the article, "Many in US are Arrested by Age 23, Study Finds".   They were quoting from a new study reported in the well respected journal Pediatrics  that looked at a national sample of adolescents and found that over 30 percent of "23 year-olds had been arrsted for an offense othern than a minor traffic violation."

Upon closer reading of the actual article in Pediatrics we discover that what the study looked at was  the "cumulative proportion of youth who self-report having been arrested or taken into custody for illegal or delinquent offenses (excluding arrests for minor traffic violations) from ages 8 to 23 years." 

According to WatchingtheGov.com "the study captured arrests for all offenses other than traffic violations, including underage drinking, shoplifting, truancy, robbery, assault and murder. Most teens who are arrested are cited for minor infractions and don’t end up imprisoned."

Lots and lots of kids are in and out of the legal system for offenses related to alcohol and marijuana. Is this the reason for what appear to be high numbers? The data did not separate out information by race or socioeconomic factors. How would it look if we could see it that way?  We know that young black men have a much higher chance of being arrested on similar charges than white teens and young adults. 

Commentary from the liberal  blogoshpere tends to blame the police, the criminal justice system, drug laws, and anti-adolescent bias in our culture. Look at this comment:
"The long term hang up of hair trigger arrests and kangaroo prosecutions is the (sic)we are creating a population of certified losers unable to ever recover. In other words, the cradle-to-prison pipeline is becoming more voluminous. People mired in this apparatus cannot get credit, cannot get employed, cannot get housing, cannot be admitted to practice a profession and are likely encouraged to continue in a life of crime to feed themselves."

For parents and pediatricians there are a number of important ways to think about this data. According to Robert Brame, the lead author of the study and a professor of criminal justice and criminology at the University of North Carolina,  "teens who wind up in trouble with the law tend to have early risk factors, such as having a troubled family, childhood behavior problems or difficulty in school."   Many of them are also mentally ill or have treatable problems like attention deficit disorder, anxiety and substance use.  It's the responsibility of the caregiver and the school to identify these students early on.

But we also know from nationally validated data that a lot of otherwise high functioning kids who star on our athletic teams and go to good colleges end up on the wrong side of the law whether they are caught or have such an encounter on their permanent record.  Sometimes it's an issue of  Halloween pranks, reckless driving, loud parties, and other "forgivable" things "teens just do," but it often is behavior that the law is managing because parents are not.  Communities, clergy, schools, parents and teens can work together to define the extent of kids' risky behavior and respond accordingly.  Responses can include programs for those who drink too much, community service for arrests, and other constructive ways of meting out justice.

No teen should be scarred for life, unable to get ahead and without a chance at restitution for behaviors that are commonplace. Nor should communities begin to accept that a criminal record is a right of passage as normal as a bar mitzvah, confirmation or a prom.  But I, for one, might be proud of my kid if he or she were arrested at an Occupy demonstration these days. 

image from bagnewsnotes.com via Googleimages






Monday, December 12, 2011

What does hockey say about us?


I was thoroughly mesmerized last week by the three part series in the New York Times by John Branch about the life and death of Derek Boogaard entitled "Punched Out: The Life and Death of a Hockey Enforcer."

First of all, the writing itself brought me to tears as I learned about Boogard's early years and the dedication of his parents that now seems almost pathological.  I imagined them driving him in the dead of night across hundreds of miles of Canadian tundra to participate in the national sport that they thought might rescue him from his gargantuan body and his young mind that could not succeed in a classroom as well as it did on the ice.

Then I was stunned by the ferocity and the ghastly descriptions of the brawls and the gladiator-like job of the enforcer, a player whose function is to literally take the gloves off and fight to frighten and intimidate the opponents.  Whereas there might be a graceful quality to hockey (one of my sons played high school varsity hockey and I can still hear the scrape and swish of the steel on the ice, but I can also remember the police presence at the games with particular opponents, "just in case.") and the elegance of a well played goal is undeniable, the presence and encouragement of the enforcer turns the game into a spectacle and a brutish game where violence an mayhem are encouraged. 

Finally, in the third article in the series I was saddened by the photos of his parents who perhaps thought they were doing the right thing; of his brother who protected and enabled his drug dependency for years; and by the shocking revelations that many of the players who sustain his degree of battering during their short lives are suffering from degenerative brain disease much like the football players we followed in the Fall.   So now it's winter and once again we are asked to ponder the morality, yes the morality of this sport that intentionally inflicts damage on young bodies and brains for the sheer enterntainment of it.

 Over the past few years as I have had the privilege of seeing athletes with head injuries and have been able to folllow them with sequential visits and Impact tests I have learned that many of these athletes are not playing for the joy of the sport.  Very often they are playing to satisfy a parental or family expectation or as a way of compensating for some perceived weakness in some other sphere of their young lives.   When they are finally pulled from the rink or the field because of injury many of them will confess to some relief at the drop in the pressure and the loss of fear of injury they experience.  As one reader wrote in the Times: "This series should be required reading for parents, coaches and children wherever hockey fever reigns."

For a previous blog post on a youth hockey team in Minnesota that is successfully encouraging more elegant and less dangerous play see this post called "Why I love Minnesota."

image from dialecticmagazine.com

Wednesday, December 7, 2011

"Dad, can we go out for a drive?"

If the teen asking this question is a newly minted driver, of course the answer should be "Yes, sure. Where do you want to go?"  Drive time is precious for conversation, for teaching and for assessment of the driver's skill. To corroborate this, a new study from Virginia in the December issue of the Journal of Adolescent Health suggests that crash, near-crash, and risky driving is significantly reduced in novice teen drivers when a parent is present.

That might not seem too surprising except that in practice in the real world we often need to remind parents of adolescents that their presence is critical in raising good offspring, whether it's good drivers, students, siblings or responsible drinkers.  Most of us accept that risk taking and adolescence go together. But, in an accompanying editorial in the Journal it is pointed out that teens do seem to know how to curtail risky behavior when a grownup is around.  So it's no surprise that parents lowered the rates of crashes/near-crashes by 75% and the rates of risky driving (measured by an ingenious on-board computer that recorded g-force, acceleration, gps data, and images of passengers) were lowered by over two thirds with a parental presence. 

What is interesting, however, was that the presence of "risky friends" (based on a questionnaire filled out by the teen driver) doubled the likelihood of a crash/near crash or risky driving.   As parents can we choose who drives around with our kids?  Can we help them avoid the peer pressure of encouraging unsafe or distracted driving practices?  Graduated driving programs have mandated the number of non-family member passengers and effectively reduce crashes. But it's not always possible to choose the friends who jump in the car in the high school parking lot once the graduated period has lapsed. But it may be worthwhile reminding one's own "risk-taker" child about the impact of like-minded friends in the car.

The third finding in this study which is a bit surprising is that kids drove in a more risky way when they were alone (allowed in the state of Virginia for new drivers) than when they were with peers of a non-risky sort.  This is a small study which would need repeating but gives us pause about unaccompanied young drivers. 

What is the lesson?   Kids are probably at their absolute best when a parent is around. So if there is any doubt about "road readiness" when Mom or Dad is in the front seat (or in my personal experience if the approval of a responsible older sibling is in question) more practice time should be in order before letting that tether out any further.

Wednesday, November 30, 2011

Tell the Grandparents You Know About Pertussis

Here's a heads-up about a subject that pediatricians are more aware of than many internists and other clinicians who care for older kids and adults.   Pertussis, or whooping cough, caused by the bacterium Bordetella pertussis, remains a serious cause of illness and even a threat to life to young infants.  Although most people have had immunizations against pertussis during childhood, their immunity or ability to fight the infection can wane with age. 

It is now recommended that a single dose of Adacel, the vaccine against tetanus which is combined with pertussis (it works better this way) be given to "all adults 65 years of age and older who have or are likely to have contact with an infant aged younger than 12 months." according to the November 2011 Infectious Diseases in Children newsletter.  This includes pediatricians who refuse to retire, grandparents who have contact with their childrens' children, and day care workers who may unwittingly expose babies to whooping cough.

In older children and adults, pertussis is usually an annoying and sometimes prolonged illness. But in very young children it can cause pneumonia and even sudden death. If you would like to actually hear the sound of the whoop click here. Here is a quote from my own mother's memoir about having whooping cough during a tornado in South Dakota:
In 1929 when I was one year old, I had whooping cough, and a tornado came to our farm.  Since I was very sick (they said I would whoop so much, Pop would hold me upside down to hopefully catch my breath), my folks did not want to take me out into the stormy weather in order to get to "the cave" for shelter.The cave was a storm cellar underground about 50 feet away from the house..... we would seek safety there, even in the middle of the night, when "the weather looked bad".  And so, the family descended to the "cellar" under the house itself. I remember none of this, of course, but heard, stories of "The Storm" as I was growing up and we played "house" with the broken dishes and pots and pans in (my grandmother's) grove of trees across the road. These fragments blew out of our house and ended in those trees.
And I feel respect and wonder at how my parents survived after sitting down there in the cellar, hearing the banging of boards and crashing of glass, (and holding a sick baby).
Dramatic, right?  Any respiratory distress, even in an adult, can be frightening.  Fortunately this degree of disease is preventable.  So, if you have friends, relatives, housekeepers, or caregivers who may be in contact with infants who are not yet fully protected through immunizations until about a year of age, encourage them to get the Adacel vaccine to protect themselves (from tetanus and pertussis) but mostly to protect the young ones in their midst.

Monday, November 21, 2011

The end of an era for me

 As 2011 draws to a close so will ten years in private practice.  As of January 1, 2012 I will no longer be with BridgeSpan Medicine in White Plains.  And I will no longer be practicing primary care for teens and young adults in Westchester.

I will be working as one of the doctors on the multi-disciplinary team of clinicians in the student health center at Barnard College in New York City.  I will be available to undergraduates for primary care, consultation and referral.  I will work side-by-side with nurse practitioners and mental health providers.  And I look forward to participating in mentoring and working with  Adolescent Medicine fellows in training.

My current patients have many options.  They can continue their primary care at BridgeSpan Medicine with Dr Brooke Balchan and her associates from Westchester Park Pediatrics, Drs. Avvocato, Ross, Wurzel and Eisenberg.  And they will be able to access specialty care via a network of fine practitioners throughout the metropolitan area.

In many ways this job is a natural progression for me from being a general pediatrician over 25 years ago when I grew somewhat expert at infants and pre-schoolers as I raised my own tots.   As they grew I was lucky enough to immerse myself in the issues of elementary school, special needs children and parenting.   Over the past fifteen years, my focus has shifted to adolescents and the concern of raising responsible, content people in our culture and how pursuing those goals can affect their health-and that of their parents.    Now as my own children are of college age and beyond, I am called to play a role in the health and well-being of  emerging adults. And how thrilling that is.  I have long thought a job in college health would be a dream for me, and now is the time.

Of course no decision like this comes lightly.  I have struggled for the past decade with the compromises I have had to make with our health care system as it has tried to grow up.  But it is a disabled patient with many handicaps and has lost its way.   As the mammoth insurance industry, unregulated and driven by bureaucracy and profit, has become the conductor of this cacaphonous symphony, the players have lost their music, lost the tune, and are struggling to play in harmony.  I am choosing to move to a smaller quartet, where I can still hear the voices of those next to me and play the classical music of healing that I was trained to deliver.

Many of my patients move in a space in my psyche in much the same way my own children do and I will miss them very much.  Parents I have come to know through tears and laughter will also be sorely missed.  And my colleagues, especially those in the mental health and education arenas, who have taught me so much about doctoring and caring, will be missed as I carry their lessons forward with me.

image from sapphirelane.com via Google

Tuesday, November 15, 2011

Dinner Table Conversation about Sex






Have fun at dinner tonight with your teens and see if they can guess the right answers on the following questions about teenage sex.*   All data comes from the recent survey from the Centers for Disease Control and their Vital and Health Statistics Report from October 2011:

*Among females ages 18-24 who had their first sexual experience (here defined as intercourse) before age 20, how many of them really wanted it to happen then?  (Answer 41%)

*What percent of boys who had sex before age 20 "really wanted it to happen at the time? (Answer 63%)

This in itself could generate some interesting discussion but if that's not enough to get you to dessert, try these:

*What percent of teen females and males had their first intercourse with someone  "they were going steady with?" (Answer for females: 70% and for males: 56%)

*What percent of females ages 15-19 use a form of contraception at first intercourse? (Answer: 78%)

*Is having an older partner at first intercourse associated with a greater or lesser likelihood of using protection at first intercourse? (Answer: lower likelihood) Be sure to talk about pressure from the Big Boys and Girls.

*What percent of females use non-pill hormonal contraception at first intercourse? (Answer: 6%)  These methods include vaginal rings, injectable and implantable hormones, and emergency contraception....all worth discussing or looking up)

*What percent of never-married teens (15-19) have had intercourse at least once? (Answer 43%)

These are interesting data and are getting a lot of play in the media.  I would point out however, from my reading today of the original document that no questions were asked about non-heterosexual experience and the rather narrow focus on intercourse as an "endpoint" begs the question of what we have discussed elsewhere about the increases in oral sex among both heterosexual and non-heterosexual teens with all the incumbent risks.

*Remind them that you are not fishing around for personal information merely wondering what they think of the data.  Right, Mom.

image from blogs.howstuffworks.com via google

Thursday, November 10, 2011

What should we do?

 Recently a patient asked me what I thought about the Occupy Wall Street movement.  I mumbled something about how I admired the courage to speak out against injustice and inequity but how I worried that their message was being dissipated by a motley group of folks without a clear goal.

I soon realized that was a cop-out.  What movement is well formed from its outset?  What change is brought about in a tidy fashion?  I soon wished I had said something different.

Then at a recent prayer service at my synagogue, Larchmont Temple, I read the following in the siddur, or prayerbook, written by Rabbi Sydney Chayet, a professor of history and a poet:

We oughtn't pray for what we've never known,
and humanity has never known:
unbroken peace,
unmixed blessing.
No.
Better to pray for pity,
for indignation, 
discontent,
the will to see and touch,
the power to do good and make new.

What Occupy Wall Street might represent for many is in fact this holy indignation, this drive for improvement and for a more moral and meaningful life.  We should be proud and pray for more people like these who are agitated  and discontent and are asking us to look for better ways to make our socity anew. Stepping out of our comfort zones and into a place that is uncertain, but certain in its pursuit of justice and fairness, is a healthy thing.  I would encourage my patient, my children and my friends to go find out what they have to say and what can be carried back home, to school and to the workplace.

image from salon.com via Googleimages.com


Sunday, November 6, 2011

“Dad, what kind of work do you do?”



As I gather a family history from a new adolescent patient and parents, I usually pause for an entertaining interlude to ask the teenager how old her parents are. Usually she will smile while the parent coyly looks away and the child guesses, often within two or three years of the correct number. After that I inquire about what kind of work her parents do. If mother is a “stay at home mom”, the way in which this is described by her children can be most interesting. Responses have ranged from “she doesn’t do anything” to “she makes sure we are all ok.” Fathers are frequently more complicated and often require a mother’s help to explain.


Recently a sixteen year old answered that her father was in “venture capital” and when I asked what that means to her, she said:”I don’t know.” Nor did the mother know. “We love and respect him,” she said, “but we can’t really explain what he does.” Even when pressed I could not elicit the vocabulary that might explain what his work involves.


So this got me to thinking about Occupy Wall Street, the dissatisfaction so many feel with our “system” and the disillusionment of many youth about their own prospects for success in the current economy and structure of our country. The sense that they have lost control over their destinies leads to the notion that finance and banking are the only means to become truly successful (unless of course they have gifts in the athletic department.) But maybe they don’t even know what bankers and financiers really do all day.


It strikes me that if one cannot share the nature of work with family and talk about the joys, frustrations, pleasures, and pitfalls of one’s job, then there is a badly missed opportunity for teaching our children about making choices and self definition. Not to mention the value to a parent of the intense scrutiny of a smart adolescent who is exploring the world in a moral, political, economic and social sense. As Anderson Cooper calls it: “keeping them honest.”


Here are some questions to start off a discussion* aimed at understanding the world of adult work and the complex decisions that go into choosing a career, seeking and responding to a “calling” and keeping values on track as one prepares for the future:


What is your kind of work called?


What do you actually DO all day?


What do you like about your job?


How did you get started in your work? Why did you choose it? DID you actually choose it?


Do you wish you could do something else? Why don’t you?


What is important to you about your work?


Is it important to make a lot of money?


Do you think the world is a better place because of your work?


What are your hopes for me and my work life?


*clearly these questions are not just for fathers, but can be valuable for any working person, professional or even grandparent

image from easypuppets.com

Saturday, October 29, 2011

A Great Way for Students to Give Back: AFYA

I first heard about AFYA when I returned from Haiti after the earthquake in 2010.  Right in our backyard, in Yonkers and run by Danielle Butin, AFYA is an extraordinarily efficient and well organized not-for-profit that collects medical and other supplies from individual, commercial and medical sources and responds to the call for them from around the world.  When I first met her, what impressed me most about Danielle 
was not only her spirit and energy but the tremendous organization of her vast supplies.  I saw row upon row of packed and tidy shelves labelled "Pediatric cardiology" or "Gastroenterology" and an entire room of drugs and pharmaceuticals in properly labelled bins.  This doesn't happen by itself.  Volunteers are taught to do this and in short order accomplish a small miracle which allows AFYA to continue its work around the world.  Please look at their website and consider organizing a group of friends to contribute your community service hours to this wonderful cause:

Calling All School Age Volunteers!
On Saturday, November 12th, AFYA is sponsoring a 16-hour sortathon, where we will celebrate and honor our teenage and young adult volunteers. At the Sortathon, volunteers will sort, inventory and pack supplies for 2-hour segments and contribute enormously to global health. We have a full day of entertainment and amazing, moving speakers lined up.

Start a team or work independently - there will be gifts for all, and prizes as well! We're expecting lots of participation, so register early and make sure to choose your two-hour shift of preference.

Please visit and share our brand new Sortathon website:  www.Sortathon.afyafoundation.org
to register and find out the details about this event -- participants will
contribute to the improvement in health for thousands abroad. Registration will require a $25 tax deductible donation.

Please help us to get the word out -- send this sortathon link to everyone you
know!

Thank you!
MORE

Wednesday, October 26, 2011

Readin' Writin' Rithmetic and Relationships

I am pleased today that my professional organization, Society for Adolescent Health and Medicine, and its president-elect,John Santelli, have come down from what is frequently the organization's ivory tower in the clouds to comment on the sex education program that is going into effect in New York City schools.  Along with Arik Marcell,  a pediatrician from Johns Hopkins, their op ed piece is a smart and compassionate answer to the October 19 Op-Ed piece entitled "Does Sex-Ed Undermine Parental Rights?"

In that article the authors painted an unsavory picture of young middle schoolers exploring all sorts of "solitary and mutual sex acts" using flash or "risk" cards.  This is what they imagine the new NYC Department of Education's requirements will consist of and fear that parents will lose control as "the effect of such lessons is as much to promote a certain sexual ideology among the young as it is to protect their health."

But Santelli and Marcell help us to see this new educational mandate in a different way:

"...public health is built on the twin pillars of scientific understanding and human rights, not ideology.
Children and adolescents are developing human beings, with rights to protection, to health and to education — and sexuality is a normal and vital aspect of human development. Comprehensive sexuality education equips young people with information they need to protect themselves against sexually transmitted infections and unplanned pregnancy and to adopt healthier sexual behaviors."
No matter what the curricula turn out to contain, parents can still have a lock on the values and morality and the when (and maybe the how and with whom) of sexuality in their children.  In fact, multiple studies have shown that kids want to know how their parents feel about sex and what their values are.   But parents have not done a very good job of it. In another Op-Ed piece today, one of the teenage staff writers for Sex,Etc, one of my favorite publications (cheap, well written by teens, and sharing a diverse and biologically correct view of sexuality in teens) points out that in 2008 while 47% of girls (ages 14-18) "said they had never discussed sex with their parents, only 6% of parents said they had never discussed sex with their children."

It might even turn out that the introduction of the biology and science of human sexuality in our schools may present an invitation to parents to engage in important conversations with their kids.  Not unlike proof-reading an English paper or (attempting to) help with math problems, the course in human sexuality can open the dialogue that so many parents and kids all want to be having.

image credit from hispanicallyspeakingnews.com

Monday, October 17, 2011

What they are NOT saying about HPV....

While the political candidates hurl insults and untruths at each other about all manner of topics, there is something getting lost in the melee.   Ever since Gardisil vaccine (to protect against Human Papilloma Virus) was approved for girls, I have been telling sceptical parents that Governor Perry's early and messy endorsement of Gardisil  really bollixed it up for those of us on the front lines.  What do I mean?  In spite of a great track record of safety and efficacy, the HPV vaccine is still not accepted as widely as it should be.  This is partly  because Perry made it look like one more BigPharma boondoggle. But it's also due to the fear that we will have to discuss SEX when we talk about the shot.

But we must talk about sex.  Listen to this:

A new study in the Journal of Clinical Oncology --available here only in abstract (abbreviated) form-- brings the stunning news that HPV is contributing to a growing number of head and neck cancers (tonsils, throat and tongue).  It seems that there are two types of oropharyngeal cancers, those caused by tobacco use and those caused by HPV. Between 1984 and 2004 in a study of 6000 patients, HPV-positive cancers increased 225% while HPV-negative oropharynx cancers dropped 50%–most likely because of a reduction in smoking and tobacco use.

Abstinence from intercourse will certainly prevent transmission of HPV to the cervix but what no one is talking about in public is that abstinence and fears of pregnancy and HIV have fostered an explosion in oral sex and other non-intercourse (some call it "outercourse") activities.  Of course they look at me funny when I tell my patients that if they are engaging in oral sex (or giving "head") there should be a condom involved.  Almost no one actually does that.  And so, the HPV is being transmitted to both men and women in growing numbers.

One other problem is that there is as of yet no screening tool to detect early HPV infection or early cancerous cells in the head, neck and oral cavity.  For cervical cancer, the Pap smear has been the standard method of early detection and along with HPV vaccine is responsible for dropping incidence of cervical cancer.

"Should the observed declines in cervical cancer and the observed increases in HPV positive oropharyngeal cancers continue into the future," Chaturvedi, the principal investigator on this study, said, (then) "HPV positive oropharyngeal cancers will be the leading HPV associated cancers over the next decade–by around 2020." 

What we need is a rational conversation and some quick, good research to determine whether the vaccine actually does prevent these oropharyngeal cancers, as most believe it will. Then we need to continue to press our insurance companies to cover this vaccine for both women and men.

Finally, we need to talk about SEX before it's a conversation about CANCER.

image from halimdeichatmd.tumblr.com via google

Tuesday, October 11, 2011

My 200th Blog: What does Sponge Bob do to our minds?

I am celebrating my 200th blogpost with a fresh little article from the October 2011 issue of Pediatrics, "Fast Paced Television and Children's Executive Function." Not exactly about teens but read on.

Researchers at the University of Virginia did a neat little experiment on sixty 4-year-olds---admittedly a small sample but just wait to see the results. What they found is that only a few minutes of certain kinds of television can have a remarkable impact on the childrens' "executive function."

Executive function (EF) is quoted in the article as including "a collection of prefrontal skills underlying goal-directed behavior, including atention, working memory, inhibitory control, problem solving, self-regulation, and delay of gratification."

The kids were randomly assigned to a 9 minute epidose of "fast-paced television" (with scene changes every 11 seconds and almost constant motion on the screen); the same amount of time watching educational television(not specified but I think we mean Sesame Street); or 9 minutes of drawing with crayons and markers on paper. Before the test phase of the research the children were evaluated to show that each group was similar with respect to socio-economic facotrs, television habits and rough measures of attention span.  They were then given four tests of executive function (HTKS, backward digit recall, tower of Hanoi, and a test of delayed gratification--all age appropriate and really interesting if you care to take a look at the descriptions of the tests).  After the 9 minute TV or drawing test period the kids were re-evaluated and the following graph shows the change between pre- activity (fast-paced tv, educational tv, or drawing) and afterwards:




Essentially what we learn here is that fast paced television can affect these four year olds' minds in a way that slower paced entertainment doesn't. All of the fast-paced TV group scored worse on all of the EF tests that were included in this study.  It did not address how long this effect persists or what effect more than nine minutes of watching might have.

In an accompanying editorial in Pediatrics, Dr Dimitri Christakis compares the fast paced television to multi-tasking in older students and adults.   Multitasking is the ability to rapidly oscillate between two or more activities, similar perhaps to watching the hyperactive motion on the screen of some shows.  He raises the question of what the social and educational implications of this potential deficit in executive function might mean as we move forward. 

Is the anxiety and inability to focus (read "poor executive functioning") we see in our teens and young adults related to this fast-paced input?  Is it a result of the related multitasking that most of our kids do so "well?"
Stay tuned.



image from sandiego6.com via Google

Thursday, October 6, 2011

An Apple from the Teacher

In my morning haze, I was paging through this morning's New York Times, feeling sad about Steve Jobs when I scanned the lead OpEd piece entitled Where's the Jobs Bill?  I was thinking the editors had come out awfully quickly with an oped piece on the genius, only to realize it was another demoralizing plea for Republicans and Democrats to get along with each other.  If Steve Jobs were writing a "bill" I think it would be in a beautiful font and it would take the lessons from his own life which he so simply recounted in the now famous Stanford graduation speech in 2004.  Some of his words:

Your time is limited, so don't waste it living someone else's life. Don't be trapped by dogma — which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.
Again, you can't connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something — your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.
I didn't see it then, but it turned out that getting fired from Apple was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.



If you know a junior or a senior (high school or college) or a gradutae or even a worried child in kindergarten who might feel overwhelmed and stressed by uncertainty or feeling powerless, share Jobs words with them.  Print them out and put them on a card against the salt and pepper shaker on the dinner table tonight.  Ponder the wisdom of this man's many gifts to all of us, including his personal philosophy. And try putting the iphones away just for the length of the conversation.

image from frumforum.com via Google

Wednesday, October 5, 2011

Autism newsletter


For the family, friend, therapist, teacher or ally of a child, teen, young adult or grown-up with autism spectrum disorder (ASD), Asperger's syndrome or high functioning autism (HFA) the Autism Spectrum News paper is a trove of wonderful information.  Almost all of us know someone in our midst who fits into these broadly defined categories.   Reading the newsletter is a brilliant way to slip inside the minds and hearts of these people.  That's saying something for a segment of our population that is often ignored and misunderstood or worse, bullied and abused. 

Just a look at some of the subjects that are covered in the Fall issue:

"Important facts about adult autism employment"

"Do parents and teachers 'get' children with AS/HFA?"

The impact of bullying on individuals with HFA and AS"

"Sensory Processing Difficulties-Dressing for Success"

Even the advertisements are interesting and enlightening:

CUNY's master of arts degree in disability studies
Research centers in New York City, including Mount Sinai's Seaver Autism Center for Research
WJCS family center for community support
and
Prince's sensory delights or "sensory engineered clothing and products" for those kids who scratch and itch and fidget because their neurology is different.

Monday, September 26, 2011

Drama Can Lead to Tragedy


Thanks to Danah Boyd and Alice Marwick from Microsoft Research who really hit the  nail on the head with their article on last week's New York Times oped page entitled "Bullying as True Drama."

In my office not a day goes by without a parent, psychologist, teacher or student referring to "drama."  As Boyd and Marwick point out, though, "drama" is frequently a dangerous scrim for something much more real and harmful. Admitting to bullying, whether as a perpetrator or a victim requires "acknowledging oneself as either powerless or abusive." 


No adolescent likes to be on either side of this equation. "Many teenagers who are bullied can’t emotionally afford to identify as victims, and young people who bully others rarely see themselves as perpetrators,"say the authors of this article.  And they continue:

"Dismissing a conflict that’s really hurting their feelings as drama lets teenagers demonstrate that they don’t care about such petty concerns. They can save face while feeling superior to those tormenting them by dismissing them as desperate for attention. Or, if they’re the instigators, the word drama lets teenagers feel that they’re participating in something innocuous or even funny, rather than having to admit that they’ve hurt someone’s feelings. Drama allows them to distance themselves from painful situations."

Microsoft Research looks like a remarkable international collaboration of social science and technology that covers issues as varied as new speech recognition technology, astronomy, and using data to identify genetic factors in disease.  These are the big minds at work on the world's thorniest and most intriguing problems and part of their mission statement is to "examine social media practices through various methodological and theoretical lenses and provide insight into how social media is reconfiguring daily life."  It's a thrill that they are using their expertise in a manner that benefits some of the least empowered (and most technically connected) in our society, namely teens. 

So next time a student, patient, teacher, parent or even a therapist calls it "drama" think again about what the backstage reality is for the people involved.

image from varyfocal.wordpress.com

Thursday, September 22, 2011

Remember Haiti?

I just received an update from Partners in Healh about the ongoing cholera outbreak in Haiti.  Please click on it and read about this disease that is there to stay for the foreseeable future.
Remember PIH in your end of year giving.

Thanks.

Tuesday, September 20, 2011

LGBTQ Youth: Suicide and Depression

Youth who identify as LGBTQ (lesbian, gay, bisexual, trans, or queer) are at almost three times higher risk of suicidality compared to "heterosexual" youth. 

Let's say that another way: if your child (or one you know or care about) identifies as gay or is attracted to someone of the same sex, he or she is at much higher risk of depression and suicidal thoughts. It turns out that youth who identify as bisexual are at even higher risk.  Other behaviors and risks that run in LGBTQ youth (otherwise known as sexual minority youth or SMY) are: substance use, eating disorders, victimization (bullying) and interpersonal violence.

Although clinicians and folks who care for young people have known for some time that the suicide rates among LGBTQ youth are high, this recent study published in theAugust Journal of Adolescent Health  looked at 24 previously published studies of depression and suicide in young people to tease out some of this data.  They remind us that even in an age when LGBTQ/SMYouth are coming out at younger ages, the risks of doing so remain high.  If victimization gives rise to a feeling of hopelessness and if a child's environment is not a validating one, all sorts of behaviors from cutting to substance use and antisocial activities and school failure can be the result.

It doesn't have to be this way.

All youth should be screened at their "physicals" for their "mental" health as well.  That should include interviewing them about their sexuality.  For LGBTQ youth further queries about harassment, discrimination or lack of validation should be made and providers should be prepared to "provide appropriate care for  youth in need."

image from dosomething.org via google.com/images

Thursday, September 15, 2011

The Period Tracker Plus

For many girls it is important to keep track of their periods.  For some it's a matter of avoiding a fertile time, for others (older we hope) it's the opposite.  For many of my patients who are young and have normally  irregular periods they should be aware of the intervals between periods. Of course for anyone having sex without protection or with imperfect protection a tracker can mean the difference between discovering a missed period before it's too late or having some options and choices shut down.

Today a seventeen year old patient showed me  "My Days", an app for android phones that allows women and girls to track their periods in as much detail as they might want.  It certainly makes it easier on the doctor when she asks: "So when was your last period?" and the young patient whips out her phone to show me this:
The same tool that helps a 14 year old discover how "irregular" she really is will also be perfect for the 30 year old who wants to know when she is most fertile and most likely to conceive.   My only concern is that the 14 year old (or anyone for that matter)will interpret those days as the only ones when she should avoid having sex or unprotected sex.  In terms of pregnancy prevention and STD avoidance it's not safe to have unprotected sex at any time.  Condoms at a minimum, and a second  form of contraceptive would be the best bet.  All month long.

A Google search of the best apps for keeping track of periods revealed that all of them have ovulation, mostly hitting it rather than avoiding it, as the goal.  I have not found a simple app that is appropriate to teenage girls.  Other concerns I have with the apps I saw online at this review are that they emphasize PINK and feel ridiculously girly-girl; they hover on PMS, moodiness, and other pre-menstrual symptoms in a way I am not sure is productive; and some of them even have warnings for men to avoid their partners during certain "times of the month."



Come on! Your "fertile window"? Yikes!

Anyone want to work with me on an app for teenagers that is more developmentally appropriate?  Kotex are you there?  I remember the pamphlet I read from you about periods in the 60's.  We can do so much better with technology in our hands.

Tuesday, September 13, 2011

Bridging a Gap

I just read Tom Brokaw's book, The Greatest Generation about people born in 1920 who experienced World War II during their twenties.  He notes over and over again that this generation was ready to sacrifice education, livelihood, time and family for the country and often gave their lives in the process.  The book profiles many famous folks from that time but also some remarkable unsung heroes.  One of the best chapters is entitled "Shame" where Brokaw reveals the lives and sacrifices of Japanese-Americans and black and Latino Americans who met with  dramatic segregation and hate during the war years.

Have we learned from the mistakes of that great generation?

Over the past week or so, a despicable YouTube video montage that purports to support the notion that Barak Obama is a Muslim was shared by a family member of mine.  It struck a cord in my children who have responded with poetic personal anecdotes.  As I read The Greatest Generation, I was struck by the possible subtext that in some way the current generation of young people is somehow deficient in patriotism, humility, sense of service and willingness to sacrifice. But my own family has come forward to show that this is not necessarily so.  The following email responses (printed with permission) to the video  were sent by my family members who decided to jump in the ring to show the global understanding and thoughtful, nuanced way they look at the world in the 21st centruy:

I have heard the call to prayer. I have been a guest in Muslim households. I currently have a Muslim housemate. And i have had Muslim boyfriends! BUt besides all of that, Obama is not Muslim. WAKE UP.

 
  I spent a year hearing the call to prayer too. I fasted during Ramadan (ok, for a day, but still), I ate a ritually slaughtered sheep during eid al adha, donned traditional Muslim dress, visited mosques, learned to speak Arabic, and I still don't eat pork. It doesn't make me a Muslim. More to the point though, being a Muslim wouldn't make me a traitor.
 
The call to prayer is a beautiful sound - I too heard it every morning in Indonesia, like President Obama, and I am no more Muslim than he. We need more people who appreciate the different cultures that make up this country, and fewer bigots who latch on to every divisive opportunity that presents itself. Inshallah -- God willing.



If the anniversary of 9/11 taught us something maybe it is that it'snot simple or straightforward.  Let us all engage in the complex efforts to understand the larger world and nurture the next generation of hope.

image from sethskim.com via Googleimages


Wednesday, September 7, 2011

Freshman Orientation-Chinese Style

I am not often accused of hovering over my children. In fact, I generally feel we have done a decent job of raising resilient, independent young adults.

But with my last two headed off to college these past few weeks, I have been hovering more than usual.  I have to stop myself from asking what time they will be home or where they are going or asking them to check in too often.   And once I dropped the first daughter off at school I was fine  with getting pushed out at 6pm after a rushed, but nonetheless teary, goodbye. Fine, that is, for about twenty miles when the flood gates opened up.

So it was particularly amusing for me to see this photo :
"Parents of newly arrived freshmen students sleep on the floor of the Youming Gymnasium at the Central China Normal University on September 3, 2011 in Wuhan, Hubei Province of China. The university opens its gymnasium for the parents who sent their newly enrolled students to the college in the new term. (Photo by Zhou Liangjiu/ChinaFotoPress)


The university set out mats for some 600 parents accompanying freshmen students on their first day of school, local media reported."  If you look carefully there are actually two adults on some mats. 
 
Maybe this should serve as a reminder of how we eventually take our children's places and they ours:
 
 
 
image from today.msnbc.msn.com and via Googleimages

Tuesday, August 30, 2011

HPV (Gardisil) Vaccine and THE TALK


Do parents get squeamish when they have to bring up HPV vaccine during a checkup for their 12 year old?  Yes, it turns out, according to a recent study.   Investigators from the Univeristy of North Carolina at Chapel Hill recently presented their work at a national meeting of the Society for Adolescent Health and Medicine. 

When it comes to girls, they note that the recommended timing of the vaccine works nicely with the age at which conversation about topics related to sexuality should be happening frequently.  Subtle short discussions engaged in with some regularity are better heard than the "talk" which is often awkward for everyone involved.  The series of three vaccines over six months allows doctors and other providers to initiate conversation and answer questions about what exactly HPV is.  But it also should be an opportunity for providers to model an easy age-appropriate three-way conversation with the young patient and the parent.

As far as boys go, the findings were a bit different and may be enlightening for providers.  "Overall," said Abigail Lees, one of the researchers, "parents believed their sons to have a low susceptibility to HPV infection and its outcomes."  They figure that this disbelief is driven by the stigmatization and anxiety that people feel with respect to anal cancer ( "my son isn't gay") and oral cancers ("just the thought of so much oral sex makes me uncomfortable"), both conditions associated with HPV.   Of course it's not rational but we all know that denial is a powerful thing.

Is it that somehow cervical cancer in females is more "acceptable" even though it is, of course, also sexually transmitted via the HPV virus?   The researchers recommend (and are funded by Merck) that "awareness campaigns" focus more on the prevalence of HPV (over 75% of sexually active people are exposed to the virus in its many forms by age 20) and less on the gruesome pictures of lesions and sores that may just backfire on parents and teens alike.

Clearly Gardisil has a PR problem and it's interesting to see how US culture surrounding issues of sexuality continues to appear to be the root roadblock to wider acceptance and immunization rates. Talk early and often to your kids. Keep it simple.  Start where they are and don't make assumptions.

image from: noplacelikehome.org

Wednesday, August 24, 2011

Colleges: First Do No Harm



Bravo to David Skorton, the president of Cornell University for speaking out against hazing in the fraternity setting in today's New York Times.  Full disclosure: my son graduated in 2010 from Cornell and was a fraternity member there.  My son also lived through a rash of suicides at Cornell during his senior year (although they were not necessarily fraternity related).   It's not random that Dr Skorton is a medical doctor and so lends a more humanistic perspective to the issue.

Even though I usually visited the frat house the "morning after" once cleanup from the Saturday night events had begun, I am sure I joined many parents in their disgust and shock at how their sons could "live that way."

The culture of the frat, whether it is steeped in American tradition or not needs to reform.  There are many traditions that we have decided need to be relegated to the history books--slavery, segregated restrooms and classrooms, rape, injustice toward the disabled, and many others.  If only more of the egregious activities were revealed, much of what goes on during "pledge" week would go that way as well:
As a physician to teens and young adults, I often hear from my patients or their parents about the ostracism and disappointment that some feel when they have been "rejected" by this wayward culture.  As parents we need to send the message that these "clubs" are not necessarily where our children should be.  The social "rejection" can be a ticket to a much more meaningful and long-lasting alternative group of friends whose activities are not alcohol or party based. If the group photo of the frat looks like this:
....be sure to ask what goes on after the ties come off.





Thursday, August 18, 2011

A mom's adoration of her teenager


"She's a true beauty, and sometimes I just look at her in awe of all that she is.  I'm lucky to have her in my life."
quoted (with permission) from a mom's office questionnaire about her 14 year old daughter.

It's not that often that we hear parents saying really kind things about their children. Often it's about how insolent, quiet, demanding, self-involved, otherwise unconnected or just plain "adolescent" they are. Of course, this interpretation often stems from concerns about one's children or one's parenting. In order to allow parents to express their worries and pride about their kids, I have parents answer a standard questionnaire about my new patients. In addition to family and medical history it gives parents an opportunity to speak their minds.

Perhaps it is because we don't have enough opportunities for our kids to hear how we feel about them that one of the early scenes from the new movie, The Help, is particularly moving. Aibileen, the Mobley family's maid, played by Viola Davis, tells the overweight, forlorn and awkward young Mae Mobley, "You is kind, you is smart, and you is important." This mantra is repeated several times in the film, helping Aibileen imprint on this young child in the absence of her own mother's love or recognition.

Let's start the new school year reminding our children of their treasured qualities. There are so many opportunities to disparage them, whether in our thoughts, to their faces or to others. Let's make the time to say the good things so that these positive messages stick as surely as the negative ones.
image from manzine.org


Wednesday, August 10, 2011

Don't Fry Your Body in Pre-Season




Heat-related illness is the most common cause of illness and even death in athletes at this time of year.  Korey Stringer was a Minnesota Vikings player who died in August of 2001 from exertional heat stroke.   The Korey Stringer Institute at University of Connecticut is dedicated to the prevention of sudden death in athletes and is supported by Korey Stringer's widow. 

There are two basic physiologic processes that contribute to this problem. These are dehydration and hyperthermia:

Dehydration is the process of water loss leading to hypohydration. Usually measured by body mass loss, urine color, urine osmolality, urine specific gravity or via serum osmolality (gold standard).

AND
Hyperthermia is a body temperature elevated above 39°C or 102°F.


And here, from the Korey Stringer website are some other definitions, in descending order of severity:

Exertional Heat Stroke (EHS)- a medical emergency involving life-threatening hyperthermia (rectal temperature > 40°C, 104°F) with concomitant central nervous system dysfunction; treatment involves cooling the body.

Heat Exhaustion- Inability to continue exercise in a hot environment due to cardiovascular insufficiency usually in combination with prolonged heat exposure, cutaneous vasodilation, muscular exertion, and dehydration.

Heat Syncope- A brief fainting episode in the absence of salt, water depletion, fluid loss or
hyperthermia, often subsequent to prolonged standing.

Heat Cramps- Painful spasms of skeletal muscles, usually after exercise in a hot environment.


For some really frightening stories about illness and two recent deaths on the football field check out this blog, Training and Conditioning

Here are some basic guidelines laid out for athletes by the Korey Stringer Institute:

1. Listen to your body- if you do not feel well, back off (lower your intensity) and seek help if you continue to feel lousy.

2. Hydrate yourself- try to keep your urine color like lemonade and not like apple juice.

3. Listen to your thirst- if you are thirsty, you need fluids.

4. Phase in exercise in the heat- called heat acclimatization, the first 7-10 days should gradually include an incremental increase in intensity, duration, equipment, etc.

5. If your teammate, child, athlete, friend, colleague, look like they are struggling in the heat, seek shade/ice/fluid/rest for the person. If they do not start to do better immediately, call 911.

6. Be sure that an athletic trainer is employed by your high school to take care of the prevention, recognition, and treatment of emergency situations in sport.

7. Be sure to educate coaches and athletes about these tips and the common signs and symptoms of heat illnesses.

8. Realize that your performance will be about 10-15% worse in the heat as compared to cooler climates. Adjust pace, intensity, and effort accordingly.

9. Be sure you are getting enough salt in your diet/sports drinks/sport foods. Sodium assists with the hydration process and you lose a lot in your sweat during intense exercise in the heat.

10. If someone is suffering exertional heat stroke, cool them immediately using cold water immersion, the amount of time hyperthermic (not the temperature obtained) is the key to outcome being life or death.

Most school athletic departments have guidelines that encourage coaches and trainers to pay attention to the Heat index and the Real Feel Temperatures when they are practicing.  Of course, they need to remember that the index at noon is very different from what they will feel later inthe afternoon.   Schools should have policies that call for cancelling practice when the Heat Index is over 95 degrees Farhenheit. Here is a website for New York State that charts the correct actions to take based on the Heat Index.  And here is a fairly good explanation of the difference betweeen Heat Index (essentially a mix of heat and humidity) and the (Accuweather) Real Feel Index (more complex that takes cloud cover, wind and other factors into account).

Knowing that the country is in the grips of a severe weather system, there is no reason to believe that the temperatures and humidity will vastly improve before pre-season starts.  It's a good idea to start acclimatizing by spending time in the heat and humidity and beginning to work out under the hot conditions to get the body accommodated.   Although water is generally good enough to hydrate most athletes, when there is a great deal of sweating, electrolyte containing drinks are going to be much better.

image from beautyangle.com




Thursday, August 4, 2011

Mom: Your Brain is Really OK

The older graduates are coming home, raiding the refrigerator and using the kitchen computer to look for a job (wouldn't want it any other way) and the youngest are sorting through extra-long twin sheets and supply lists while everyone scrounges for the last frozen pizza for a SNACK, and the laundry keeps cranking through the machines (small prayer here to the appliance gods).   I am impressed by my own ability to juggle it all while I listen to Adele and run to the grocery store for more milk and juice and go to work.

Funny thing because I was just thinking about how my mind was getting old and I keep losing my keys or my parking spot or forget that I already told the kids that story from my own freshman year.  And just in time a book was recommended to me that explains how the middle aged brain can actually do all these things, i.e. forget and accomplish so much.  The Secret Life of the Grown-Up Brain:the surprising talents of the middle-aged mind by Barbara Strauch, science and health editor at The New York Times, is a primer on the current psychological and neuroscience research into the ways in which my mind and those of many friends and parents of patients are functioning.  Trust me, it's a godsend.

Next time I get reprimanded for re-telling a stupid joke or forgetting a friend's name or the plot of a movie (or that I even saw it before) let me remind people that Strauch says we are better at problem-solving, integrating, social expertise, judging character and situations, multi-tasking (oh yeah!) and wisdom.  Used to be that wisdom came with "old age" but it turns out no one really studied healthy middle-aged people so much before.  And contrary to decades of "wisdom" it turns out that the brain can make new cells and most importantly, new connections.

So I say, bring it on that middle age stuff.   Reading this book I felt empowered to recognize how we have traversed so much life and are really experts in our own little corners.   Like the Kali, the multi-limbed Hindu goddess associated with eternal energy and motherhood (and also violence since the world is not so simple), we have many arms and they are all moving, keeping the worlds we inhabit in balance.

Tuesday, July 26, 2011

Can Me and My Boyfriend Have a Sleepover?

image from blogs.marinij.com
"Normalizing teenage sex under the family roof opens the way for more responsible sex education."

It turns out that this thoughtful statement is pretty radical in the United States.  And that is probably why Amy Schalet's article in the New York Times is one of the top ten most frequently emailed articles today.  Although her data is based on a very small (130) and narrow ("all white, middle class and not particularly religious")  sample of people, it is provocative for many. It's difficult for most Americans to "normalize" teenage sex when such a loud section of the national discourse looks at sex as "urges" that people cannot manage well, that inevitably end in bad things like pregnancy, STD's and broken hearts.  Teen sex is seen by  many as something to be tamed, ignored, suppressed or at worst denied.

Some parents sanction a fully open relationship over sexuality and others, whether by tradition, faith, politics, or squeamishness, prefer to be discrete. All parents need to be as clear as possible about their values and the expectation that teens will be safe-emotionally and physically.


Schalet makes the interesting (and for many, counter-intuitive) point that parental involvement in their childrens' emotional and intimate lives allows them more ability to influence and protect.  She nicely calls it "control through connection." 

However, when I look at teenage sex through a developmental lens, whereby we expect adolescents to become independent, to make mistakes, to take risks and to experiment with lifestyles and relationships (meaning that sometimes they decide to breakup), it might be more difficult for the average teen to traverse these waters if the boyfriend or girlfriend has become part of the family. 

Monday, July 18, 2011

Medical Care for Young Adult Men

A recent article in the Journal of Adolescent Health focussed on the health care access of young adults  (19-24).  Available in abstract here, it makes a number of points:
insurance matters: "young adults are twice as likely to be uninsured than any other age segment of the population"
males have greater barriers to accessing primary care than females: increasing numbers of young women seek care from their gynecologists rather than  primary care providers but clearly young men do not have such an option.
clinical guidelines need to be developed for primary care: other than in the specialties of Ob/Gyn and Adolescent Medicine, there are few guidelines for managing the health of young adults.
young adulthood remains a missed opportunity for preventive interventions: all of the health issues of middle age take root in the younger years (overweight, heart disease, diabetes, bad habits, poor stress management) and anticipatory guidelines should be laid  out early.

For young men ages 15-29, two thirds of deaths are accounted for by "unintentional accidents", homicide and suicide. In other words, behavior and mental health are more responsible for losing our young people than infections, cancer, or heart disease. And the behaviors we are talking about here are excessive and dangerous drinking; reckless driving; risky athletic pursuits; untreated anger, depression and anxiety; and unsafe, unhealthy or unethical sexual practices.

How upsetting that young men in our midst get the shortest end of the stick when it comes to health care!  In spite of the fact that young adults have higher rates of mortality, more at risk behaviors, and more chronic disease than teens, they have much less access to medical care. Just when young adults start to "think clearly again" after the fog of adolescence they are rudderless when it comes to their health care. A larger proportion of their care is delivered in emergency departments and is not covered by insurance thereby almost ensuring poor follow-up. There are numerous missed opportunities for behavioral counselling on anger management, smoking cessation, prudent alcohol use, safe driving and athletic activities.

We can hope that as more allied professionals (nurses, nurse practitioners, medical assistants) join other providers in caring for this population they will receive the hands-on approach they have been accustomed to with their pediatricians and adolescent medicine providers. In the mean tim, orthopedists, emergency room doctors, urologists, and dermatologists can all pitch in to ask the questions young men need to answer and learn from.