Friday, May 27, 2011

Get Your Head Examined!

You'd have to be really checked out to have missed the hubbub about concussions, aka "traumatic brain injury" or TBI, that has been in the media over this past year.   Now you have an opportunity to protect yourself or your child, to contribute to neuroscience and to make some money.   How much fun is all of that for a summer when jobs are scarce and it's going to be hot?

Here is the story.    Standards for concussion diagnosis and management are rapidly changing.  It is now clear that concussions are much more common than previously recognized and that recovery may take much longer than we knew.  Neuroscientists have been working to develop more objective ways to detect the changes in the brain that are associated with head trauma so as to make wise decisions about return to play. 

My alma mater, Cornell Medical School,  and the Brain Trauma Foundation reached out to me to recruit athletes and people ages 7-80, to study a new method of detecting minimal brain trauma.

Here is what they said (bold type mine):

The Brain Trauma Foundation is investigating a new method of identifying concussions and assessing attention and memory deficits caused by mild Traumatic Brain Injuries in children and adults. We are working with the Department of Defense,
The James McDonnel Foundation, and several leading medical universities to test a newly developed eye tracking device that is able to detect the possible concussions by assessing attention delay in less than 1 minute.

We are looking for children between the ages of 7-17 and adults between 18-55 years who have sustained a previous mild traumatic head injury, along with healthy individuals between the ages of 7-74 who would like to participate as our controls. We are also looking for participants who have been diagnosed with Attention Deficit Disorder. Additional exclusion criteria include no prior neurological diagnoses, no history of substance abuse problems, no major psychiatric disorders, no gross visual or hearing problems, and no pregnant women.

Prior to enrollment, we conduct a 20-30 minute telephone screening to determine eligibility. Testing is conducted at the Citigroup Biomedical Imaging Center on the Weill-Cornell Medical College campus in NYC and usually takes about 4 hours. Our protocol is WCMC IRB-approved and includes interviews, computer tests, paper-and-pencil tests, and an l MRI scan. Participants are compensated $450 for the 4-hour testing session, and those from the control sample are free to use the data we collect as baseline testing for future mTBI’s (ie concussions).
For more detailed information go to the Brain Trauma Foundation and click on research for lots of information.  Alternatively you can email Jodi Kanter at  It feels great to be a part of something this important.  Please let me know if you participate.

Thursday, May 19, 2011

"How external cues make us overeat"

True confession.  Last night I polished off the bottom third of the Edy's coffee ice cream.  Was I hungry? No.  Was it late? Yes.  Am I trying to gain weight? No.  Was it pretty lame? yes.

So today the May 2011 Nutrition Action Newsletter cover story called "Under the Influence" intrigued me.  What made me do that?  Ever mindful of using my own life as a laboratory for making me a better doctor and more empathic toward my patients, I decided to read on.

The article describes research done by Brian Wansink of Cornell University who applies social science, psychology and economics research techniques to demonstrating why and how people eat unintenionally or mindlessly.  Sometimes it's just the environmental cues rather than hunger or even an emotional need:
  • People will actually eat 45% more popcorn at a movie if they have a larger bag (but not more popcorn). 
  • The proximity of a jar of Hershey's kisses on a person's desk can lead to eating almost twice as many in the course of a day than if the jar is just six feet away.
  • The name of a food (like "Edy's Slow Churned" vs "plain coffee ice cream") can influence the amount of food a person eats and how they enjoy it.
  • The size of the plate and the type of plate will influence the quantity of food eaten.  A stylish plate will contribute to the experience of a brownie much more than if it is served on a napkin.
  • Eyes are more important than cues from the stomach.  In one experiment, people ate 28% more chicken wings if the bones were removed as opposed to building up on the table.
  • We are all affected by something called the "halo" around foods. In one study people estimated the calorie count of food labelled as "organic" to be 15-20 percent less than if it was not labeled as such. 
I love the Nutrition Action Health Letter for a number of reasons. Published by the wonderful Center for Science in the Public Interest, it comes out ten times a year.   It's inexpensive, fun to read, full of information, edgy, witty enough, politically left enough to create a stir, and best of all the back page has a column called "Food Porn." Here they expose foods from restaurants or packaged food that is notoriously high in calories, saturated fat, sodium or other harmful ingredients.  They also expose the "halo" effect and educate readers while keeping them laughing and giving them great alternatives.

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Friday, May 13, 2011

Can you afford a $39 Sports Physical?

 For $39 you can buy a manicure-pedicure; a dinner at a local restaurant (without much wine); a movie for four (except on Tuesdays when it's free for Optimum customers);  an exercise class for two; or half a tank of gas.   CVS' Minute Clinic (is that "minute" as in a sixtieth of an hour or is that "minute" as in very small?) is offering a special on the sports physical for just $39.    If you are really so busy or disorganized or unlucky with your insurance or physician,  you can take your high school junior to have a ten minute physical at the local CVS.  You choose. If you must.

Of course, according to their website,  at CVS you will be required to call or otherwise contact your regular pediatrician or other provider to obtain your child's immunization record and health history (Did he have a CT or an MRI back in 1998 when he had that concussion?  Do they care?  Do I remember?) In exchange for all this information and a few minutes of time (and it seems without even the indignity of having to undress to be examined) they will fill out and stamp and sign all the requisite paperwork.   Back to practice you go!

But will they really do what is required of a doctor to verify that a student is safe to participate in sports?  Will they know (if you or your independent junior does not tell them) that your son sat out an entire six weeks of basketball practice after his head injury last February?  Not if he really, really wants to play lacrosse and decides not to tell them.  Even though your pediatrician is fully aware of this. Will they care if he has had unprotected sex, that he has genital warts, but does not have to take his clothes off at the minute clinic?

Probably you get the point already.  Our bodies are not like our cars or our pets.  It might be worth the discount coupon to have the oil changed at the local QuickLube place on the corner.  But are we really ready to treat our children like machines that give up their secrets quickly and reliably?  Are we really ready to surrender our therapeutic relationship with someone who really knows our history, about the divorce, about the concussion or the history of asthma to someone who really has no interest in our children's health and welfare? 

McDoc might be here to stay but all you have to do is "Just Say NO."  Please do.

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Saturday, May 7, 2011

Mother's Day

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Today I received an email with Anna Quindlen's wonderful essay, "All my babies are gone now" from her book, Loud and Clear, published in 2005, but with a timeless message for those of us experiencing the metamorphosis of our babies into teens and young adults.  Enjoy and pass it along.

All my babies are gone now. I say this not in sorrow,
but in disbelief.

I take great satisfaction in what I have today: three
almost-adults, two taller than I am, one closing in
fast. Three people who read the same books I do and
have learned not to be afraid of disagreeing with me
in their opinion of them, who sometimes tell vulgar
jokes that make me laugh until I choke and cry, who
need razor blades and shower gel and
privacy, who want to keep their doors closed more than
I like.

Who, miraculously, go to the bathroom, zip up their
jackets and move food from plate to mouth all by

Like the trick soap I bought for the bathroom with a
rubber ducky at its center, the baby is buried deep
within each, barely discernible except through the
unreliable haze of the past.

Everything in all the books I once poured over is
finished for me now. Penelope Leach, T. Berry
Brazelton, Dr. Spock. The ones on sibling
rivalry and sleeping through the night and
early-childhood education - all grown obsolete. Along
with Goodnight Moon and Where the Wild Things
Are, they are battered, spotted, well used. But I
suspect that if you flipped the pages dust would rise
like memories. What those books taught me, finally,
and what the women on the playground taught me, and
the well-meaning relations - what they taught me, was
that they couldn't really teach me very much at all.

Raising children is presented at first as a true-false
test, then becomes multiple choice, until finally, far
along, you realize that it is an endless essay.

No one knows anything. One child responds well to
positive reinforcement, another can be managed only
with a stern voice and a timeout. One child is toilet
trained at 3, his sibling at 2.

When my first child was born, parents were told to put
baby to bed on his belly so that he would not choke on
his own spit-up. By the time my
last arrived, babies were put down on their backs
because of research on sudden infant death syndrome.
To a new parent, this ever-shifting
certainty is terrifying, and then soothing.

Eventually you must learn to trust yourself.
Eventually the research will follow. I remember 15
years ago poring over one of Dr. Brazelton's
wonderful books on child development, in which he
describes three different sorts of infants: average,
quiet, and active. I was looking for a sub-quiet
codicil for an 18-month old who did not walk. Was
there something wrong with his fat little legs? Was
there something wrong with his tiny little mind? Was
he developmentally delayed, physically
challenged? Was I insane? Last year he went to China.
Next year he goes to college. He can talk just
fine. He can walk, too.

Every part of raising children is humbling. Believe
me, mistakes were made. They have all been enshrined
in the 'Remember-When-Mom-Did' Hall
of Fame. The outbursts, the temper tantrums, the bad
language - mine, not theirs. The times the baby fell
off the bed. The times I arrived late for preschool
pickup. The nightmare sleepover. The horrible summer
camp. The day when the youngest came
barreling out of the classroom with a 98 on her
geography test, and I responded, 'What did you get
wrong?' (She insisted I include that here.) The time
I ordered food at the McDonald's drive-through speaker
and then drove away without picking it up from the
window. (They all insisted I include that.) I did
not allow them to watch the Simpsons
for the first two seasons. What was I thinking?

But the biggest mistake I made is the one that most
of us make while doing this. I did not live in the
moment enough. This is particularly clear now that t he
moment is gone, captured only in photographs. There
is one picture of the three of them, sitting in the
grass on a quilt in the shadow of the swing set on a
summer day, ages 6, 4 and 1. And I
wish I could remember what we ate, and what we talked
about, and how they sounded, and how they looked when
they slept that night. I wish I
had not been in such a hurry to get on to the next
thing: dinner, bath, book, bed. I wish I had
treasured the doing a little more and the
getting it done a little less.

Even today I'm not sure what worked and what didn't,
what was me and what was simply life. When they were
very small, I suppose I thought
someday they would become who they were because of
what I'd done. Now I
suspect they simply grew into their true selves
because they demanded in a thousand ways that I back
off and let them be. The books said to be
relaxed and I was often tense, matter-of-fact and I
was sometimes over t he top. And look how it all
turned out. I wound up with the three
people I like best in the world, who have done more
than anyone to excavate my essential humanity. That's
what the books never told me.
I was bound and determined to learn from the experts.

It just took me a while to figure out who the experts
 ---Anna Quindlen

Thursday, May 5, 2011

Virginity and the Prom

 This article was published yesterday in my quarterly newsletter but by popular demand I am posting on my website today so that anyone who is not signed up for my newsletter can read it.  Thanks for all the interesting reactions to this story from patients and parents alike.    And here's to a happy, memorable prom for all those we care about: 

If you are a prom-goer, the parent of one, or maybe one of the chaperones -- listen up. After you think and talk about a date, a dress, whether to wear a cummerbund, which friends to share a limo with, which after-party to attend, and what to do about alcohol, remember to think and talk about sex, too.

I once read that 1 in 5 seventeen-year olds plans to have sex for the first time on prom night. Hmmm. Stated another way, twenty percent of prom-goers will lose their virginity on prom night. If we consider that half of US teens do not use condoms at the time of their first intercourse, we are looking at lots of unprotected intercourse. Might as well slip the "morning after pill"  into the OJ at the after-prom breakfast. Just kidding.

Most of us know that sex education at home ought to take place over many years and in many different conversations. But maybe prom deserves yet another chat. What are the important messages to share during this conversation?

For a lot of reasons, "loss of virginity" should be a "planned" thing. Not a spontaneous, swept-up-in-the-moment sort of event. Planning actually prevents regret, disease, embarrassment, and unwanted commitments, like pregnancy and babies.

Virginity is not a gift to give away. Nor is it a reward for being asked to the prom. You never "owe" anyone sex or sexual favors. A conversation ahead of time, in the calm of a cool sober moment can set the boundaries before there is a misunderstanding.

What is virginity anyway? It is not an anatomic reality; it is a concept. Teens experiment plenty with fondling, touching, hooking up, playing the bases, "outercourse" or whatever you want to call it before they have intercourse. They incur plenty of risk of herpes, HPV, other STDs and even pregnancy from these activities alone. The physical reality of intercourse is on a continuum with all these other ways of being sexual. Nevertheless, few would argue that intercourse ratchets up the risk - emotional, physical, and psychological.

If you decide that prom night is the night, and you are confident that the person you have chosen is someone you can trust with your body, your emotions and your reputation, then ask yourself one other question: How can I make this experience the best it can be, one that I will not regret for as long as I live?
  1. Buy condoms, whether it's for you or for your partner.
  2. For Girls: buy or ask your doctor for a prescription for Plan B. (Plan B is the morning after pill, available over the counter for anyone over 17 with ID.)  If the condom "malfunctions" this is imperative as back-up. If you aren't sure how to use it check here.
  3. Drinking is illegal, of course. If you choose to drink anyway, do not consume more than one drink per hour. Intoxication will take away from the experience in ways you won't even realize. Make the first time a good time, and one to remember, literally. Don't find yourself asking the next day: "Did I really say and do that?"  
  4. Take your time with your lover. Don't rush. Enjoy the touch, the pleasure, the joy of being sexual with someone who matters to you. Being a good lover takes practice. Don't be too tough on yourselves if it doesn't seem like the movies.
If you choose abstinence, have you thought through how you will do that? Abstinence may take more advanced planning than sex! What will I say and when? What if he/she/I get carried away? Will "No" mean "No"? Can I withstand the pressure? What if I lose my relationship for refusing? What if someone forces me? Try this:  Stand in front of your mirror and try saying "No, I don't want to have sex tonight" or "That's as far as I want to go."  Then wipe that smile off your face and practice saying "No" like you really mean it.

Even if you have had intercourse already with this person or someone else, it is perfectly fine to decide that on this particular occasion, you will be abstinent. The choices are yours and belong to no-one else.

To reinforce your choice about abstinence, you should choose not to drink alcohol. Alcohol will lower your inhibitions of course, but it might be putting you at risk of changing your mind, getting swept up in the craziness or making regrettable decisions.

There are other options to consider. If you cannot have "the" conversation with your potential date, then consider going with a friend or a group rather than a "date". Once the party starts large groups of kids who are not looking for sex can have great fun being together.

Let your parents know where you will be and when. Be sure you have an escape plan if things are dangerous or dangerously dull. Always have your cell phone and cab money handy

Remember to put your own feelings first when it comes to sex. Be proud of whatever decision you have made and trust your sober judgment.

PS: It's not just adolescent medicine doctors who think about this stuff. If you don't believe me, check out what the limo drivers have to say here: