Adolescent and Young Adult Health

The War and Us

2010-08-31T18:23:00.000-04:00

Because my son, Nick, is in The Basic School of the USMarines in Quantico Virginia, I have found myself reading books about the war that I would not even have stopped to look at until recently.

First, I read War by Sebastian Junger who is the wonderful writer many of us admire from his book The Perfect Storm. In War, Junger chronicles a storm of a different sort as he shows us what it is like to be stationed for months at a forlorn outpost in Afghanistan with a small platoon of bored, lonely and confused soldiers. This is a story of the agony of waiting, of sitting out their tour of duty in a devastated and uncertain area.

The next book I read is The Good Soldiers by David Finkel that recounts his eight months in Iraq while embedded with soldiers during the surge. A reviewer on Amazon.com summed it up this way, better than I ever could:

It's not easy to read. It's not fun. It always seems like the audience wants these types of books to be either blatantly anti-any-war polemics, or rah-rah, wave-the-flag screeds. Iraq was neither of those places. It wasn't anything other than the worst place on earth, with a lot of bad things happening, and everybody telling a lot of funny stories while they were hoping to get home okay. Nobody really remembers or considers the soldiers who had to go out there, into that fight. They think they do, but they don't. This book will help you understand; oh, will it ever.

I can only tell you that my personal reaction to these Up-Close-And-Personal accounts went deeper than just the read. Yesterday when I boarded a plane to fly home after vacation, I saw a very young soldier in army camouflage seated in the bulkhead seat in first class. Some spirit possessed me to lean over to him as I passed and say "thank you for whatever you do." As he smiled at me and thanked me in return, I recognized some person in myself that I was not familiar with until this summer. That's a person who used to think there was some pathological weakness about a US soldier, especially someone who would have been to Vietnam. As the soldiers in these two books show, these warriors are our very own boys and girls-- brave, adventurous, fit, idealistic, damaged, funny, talented, and scared.

I wish I could believe that the current drawdown and return of our troops meant the end of something. I fear it will be just a new phase, maybe even more removed from our daily lives, even more inaccessible to our understanding. Bravo to Junger and Finkel for exposing the harrowing, disconcerting and unsettling inner workings of this war in writing that is gripping and has the ability to change us.

Lessons from the Garden for Parents

2010-08-23T07:43:00.000-04:00

Back in the Spring I bought those familiar little spindly plants in a four-pack at the local nursery imagining that I would enjoy a few meals of sophisticated sauteed zucchini blossoms stuffed with goat cheese.
But now three months later, my plants are almost waist high, the leaves as big as a t-shirt and the blossoms usually forgotten under a jungle. What lies beneath is a zoo of zucchini that are proliferating out of control. Just when I think I have corralled them and harvested them and sent them on their way to be pickles, fritters, frittattas, parmesans, breads, grilled side dishes, and ultimately compost, I take one more gander and there hiding below me is one more. Bigger than the last ones, or more deformed, or even in the shape of conjoined twins, or slightly orange, or completely rotten and falling apart. How come I missed this one or that? How did it grow to be this way right under my watchful eye? All I did was plant and wait. And here is a gaggle of ZOOKS!

Had I pruned more, harvested more blossoms, pinched back the foliage, been more watchful, applied more discipline, would it have made a difference? Would it have produced a different crop of perfectly shaped, predictable, tasteless, uniform and dullard veggies for me?

You get the idea, anyway. We plant, we sow, we harvest, we marvel. At the uniqueness, the humor, the variety, the troubles, the stealth, the versatility, and the inexplicable offspring that result from our love and labor.

On Your Marks, Get Breakfast, Go!

2010-08-21T08:59:00.001-04:00

Looking for a great way to start the day once school begins? Everyone knows that breakfast is key. Nonetheless, when I see students in the mornings for sports physicals, or when I talk with patients in my office, I am struck by how frequently they confess to never eating breakfast.

I am seldom accused of being a helicopter parent and strongly believe in kids' independence and self reliance, but I think parents can and should go a long way to making breakfast happen in the morning. It can be as simple as a bowl of cereal, but there are many other quick, fun, delicious ways to start the day. Since I drive my kids to school, I frequently pack a small picnic basket (it's literally a small basket) with foil-wrapped warm goodies, a water bottle of milk or hot chocolate, and napkins.

Although it does require a bit of extra time on mom's part, the rewards are huge, and the effort is well worth it. Here I share with you my recipe for breakfast bread which comes to mind right now because I have some monster zucchini in my garden that need a destination. Breakfast bread can be made on the weekend and can last the whole week (in theory anyway--you'll see, it's a real hit.) It is highly nutritious, easy to slice and can be supplemented with butter, jam, nut butter or cheese. My group tends to like it just plain.

Breakfast Bread Recipe

Makes two 8-inch or three 6-inch loaves
Ingredients:

5 eggs
1 cup oil (safflower or canola)
1 TB fresh lemon juice
2 tsp vanilla
3 cups flour (half whole wheat, half white)
1 ½ cups sugar
2 TB cinnamon
2 tsp baking powder
2 tsp baking soda
1 tsp salt
2 ½ cups grated veggies (zucchini, carrot, squash, apple, in any combinations)
½ cup chopped walnuts (better if roasted before adding)
¼ cup raisins (better if soaked in OJ or even water)

Method:
Prepare loaf pans: spray with oil and coat with demerara (coarse) sugar. Pat to empty. (This gives the breads a sweet, crunchy crust that also acts to keep the bread moist.)
Preheat oven to 350.
In large mixing bowl, beat eggs, oil, lemon and vanilla until foamy.
In separate bowl, sift flour, sugar, cinnamon, baking powder, soda and salt. Mix in veggies, nuts and raisins. Gradually add egg mixture, beating until smooth, but not over-beating. Pour batter into pans. Sprinkle cinnamon and coarse sugar on top of batter.
Bake about one hour until tester just comes out clean. Cool a bit, then invert carefully, and continue cooling.
May be wrapped in foil and kept in refrigerator or sliced and frozen.

Watch here for more breakfast options. Soon it will be a happy habit!
image credit

Guys Get a Turn at STD Prevention Too

2010-08-19T07:18:00.001-04:00

HPV or Gardisil is now approved for boys and men. Over the past 6 years we have been vaccinating girls and women, and now boys and men can be on an equal footing with this virus. It is now recommended for boys and men ages 9-26.

HPV, or human papilloma virus is a ubiquitous virus, easily contracted through intimate contact or touching that does not necessarily involve intercourse. "Outercourse" and oral sex are easy ways to pass HPV among partners, friends, friends with benefits, etc. You get the picture.

We know that over three quarters of people have been exposed to HPV by the time they are sexually active for a short period of time. We also know that most types of HPV in most people can be disposed of by our amazing immune systems. However, there are certain sub types of HPV which we know can wreak havoc and are not so easily gotten rid of. The most frightening consequences of these infections are genital warts and cervical cancer.

Genital warts are not pretty. I chose not to display images of them but you can see some pretty nasty pictures of them here. People might remember from health class that genital warts can be contracted by skin to skin contact outside of the areas protected by condoms. Hence the advantage of the HPV vaccine.

Downsides to this vaccine? It is expensive as these things go;but my brief investigation has taught me that most insurance companies are covering it. They know how much treating one case of genital warts can cost and they are only measuring the financial costs, not the emotional and psychological ones ("You gave me WHAT?"). In addition to cost, immunization involves three shots over a six month period and truth is they hurt a bit. But hey, nothing compared to having a wart burned off the private parts.

Ask your doctor about HPV vaccine. Or contact my office.

Money and Mental Illness: how much does it matter?

2010-08-12T10:30:00.000-04:00

Today Lisa Belkin published an article in the New York Times which profiles some of the life of Millicent Monks, the grand niece of Andrew Carnegie. Monks has just written a book called "Songs of Three Islands, a Story of Mental Illness in an Iconic American Family" and Belkin's interview with Monks is a poignant story of a woman's attempt to explain her history and her legacy to herself.

As interesting as the interview (and probably as interesting as the book itself) is the conversation on Ms Belkin's blog, where readers (including myself) are weighing in with personal anecdotes and reactions to this story. Many, of course, are noting that the disabled Monks/Carnegie clan can hole up on beautiful, remote and private islands and have round the clock caregivers if they need and want them. Such options for daily care are not available to many and in our current dysfunctional health care system, it is difficult for many even to get the therapy or medications that they need for proper diagnosis or to keep their illness in check.

However, it is worth noting that much of the misery of family members in this situation arises from the reluctance to seek treatment, the aggression, the hostility, and the loss of motivation that is inherent to some mental illness itself, particularly borderline personality disorder which appears to have afflicted some of Monks' family. No amount of mothering, management or even money will dissolve these enduring difficulties. No amount of self-flagellation or questioning will really help the strong, healthy survivors in the family to carry on.

But understanding mental illness and genetics can sometimes help create the cushion that is necessary to protect oneself. The efforts of Monks and Belkin might serve to encourage more of us to explore the family tree and grow in our knowledge and compassion.

Puberty Hits the News!

2010-08-10T12:09:00.002-04:00

First graders with breasts? Third graders just mastering their multiplication tables also managing menstruation? Anecdotal reports from school nurses and my experience as a district physician have been calling attention for a while to what appears to be the earlier onset of puberty in early elementary years, especially among overweight girls.

So what is going on? A study reviewed all over the news yesterday but published in the American Academy of Pediatrics journal Pediatrics, showed that in fact the onset of puberty for Hispanic and black girls is not much earlier than reported in 1997 but that for white girls the onset does appear to be dropping to age 7 or 8. The reasons for earlier development are not clear. Pudgy girls appear to develop signs of breast development earlier, but in a 2009 Danish study girls were developing earlier whether overweight (measured as BMI) was a factor or not.

Researchers are postulating and concerned that some other factor in our environment, such as the chemicals in many of the ubiquitous plastics, may be disrupting the natural endocrine systems of our young girls. Further studies will need to be done to determine how this might actually happen and whether it is true in early bloomers.

In the mean time, what should we do?

As the lead author of the Pediatrics study, Dr. Frank Biro, suggested in an interview with the Los Angeles Times "...for younger children and the tweens, they should probably live a little bit greener. People could eat together as families — not avoiding fast food, but minimizing it to once a week — and families could engage in regular physical activity." Managing weight, living "green" and keeping the family meal might all serve to protect us from the risks of overweight, bad chemicals, and stress.

It's amazing how frequently it comes down to this simple bit of advice, best encapsulated by Michael Polan: "Eat real food, not too much, mostly plants." And I think I would add that we should avoid drinking, eating, and microwaving out of plastic containers until we have more information.

image credit: Google images

Workshop for Middle School Girls on Relationships

2010-08-04T14:13:00.000-04:00

Queen Bees, Wannabees, Bullies, Friends, Best Friends Forever!
As our youngest teens and tweens head to middle school, some of them need tips, advice and coaching on handling the new and strong social relationship challenges that will meet them.

To help with the transition we are announcing a three part series of workshops for middle school girls, grades 6-8. The groups will be led by Jenifer McLaughlin,a social worker with vast experience leading groups in schools who is now sharing my new office in White Plains.

The series looks like this:

Tuesday August 31, 5:30pm:
Transitioning (fitting-in versus being yourself)

Tuesday, September 14, 5:30pm
Understanding peer relationships(why do kids act that way sometimes?)

Tuesday, September 21, 5:30pm
Navigating Social Media (Getting the most out of Facebook and the Internet)
Girls may choose to attend one or all three sessions. Each session will cost $10, last one hour, and be held at the office in White Plains. Small healthy snacks will be available.
Please RSVP to 698-5544 or email engellandoffice@aol.com

image from www.wondercomments.com

Book Review: Girls on the Edge

2010-07-27T12:34:00.003-04:00

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.

Extreme Sport/Extreme Heat

2010-07-19T22:03:00.008-04:00

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!

"Meet my Sister, Ana Rexia"

2010-07-21T17:06:00.002-04:00

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

OOPS! It's the Morning After!

2009-05-07T12:45:00.000-04:00

Just kidding.

But actually, yesterday, May 6, was the National Day to Prevent Teen Pregnancy! The most recent US data (2007) shows that the teen (15-19 year olds) birth rate has crept upward to 42.5 births per 1000 population. Read that another way: 4.25% of teens ages 15-19 had a live birth in 2007. Not pregnancies, not sex, not abortions, not the morning after pills. Live Babies! The data does not tell us how many of these were planned pregnancies, but most child and adolescent experts would agree that the risk to the health and long term well-being to the mother(education, earning potential, physical and mental health) and to the child (risk of prematurity, abuse, learning disabilities, school problems and more) is significant in teen mothers

If you know a teen or are one, first bookmark my blog, and then check out this website:

www.stayteen.org

and take the scenario-based quiz that will test your savvy on issues of sex and contraception. If you are a teen, ask your parents to take it too! Then go back to my earlier post on sex education by cell phone and the Morning After Pill.

And I promise the next post will not be about sex!

Sex Ed by Text

2009-05-03T10:27:00.000-04:00

Today's New York Times Style Section (why does most news related to teens seem to appear in this section?) has a lead story about a pregnancy prevention program in North Carolina. What makes this program different is that teens can anonymously text a query to a Text Line and within 24 hours, often faster, they will get a reply from a trained, live counselor.

Brilliant. Kids don't get complete sex ed in high school (in North Carolina schools are mandated to teach an abstinence-only curriculum);they forget what they are told in class; they make dumb mistakes; they have a hard time talking with parents; and devour any opportunity to talk privately and confidentially to an adult (no question is off limits in my office and I am amazed at what kids need to know).

Not without controversy. Those who would rely on abstinence only education prefer to do their teaching at home and not lose control to a cellphone! Data unfortunately shows that this tack has not been working too well, both in terms of the knowledge imparted (values and plumbing both get short shrift) and in terms of prevention of unwanted pregnancy.

From my opportunities to chat with parents about teen sexuality and sexuality in general, I would say someone should start a hotline like this for ADULTS!

Pedal Power

2009-05-09T21:20:00.000-04:00

How many bikes do you and your friends have rusting and gathering dust in your basement or garage? With my large family that rides, we have collected more than a few over the years. Today, at last I was able to recycle them to a cause I want to share with you. Pedals for Progress organized a collection station in the driveway of a local church. Within minutes of my arrival volunteers had de-pedaled and rotated the handlebars on my two old Treks and were ready to stack them in a UHaul to ship off to one of many countries they supply. Nicaragua, one of the nations highest on my radar screen since I worked there last year building houses with Bridges to Community, has received over 30,000 bikes through P4P.

Pedals for Progress points out that they ship more than mere bikes. A bike can provide access to a livelihood or an education for the poor of the world. And what does this have to do with adolescents? As our world shrinks to a more global neighborhood, our responsibility toward our brothers and sisters abroad is as great as toward those at home. I remember meeting teens in Nicaragua who could not get to junior high or high school because they had no transportation (or means to pay for public access to) public schools that were several kilometers away.

I urge you to check out Pedals for Progress and put your used bikes to work for others! It feels great. And saves our landfills too.

FDA Approval of Plan B for 17 year olds

2009-05-01T12:30:00.000-04:00

For the past two years, Plan B or the Morning After Pill, has been approved as an over the counter medication for use by women and can be purchased over the counter by men or women over age 18 with ID. For young women under 18, a prescription is necessary in addition. There has never been any scientific doubt as to the safety and efficacy of the medication for women under age 18. The current policy was agreed upon by the Bush administration as a sort of compromise between the medical and the conservative communities.

However, now it appears the FDA is set to extend approval of its sale over the counter to women (and men) 17 and over. What difference does a year make? Let’s look at the CDC data from the 2003 National Youth Risk Behavior Survey (an enormous study that polled almost 200 high schools across the country. According to my back-of-the-envelope calculations, there are approximately 12 million teens who are sexually active between the ages of 17 and 18. If we consider that only about half of all episodes of intercourse in this age group are protected by a condom we can see that there are literally millions of moments when a morning after pill could be a wise choice.

Of course, better to use a condom each and every time since nothing protects better against STDs.

Cinco de Mayo

2009-05-05T10:49:00.000-04:00

Dinner time is always a time for me to challenge assumptions. So last night after watching President Obama flub the Cinco de Mayo greeting (because it was Quatro de Mayo), we began discussing what it really is. There was one vote for Mexican independence, another for the Day of the Dead and one "not sure/undecided.

Well turns out to be "none of the above. Cinco de Mayo is a regional holiday, according to Wikipedia, that celebrates the 1862 victory of a poorly armed, small Mexican army from the state of Puebla against the French military who were widely expected to win. Sounds like Hannukah and the Macabees to me!

Although it is widely celebrated in the Mexican diaspora in the US, "Cinco de Mayo is not "an obligatory federal holiday" in Mexico, but rather a holiday that can be observed voluntarily," according to Wikipedia sources. Wouldn't it be nice, since so many in Mexico are still quarantined from public places and staying home to prevent the spread of H1N1 influenza, if the government would just declare it a big day of fiesta and allow el pueblo to let its hair down. A sort of Passover, come to think of it, for those who have come through this plague that, so far anyway, isn't one. Masks or no masks, Feliz Cinco de Mayo!

Dads' and daughters' discoveries

2009-05-18T22:55:00.000-04:00

A recent study of teen sex has shown that in two-parent households, when Dads get wind of their daughters’ sex lives—especially when the girls’ self-described behavior is “risky” (“premature”, multiple recurrent partners, or poor use of birth control)--fathers ratchet up their attention.

This increased attention from Pop apparently has a measurable effect on girls’ subsequent sexual behavior. This effect is small (7% change—whatever that means in real life) but apparently deviates from previously held notions that parents look the other way or become less involved when risky teen sex is involved. The study (published in the journal Child Development, May/June 2009*) whose lead author is Rebekah Levine Coley, did not discuss how exactly Dads showed their increased interest or involvement in daughters’ lives.

Did they ground them?
Did they punish them?
Were they just "disappointed"?
Did they play more Scrabble with them?
Did they take them to a doctor and get them birth control pills?
Did they just talk to them? What did they say?

How many ways can we imagine that a Dad might react to his daughter’s “risky sex” in ways that would lead her to curtail her activity? Send your ideas to me, please!

*This article in its entirety is not available free online so I have pasted together bits and pieces from multiple on-line reviews.

So we know they're drinking. Now what?

2009-05-24T15:58:00.001-04:00

This week I hosted a group of nine local moms in my office to chat about the realities of alcohol and our kids. We talked about how the "just say no" campaign does not really appear to have worked so well. The numbers of kids drinking and the frequency and amounts consumed are remarkable, as recent surveys and my office contact with kids show.

A few random but important points emerged from our conversation:

The debate about lowering the drinking age back to 18 is a real one, especially on college campuses (and initiated by college administrators)
The culture among teens has become one of binge drinking, often with the goal being drunkenness, just shy (hopefully) of illness.
We need to consider carefully the value of "teaching our kids how to consume alcohol" even if that takes place in our own homes and with us before they go off to college.
We need to look at how we adults consume alcohol. Recent US government-sponsored programs are helping folks Rethink drinking
Data shows that binge drinking before age 16 increases the risk of alcoholism in a vulnerable child by eight fold.
It is possible to enforce certain absolutes: curfew time, checking in upon returning home; never, ever, driving after drinking; protecting friends from dangerous alcohol poisoning or vulnerable social situations;holding off on drinking altogether until at least age 16 (or more).
It is possible to teach some safe drinking rules without endorsing illegal imbibing. Kids should be taught to avoid alcohol when tired, depressed, hungry, angry, thirsty, sad, or alone.

There are no easy answers to this problem. But it is worth considering the merits of a "risk reduction" approach to alcohol and teens rather than avoidance of the issue or punishments that do not teach or lead to underground, even more worrisome activities. Cheers!

Over the past few weeks . . .

2009-05-27T21:37:00.000-04:00

Over the past few weeks I have been crawling and climbing up the learning curve on blogging. I have been exploring a multitude of websites and news publications on parenting teens. There are some wonderful whacky things out there. Everything from moms sharing news on diapers to true confessions about terrible parenting errors people have committed. I have discovered a sorority of bloggers at blogher.com.

In addition I am discovering how to get my self into the blogoshpere by "introducing myself" online to other bloggers. I was able to connect with a reporter who is interested in how doctors are beginning to use social media as a part of their practice,either as promotion or as a way to communicate with patients. Since I do both, I was written up in their blog.

I love that line about "limitless knowledge and a connection on a whole new level is the true power of the healthcare/social medical relationship." I have no illusions: I will never catch up to my kids or my patients when it comes to this stuff, but I feel a whole lot more savvy and linked in than a month ago!

Parenting Teens-adjective or verb?

2009-06-01T16:03:00.001-04:00

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

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

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

Why Blog?

2009-06-02T11:07:00.000-04:00

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

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

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

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

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

Thanks for coming along!

Twitter: Guiding parents and others of us in the dark

2009-06-09T10:50:00.000-04:00

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

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

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

Two Birds with One Stone: Pregnancy and HIV?

2009-06-15T09:51:00.001-04:00

How cool is this?

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

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

ADHD and Medication: cause for alarm?

2009-06-19T17:27:00.000-04:00

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

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

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

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

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

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

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

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

Plan B Goes Generic

2009-06-25T09:28:00.000-04:00

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

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

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

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

Health Care Reform and Restoring Dignity to Medicine

2009-11-15T20:57:00.000-05:00

With so much talk about health care reform it's easy to lose track of the individual stories of people across the country who live, get sick, need care and "consume" health care. There is probably no better way to appreciate these stories than to hear Anna Deveare Smith tell them. The actress, interviewer and playwright is currently in performance in New York with her "Let Me Down Easy" show which is a distillation of interviews conducted with over 300 patients and people across the country over the past eight years. From this vast trove, Smith has developed 20 roles that she plays on stage in her one woman show.

Her project started as an assignment from a Yale medical school professor who asked Smith to show doctors how to gain understanding and insight from really listening to patients' stories. But she goes way beyond her original assignment to show us how the likes of Lance Armstrong, Ann Richardson, a rodeo rider and a New Orleans Charity Hospital physician look at illness and suffering in the broadest sense. We learn from Smith about our health care system, about the ways folks struggle with life and death and the life cycle, and about how to rescue "grace and kindness" in a world of suffering, disappointment, and broken hearts.

One of the best segments is about the notion of charging one price for whatever ails you. It makes complete moral sense that the cost of whatever problem a patient has should not be based on its threat to his or her life. In an interview on public television with Bill Moyers

Smith says that when people are charged a "flat rate" for care, "that's when you'll get your good doctors," when money doesn't matter any more.

Now that Wall Street can no longer necessarily pull the best and the brightest, we can hope that the helping professions will attract some of those best and brightest for the right reasons--namely to engage with people. Prospective doctors will see that they can treat themselves to the joy of medicine through patients' marvelous stories, not merely because of a dearth of money-making jobs elsewhere.