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Daily Dose

Say No to Tanning Beds!

1.30 to read

I have previously discussed the importance of sunscreen but it is equally important to discuss the risk of artificial tanning and the use of tanning beds. I have emphasized that it is never too young to start using sunscreen, but for some reason teens think that tanning beds are a safe way to tan rather than going outside in the sun.

Not so.....tanning beds are using UVA radiation which can cause mutations in your DNA which can then lead to skin cancers. Dermatologists are seeing an increase in young women (who are more likely to use tanning booths) in their mid to late 20’s with  the deadliest form of skin cancer, malignant melanoma. Many of these women admit to frequent tanning during their teen age years.

Malignant melanoma is different than basal cell carcinoma and squamous cell carcinoma,  the other more common forms of skin cancer. Malignant melanoma may spread rapidly to internal organs and lymph nodes, and if not detected at an early stage,  may be fatal within months to years.

Young girls need to understand the risks of using a tanning bed and should be encourage to use a spray tan or a tan towel to achieve the “glow” that they are wanting. They need to understand the risks that are proven to be associated with tanning bed use. Many teens and young adults are using tanning beds that are provided at their dorms or apartments as well.

If there is a family history of melanoma or unusual moles then the risk may be greater to develop an atypical mole. Those young adults who have tanned need to be followed by a dermatologist who can examine their body head to toe and “map” their moles and identify any unusual moles. At the same time they may be educated as to how to follow their own moles and changes they should be aware of.  Do you know that melanomas may arise anywhere on the body, not only the sun exposed area!

Recent articles have shown that tanning beds may be associated with an increase in non melanoma skin cancers as well. While these lesions may take longer to develop, teens and young adults need to be aware of this risk as well.

The state of California has become quite progressive in advocating for the safety of children and their skin.  California recently passed a law that children under the age of 18 may no longer use tanning beds. Other states are looking at similar legislation. Makes sense to me!

So....... no suntanning and no tanning beds. Rub, wipe or spray on your tan or enjoy beautiful fair skin. Not only is it safer, you don’t have to worry about wrinkles later in life (trust me on this issue!)

That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Travel Alert for College Students

1.30 to read

With college students from all over the country traveling over the Thanksgiving weekend,  the CDC has issued a health advisory to doctors to be on “the look out” for meningococcal meningitis and sepsis.  As you know, travel is a great way to spread germs, even unknowingly,  and many college kids left their campuses and headed home for Thanksgiving. In just a few weeks  they will be traveling again for Christmas/winter break.  

While there are different types of bacteria that cause meningitis, there has been an outbreak of serotype B meningococcal disease in students at both Princeton University and at The University of California, Santa Barbara (UCSB).  Unfortunately, the two meningococcal vaccines that adolescents receive do not protect against serotype B disease. The vaccines licensed in the United States protect against meningococcal serotypes A,C,W,Y.  (Make sure your students are protected with this vaccine). 

Because there have been 8 cases of serotype B meningococcal disease at Princeton and 3 more cases at UCSB, the CDC is concerned that there could be more cases identified in different parts of the country,  spread by college students traveling coast to coast.

Meningococcal disease comes on quickly and has symptoms like many other illnesses, including the flu. Meningococcal disease causes headache, fever, body aches, nausea and vomiting and often a rash which is classic for the disease. This disease seems to cluster in adolescents who are constantly in close contact with one another.  But, meningococcal disease makes patients even sicker than the flu and other viral infections, and typically begins much more quickly. These patients get sick and look very sick quickly, a matter of hours at times.  

So parents, if your child develops a fever, headache, stiff neck and a rash make sure you call your doctor. Doctors, we all need to be aware of the outbreak of meningococcal disease and for patients who appear extremely sick consider the diagnosis.

The best way to prevent disease continues to be good hand washing, and cough hygiene.  Make sure your students have been vaccinated for meningococcal disease and the flu as well!

Daily Dose

Miley Cyrus Smoking Salvia

Video of Miley Cyrus smoking salvia has been making the rounds on-air and online. What is salvia and why are tweens/teens smoking this herb? As you know, I always try to stay abreast of new stories and pop culture trends that might affect my patients (as well as my own family). One recent event caught my eye. The video of Miley Cyrus allegedly smoking salvia has been viewed by many. Prior to this I had not heard very much about salvia. As it turns out, I should have.

It seems that this plant (a member of the mint family) is a well-known naturally occurring hallucinogen.  Salvia is actually the most potent naturally occurring hallucinogen (LSD is a synthetic hallucinogen) and has become quite a sensation among the adolescent crowd who often post videos of themselves after smoking or ingesting salvia. It is in this manner that adolescents became aware of the effects of salvia and realized that it is easy to obtain either on line or in smoke shops. Over the last several years as salvia has gained more attention, it has been banned from being sold in 20 states in the U.S. with even more states considering legislation.  That does not seem to prevent its sale on line as a Google search listed pages of sites with salvia for sale. The effects of salvia typically occur almost immediately after smoking the herb, and typically last about 5 – 8 minutes. It is common to see speech and coordination problems, along with a feeling of giddiness and disorientation.  Salvia activates opioid receptors in the brain which causes the differing hallucinogenic symptoms.  It has the potential to be both physically and psychologically addictive, especially in the adolescent population who are dealing with multiple issues during their maturation. For a teen who is sad, depressed or anxious, the use of salvia may become a way to mask their problems rather than dealing with their issues. While a teen’s first encounter with salvia may be a ”one time” exposure at a party, the easy availability of this plant on line may make it more appealing for repetitive use.  Salvia may also be chewed or consumed in a liquid, as well as inhaling herb.  The latest “Monitoring the Future Survey” which ask teens about their recent drug use did not show an increase in salvia use among 12th graders, but it did show that 1.7% of eighth graders had admitted to using salvia at least once. The concern is that these numbers may rise and the DEA has labeled salvia a “drug of concern”.  With the YouTube video of Miley Cyrus using salvia, there are now even younger kids aware of the plant and its effects.  Children as young as 10-12 years are reporting salvia usage.  I have asked many of my pre-teen and adolescent patients about salvia, and while most deny usage they all seemed to “know” what salvia was and how they could get it. So, yet another discussion for parents to have with their children. This also brings home the necessity of monitoring not only what your children watch on line but what they buy. Salvia appears to be pretty cheap and is easily purchased with a PayPal account.

Daily Dose

Fainting

1:30 to read

Seeing your child faint is always scary for a parent. But in reality, fainting (syncope) is more common than one realizes. Fainting is defined as a transient loss of consciousness and occurs in 15-20% of children.  It is very reassuring to a parent to hear that in most cases fainting is not serious and is only due to cardiac causes (a parental fear) 2-6% of the time.

When parents bring their child in “because they fainted”, the most important part of the evaluation is a good history.  I ask both the parent and child questions.  If there were witnesses other than a parent it is important to question them as well.

I always want to know when the event occurred? Was it when they first had gotten up in the morning, had they eaten before the event?  Do they remember how they felt before they fainted, and did they feel “funny or dizzy” beforehand?  Were they actively exercising when it occurred?  Do they remember “waking up” and how they felt? Did they “wet their pants”?  Most importantly is there any family history of a sudden cardiac event or death (ask about drowning or seizures).

Parents often want to “have a lot of tests run” to rule out “everything”…but after a good history the most important next step is a thorough physical exam.  Just good old fashioned medicine, prior to anything else.  

The most common reason for fainting is often an association with “emotional stress - like seeing blood”, but there are other causes such as hunger and low blood sugar, heat, anxiety, or dehydration. This type of fainting is called vaso-vagal sycope or neurocardiogenic syncope.  Thankfully this type of fainting can be managed by teaching the patient to recognize their symptoms  and protecting them from falling and hurting themselves, not from fainting but from a possible secondary head injury. I tell every one of my patients that has fainted….if you feel funny, dizzy, see spots or whatever and “think” you are fainting, SIT DOWN!!! Fainting will not kill you but cracking your skull might.

I usually do a baseline EKG on children who have a “first fainting episode”, as it is an easy test and I have an EKG machine in my office.  ( not all doctors will even do an EKG).  This will rule out some abnormal rhythms or cardiac enlargement.  Although each case is different, there are “red flags” that should prompt a more extensive evaluation. Fainting that occurs during exercise should always have a more detailed work-up. Having a family history of certain cardiac diseases should also necessitate further work up. In these cases I typically refer patients to a pediatric cardiologist for further evaluation which might include an echocardiogram, a stress test or even cardiac monitoring. 

Actually, all 3 of my own children fainted during their teen years..so weird, but I did know it was more common than people think. Interestingly, they all seemed to “outgrow” fainting.  Anecdotally, In my own experience fainting seems to be so much more common during adolescence, while those hormones are raging…which is very stressful.

Your Teen

Blogging Could Be Good Therapy for Teens

1.45

When I was a teen if you had something you really wanted to get off your chest, but didn’t want anyone to know, you’d write it down in your diary. It was a safe place to express sadness, confusion, anxiety, joy and excitement. And being a teenager, all those emotions were swirling inside my head pretty much all the time. For some strange reason, I always felt better after writing it all down, clicking the lock shut, and placing the diary in a spot I thought no one would look. My musings were usually personal thoughts that I didn’t think anyone would understand anyway. In fact, I thought Bob Dylan captured my anxiety pretty well when he sang “If my thought-dreams could be seen -
They’d probably put my head in a guillotine.”

Today’s kids are much more likely to share their “thought-dreams” over the Internet in a personal blog, and a new study says that could actually be very helpful.

Research has long supported the therapeutic value of diary keeping and journaling for teens and adults. But now, researchers suggest that blogging might even be better.

The study, published in the journal Psychological Services and conducted by Meyran Boniel-Nissim and Azy Barak, psychology professors at the University of Haifa, Israel, found that engaging with an online community was more effective in relieving the writer’s social distress than a private diary would be.

So, how did they discover that? They randomly surveyed high school students in Israel who said they had difficulty making new friends or relating to friends they already had. Researchers selected 161 teens to participate in the study. The average age was around 15 and there were 124 girls and 37 boys. 

The teens were then divided into 6 groups. The first two groups were asked to blog about their social difficulties, with one group asked to open their posts to comments. The second two groups were asked to blog about whatever struck their adolescent fancy; again, with one group allowing comments. All four groups were told to write in their blogs at least twice a week. As a control, two more groups were told to keep either an old-fashioned print diary or to do nothing at all.

Four psychologists reviewed the blog entries to determine each writer’s relative social and emotional state. In all the groups, the greatest improvement in mood occurred among those bloggers who wrote about their problems and allowed people to respond.

People who responded offered positive feedback and support, and that appears to be the key.

“The only kind of surprise we had was that almost all comments made by readers were very positive and constructive in trying to offer support for distressed bloggers,” Dr. Barak wrote in an email to the New York Times.

 Royar Loflin, a 17-year-old blogger from Norfolk, Va., who did not participate in the study, says that blogging helps her find a little peace of mind.  “I definitely write posts in which I talk about being overwhelmed, and it helps me to relax. People will write in the comments, ‘I remember when I was in your shoes’ ” and ‘Don’t worry — you’ll get through the SATs!’ and it’s wonderful,” she said. “It really helps put everything into perspective.”

Once again I am reminded -The times they are a changing.

Source: http://www.nytimes.com/2012/01/29/fashion/blogging-as-therapy-for-teenag...

Your Teen

HPV Vaccine Safety

1.15 to read

Do you have a teenager?  If so, have they received their HPV vaccine?

HPV stands for Human Papilloma Virus, which may cause cervical and penile cancer, oral cancers and genital warts.  There has been a vaccine available since 2007.

A recent study in the journal Pediatrics looked at vaccination rates for teens and the HPV vaccine. While 80% of teens are receiving their Tdap booster, and 63% of teens are current on their meningococcal meningitis vaccine, only 32% of teens have received all 3 doses of HPV vaccine.

Parents whose teenagers had not received a first HPV vaccine or completed the series often said that the vaccine was “not needed or necessary”.  

Other parents whose children had not received the HPV vaccine and who did not intend to vaccinate their children stated that they “were worried about the safety or side effects of the vaccine”.

The HPV vaccine has had a good safety record and has been shown to be very effective in preventing HPV infections.  The vaccine has been studied in the United States for amost 7 years, and in Europe and Australia for almost 10 years.  

The vaccine does not treat HPV disease, but rather prevents it, so the vaccine needs to be given to adolescents prior to any exposure to the virus.   While many parents feel comfortable discussing sexuality with their children, other parents are uncomfortable with vaccinating their children for a sexually transmitted disease.  

Getting parents to complete the series (which is given over a 6 month period) has also been a hurdle and  the vaccine is not effective until all 3 shots in the series has been completed.

If you have questions about the HPV vaccine, talk to your doctor in order that all of your questions can be answered. I know I have given my 3 children the vaccine and encourage all of my patients age 11 and older to receive the HPV vaccine series. 

Daily Dose

Dangers of Texting While Driving

I was watching the news the other evening (not the same as morning news surfing while on the treadmill) and there was a news segment on texting while driving.

We have discussed this issue on the radio show several times. The data surrounding accidents occurring secondarily to texting while driving becomes more alarming each day. In this segment they showed a public service announcement (PSA) that had been shown in Great Britain, which was produced to show the dangers of texting while driving. The introduction talked about risks of accidents while texting while also discussing how texting is as dangerous, if not more, than drinking and driving. They then showed a clip, which was produced to show teens in a car talking together, while at the same time texting other friends. The simulated PSA then goes on to show the driver being distracted as she answers a text and the ensuing accident involving multiple vehicles. This piece then shows the girls in the car (remember it is a re-enactment, also in slow motion at times) as they are hitting the other cars, being thrown about inside their car. It is so difficult to watch as the girls are catapulted inside the car, into one another, as well as into the windshield and dashboard, and there is blood everywhere. As the piece closes, all of the cars come to a stop and the girls are shown. They slowly realize that they have been in an accident and one of their friends is dead. The entire segment probably lasted no more than a minute, but it may have been one of the most difficult 60 seconds to watch, as it is many parents’ nightmare! This PSA is not being shown in the U.S. and some parents may think it is too graphic to show to their children. In my opinion, any teen that has a phone and a driver’s permit/license should be required to watch this, and younger teens may need to watch this too.  There have been fatal accidents involving trains, and buses all secondary to the driver texting while on the job. The statistics continue to show an alarming number of accidents due to driver inattention due to texting. My son has a friend whose precious sister was recently killed in an accident that is thought to be due to the fact that she was texting while driving. There were no drugs, or alcohol and she had on her seat belt. It occurred on a beautiful morning without rain or fog but she crossed the median while driving. The rest of the story is tragic. We have all become addicted to our phones, and Blackberry’s. There is NOTHING so important that it cannot wait until we have stopped the car. Not a business meeting, call from home or teen party or rendezvous that needs to be instantly answered. The only job we need to have while driving is to focus on driving. I am continually reminding myself of this, as I feel my Blackberry vibrate while I drive. I have to resist the urge to look. Maybe it is better to just turn it off while in the car. We all managed to function without instant communication for a long time.  Life went on. If you haven’t seen this, watch it with your teens. Make a point of reiterating the dangers of texting while driving. Have them turn off their phones in the car. It is too bad we can’t have a device that will turn the phones off when we start the car, and make us ALL resist the urge to be in constant communication. Turn on the music; it is less distracting than a phone! That’s your daily dose, we’ll chat again tomorrow.

More Information: Public Service Announcement (WARNING: This is a dramatization, containing realistic graphic material)

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Your Teen

Experts Recommend Screening All Teens for Major Depression

1:30

Studies indicate that one-in-five U.S. children have some for of mental, behavioral or emotional problems.  Among teens, one –in- eight may suffer from depression with only about 30 percent receiving any treatment.  Those are troubling statistics for parents, caregivers and health professionals.

The U.S. Preventive Services Task Force (USPSTF), believes more needs to be done to help these children and has recommended that primary care physicians screen all patients between the ages of 12 and 18 for major depression.

Screening tools are available to help primary care doctors accurately identify major depression in adolescent patients, and there are effective treatments for this age group, the task force said.

"Primary care clinicians can play an important role in helping to identify adolescents with major depressive disorder and getting them the care they need. Accordingly, the task force recommends that primary care clinicians screen all adolescents between 12 and 18 years old for this condition," task force member Dr. Alex Krist said in a USPSTF news release.

Currently, there isn’t enough evidence to know whether screening children 11 and younger would be beneficial. The task force noted that more research on depression screening and treatment in this age group is needed.

The consequences of undiagnosed and treated major depression in teens can have serious consequences such as involvement in the criminal justice system, drug or alcohol abuse and in some cases, suicide.

"It is important to take any concern about depression seriously, regardless of age, and any parent who has a concern about their child's mood or behavior should talk with their child's primary care clinician," he said in the news release. Kemper is a professor of pediatrics at Duke University School of Medicine, in Durham, N.C.

The recommendation was published online Feb. 9 in the Annals of Internal Medicine and Pediatrics.

For more information about child and teen depression, one resource is The American Academy of Child and Adolescent Psychiatry at http://www.aacap.org.

You can also talk with your family doctor or pediatrician if you feel your child is suffering from depression. They should have resources for you as well.

Source: Robert Preidt, http://www.webmd.com/children/news/20160208/doctors-should-screen-teens-for-major-depression-us-task-force-says

 

 

Your Teen

Headlines: Another Teen Suicide

On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years.The sad and desperate story of a college student who killed himself after a roommate secretly videotaped him having sex, and streamed it live on the web has made headlines across the world.

18 year old, Tyler Clementi, was embarrassed and humiliated by the invasion of his privacy. He jumped to his death from the George Washington Bridge. Unfortunately, Tyler is not the only teen who thinks suicide is the only way to end his suffering. On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years. Amazingly, suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The current headlines demonstrate that it is more important than ever that parents are aware of the symptoms of depression and substance abuse.  Suicides increase substantially when the two are combined. What symptoms should I look for? - Change in eating and sleeping habits - Withdrawal from friends, family, and regular activities. - Violent, rebellious behavior, or running away - Drug and alcohol use. - Unusual neglect of personal appearance - Marked personality change - Persistent boredom, difficulty concentrating, or a decline in the quality of     schoolwork - Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. - Loss of interest in pleasurable activities. - Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: - Complain of being a bad person or feeling rotten inside. - Give verbal hints with statements such as: “I won't be a problem for you much longer,”    “ Nothing matters,” “It's no use, and I won't see you again.” - Put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc. - Become suddenly cheerful after a period of depression - Have signs of psychosis (hallucinations or bizarre thoughts.) What should you do if you notice these symptoms in your child? If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide,"  always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a healthier mental outlook.

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