Winter arrived in full force to welcome in 2021 with snow blanketing the ground. And with snow, along came the excitement for sledding. While sledding can be a fun winter activity for children and adults alike, it is important to take some precautions to keep everyone safe.

1. Sled during daytime hours. Avoid sledding at night or in poorly lit areas to reduce the chance of injury.

2. Dress warmly. Hats, mittens/gloves and appropriate winter gear are advised to prevent hypothermia. Children are at a greater risk of hypothermia than adults.

3. Consider wearing a helmet. Yes, the American Academy of Pediatrics recommends considering a helmet, just as children do for skiing. Sledding can lead to concussions and other serious injuries.

4. Avoid sledding near trees, bodies of water and fences.

5. Young children should be supervised at all times.

6. Teach children how to roll off of a sled that will not come to a stop on its own.

7. Children should ride upright with feet first and in the forward -facing position. This will decrease the likelihood of a head injury.

8. Avoid pulling children on sleds behind vehicles.

Have fun and enjoy the snow this winter!
Dr. Jennifer Teegarden

If you have a teenager at home, you likely know all too well about sleepy teens.  Teenagers need on average about 9 to 10 hrs of sleep at night, but most of them aren’t getting this amount of rest consistently.  Teenagers are growing, not just physically, but their brains are also developing, increasing their need for more sleep.  
 
So, why are they not getting the recommended amount of sleep?  Well, most teens brains are engineered to want to stay up late and sleep in.  However, most middle schools and high schools start early, with most teens arriving to school each morning by 8 am and some as early as 7 am. This translates into early wake times.  Sports, late evening practices, extra – curricular activities and increased amounts of homework often mean late nights for many teens.  
 
Lack of sleep or sleep deprivation in teens can have significant consequence and affect them in a variety of ways.  Teens lacking in sleep may often be more moody or irritable.  Parents may also notice an increase in more risk – taking behaviors such as fast driving, smoking, and drinking alcohol with chronic sleep deprivation.  There has also been an association between lack of sleep and an increase in reported car accidents and teens falling asleep at the wheel.  School performance often suffers as well and should be a red flag if parents are noticing a change in their teen’s grades. Attention, memory, and decision making all are affected by not getting enough zzz’s.  

So, if this sounds all too familiar with your teen, what can you do to help?  Well, there are a number of actions parents can take to help their teens get the rest they need.

1. Sleep schedule:  yes, teens can benefit from a sleep schedule.  Having a nightly routine and sticking to it.  A consistent bedtime and wake time can help.
2. Avoid oversleeping: (insert teen eyeroll).  Sleeping in might just be your teen’s favorite weekend pastime.  However, sleeping in until noon on Sundays is going to make it difficult to get to bed on time Sunday evening.
3. Early afternoon naps: If your teen is tired after school and he or she has time to nap before their evening practice or activity, a 30 minute nap can help provide some much needed rest.
4. Avoid screens: now, this is a hard one.  Avoiding use of TV’s, smart phones and other screens at least 1 hour prior to bedtime is advised.
5. Avoid caffeine: teens should have limited caffeine consumption.  Avoiding all caffeine during the afternoon and evening hours can help as well.  
​
If your teen is persistently tired despite implementing some actions to increase their rest, or you notice excessive snoring, contact their primary care physician for further evaluation and recommendations.

Sweet dreams!
Dr. Jennifer Teegarden

There has been a lot in the news recently about voluntary recalls of Zantac (ranitidine).  In short, the FDA found trace amounts of N-nitrosodimethylamine (NDMA), a probable carcinogen (cancer-causing compound), in some lots of the medication by several manufacturers.  
 
While the headlines are scary, this topic deserves a little unpacking.
 
First, let’s gain a little perspective.  According to the FDA, the levels of NDMA in many tested ranitidine products are similar to those consumed through "common foods like grilled or smoked meats.”  For some people, this statement is quite reassuring, while others are thinking, “What?!  My favorite grilled meat can cause cancer?”.  Well, yes and no.
 
Cancer is caused when damages to DNA result in uncontrolled over-growth of a cell or tissue.  Most of the time, our cells recognize the damage and either fixes the DNA or destroys the cells that have gone rogue.  A person’s overall risk of cancer is based on a number of factors including genetics and environment exposures https://www.cancer.gov/about-cancer/causes-prevention/risk/substances.  While some exposures can be avoided (tobacco smoke, excessive sun exposure), others are more difficult to avoid since they are present in the environment, including the air we breathe and the food we eat.  
 
Health Suite 110’s stock of ranitidine was not affected by these recalls as we are stocked by a different manufacturer.  That said, the FDA recommends “patients taking prescription ranitidine who wish to stop should talk to their health care professional about other treatment options. Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition. FDA’s testing of samples of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these medicines”. 
 
You can read more about the recall and specific lots affected on the FDA website: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine. 
 
For patients who prefer to switch from taking Zantac, these medications are not all interchangeable.  While Zantac, Pepcid and Tagament are all histamine-blockers (H2-blockers), things like Prevacid and Prilosec are proton-pump inhibitors (PPIs) and have different implications.  H2-blockers are generally felt to be safe for long-term use, while long-term use of PPIs can increase the risk for C.diff, pneumonia and osteoporosis.  If you require antacid medication on a daily basis, be sure to discuss with your physician.  Sometimes there is an underlying cause that can be treated (H. pylori infection, obesity, food triggers) and other times the risk of taking a medication long term far outweighs the risks of not taking it, particularly for folks who have pre-cancerous changes in their esophagus from long term reflux (Barrett’s esophagitis).
 
 
In summary:

• If you suffer from heartburn or gastroesophageal reflux (GERD), do not stop or change your medication without first discussing with your doctor.

 

• Talk to your doctor to discuss ways to reduce your heartburn symptoms (weight loss, avoiding food triggers and late-night eating).

 

• Consider ways you can reduce your exposure to carcinogens, including limiting intake of meat cooked at high temperatures, see below.

 
 
 
Five Steps for Cancer-Safe Grilling
1. Marinate: Studies suggest that marinating meat before grilling can decrease formation of carcinogens. 
2. Pre-Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to flame by partially cooking it in a microwave, oven or stove first. 
3. Go Lean: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently.
4. Mix It Up: Cutting meat into smaller portions and mixing them with vegetables can shorten cooking time.
5. Go Green: Grilling of vegetables and fruits produces no carcinogens. So, add veggies and cut down the amount of meats.
 
 
Happy grilling!
Kylie Vannaman MD

For some, the holidays are a time for gathering, joy, cheer, family, friends, peace and togetherness. For others, the holidays are instead filled with isolation, stress, depression, family turmoil, heartache, and loneliness.  And maybe for the majority of us, it is a combination of the above.
 
During this season of thanksgiving, it can sometimes be difficult to maintain an attitude of gratitude. Some may feel it is only obtainable when all is going well.   According to Robert A. Emmons, Ph.D (noted to be the world’s leading scientific expert on gratitude and a professor of psychology at the University of California, Davis, and the founding editor-in-chief of The Journal of Positive Psychology), one of the five myths about gratitude is that it isn’t possible or appropriate in the midst of adversity or suffering. 

“Some argue that it’s impossible to be grateful in the midst of suffering. When life is going well, when there’s abundance—sure, then we can be grateful. But what about when we’re facing hard times? I believe not only is gratitude possible in those circumstances—it’s vital to helping us get through them. When faced with adversity, gratitude helps us see the big picture and not feel overwhelmed by the setbacks we’re facing in the moment. And as I’ve suggested above, that attitude of gratitude can actually motivate us to tackle the challenges before us. Without a doubt, it can be hard to take this grateful perspective, but research suggests it is possible, and it is worth it.”
https://greatergood.berkeley.edu/profile/robert_emmons#articles
 
Gratitude has been studied in patients after heart attacks. Gratitude at 2 weeks after a heart attack was associated with a higher self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) and improved emotional well-being 6 months later. It was concluded that gratitude may help recovery from a heart attack and that interventions promoting this positive construct could help improve adherence and well-being.
https://www.ncbi.nlm.nih.gov/pubmed/27796252
 
In another study of asymptomatic heart failure patients, gratitude journaling decreased lab results related to heart failure morbidity such as inflammation. 
https://www.ncbi.nlm.nih.gov/pubmed/27187845
 
Here is a TED talk I recently watched which involves a physician and her journey with gratitude while caring for a son with an incurable and terminal illness. Can you apply her experience to your own life’s situations? - https://www.youtube.com/watch?v=HHTmiHB6aXk&feature=youtu.be&list=PL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZhttp%3A%2F%2Fyoutu.be%2FHHTmiHB6aXk%3Flist%3DPL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZ
 
But how can I develop more gratitude?
I recommend a review of the following article by Dr. Emmons titled 10 Ways to Become More Grateful - https://greatergood.berkeley.edu/article/item/ten_ways_to_become_more_grateful1
 
Lastly, how can I be better prepared for the upcoming holiday season (and any “season” of life)?
I often recommend guided imagery, which is a form of meditation, as a way to practice mindfulness. By reconnecting with ourselves and being present for a short period of time, we can be better prepared for the stressors and challenges of life. 
To see if guided imagery is right for you, try listening to guided imagery audio for free on this Kaiser Permanente website - https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/FchBDoMgEADAt_iAzYZEYfFmhH6hhdsGiZIIGELt99seZ9DjC33hO-3cUy18_uxCLD22md9bqnCnLVZ8okd_Nd4zoysVAocj_o9bT-GM6IzVap2MBamlBCGsgEWPBohoUkKp8UErXjnTZxmGL2IKPpI!/
If you find these audio sessions helpful and would like more, I recommend resources from the following website - https://www.healthjourneys.com
 
“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. It turns problems into gifts, failures into successes, the unexpected into perfect timing, and mistakes into important events. It can turn an existence into a real life, and disconnected situations into important and beneficial lessons. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow. Gratitude makes things right.”
Melody Beattie

Dr. Charles Willnauer

We usually think of “dementia” as simply memory loss, but it is much more than that. The term “dementia” is defined as having memory loss AND difficulty in one other area such as:
 

• - Speaking or writing coherent sentences  

1. - Recognizing familiar surroundings 
2. - Planning and carrying out complex tasks 

 
These symptoms must interfere with independence and quality of life to be considered to be consistent with dementia. 
 
What causes this horrible disease?
There are several diseases that affect the brain which can result in dementia. 

1. - Alzheimer Disease – the most common cause of dementia. We have no idea how it develops or why. But we do know it causes changes in the brain by depositing plaques called “beta amyloid” on the brain tissue. This leads to loss of nerve cells. 
2. - Vascular dementia – this is a result of decreased blood flow due to strokes, narrowing of blood vessels, or other arterial diseases that cause decreased perfusion of the brain. Remember, blood has oxygen. Good blood supply is critical to help the brain function. 
3. - Dementia with Lewy bodies – These abnormal structures called “Lewy bodies” form within the brain cells and cause hallucinations and delusions. They can cause Parkinson’s like symptoms including tremor, stiffness, and abnormal balance. 
4. - Various other causes – There are multiple health condition that can injure brain cells that may lead to dementia. 

 
What tests should you have?
The first step is to have a conversation with your primary care doctor. There are a few blood tests you might discuss, like thyroid levels, B12, and other blood tests. Imaging may include CT or MRI brain. There are various other experimental imaging studies that are under investigation. Finally, a lumbar puncture might be needed as well to analyze the spinal fluid. Again, the best place to start is with talking with your primary care doctor. 
 
How can you treat this disease?
It all depends on the type of disease. There are a few medications that may help with quality of life and memory. Unfortunately, there are no treatments that can halt the progression of the disease. Clinical trials help us find a cure and current trials are testing medications that block the progression of the disease. 
 
To decrease the risk of developing dementia, follow a healthy dose of physical activity, a healthy diet, and engage in social interaction. As simple as this may sound, these 3 recommendations can be difficult to complete consistently. Genetics may also play a role in developing dementia. Unfortunately, there are no genetic tests that are validated that accurately predict the development of dementia. 
 
Cherish each and every moment. Live with gratitude. 
 
Dr. Ahmed 

School is back in session and in addition to hitting the books, many students are back in the gym training for fall sports.  Each year, more than 60 million school aged children participate in organized sports!  Being a member of a sports team can bring a number of great experiences and life lessons for students, along with fun and great memories.  So whether your daughter or son plays volleyball, basketball, football, tennis, baseball, runs track or is a tumbling gymnast, it is important for parents and students to be aware of overuse injuries.
 
What is an overuse injury?  An overuse injury is damage to a bone, muscle, tendon or ligament caused by repetitive stress and without given the time to properly heal. Children and teens are at increased risk for overuse injuries for a multitude of reasons.  Their growing bones are more susceptible to injury and they might not always be aware the symptoms that they are experiencing could be an overuse injury. Some common examples include tennis elbow, runner’s knee, pitcher’s elbow and shin splints.
 
What symptoms should student athletes and their parents be looking for?  Well, there are four stages of overuse injuries and how they typically present and progress.

Stage 1: Pain in an affected area after activity 
 
Stage 2: Pain in an affected area with activity, but not limiting performance 
 
Stage 3: Pain during activity and limiting performance 
 
Stage 4: Chronic persistent pain even at rest
 
 
What can student athletes and parents do to help prevent overuse injuries . . .
1. Every student athlete should have a PPE or preparticipation physical evaluation.  Ideally this evaluation or sports physical should be performed by your child’s primary care physician, who has knowledge of their prior health history and can follow them for any chronic conditions as well as help manage any acute injuries.

2. All student athletes should maintain year-round fitness, during the season and the off season as well.

3. Proper warm ups and cool downs with all practices and games.

4. Limit a particular sport to 5 days per week. This also helps to prevent burnout.

5. It is recommended that athletes participate in only one sport and on only one team each season.
6. Encourage participation in a variety of sports. This gives your child an opportunity to learn new skills, make new friends and even maybe find a new passion.   
 
If your student athlete has pain or symptoms of concern, contact their primary care physician for an evaluation.  

We wish all of our student athletes a fun, safe and healthy season!
Dr. Jennifer Teegarden