Heatstroke prevention

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July 31 is national heatstroke prevention day. On average, 37 children die in hot cars every year in the US. 87% of those are ages 3 and younger. Vehicular heat stroke is largely misunderstood, with the majority of parents believing they could never forget their child in the backseat of a car. Even the most cautious parent can be thrown off by a change in routine, lack of sleep, stress or fatigue.

2/3 of the increase in temperature happens within the first 20 minutes, and a child’s body overheats 3-5 times faster than that of an adults. Even with windows cracked, the temperature inside a car can reach 125 degrees in minutes.

To help make sure you keep your child safe, we’d like to give you some ideas to always check for baby.

Make it a routine to open the back door of your car every time you park (at work, home, grocery, etc.) to make sure no one has been left behind. Put your purse, bag, cell phone or something else important you always need in the backseat to remind yourself to check every day, every time. Send your significant other a photo of your child inside daycare every day when you’ve dropped them off, or send them a photo at home once you’ve picked them up and have them inside the house.

Additionally, make sure your child cannot get into a parked car. Keep vehicles locked at all times, even if they’re parked in the garage or driveway. Keep car keys and garage remotes up and out of reach of your children. Ask your neighbors, friends, family and guests to do the same.

If your child goes missing, immediately check all vehicles- inside the trunk and front and back seats carefully, even if they’re locked. A child may lock the doors after entering on their own and may not be able to unlock them.

If you see a child alone in a vehicle, get involved. Call 911 immediately. If the child seems hot or sick, get them out of the vehicle as soon as possible.

Talking to children about tragedies

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After a horrific event like a mass shooting or terrorist attack, parents find themselves trying to make sense of the event, all while trying to figure out what, if anything, they tell their children. Each child has unique needs in a crisis. Often, it will depend on their age, if they knew anyone affected by the crisis and how much they have been exposed to the news. Allow your child to give you clues about how to meet their needs, and remember that all children are different. One may ask you many, many questions, whereas another may only want extra hugs and to watch a movie. Both of these reactions are OK!

Ask your child what they’ve heard. Allow them to tell you what, if anything, they heard. Once they’ve told you, ask them if they have any questions. Keep your answers straightforward and direct. In general, it is best to share basic information, no graphic or unnecessary details. It’s important to understand that they’re asking you questions because they need someone they trust to listen to their questions, accept their feelings and be there to support them while they work through their emotions. Staying silent on the issue won’t protect them from these events, as much as we’d prefer for them to not have to hear about what’s happened.

While it may be possible to limit your child’s exposure to media within your home, it is difficult when you’re not within your own home, or if your child is older and has access to a cell phone, social media or news accounts.

Even your youngest child will hear about tragic events, and it’s better for them to hear information from a parent or caregiver than another child or general media. Additionally, younger children may respond with forms of dependence, like acting clingy, refusing to sleep alone and experiencing separation anxiety. They may also throw temper tantrums or wet the bed. An older child may respond with anxiety, sadness, risky behavior or outbursts at school.

Feelings of sadness, fear and confusion are normal reactions. However, if your child seems very upset and unable to recover from fear, starts having trouble in school or home, or isn’t able to get up and go to school, you may want to contact your child’s doctor for additional advice. Additionally, if you are concerned they need more information or support than you’re able to provide, you can reach out to their teacher, school counselors or doctor for additional support.

Cervical Cancer Screening Guidelines

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In 2012, the way we screen for cervical cancer changed. There were new guidelines for PAP smear testing based on medical evidence, supported by the American College of Obstetrics and Gynecology.

The new recommendations, which IHA providers agree with and follow, start with a PAP test at age 21, followed by PAP testing every three years between 21 and 30 (if you’re low-risk). Once you reach age 30, you’ll be tested every five years with a PAP test and high-risk Human Papillomavirus (HPV) test. As long as you’re low-risk, and the tests are normal, you’ll remain at the five-year interval for testing.

If you are high-risk (you have a history of abnormal PAP tests or have had prior cervical procedures), you may not fit in these recommendations. Your provider will discuss what the best screening frequency is for you based on your history.

In certain situations, a woman may no longer need PAP testing. Generally, if you’re over 65 and have had normal tests previously, you may no longer need PAP tests. You may also be exempt from PAP testing if you have had a certain kind of hysterectomy. You and your provider can discuss and decide if that is best for you based on your risk factors.

A PAP test is a safe way to screen for cervical cancer, with little to minor discomfort. Your provider will use a speculum and a soft brush to take a sample of your cervical cells. If your PAP test is abnormal, your provider will request you come back for additional testing.

If you have additional questions about what to expect, please talk to your provider.

Teaching the Immune System to Target Cancer

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Thanks to continuous advances and breakthrough in cancer research, the medical community has been witnessing an unprecedented flow of success

stories through innovative immunotherapy and targeted therapies. Cancer specialists are now able to work successfully with their patients toward less toxic and more effective cancer treatments. Immunotherapy and targeted therapies are ushering in a new era in the fight against cancer.

 

It all starts at the cell level. Under certain series of unfortunate circumstances, some cells in our bodies become corrupted and start to grow to form cancerous cells. Normally, the immune system is supposed to patrol and detect those abnormal cells and destroy them. However, cancerous cells often find a way of evading the immune system through certain mechanisms including receptors.

What are cell receptors and what do they do? Well, certain receptors on the cell surface resemble the function of passcode or Identification Cards (ID cards). Normal cells have “good” passcodes on their surface and when those normal cells are scanned by the cells of the immune system, they are allowed to survive. However, cancer cells are often able to fool the immune system by acquiring (stealing or forging) those same “good” receptors (ID cards). As such, “impostor” cancer cells pass the scanning test of the immune system and they survive and keep growing in number.

Immunotherapy and targeted therapies specifically address this flawed issue of “fake IDs” by training and waking up the immune system to appropriately fight cancerous cells. For example, medications called “check-point inhibitors” block the interaction between particular cancer cell receptors (or fake IDs) and the immune cells “scanners” in order to uncover the true identity of cancer cells and allow the immune system to destroy them.

There are also several other mechanisms by which immunotherapy can help the immune system to detect and destroy cancer cells. The bottom line is that many patients who suffer from cancer can now be offered less toxic and more effective treatments through FDA approved immunotherapy and targeted therapy. In addition to standard therapies, patients have now more opportunities to enroll on clinical trials that are looking to uncover newer ways to teach the immune system to target effectively cancer cells without affecting the normal bystanders.

The Life-Saving Benefits of Colonoscopy Screening

National Colorectal Cancer Awareness Month is a great time to talk about one of the most preventable and treatable forms of cancer, if diagnosed early. It may seem intimidating, but a colonoscopy is a very simple test and a big reason why there are more than one million colon cancer survivors in the United States.

A colonoscopy test is a visual examination of the large intestine (colon) using a lighted, flexible video colonoscope. The scope also has a camera to help the physician document findings and notable features.

A colonoscopy is more than just a test. If a polyp is found, it can usually be removed during the exam, thereby eliminating the need for a major operation and potentially preventing the development of cancer. If a bleeding site is identified, treatment can be administered to stop the bleeding. Other treatments can be given through the colonoscope when necessary and further studies or treatments may be recommended.

Colonoscopies also can be used in the diagnosis, treatment or prevention of other issues, such as:

  • Abdominal pain, discomfort or change in bowel habits
  • Chronic diarrhea or constipation
  • Colitis (Ulcerative or Crohn’s)
  • Diverticulosis and Diverticulitis
  • Alternative tests to a colonoscopy include a barium enema or other types of X-ray exams that outline the colon and allow a diagnosis to be made. In addition, study of the stool and blood can provide indirect information about a colon condition. These exams, however, do not allow direct viewing of the colon or removal of polyps or biopsies to be done.

    If you’re at risk for colon cancer because of age, medical history or family history, talk to your doctor. They can help you determine which test is right for you.

Car seats: why do they expire and can I recycle them?

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As all parents and caretakers know, a car seat is mandatory for young children and infants. But what do you do when your child has outgrown their seat, or it’s expired or been in an accident? There are approximately 12 million car seats purchased in the US every year, many of those ending up in landfills once they’ve been retired.

90% of the materials, by weight, can be recycled. There are two locations in Ann Arbor that accept retired car seats for recycling, which are listed below.

Why does a car seat expire or become unusable after a car accident? They expire because the plastic materials they’re made of degrades over time from ultraviolet light, which weakens the effectiveness of the frame to withstand impact in a crash.

They’re unusable after an accident, even if they look fine, for similar reasons. Think of the car seat like an airbag- it’s there to save your child’s life. You have to replace your airbag after a crash because it can no longer withstand impact and help save your life- it’s only useful for one crash. A car seat is the same. It may look like it hasn’t sustained any damage, but there could be cracks or fractures in the plastic that puts your baby’s life at risk in the event of another crash.

To properly dispose of a car seat, you should strip the entire seat of the cover, the straps, disassemble everything and cut the straps. It’s also recommended you write all over the plastic base something like “EXPIRED” or “CRASHED” in permanent marker, to stop someone from trying to use it. There are two locations in Ann Arbor that accept car seats for recycling: Drop-off station on East Ellsworth, and the recovery yard on Jackson Road. For more information visit Recycle Ann Arbor.

Talking to Your Teen About Underage Drinking

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By the time they reach 8th grade, nearly 50% of all adolescents have had at least one alcoholic drink with over 20% report having been drunk. In addition to being illegal, underage drinking poses high risks. While your child is young, there are significant changes in the body, including rapid hormonal changes and the formation of new networks in the brain. Young adults are extremely vulnerable to alcohol-related brain damage. The immediate and long-term risks associated with underage drinking continue to show the need for prevention and treatment programs.

The 2013 Youth Risk Behavior Survey (link) of more than 13,000 high school students nationwide found that in the past 30 days:

  • 35% drank at least one drink containing alcohol
  • 21% drank five or more drinks containing alcohol
  • 6% drank 10 or more drinks containing alcohol in a row
  • 10% drove after drinking alcohol
  • 22% rode with a driver who have been drinking alcohol

As a parent, you should feel comfortable talking to your children about underage drinking, the risks and the consequences. Often, teens do not consider consequences when making choices like to drink underage, because they do not believe they could get in an accident, or drink so much they pass out. However, alcohol related crashes are greater for drivers aged 16-20 than drivers 21 and older.

Peer pressure plays a huge role in underage drinking, as well as how alcohol is portrayed in the media. Your relationship with your children, how you discipline them, how you communicate with them and your involvement in their life are all huge influences in their choice to drink underage – or not. Communicate with your children, be involved in their lives. Encourage their growing independence, but set appropriate limits. Make it easy for them to share information about their lives, and share information about yours. Perhaps you engaged in risky behavior as a teen that you would like to make sure they do not repeat. You could be open about your teenage years and experiences. But do not glamourize any underage drinking you may have done, and be sure to tell them about the great experiences you had without drinking.

Help your children practice ways to say no to their friends: “No thank you, I’m fine,” or “I’d rather be sober,” are great places to start. Set clear rules about alcohol use and enforce the rules you set.

You need to be a positive role model for your children as well. If you drink, drink responsibly. That means not too much or too often. Do not drive when you have been drinking. Get help if you think you have a problem. And do not give alcohol to your children.

If you have any questions about how to start the conversation with your children, ask their pediatrician. They may have suggestions or resources that will help you along the way.

 

Talking to Your Teen About Smoking

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Did you know that every day nearly 3,800 people younger than 18 smoke their first cigarette? According to the Department of Health and Human Services 2,100 youth who are occasional smokers become daily smokers every single day.

The harmful effects of nicotine in teenagers and young adults creates an important call to action for parents. Don’t wait to start the conversation about the hazards of smoking. If you yourself are a smoker, seek help to quit. 5.6 million children alive today (or 1 in every 13 children) will die early from smoking if we do not do more to reduce current smoking rates.

It may be a tough topic to talk about but it’s an important topic. Teens may be more concerned with the immediate impact smoking has on their lives than they are with their health in the future. Emphasize the immediate negative impacts. Remind them that:

  • Smoking around friends or siblings can be damaging, as secondhand smoke is known to be harmful. (Half of all children between ages 3 and 18 are exposed to cigarette smoke regularly).
  • Teens who smoke tend to be sick more often than their non-smoking peers, and may develop lung problems or have more asthma attacks. If your child is an athlete, this can harm their athletic performance.
  • Smoking has a negative effect on their personal appearance (bad breath, yellow teeth, wrinkly skin).
  • Smoking may lead to the use of alcohol and other drugs.

 

On the positive end, there are healthier ways to shine within a peer group, by saying no or through unique interests or hobbies. Also remind them about the long-term effects:

  • Tobacco use is the single most preventable cause of death in the US and in the world.
  • Smoking is well-known to cause heart disease, cancers and stroke.
  • Smoking decreases life expectancy.
  • Nicotine has negative effects on brain development which could have lasting effects on memory and attention.

 

Remind your child that smoking includes e-cigarettes and hookahs. Both have some of the same dangerous effects as cigarettes. Starting the discussion about smoking when your children are young and continuing it through their high school years is important. You, as the parent, are a role model and the greatest influence on your children’s lives. Set a positive example by quitting smoking if you currently smoke.

They will need consistent reinforcement, support and guidance. Knowing if your children’s friends smoke is important. You may be able to help them practice ways to say no. For example “No thanks – I’m good” or “Gross! Those things stink!”

Help your children understand that TV shows and movies may make smoking look “cool” when in reality it’s very harmful. Remind them it’s much harder to quit smoking than it is to start in the first place. Tell them stories about family members with health problems related to smoking, make it real.

Talking about smoking with your children may seem challenging, but it’s important. If you have questions, ask your child’s doctor for information that may help kick-start or continue the conversation.

Know Your Spots

Protect yourself by knowing the warning signs of skin cancer

Many people are familiar with melanoma, one of the most deadly forms of skin cancer, but are you aware that there are other, more common types of skin cancer that you should be watching for? As we prepare for warmer weather, it is important to know how to prevent and detect skin cancer.

An ounce of prevention

Sun avoidance is key to preventing the development of skin cancer. Ultraviolet (UV) light exposure, such as from the sun or indoor tanning beds, is a known risk factor for the development of melanoma and non-melanoma skin cancers, especially in fair-skinned individuals.

Avoiding tanning beds, staying out of peak sun exposure (during the mid-day), seeking shade, and wearing long sleeves, pants, and a wide-brimmed hat are your best bets to keep your skin looking younger for longer and for the prevention of skin cancer.

If must expose your skin to the sun, using a sunscreen is helpful. Daily use of a broad-spectrum (UVA and UVB blocking) sunscreen is recommended. In the summer months, a minimum SPF (sun protection factor) of 30 is suggested, but the higher the SPF number, the better. If you use moisturizer or make-up, look for products that contain a sunscreen, and you can skip daily application of a second product to your face. Application of an adequate amount of sunscreen is also important to achieve the desired effect. Approximately one ounce (two tablespoons) is the amount of sunscreen required for one full body application. A thin coat of sunscreen can provide one half or less of the labeled SPF. Check to make sure that your sunscreen is not expired. Even if your sunscreen is labeled as water-resistant, be sure to reapply frequently, especially if you are perspiring or swimming.

Get to know your skin

I recommend a full body self skin examination once per month. Pick a day of the month that is easy to remember, such as the first of the month, or another number of personal significance. If you “know your spots,” it is easier to recognize and treat potential skin cancers at an earlier stage.

Know the warning signs of skin cancer

The most common type of skin cancer is basal cell carcinoma. This is a slow growing skin cancer, but can be locally destructive if left untreated. This presents most commonly as a fragile, pimple-like bump that bleeds easily. This cancer fails to heal like a normal pimple would. Scaly, pink or red patches of skin that do not respond to moisturizer may also be a warning sign basal cell carcinoma.

The next most common type is skin cancer is squamous cell carcinoma. This can present as a scaly, sandpapery, rough patch of skin that fails to respond to moisturizer. It may also present as a new or rapidly growing lump on the skin, sometimes with a crusty center.

A less common, but more dangerous form of skin cancer is melanoma. An easy to remember mnemonic device highlights the warning signs of melanoma – look for the “ABCDEs.”

IHA ABCDEs for checking moles

It is also helpful to look for the “ugly duckling” or “black sheep” of your moles or spots. If you have a mole that stands out from the rest of your moles, a professional should examine it.

Other rare forms of non-melanoma skin cancer also occur, such as merkel cell carcinoma or tumors of sweat glands and oil glands.

A baseline visit with a board-certified dermatologist is recommended to screen for any potentially concerning lesions. Your dermatologist can provide further education about how to perform a self-skin examination, will discuss your individual risk factors for skin cancer, and can help you to design a plan for sun protection.

To schedule an appointment with an IHA Dermatologist, please call 734.677.DERM (3376) or make an appointment.

Resources

How to Select a Sunscreen

How to Perform a Self Exam

What to Look For

Breastfeeding: When and How Much Does My Baby Need to Eat?

The first few days your body will make colostrum- a thick yellow/orange colored liquid that is VERY important for your baby to eat. It is nutritious and will help protect your baby from sickness. There may only be a tiny amount and that is OK and normal.

Between days 2-5 your milk will come in and will start to change to a creamy yellow to milky white color and there will be much more. The most wonderful thing is that your body will make milk according to your baby’s needs both in quantity and in nutrition!

To make sure you have enough milk, feed your baby when they ask to be fed or “on demand” feeding. There is no need to wait a certain amount of time before feeding and it could be less than an hour before your baby wants to feed again. It is normal for a newborn not to have a pattern for when they would like to eat and it is important for you to feed them often for both their health and to make sure you have enough milk for them.

Look for signs your baby is ready to eat such as:

  • Making soft sounds, whimpering- don’t wait for a full-blown cry to try!
  • Mouth movements- licking lips, sticking tongue out
  • Trying to put hands/fingers in mouth
  • Turning head toward breast or chest (this is called rooting)
  • They are awake and looking alert

The most important thing is to feed your baby when they ask to be fed and to make sure they are feeding every 2-3 hours for the first 2-3 weeks.

Don’t let your baby sleep through the night at first, if needed wake your baby at least every 3 hours. This will ensure that your baby is getting enough to eat and that your body makes enough milk.

This will be at least 8-12 feedings in a day and it may be more that is OK and normal.

Once your baby is older and stronger, they may not eat as many times each day and will be able to sleep for more hours at night.

How do I know if the feeding is good?

  • You can hear your baby swallowing and may see milk in their mouth when they are off the breast.
  • You feel your breasts are softer after feeding
  • You feel strong, deep pulling as your baby eats
  • Your baby nurses for about 15-20 minutes each side or 20-30 minutes on 1 side.

How do I know if they are full?

  • Your baby may become drowsy or sleepy after feeding
  • They look relaxed (hands and shoulders are relaxed)
  • Their mouth falls off your breast because they are so relaxed

How do I know if they are getting enough?

  • Your baby should have at least 6-8 wet/poopy diapers per day
  • We will check your baby’s weight when you come in for appointments to make sure they are gaining weight.

Call our office, IHA Pediatric Healthcare – Arbor Park, if you have any concerns, we are here to support you! (734) 434-3000