November 12th, 2009 03:10pm
Mitchell F. Davenport
The ACE (Adverse Childhood Experiences) study is a collaborative effort of the Department of Preventive Medicine at Kaiser Permente in San Diego and the Centers for Disease control. It originated with observations of Dr. Vincent J. Felitti who was conducting a weight loss program in the 1980’s.
The patients having the most success were actually dropping out of the program. In follow-up interviews of over 200 patients, he made a number of observations:
· Child sexual abuse was very common among the obese
· For most of them, their obesity began after their abuse
· Many patients saw a relationship between their abuse and their obesity
· Obesity was not the problem it was the solution to other problems more psychological in nature
This led to the largest study ever done (17,000+ people) that explores the long term health and social effects of adverse childhood experiences. For the sake of the study, the following experiences were considered adverse:
· Recurrent and Severe Psychological abuse (11%)
· Recurrent Physical abuse (28%)
· Contact Sexual abuse (21%)
· Violence against the respondent’s mother (13%)
· Living with substance abuse (27%)
· Living with mentally ill or suicidal parents (19%)
· Living with individuals who had ever been
· incarcerated (3%)
· Both biological parents not present (23%)
In brief, the findings are these:
· ACEs are surprisingly common
· ACEs still have profound effect 50 years later
· ACEs tend to appear in groups (where there is one there are usually others)
· Early experiences are transformed
into organic disease, social malfunction and
mental illness
· ACEs are the main determinant of the health
and social well-being of the nation.
In our next blog, we will discuss the more specific findings of the study.
October 20th, 2009 10:12pm
Dr. John C. Maynard
The kidneys of people with Chronic kidney disease (CKD) function at less than 60 % of normal. This effects millions of Americans. One study showed that more than half of people with CKD do not know they have it. These are the major risk factors for CKD: diabetes, hypertension, obesity, smoking, family history of CKD and being over 60 years of age. Early detection can slow down or even prevent kidney failure. On Saturday, October 24, 2009, the National Kidney Foundation of Illinois will visit the Rockford community with the KidneyMobile, offering free screening for diabetes, hypertension and kidney disease at Rockford Nephrology Associates, 612 Roxbury Road, from 10 am to 2 pm. For more information call 312-321-1500 or visit www.kidneymobile.org.
September 20th, 2009 09:03am
Donna Addison
My father has known for many years that he had cataracts. As this is a very common problem for older adults–in fact, many sources claim that over 50% of persons over the age of 65 have cataracts–his diagnosis didn’t concern any of us. Over time, he needed “stronger” prescriptions in his glasses and he admitted it was hard to see at night while driving. It wasn’t until he announced he couldn’t read those big green street signs mounted on traffic lights that I got nervous about these cataracts. Although he knew all about the surgery, my dad didn’t seem very motivated to get the surgery. Perhaps he was recalling the days of my grandfather’s cataract surgery in the 1970’s: lengthy surgery, huge eye patches, special glasses, all sorts of eye drops, issues with sight. Perhaps he just didn’t think his eyesight was “bad” enough to warrant surgery. Thankfully, after realizing those big green signs were no longer visible to him, he finally agreed to go forth and schedule his cataract surgery.
Cataracts are the clouding of the eye lens. Surgery is performed to replace the clouded lens with an artificial lens. Usually a pretty simple procedure, the surgery lasts 30 minutes or less and is completed on an out-patient basis. My dad was scheduled to have one eye done first and the other done a week later. All my dad had to do was show up for pre-op as scheduled, receive an I.V. with a local anesthesia (the “twilight” medication, he reported), get his eye numbed and immobilized, and be done with the actual cataract surgery within 15 minutes. No stitches, no eye patch, no lengthy recovery. My mom drove him home, where he promptly returned to playing games on the computer. Rest, relaxation, eye drops and not touching his eye was about the only concerns he faced. He was delighted to report he could see very clearly after surgery and made sure to rub it in that he no longer needed his glasses to see. I’m guessing that he wishes he would have had the surgery sooner.
Cataract surgery is usually very safe and has little risk; however, there are always risks involved with surgery. Not to scare anyone, but my dad did experience a medical issue while having one of his eye surgeries: his blood pressure plummeted and they were unable to continue with the surgery until he was stabilized. Because he was in a surgical setting, surrounded by medical professionals, he was in safe hands. When asked later about this, he replied “it was no big deal.”
Now that the cataracts have been removed, he won’t have to worry about them re-developing. He still needs glasses to read small print, but he is still glasses-free for everything else. I’m happy to report that the man who waited until he couldn’t read street signs is now trying to convince me that I need to have eye surgery so I don’t need glasses.
August 3rd, 2009 02:36pm
Mitchell F. Davenport
(Warning: Beginning with this blog, the next few will be about childhood trauma. If you are reading these articles and have a history of being traumatized, these articles could trigger a trauma reaction in you. If this should happen, contact a mental health care provider immediately).
Near the end of the movie Rambo, there is a scene in which Sylvester Stallone (“Rambo”) is in the police station surrounded by policemen who want him to surrender himself. On the contrary, Rambo is geared up for a fight. Also inside with him is his mentor and trainer. The police have sent him in to try to get Rambo to surrender. In a very heated scene in which his mentor is talking to him about giving up, Rambo breaks down and starts crying. In the midst of his tears he shouts at his mentor something like, “I can’t just turn it off!” People recovering from trauma often feel that way, “I just can’t turn it off.”
The Classic Rock group, Metallica, has a line that is repeated in one of their songs over and over again, “and the memory remains.” Trauma messes with our memory which in turn messes with our fight or flight tendency, and (especially in children) the result becomes a noticeable inability to regulate emotions.
Before going any further, it might be helpful to define trauma. One might say, “Trauma is in the eye of the beholder.” Two people can be in a car accident and one of them develops severe trauma symptoms while the other is unfazed. (It is estimated that between 18 and 45% of people in car accidents will develop Post Traumatic Stress Disorder.) So, while keeping in mind that trauma is a subjective experience unique to each individual, we can say in general that trauma is “an experience that produces psychological injury or pain” (dictionary.com). The Early Trauma Treatment Network defines trauma as it relates to children as “an exceptional experience in which powerful and dangerous stimuli overwhelm the child’s capacity to regulate emotions.” The Adverse Childhood Experiences study chose to refer to trauma-like experiences as “adverse childhood experiences.” In doing the study they chose the following as “adverse childhood” experiences: childhood abuse and neglect; growing up with domestic violence, substance abuse or mental illness in the home; parental discord, and a family member involved in crime. While technically one would not necessarily call these traumas, they increase the odds of a person later in life having physical and emotional difficulties.
The body and the brain remember, often wreaking havoc in the traumatized person’s life.
(In our next blog we will examine the results of the ACE study mentioned above and following that we will look at the specific impact of trauma on children and the diagnosis of Post Traumatic Stress Disorder.)
July 21st, 2009 06:58am
Donna Addison
Whether it’s in the garden, on the golf course or taking in a local ball game, seniors should be aware of dangers related to heat exhaustion and heat stroke. Because seniors tend to have decreased ability to sweat, tend to have medical issues and due to side effects of some medications, they are at risk of experiencing heat-related illness.
Heat exhaustion occurs when the body become overheated and dehydrated. Heavy sweating, rapid pulse, headache, fatigue, muscle cramps thirst, dizziness and nausea are all classic signs of heat exhaustion. It’s a good sign if you’re sweating profusely, as this is a sign of heat exhaustion, not heat stroke. If you are a senior enjoying a round of golf at noon in August, there’s great potential for heat exhaustion. Time to get out of the sun and relax in the clubhouse!
Heat stroke is a medical emergency and can be fatal. It occurs when the body’s temperature gets too high and the body is unable to cool itself. Symptoms include rapid pulse, difficulty breathing, unusual behavior, confusion, agitation, flushed skin and/or seizure. Don’t look for sweating, as many people with heat stroke do not sweat. Seniors need to immediately get out of the sun and into the shade or air-conditioning–do whatever you can to lower the person’s temp. When in doubt whether or not someone has heat stroke, call 911 and get emergency medical treatment.
This summer, seniors should remember to drink plenty of fluids; stay out of the sun during the hottest part of the day; wear loose-fitting, cotton clothing; take cool showers; limit alcohol & caffeine consumption; and, enjoy air conditioning!
July 16th, 2009 05:58pm
Megan Nimmers
People of all ages of sizes can devolp sleep apnea, a disorder in which people actually stop breathing in their sleep. Undiagnosed and untreated sleep apnea may contribute to daytime fatigue and behavior problems. According to a recent study in the journal of the American College of Chest Physicians, children who snore loudly were twice as likely to have learning problems. Following a poor nights sleep, children are more likely to be hyperactive and have difficulty paying attention. These are also signs of attention deficit/hyperactivity disorder (ADHD).
Sleep apnea may also be associated with delayed growth and cardiovascular problems. If your child is exhibiting symptoms of sleep apnea, talk to your doctor.
During the night, a child with sleep apnea may:
*Snore frequently and loudly.
*Have pauses in their breathing, gasps or snorts.
*Be a restless sleeper or sleep in abnormal positions.
*Sweat heavily in their sleep.
During the day, a child with sleep apnea may:
*Have behavioral, school and social problems.
*Have headaches during the day, but especially in the morning.
*Be irritable, agitated, aggressive and cranky.
*Fall asleep during the day.
*Speak with a nasal voice and breathe regulalry through their mouth.
June 22nd, 2009 07:58am
Donna Addison
If you grew up with manual typewriters, actual encyclopedias and record albums, you remember the days before computers. There was no Internet, no Google, no email. I still remember getting my first computer in the late 1980’s. I opened the boxes, set it up and then stared at it. I didn’t know how to turn it on, let alone use it. Today, I cannot imagine living without my computer–it’s a tool I use daily to stay in touch with family and friends, find information needed for work and leisure, to pay my bills keep my checkbook balanced. Despite growing up in the days before computers became a household mainstay, the “Baby Boomer Seniors” seem to have made a smooth transition from the typewriter ribbon to the Laser jet printer. My mom and dad are always on their computer, whether it because they are playing “Free Cell” or checking up on me via “Facebook.” Not surprisingly, though, there remain many seniors who have not used a computer or who are fearful of taking the leap into this world of electronics. I assure them it’s never too late to learn a few new skills!
Seniors using computers can build dexterity by using the keyboard, mouse and other peripherals that come with today’s gaming systems. Whether it’s looking for information through a search engine or reading the local paper on-line, computer use gives their eyes a work out through all that scanning of the information displayed on the monitor. Learning new skills and putting those skills to use may help keep memory alive and well. Communicating with loved ones–or, even finding those long lost classmates–can bring joy to anyone’s day. For those that are house-bound, the computer can bring the world to the home.
Seniors don’t need to know how a computer actually “works;” they just need to know how to use this invaluable tool to their advantage. Don’t let a lack of knowledge scare you away from computer use; there are plenty of classes, over-sized monitors and even large-print books that can help you navigate this strange, new world. If my 85 year old aunt can send email, so can you!
June 18th, 2009 03:16pm
Mitchell F. Davenport
In my last blog, I concluded that “ADHD is a debilitating disorder causing trouble for the child, the parents, and the teachers.” I also promised to address the issue of how ADHD is diagnosed. To make a formal diagnosis of a mental disorder in the USA, the Diagnostic and Statistical Manual of Mental Disorders, IV (DSM IV) is the most often used standard in diagnosing. It is published by the American Psychiatric Association and groups symptoms under certain labels that we call a diagnosis. In the medical field, you might go to the doctor with a stomach ache and the doctor tells you that you have appendicitis. “Appendicitis” is the diagnosis.
In the DSM there are 3 types of ADHD:
· ADHD, Inattentive Type
· ADHD, Hyperactive/Impulsive type
· ADHD, Combined Type
Whenever diagnosing children, it is important to keep their developmental stage in mind. Behaviors that are “normal” for one developmental stage may not be “normal” for another. According to the DSM, in order to have ADHD, Inattentive Type, the child must have at least six of the following: 1) often fails to give close attention to details or makes careless mistakes in schoolwork; 2) has difficulty sustaining attention in tasks or play activities; 3) often does not seem to listen when spoken to directly; 4)Often does not follow through on instructions and fails to finish things; 5) has difficulty organizing tasks and activities; 6)avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort; 7) often losing things; 
is easily distracted; 9) is forgetful during daily activities.
Besides having six of the nine symptoms listed above, these behaviors must cause impairment in the child’s daily functioning and be present in two or more environments. For example, a child who displays the above symptoms at school but not in other environments would not be diagnosed with ADHD. The assumption being that since ADHD is a brain based disorder, if present, it should manifest in most or all of the child’s environments. If it only manifests in one environment then there is probably something particular to that environment that needs to be adjusted as opposed to diagnosing (and medicating) a child with ADHD.
We will look at the other two forms of ADHD in my next blog.
May 18th, 2009 07:42am
Donna Addison
Doors and windows locked? Check.
Lights on a timer? Check.
Paper delivery canceled? Check.
Trip Itinerary? Check.
Swim suit packed? Check!
If you are one of the lucky seniors who will be traveling this summer, you’ll probably need more than your passport and sun screen while away from home. One of the most important things you can do when traveling is to keep your prescription medications with you, not packed in a bag you may not see for days! If possible, keep medications in original containers from the pharmacy. That way, the medications will be easy to identify, all the needed information is right on the label and you’ll be able to get refills if you end up being away from home longer than anticipated. If you require insulin injections, make sure your syringes, lancets and insulin are marked by prescription label with your name & prescription information. Don’t forget to pack your glucometer and test strips! While packing your meds, don’t forget to bring a small bottle doctor-approved pain medication such as Tylenol or ibuprofen. There’s nothing like having a headache while away from home and not having immediate access to do something about it. In addition, you’ll save money–resorts are known for high prices on necessities! No matter where you are going, it’s always a good idea to take along some over-the-counter medication that will take care of any gastro-intestinal distress that may occur along the way. You don’t have to be in Mexico to get something that resembles “Montazuma’s Revenge.” Overeating, a change in eating routine or even drinking a different city’s water can lead to some unwanted consequences. Whether traveling by car, boat or plane, consider including some motion-sickness medication in your bag; as long as your physician says it’s okay to take, you’ll be a lot happier if you aren’t motion sick during any part of your vacation. If you have seasonal allergies or have allergies of any kind, don’t forget to include antihistamines in your carry-on. Just because something is not in bloom at home doesn’t mean it won’t be in bloom where you are going!
While on vacation somewhere warm, keep in mind the dangers of heat exhaustion and heat stroke. Make sure you stay hydrated; drink plenty of bottled water. Remember: many medications can make you more susceptible to heat-related medical issues.
Other things to keep in mind regarding that summer vacation: if you have pre-existing medical conditions, check in with you doctor before going on vacation. Make sure someone knows where you are going. Keep your identification with you at all times. Wear a hat, sunscreen and sunglasses when out and about. And, never forget to ask for your senior discount on everything from hotel rooms to meals!
May 8th, 2009 02:25pm
Mitchell F. Davenport
I was visiting with a couple of friends over a drink and one of them started talking about her child that has ADHD. When she paused a moment, my other friend said , “ADHD is over-diagnosed. It is a plot of the drug companies to sell drugs, and besides, for those that really have it, it can be controlled by diet.” To which I quietly spoke up and said, “Really, research indicates that diet has very little to do with controlling ADHD.” To which my dubious friend replied, “Well if its not the diet, it’s the parenting then. Parents just don’t parent like they used to!”
What do you think about ADHD? Is a myth or truly a disorder? Is it over-diagnosed? Under-diagnosed? Is it due to parenting problems?
I don’t know what it is about this disorder that creates such controversy. There is a lot of quality research out there that indicates : 1) ADHD does exist, 2) it is a brain based disorder, 3) diet has little impact on its symptoms, 4) parents impact but do not cause ADHD.
1. ADHD does exist. Before I was a mental health professional, I had some friends who had a 4 year old boy who climbed anything possible. He could often be found on top of the refrigerator. He could not sit still for longer than a few seconds and was constantly on the go. He had a very difficult time during routines and needed frequent proddings or threats of consequences to do things like put his toys away. His parents were very passive and he seemed to run the home. I wondered if he really had ADHD or that if the parents were more strict and had a better routine would this kid be “normal.” Then I met Mikey (case study from first blog)! There are some children that are simply wired differently and cannot function in the world the same way we do.2. It is a brain based disorder. A brain imaging study has pinpointed exactly where the brains of children with attention deficit hyperactivity disorder differ from those of other children. It has been found that children with ADHD have smaller brains than children who do not have ADHD and researchers have long suspected that the disorder itself is the result of a dysfunction in the frontal lobes of the brain where we control our emotions and impulses. Using magnetic resonance imaging (MRI) researchers have learned that the part of the brain associated with attention and impulses (bottom frontal lobes) was indeed smaller than in children who did not have ADHD.
Researchers have also learned that the outer layers of the brain of children diagnosed with ADHD are thicker.
3. Diet has little impact on its symptoms. There are many websites claiming to have special diets that will help children with ADHD. While I don’t want to discount diet totally. To this date, there is no compelling evidence that diet has a substantial impact on ADHD behaviors. Most of those who say it does are like my friend above. They know someone that changing their kids’s diet seemed to help his ADHD. Anecdotal stories are not a good subsititute for scientific research and there is little support for the diet theory from studies that were conducted properly.
4. Parents impact but do not cause ADHD. There is no doubt that some parents are better equipped to be parents whether the child has ADHD or not. Parents of children with ADHD have a big challenge ahead….phone calls from school about misbehaviors, neighbors who won’t let their kids play with your’s, and the list goes on. While it is not the parenting that causes the ADHD, “good” parenting can go a long way in helping a child who has ADHD. Children with ADHD need firm limits, routines, and lots and lots of patience.
Well, hopefully I’ve given you something to think about. The next time we will go into the characteristics of ADHD.
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