Tuesday, April 17, 2018

Is Your Home Safe for Your Child?

The Top Five Ways to Protect Your Child at Home

By Celeste Caballero, MD, San Angelo
TMA Hard Hats for Little Heads Physician Advisory Panel

Did you know accidents at home and in the car are the most common cause of infant/child injury or death? In my medical practice as a pediatric doctor, I talk with parents every day about safety in the home during well-child exams. I do this because safety is a big deal, and accident prevention is key. April is Child Safety Month in Texas, and these are the top five tips I give parents to make their home and car safer:

Dr. Caballero fits helmets on children during a TMA Hard Hats for Little Heads helmet giveaway event.
  1. Protect from falls! Falls are the leading cause of injury to children between the ages of 0 to 19 nationwide, sending some 8,000 children to the emergency department (ED) daily. Always make sure your child wears a well-fitted helmet when on a bike, scooter, skateboard, or skates. And check that surfaces under playground equipment are soft — sand or wood chips — and not hard like grass or dirt. Always supervise your child around stairs and playground equipment.

  2. Buckle up! Every hour, nearly 150 U.S. children are seen in the ED for injuries suffered in a car accident. Make sure you are using the correct car seat, booster seat, or seat belt for your child. Follow these guidelines to find out if you’re using the right one based on your child’s weight, height, and age.

  3. Lock it up! Two children die and more than 300 children are treated every day in the ED for poisoning by household cleaners and medicines found in many homes. Children are curious, and will eat or drink almost anything. Keep medicines, household cleaners, and detergent pods in their original packaging and put them in a place a child can’t see or reach. Post this Nationwide Poison Control phone number on your refrigerator: (800) 222-1222.

  4. Watch the water! Drowning is the leading cause of death in children ages 1 to 4 years old. A child can drown quickly and quietly. Also, floaties don’t prevent all drownings. Adults should take turns watching children every minute they are in a bathtub, pool, or other body of water — and parents should avoid distractions like talking on the phone. Make sure your child has a life jacket on at all times in and around lakes or the ocean, even if they know how to swim. Put a life jacket on a weaker swimmer in the pool. Install a four-sided fence around your backyard swimming pool with self-closing and self-latching gates.

  5. Guard the flame! Like poisoning, burn injuries send 300 children to the ED and claim the lives of two children daily. Closely supervise or restrict a child’s use of the stove, oven, hair curling irons, and clothing irons. Make sure you have smoke alarms on every floor of the house and near all bedrooms, and remember to test them every month. Set your water heater to 120° Fahrenheit or lower to prevent burns from hot water in the bath or sink.

The home, meant to be a place of love and nurturing, can be a very dangerous place for your child. With careful attention, you can make your home safer and help your child avoid an ED visit. Now that’s smart parenting!

Monday, April 9, 2018

Measles: Once Gone, Its Threat Has Returned

You may not have seen it or know anyone who has had it, but measles is a looming threat, especially for children who are not vaccinated. Measles — declared eliminated in the United States in 2000 thanks to vaccines — has returned to Texas and other areas. Physicians say the shot to prevent measles is the best defense against it. Unfortunately, declining vaccination rates have allowed the disease to return.

Measles is a virus that travels by direct contact or through the air. It is so contagious a person can catch measles just by walking into a room where a measles patient had been present and then left two hours earlier.

You don’t want to get this,” said Jason Terk, MD, a Keller pediatrician and member of Texas Medical Association’s (TMA’s) Be Wise — ImmunizeSM Physician Advisory Panel. “Besides making a child miserable during the illness, measles can lead to very severe complications like measles pneumonia, and brain inflammation that can appear years later.”

For some children, measles can be fatal.

Symptoms, which typically last seven to 10 days, start with a fever, followed by a cough, runny nose, and red eyes. About three to five days later, a person with measles will develop a rash that starts on his or her head and travels to the rest of the body. Someone with the disease can be contagious for up to four days before a rash appears — possibly before knowing he or she has measles. People with measles also are contagious after the rash appears.

Doctors can treat only the symptoms, not the illness. Treatment can include medicines to reduce fever and boost low vitamin A levels. Doctors may prescribe antibiotics for secondary bacterial infections.
A measles vaccine was developed in 1963. It is 97-percent effective at preventing the disease. The shot for measles, commonly called the MMR vaccine, also protects children against mumps and rubella. The Centers for Disease Control and Prevention (CDC) recommends two doses of vaccine for children — at 12-15 months of age and at 4-6 years. And even if someone who has been vaccinated gets measles, the illness should be milder.

Before the vaccine was developed, measles killed 2.6 million people annually, according to the World Health Organization. Measles remains a leading cause of death among children worldwide, claiming the lives of some 89,000 each year.

Once thought to be eradicated in America, measles seems to be making a comeback. In North Texas, 21 people, mostly children who were never vaccinated, came down with measles at a Dallas-area megachurch in 2013. The outbreak began when a man who contracted the virus on a trip to Indonesia then visited the church.

That scenario is becoming more common. Measles cases in the United States typically are imported from other countries where measles remains an active threat. When someone who hasn’t been vaccinated is exposed to measles during international travel, he or she can bring it back here with the potential to infect others.

This year, six people who had not been vaccinated were confirmed to have measles in Ellis County.

“Diseases like measles are kept at bay because a critical mass of people are vaccinated against them,” Dr. Terk wrote in a letter to The Dallas Morning News following the Ellis County outbreak. “Outbreaks occur when that critical mass is eroded.”

Even a small group of unvaccinated individuals can pose a risk for the population at large. A 2017 study published in JAMA Pediatrics showed a 5-percent reduction in measles vaccination coverage among 2- to 11-year-olds nationwide could result in a three-fold increase in measles cases across the United States.

Physicians urge the MMR vaccination to prevent unnecessary suffering, even death.

“There are very few viruses as contagious as measles,” said Edward Dominguez, MD, a Dallas infectious disease specialist, and member of the TMA Be Wise — Immunize Physician Advisory Panel. “We need to really focus on getting kids vaccinated to prevent it.”

Find more information on measles and vaccinations on the TMA website.

Wednesday, April 4, 2018

The Joys of (Safe) Bike Riding

Dr. Wright's daughter and her friend ride an obstacle course
at a TMA Hard Hats for Little Heads event.
By John B. Wright, MD, Port Lavaca family physician
TMA Hard Hats for Little Heads Physician Advisory Panel member

I remember riding a bike as a kid. It provided a sense of freedom, giving me the ability to travel around the neighborhood and play with my friends. Experiencing the wind blowing in my face and the speed I could accomplish going down hills was sheer joy. 

As a kid, I never thought about safety. Fortunately, I did not have a major accident, only a few scrapes here and there when I fell. I remember a small cut on my forehead once, but I never needed stitches.

As an adult, I became reacquainted with cycling during medical school. My roommate, Mike, convinced me to get a road bike for exercise. The joys of riding a bike returned, and I’ve learned to love riding in endurance events such as the MS 150 (a Houston-to-Austin bike ride that supports multiple sclerosis research) and the Hotter ‘n Hell Hundred (a four-day cycling event in Wichita Falls). You can see more while riding in the countryside at 15-20 mph on a bike than while driving at 70 mph in a car. It’s a great chance to experience nature more intimately. 

Left Image: Dr. Wright during the MS150 from Houston to Austin.
Right Image: Dr. Wright (right) and friends Mike Lu (left) and Eddie Ngo (center) during the MS150.

Now when I ride I always think about safety, and I always wear a helmet. Anything that can reduce the chance of head injury up to 85 percent is a great idea. Friends and patients have shown me their dented helmets after a fall but not more than a scrape on their body to show for it. Their helmet likely saved them from a serious head injury.

I first heard about the TMA Hard Hats for Little Heads program eight years ago. I have been hosting events yearly ever since and have given out hundreds of helmets to kids in our small, rural community of Port Lavaca. The local police department registers bikes at the same event.

Dr. Wright fitting helmets on children at TMA Hard Hats for Little Heads events.

I’m glad kids are still enjoying the outdoors and the simple pleasures of riding bikes. They have an advantage of having plenty of equipment available to make their excursions safer. Adults, be sure you’re setting a good example for the kids around you by wearing your helmet and encouraging kids to use properly fitted helmets, too. It just might save their life.

Thursday, March 29, 2018

Don't Politicize Vaccines

Stan Spinner, MD
Lindy McGee, MD
Julie Boom, MD

This article was originally published on TribTalk, a publication of The Texas Tribune.

A patient receives an immunization during a Texas Medical Association conference.

Disease does not care if you are a Democrat or a Republican. Cancer does not care whether you voted for Donald Trump or Hillary Clinton. Influenza has no concern about whether you showed up to vote in the March primary election in Texas. As far as whooping cough is concerned, you can watch whichever cable news you choose and read the web sites of your choice.

The fight to stop disease needs to be non-partisan and non-political, too. People of all political stripes came together to stop polio in its tracks. In the past, Americans understood that critical life-saving tools like vaccines are a part of our national responsibility. Just as our soldiers are fully vaccinated before they go to war, we citizens on the home front have, in the past, done our part to protect the public health and national security.

The life-saving power of vaccines should transcend politics. Unfortunately, vaccines entered the political discourse during the 2018 election season. Attacks on public officials who support vaccines are attacks on a fundamental building block of public health. Just as politicians should support clean drinking water and flood prevention, they should support vaccination as a proven measure to prevent disease.

Vaccines are a victim of their own success. Americans may not appreciate the power of vaccines because fewer and fewer of us have actually seen diseases like polio firsthand. If you do not personally know someone who has suffered or died from a vaccine preventable disease, it might be tempting to say vaccines are unnecessary in order to score easy political points.

Politicians who find political expediency in questioning the need for vaccines are playing a dangerous game. The 2018 Texas primaries demonstrated that voters in the Democratic and Republican primaries support vaccines, as anti-vaccine candidates lost at the polls.

Two strong supporters of vaccines in the Texas Legislature handily defeated anti-vaccine candidates in Republican primaries. In a high-profile Houston race, state Rep. Sarah Davis defeated her anti-vaccine opponent. In rural Texas, a less-heralded race demonstrated the broad base of support for vaccines as state representative, family doctor, and immunization champion Dr. J.D. Sheffield defeated his anti-vaccine opponent. In San Antonio, Democratic incumbent District Attorney Nico LaHood lost his primary – in part because of his anti-vaccine views.

For many reasons, Texas must not allow politicians to smear the life-saving power of vaccines for political gain. In this year’s primary election, Texans spoke loudly and clearly of their support for vaccines. In the months to come, we will learn if our elected officials have heard the voters. Texans must ensure vaccines do not become a political football in the November general election. We are confident that voters will again support science and reject anti-vaccine candidates.

Dr. Spinner is Vice President and Chief Medical Officer at Texas Children's Pediatric Associates. Dr. McGee is Associate Professor of Pediatrics-Academic General at Baylor College of Medicine. Dr. Boom is Director of the Texas Children's Hospital Immunization Project. All three physicians are Houston pediatricians.

The Texas Tribune is a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.  

Tuesday, March 27, 2018

Why Should Texans Care About Bleeding Control? What Can You do to Help?

By Andrew Fisher
Texas A&M University Medical Student
U.S. Army 75th Ranger Regiment Veteran

It’s possible to bleed from an extremity and die within three minutes. The threat is greater since the average response time for an ambulance is seven minutes and law enforcement is eleven minutes. Trauma is the leading cause of death under the age of 46 and the leading cause of productive life years lost under the age of 75. This can have a significant impact on Texans. Most of the potentially survivable deaths in trauma are due to bleeding, some of which can be easily controlled with basic life-saving techniques — techniques you can learn by visiting www.bleedingcontrol.org, or attending a Bleeding Control Basics class during National Stop the Bleed Day on March 31.

The History Behind Stop the Bleed Day: Lessons Learned in Blood

In 1996, Frank K. Butler, MD, and colleagues published an article “Tactical Combat Casualty Care in Special Operations.” This spurred the creation of Tactical Combat Casualty Care (TCCC). It focuses on identifying and treating the three major causes of preventable death and emphasizes early tourniquet application (a device that constricts blood flow to an extremity thereby stopping blood loss). Preventable death happens when an individual’s injuries are not inevitably fatal and could be prevented with optimal medical care. There are three major causes of preventable death in combat — bleeding from an extremity, a collapsed lung that creates tension in the chest, and airway obstruction. The causes of preventable death are multifactorial, but by far massive bleeding is the major cause. One U.S. Army unit was able eliminate preventable death in combat — a feat never before accomplished by any unit in the history of combat. The 75th Ranger Regiment accomplished this feat by teaching every soldier how to identify and treat the three major causes of preventable death. Leadership involvement and following the guidelines published by the Committee on Tactical Combat Casualty Care (CoTCCC) were key to the success of the Rangers.

We know tourniquets and hemorrhage (bleeding) control are effective in saving lives. In Iraq and Afghanistan, up to 2006 when tourniquets were just starting to be used, extremity bleeding caused nearly one in ten (7.8 percent) of total fatalities. From 2006 to 2011 however, just 2.6 percent of people died from extremity bleeding. That’s a 67 percent decrease in fatalities from extremity bleeding.

How Does This Relate to the Public (Civilian Sector)? 

The Hartford Consensus, published in the wake of the Sandy Hook shooting, provides guidelines for people in active shooter situations. The concept is easy: early and definitive control of external bleeding through tourniquets and hemostatic dressings (bandages designed to quickly stop bleeding) would save lives and decrease preventable deaths.

In 2016, a report titled  “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury” helped identify the number of preventable deaths in the U.S. The report listed eleven recommendations aimed at better coordination efforts between the military and civilian experts in order to reach zero preventable deaths in the U.S. The report identified, of the 147,000 trauma deaths in the U.S. in 2014, 20 percent (or 30,000 people) could have survived with aggressive bleeding control and optimal care.

Events like the ones that happened in Parkland, Sandy Hook, Boston, and Orlando show that an active shooter incident, or acts of terrorism, can happen anywhere and anytime. While a terrorist event catches everyone off guard, bystanders can be better prepared to save lives with a Bleeding Control Basics course.

It’s very unlikely you will be in an active shooter or terrorist event, but it is more likely you will be present at a traumatic event caused by an accident. It could be a motor vehicle accident, a home accident, or at a place of employment. Regardless of where, proper training and preparation enables you to react and respond.

You can prepare yourself by taking a Bleeding Control Basics course. This is an effort by the Stop the Bleed initiative, which has mutual involvement from the White House, the Department of Homeland Security, the American College of Surgeons, and the American College of Emergency Physicians. Everyone has the power to stop life-threatening bleeding caused by injuries in the home, industrial settings, or even mass casualty events. State and local government, medical groups, healthcare organizations, and local first responders share a mutual interest to inform the public that this training is available.

This Saturday, hundreds of free Bleeding Control Basics courses will take place across for National Stop the Bleed Day. Click for information about taking a course. This initiative was started in September 2017 by current and former members of the U.S. Army and law enforcement. They recognized the need for civilian or bystander hemorrhage control in many situations before EMS arrives.

If you are interested in serving your community as a Bleeding Control Instructor on March 31 or any other time, please contact The National Stop the Bleed coordinators in your area at stopthebleedday.org or visit bleedingcontrol.org to register.

Monday, March 26, 2018

Hard Hats Save Little (And Big) Heads

Dr. Barker fits a helmet on a child during a
Hard Hats for Little Heads helmet giveaway event.
By Charles O. Barker, MD, Dallas
TMA Hard Hats for Little Heads Physician Advisory Panel member

I have been involved with the Texas Medical Association’s (TMA’s) Hard Hats for Little Heads program for a number of years. St. Barnabas Presbyterian Church in Richardson will conduct its 13th Annual Health Fair just before school starts in August, and again, I plan to be there with friends to fit about 100 heads with bike helmets. I do this because it is the right thing to do, the compassionate thing to do, and certainly the family doc thing to do. 

I also have personal reasons for wanting to put hard hats on all our little or not-so-little heads. Those riding bikes, skateboards, and other fast-moving platforms with “naked” heads are especially vulnerable to injury.

During the late 1980s, I trained hard and competed in triathlons. Back then, bike training could be dangerous because much of it was on open roads — some busy — and some on backroads. Today, bike training is even more dangerous, with motor vehicle drivers using electronic devices while driving. Over the years, several of my good bike training buddies lost their lives in this way.

I remember the day I was riding on White Rock Lake Trail, a safe, well-designed trail that runs along Dallas’ White Rock Lake. Frequent locator markers tell you exactly where you are on the trail. If you have a problem, you just call 911 and give the locator number, and help will be on the way. I thought, “How great, if I get into trouble! Thank you, Dallas.” 

I never had to use this safety net, but got really close once. I was bike-riding by myself (shouldn’t have done that!), had my helmet on (thank goodness!), and was on my way back to my car. I rounded a corner a little too fast on the paved trail when my racing tire slipped off the edge of the path into that “not-so-sweet” grass-pavement zone. My attempt to return to the pavement was met with going head over heels onto the concrete. 

The first thing that hit was my “little” head, which was saved only by that “very sweet” helmet. I had never heard that sound before — helmet hitting concrete. If I had not been wearing that helmet, I’m pretty sure I would have been knocked unconscious — or worse. And the location markers would not have done me any good; I was alone and would have been at the mercy of the next passerby.

My experiences have taught me several things can prevent or mitigate brain injuries: 
  1. Bike ride and train only on protected roads or designated biking trails; 
  2. Train with others of equal ability — and stay together; 
  3. Wear a well-fitted helmet; and 
  4. Make sure your bike, its parts, and tires are in good shape. 
Simple. And yet we all fall short of following the good advice. We can do better, right?  Thank goodness I am here to tell the story … and very motivated to put those hard hats on little heads.

Wednesday, March 21, 2018

Mental Health: Not Just Something to Think About

By Maria Monge, MD
Austin adolescent medicine physician

It is Global Teen Health Week and today we are focusing on Mental Health. Research shows that a healthy mind helps keep bodies healthy. Adolescents and young adults are significantly impacted by mental health issues. In the United States, almost one in seven teens is currently dealing or has dealt with depression. What’s more, one in three has current or past anxiety. Globally, suicide is the second leading cause of death in adolescents and young adults.

As an adolescent specialist, I routinely discuss mental health concerns with my patients and their families, as I firmly believe that good physical health is linked to good mental health. I often give my patients these five tips to improve their mental health.

Five Tips for Improving Mental Health

  1. Sleep. According to the National Sleep Foundation, adolescents and young adults require 8-10 hours of sleep per night for optimal functioning throughout the day. Unfortunately, very few teens are able to achieve this. Strategies such as consistent bed time and wake times, trying not to nap during the day, using filters to block blue light filters from electronic devices (blue light can disturb your sleep cycle) and avoiding all electronics one hour prior to bedtime can all be helpful to promote better sleep quality.
  2. Eat. Teens need consistent meals throughout the day as well as enough food to fuel their bodies, brains, and activities. Skipping meals and nutrition can lead to increased anxiety, feelings of sadness, and inability to think clearly. Some teens like to eat multiple times per day such as three smaller meals and three snacks, while others find that eating three full meals is a better option. Either way, nutrition fuels a healthy and happy brain.
  3. Drink water. Setting a goal of 64 ounces (8 cups) of water per day not only helps with overall health, but also with mental health. Even mild dehydration can have an effect on mood. A way to judge how much water Is consumed in a day is to fill up a 64-ounce container with water and place it in the refrigerator and only drink water from that container during the day. People are often surprised how little they are drinking! It is a good visual reminder of just how much fluid we need to stay healthy.
  4. Exercise. Experts recommend 60 minutes of physical activity every day for children and young teens, and at least 60 minutes 3-5 times per week for older teens and young adults. The physical activity should be of moderate intensity and include some strength training, such as body weight squats or resistance band training. Often it is helpful to set small goals for exercise and work up from there. Additionally, scheduling a time to exercise helps to make it part of a routine.
  5. Practice Mindfulness. Teenagers and young adults often feel stress and anxiety about their lives. Mindfulness is a mental state that occurs when an individual acknowledges and accepts his or her present emotional and physical feelings. It is a powerful way to deal with stress in the moment and is a way to approach life without judgement. Using mindfulness has been shown to decrease stress, anxiety, and symptoms of depressed mood. It is sometimes not easy to be mindful, especially when faced with a stressful situation, but practicing skills over time can really help with this. There are multiple websites and free mobile applications that are available to guide teens. (The Journal of Medical Internet Research, a peer-reviewed journal for digital medicine and health care, published their findings on the best mindfulness mobile apps — you can view their results here.)

If you or your family member are experiencing signs of depressed mood, anxiety, or overwhelming stress, please call your doctor for an evaluation. If you or a family member does not feel safe or is experiencing thoughts of suicide, immediately call 911, go to your local emergency room, or contact the National Suicide Prevention Lifeline at 1-800-273-8255. 

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