Archive for August, 2009

Autism is a developmental problem that appears early in childhood.  It affects a child’s social interaction, language, and behavior.  This makes it difficult for an autistic child to communicate and interact with others.

Up to 6 out of every 1,000 children in the U.S. are diagnosed with autism and the numbers seem to be rising.  This fact could be due to an actual increase in the incidence of autism or perhaps is just a reflection of better detecting and reporting of the condition.

Diagnosis is difficult.  Although the signs of autism may show up by 18 months of age, the diagnosis may not be reached until the age of 2 to 3 years. Early diagnosis is associated with a better chance of improvement.

Common symptoms of autism are:

  • Social Skills: May not respond to his or her name, has poor eye contact, appears not to hear you and retreats to his or her own world.
  • Language: Starts talking later than other children, no eye contact when speaking, can’t start a conversation or keep one going, and loses previously learned ability to say words or phrases.
  • Behavior: Performs repetitive movements, develops strict routines and rituals, moves constantly, and is disturbed by the slightest change of routine.

There are many possible causes of autism including:

  • Genetics – Some genes are inherited and some can change after birth.
  • Environmental factors – Environmental pollutants and virus infections may play a role in triggering autism.
  • Other causes – Problems during labor and delivery during birth as well as possible effects of the immune system may cause autism.
  • Immunizations – This is the greatest controversy and a major reason why parents choose not to have their children routinely immunized.  After much extensive study, to date, no link has been found between immunizations and autism.  Again, this remains very controversial.

Risk factors include:

  • Childs sex.  Autism is 3 to 4 times more common in boys than girls.
  • Family history.  Families with one autistic child run a higher risk for having a second child with the disorder.
  • Paternal age.  The older the father the greater chance of having an autistic child.

Treatment of autism may include:

  • Behavior and communication therapy
  • Educational therapy
  • Drug therapy (may help symptoms, is not a cure.)
  • Creative therapy such as music and art.

Coping with autism:

  • Find a team of professionals who you can trust.
  • Learn as much as you can about the disorder.
  • Seek out other families of autistic children.

We, as a community, need to be understanding and supportive of families with autistic children. Working with a child that requires extra attention can be exhausting for families. Autistic children can also bring talents beyond expectation. We can be grateful for such famous autistic geniuses as Beethoven, Mozart

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Falls In The Elderly

Falls are the leading cause of injury related emergency room visits in persons over 65 years of age.  The risk of falling increases with age and is greater for women than men. Falls are the leading cause of death from injury among the elderly.  Almost 10,000 deaths in older Americans are associated with falls every year. The most significant consequence of falling is the loss of independence. After a serious fall, an elderly person often suffers a decline in normal activities of daily living and is often permanently placed in an assisted living facility or in a nursing home.

Hip fractures are a frequent consequence of falls and occur to more than 250,000 elderly people at a health care cost of approximately10 billion dollars each year. Twenty five percent of those who sustain a hip fracture require life-long nursing home care. Other injuries from a fall include head injuries, lacerations, severe bruising and fractures of arms or legs.

Risk factors of falls and preventative measures are as follows:

Impaired vision:

  • Have regular vision checkups.
  • Add contrasting colored strips on the edges of first and last steps to identify change of level.

Lack of physical activity:

  • Exercise regularly to maintain muscle tone and strength.


  • Work with your doctor to diagnosis and treat osteoporosis (thinning of the bones).


  • Prescription pain medicine, sedatives, and anti depressant drugs are the biggest medication culprits in causing falls.
  • Beware of alcohol interacting with drugs.
  • Know the common side effects of your medications.

Home hazards:

  • Avoid throw rugs.
  • Reduce clutter.
  • Maintain adequate lighting.
  • Install grab bars around tub and toilet.
  • Keep commonly used items in easy reach.
  • Avoid using floor polish or wax to prevent slipping.
  • Remove caster wheels from furniture.
  • Use night lights.
  • Avoid steps stools and ladders.

I would love to start a campaign to have our society remove all concrete parking bumpers in parking lots.  They are accidents waiting to happen. The elderly tend to fall face first onto the pavement as I have witnessed all too many times in my practice. Please be extremely careful when walking to and from your car to avoid tripping over these bumper hazards.

As we age, we all need to move around more carefully and slow things down a bit to prevent falls and to help us enjoy a longer, healthier, and independent life.

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Summer Sun

Summer is here and many of us are being exposed to an abundance of sunshine. I’d like to explain how we can best avoid the harmful effects of the sun.

We all know that the sun provides visible light to our earth, but it also provides invisible light called ultraviolet rays of which there are two types. Ultraviolet A (UVA) causes skin aging and skin cancer, not visual sunburn.  Ultraviolet B (UVB) is what actually causes the traditional sunburn. The sun’s rays are strongest between 10:00 AM and 4:00 PM.

Some people are more sensitive to the damaging effects of the sun. Those who have blond or red hair, light colored skin and light colored eyes will get sunburn quicker than those with darker skin and eyes.

Sunlight damages the skin in the same manner as a heat burn, causing symptoms ranging from a first degree red, hot painful burn to a second degree burn causing blisters and deeper damage to the skin.  Unprotected long term exposure to sunlight will cause wrinkling of the skin with the appearance of premature aging.  The most serious effect of sun damage is the increased chance of developing a deadly skin cancer called melanoma.

The best protection against the damaging effects of the sun is to have your skin covered by clothing to the greatest extent possible.  Wear light colored tightly woven clothing. If impractical to be protected by clothing, then a sunscreen lotion is necessary.

Sunscreens are rated by a code called SPF (sun protection factor) which you will see on the label of all sunscreens.  It rates how long a person can be in the sun without being burned.  There is no proof that SPF ratings over 30 give any measurable benefit. Most sunscreens now protect against both UVA and UVB. Check the label before you buy a sunscreen lotion.

Proper application is the key to success. Apply sunscreen at least 20 minutes prior to sun exposure.  Use about 1 teaspoon per body part such as the face, an arm or a leg.  Use 2 tablespoons (comparable to a shot glass) to cover the body when wearing a bathing suit.

Most sunscreen lotions are labeled either “water proof” or “water resistant.”  Even these need to be reapplied after swimming, towel drying, or heavy sweating. Read the directions on the label.

Apply the sunscreen to all exposed body parts especially those often overlooked such as tops of ears and feet, back of the neck, face and bald spots.


  • Avoid sun exposure especially between the hours of 10:00 AM and 4:00 pm.
  • Always wear sunscreen and reapply frequently, at least every 2-3 hours, or more frequently if your skin gets wet from swimming or sweating.  One application in the morning will not protect you through the whole day.
  • Keep yourself covered with light colored tightly knit clothing as much as possible.
  • Avoid tanning salons.
  • See your doctor if you have a sunburn and are experiencing unbearable pain or significant blistering.
  • Check your skin (all areas) regularly for any unusual dark lesions.
  • Protect your eyes with UV rated sunglasses.

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I’ve had patients recently voicing their concerns about the “recall” of Tylenol products. I will use the terms Tylenol (the most recognized brand name) and acetaminophen (the chemical name) interchangeably in this article. A Federal Drug Administration panel has recently made several recommendations concerning Tylenol and Tylenol containing products.  Again, these are only recommendations and are not written in law as of this time. The FDA recommendations are as follows:

  • That prescription Vicoden (hydrocodone and acetaminophen) and Percocet (oxycodone and acetaminophen) be banned from further use.
  • That over the counter products that contain acetaminophen (there are literally hundreds of such medications) carry stronger warning labels.
  • Reduce the maximum over the counter strength of a Tylenol pill from 500 mg. to 350 mg.

What’s at issue here is the fact that acetaminophen in high doses can cause liver damage and in very high doses can cause liver failure and death.  This problem usually occurs when patients take more than the recommended daily dose of Tylenol or when they take Tylenol plus another combination drug that also contains Tylenol, such as Theraflu or Nyquil, thus unknowingly exceeding the recommended dose.

Since it is well known that alcohol also has a negative affect on the liver, the combination of alcohol and Tylenol consumption together has an even greater negative affect on the liver.

Tylenol has been around for decades and has been consumed by millions of people worldwide for the relief of pain and fever.  I believe that when taken in recommended doses it is safe and effective.  The alternatives to Tylenol such as aspirin or anti inflammatory drugs such as ibuprofen have their own risks in terms of stomach bleeding.  The decision to take either Tylenol or an aspirin product is a matter of risk versus benefit. You may wish to speak with your doctor about this.

I agree with the panel’s findings and recommend the following:

  • Tylenol or its various products should not be used if one consumes more than two alcoholic drinks per day.
  • The maximum single adult dose should be no greater than 650 mgs.( two 350 mg. tablets)
  • The maximum daily dose should be less than the currently recommended dose of 4,000 mg.  I propose taking no more than 2800 mg. per day which is equal to taking two 350 mg. tablets every six hours.
  • Always carefully read the label on the bottle of any over the counter medication to see if acetaminophen is one of the ingredients.

Be careful but not fearful of Tylenol.  For treating pain or fever it is a very useful medication when used properly.

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Over the years of my emergency/urgent care career I’ve dealt with many different injuries and illnesses seen commonly during the summer months.  I’d like to share some of my thoughts on making this a very safe summer for everyone.

  • Sunscreen –  Almost everyone who spends time out in the sun MUST wear sunscreen to block the harmful, damaging effects of the sun’s ultraviolet rays on our sensitive skin.  Use a sunscreen that offers protection against both UVA and UVB rays and has an SPF rating of at least 30. Apply it liberally and often (at least every two hours).  Parents, protect your kid’s precious skin.
  • Insects –  Beware of the many summer bugs lurking out there.  For mosquito protection use a repellant that contains DEET which when used as directed is safe for adults and children over 2 months of age. Regarding the stinging insects such as yellow jackets, wasps and honeybees, avoid them if they are in your vicinity. If you do get stung by a honey bee (which is the only one of the stinging insects that leaves a stinger behind in your skin), remove it as quickly as possible by any means possible.  It is now OK to just pull it out with your fingers and not waste time finding something with which to scrape it off.  Immediately apply ice to the sting. When out in a woody or grassy area always check your entire body for ticks when you get home. If you find one, remove it as soon as possible by getting a pair of tweezers, grabbing the tick  close to the skin and pulling it straight out.
  • Poison oak –  The best protection is to recognize it and avoid it. If you come into contact with poison oak with your skin, clothing (including shoes and shoe laces), or garden tools, wash off immediately with soap and water.  Poison oak oil must be washed off of your skin with in a few minutes in order to avoid the dreaded rash. Remember, all parts of the poison oak plant contain the nasty oil, including the leaves, branches and roots.
  • Heat –  Heat exhaustion is manifested by extreme sweating, fatigue and cramps. Heat stroke (a life threatening condition) is manifested by lack of sweating, red hot skin,  and a very high body temperature.  Both conditions can usually be prevented by drinking plenty of liquids and avoiding direct sun as much as possible especially between the hours of 11:00 AM and 4:00 PM.
  • Water safety –  4,000 Americans drown every year, mostly men by a factor of 4 times more than women.  Alcohol is frequently involved.  Make sure the kids are supervised in the water every single minute. Watch out for rapid currents, rip tides, rocks, and always be aware of your surroundings.  Boat injuries claim another 700 American lives a year.  Drive your boat sensibly, have enough life preservers on board and do not drink alcohol and drive.
  • Bicycling –  WEAR A HELMET!  No matter how obvious this bit of advice is, I still see people riding without a helmet and I really cringe when I see children without this life saving protection. Head injuries are often very serious, if not deadly, and are inexcusable for lack of a helmet. Be aware of your surroundings and be in control of your bike at all times.  Don’t take foolish chances.
  • Eating –  Summer picnics can be a common source of food poisoning manifested by vomiting and/or diarrhea..  Food left out too long is the usual culprit. Handling uncooked chicken or eating undercooked chicken is also a common source of this illness.
  • Driving –  We all drive more during the summer.  The cheapest form of life insurance while you are in a car is the good old seal belt.  WEAR IT!  Make sure your children are in proper age appropriate car seats.  Hand held cell phone use while driving your car is now illegal. Don’t break the law.

Have a very enjoyable safe summer.

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