TVs and TIRED KIDS (and Parents)

Televisions have become so commonplace that we often barely notice their presence. Many families leave the tv on for most of the day, more like background noise than anything else. A article recently published in PEDIATRICS addresses the use of television in preschool aged kids, 3-5 years old. The roughly 600 children in the study showed an increase in sleep problems associated with evening media use (television and computers), especially when that tv was located in the child's bedroom. Additionally, the study found that watching violent programs increased sleep problems, regardless of the time of day that the program was viewed.

Interestingly, the average reported screen daily screen time was a little over an hour, with roughly 14 minutes occurring in the evening. Remember that these were 3-5 year old preschoolers, and the information was obtained from parents filling out media diaries and sleep questionnaires. If this information was accurate, then please note that even kids watching LESS than the recommended maximum of two hours per day were still affected. Nearly one in five parents reported sleep disturbance in their child. (As an aside, please note, parents, that the medical community strongly recommends NO TELEVISIONS in kids' bedrooms!)

We are learning more and more about the impact of computer screens on our brains, and consistently finding that screen evening screen use impairs the quality of sleep. For children, adolescents and adults alike, we need to go back to "the good old days" of READING or relaxing in a warm bath before bed...but remember to read from a BOOK, not an electronic reader!

BOTTOM LINE: Media screen viewing, especially in the evenings before bed, impair your quality of sleep. If you have daytime fatigue, focus on LIMITING your screen time!

FDA's New Cigarette Labels- Wonderfully GROSS!

Let's hear it for the FDA! Cigarette boxes will no longer carry the simple boxed warning that smokers have come to ignore over the last couple decades. Instead of these simple printed words, now there will be nine different graphic images with accompanying appropriate messages. "WARNING: Smoking is addictive"- showing a man smoking from the hole in his tracheotomy (a hole in the neck surgically created for patients on ventilators long term), or "WARNING: Cigarettes cause fatal lung disease" with a picture of healthy pink lungs next to horribly diseased lungs. I think my favorite, though, is the one I posted above, with the yellowed teeth and cancer sore rotting on the lip.

I believe we need to address tobacco addiction at the age and interest level of the smoker. Teens rightly aren't terribly concerned with emphysema at age 60, nor lung cancers even as early as their 40s. They MIGHT listen, however, to concerns about bad breath and yellow teeth. An older smoker, however, may believe tooth whiteners and listerine will fix any transient problems, but the threat of stroke or heart attack from tobacco-related disease might hit home.

Whatever the age, I am pleased to see new marketing strategies put in place to shake up the routine. The FDA will be rotating pictures/messages to be sure that smokers are barraged with new warnings as they begin to be desensitized to the first batch.
Smoking is VERY addictive, and I have yet to meet a smoker over the age of 30 who doesn't wish they had never picked up that first cigarette- even those who steadfastly maintain they enjoy smoking and "don't care if it kills (them)".

BOTTOM LINE: If you still smoke, PLEASE talk to your doctor and find out what options you have to help you QUIT for LIFE.

Sunscreen Labeling Update from the FDA

Hooray! The FDA issued a press release this week that will only allow sunscreen products that protect against BOTH UVA & UVB rays to be labeled as "Broad Spectrum" and they must have SPF values of 15 or higher to state that they reduce the risk of skin cancer and early aging. Previously, SPF only addressed UVB rays, which are the primary cause of sunburn. Both UVA & UVB cause skin damage and skin cancers.

Earlier this month, I blogged about "which sunscreen is best", but let me review a couple key issues. SPF- Sun Protection Factor- measures the amount of solar energy required to cause a sunburn on protected skin versus unprotected skin. While in general terms that means a sunscreen with an SPF of 30 should allow you to be in the sun for 30 times the sun exposure before causing damage, realize there are two major qualifying factors. One, the UV radiation is more intense at different times in the day. Fifteen minutes at noon may equal an hour early in the morning. Two, no sunscreen- even when applied correctly- stays fully effective more than a couple hours. What's correct application? A full OUNCE per person, applied thoroughly and reapplied every two hours. Of course, altitude, latitude, cloud coverage and skin type all factor into the degree of solar intensity required to cause damage as well. With this in mind, the FDA is additionally proposing to limit the maximum SFP to "50+" as there is no evidence to show that products with SPF's higher than 50 provide any additional protection beyond those labeled as 50.

What does all this mean for the average consumer? For now, keep reading sunscreen labels more closely, making sure that the product you are choosing protects against BOTH UVA and UVB radiation. Typically, if you look at the active ingredients and see zinc or titanium dioxide along with several other chemicals, you've got the right product. The new labeling wont be obvious on the shelves till next summer, so while this announcement is a step in the right direction, don't assume products labeled "broad spectrum" this year are truly that. Also, please don't forget about hats and protective clothing, especially if you are going to have extended time outdoors.

BOTTOM LINE: Double check your sunscreen to be sure you are protecting your skin from BOTH types of UV radiation- UVA & UVB- because they BOTH cause skin damage that can lead to skin cancers.

Puppy Love & Alzheimers

This week our family welcomed it's newest member- Tozi (after the Atzec goddess of nature & water), an 8 week old Portuguese water dog (a virtually non-shedding, friendly breed often used as therapy dogs). I want to share a wonderful experience that this young pup has already brought to us. We took Tozi to visit my Dad, who lives in a memory care unit. All of the residents have some form of dementia, primarily Alzheimer's. As we walked in carrying the puppy, we were greeting with smiles, oohs and ahs. Although I was a bit apprehensive about her wiggly body and sharp puppy teeth, I asked if anyone would like to pet her. And did they EVER!

Almost every resident not only wanted to pet her, but asked to hold her. They snuggled her to their chests and chins, encouraging her to give them a "kiss" on their cheeks. I was amazed at Tozi's instinctive, unbelievably CALM response. She went practically limp in their arms, gently raising her head for pats and kisses. One sweet lady balked when we went to remove Tozi from her arms- "Don't rush me! I could hold her and love on her all day!" The joy one tiny six pound pup could bring was immeasurable. I started asking everyone about what pets they had cherished, and all the residents seemed to jump in. One lady had every type of pet you can imagine, and a few I'd never heard of (waltzing mice?!)

Our other dog is a labradoodle, another breed that is often used for pet therapy. Full therapy dog training takes a few years, many courses, and lots of consistent practice. That being said, I believe that a loving snuggle with any cooperative, calm pet goes just as far for most people suffering from dementia. Obviously, you must be careful that the animal does not harm anyone (the lawyers make me add that!) Our pup has already made a second visit, and the smiles & joy keep coming.

BOTTOM LINE: People with dementia are thirsting for love and touch as much if not more than the rest of us. Remember to share some some love & touch- or maybe even some puppy love-on your next visit.

Exercise and Strokes

Hooray! We have yet ANOTHER great reason to exercise. The journal Neurology has published a study this week that showed older people (mean age 70) who participate in moderate to intense levels of exercise have nearly HALF the risk of silent stroke compared with their less active peers. This study looked at 1200 adults with no clinical signs of stroke. The participants had brain MRI scans, and nearly 200 of them had evidence of a silent stroke. All the study patients were interviewed about their regular activities, from golf to hiking or other vigorous exercise. In fairness, 43% who had normal brain studies did no regular exercise at all. However, it is impressive that those people who regularly had significant aerobic activity had a 40% DECREASED RISK of silent stroke- even when this risk factor was isolated from other risks such as high blood pressure or cholesterol.

Exercise has so many benefits- from improving our mood, to increasing energy, to decreasing stroke risk. And it's never too late to START exercising! The more "out of shape" you are, the more important it is for your overall health to get moving. Simply "start low, and go slow" to avoid injury. In practical terms, I'd suggest starting with WALKING and consider getting a PEDOMETER (grab a pedometer app on your iPhone and get started counting steps right now!)

BOTTOM LINE: Exercise benefits include decreasing your risk of silent stroke, so if you value your brain cells, get moving!

Cell Phone DANGER

Last week, the buzz in much of medical media centered around cell phone use and risk of cancer, because an early release of a study published in an oncology medical journal noted that cell phone users had a 40% INCREASE in gliomas, which are a type of brain tumor. To put it in perspective, though, the baseline glioma risk in the general population is 1 in every 200,000 adults. The potential cell phone increase would increase that risk to 1 in 120,000. However, given the 5 BILLION cell phone users worldwide, everyone is understandably concerned with whether or not they can cause cancer in humans. The World Health Organization International Agency for Research on Cancer (WHO/IARC) has indeed now classified these radiofrequency electromagnetic fields as "possibly carcinogenic to humans (Group 2B)". Of course, these fields can come from microwaves, tv's, and radars, as well as cell phones.

When are the phones considered dangerous? When the phone is used on the same side for 30 minutes/day for > 10 years. (Lancet Oncology; July, 2011). Previous studies showed no increased risk if you alternate ears as you talk on the phone, and the jury is still out regarding blue-tooth and other wireless devices.

What is my level of concern? As usual, I think overuse of nearly anything can be harmful to your health, whether it's chocolate, french fries, wine or cell phones. I know that cell phones are causing far more harm RIGHT NOW as people chat on the phone nonstop as they drive, and heaven forbid, TEXT. I was nearly hit in a parking garage today by a driver busily texting as she negotiated the tight ramps. Apparently simply dialing your phone while driving TRIPLES your risk of a car accident, and texting increases that risk by a factor of 28!!

As a side note, my kids know that I am always looking for pictures for this blog. We were driving the other day, and a young woman passed us (in the right hand lane, mind you!) while she was looking at her cell phone AND smoking a cigarette. Immediately everyone in our car (EXCEPT THE DRIVER) reached for a phone or camera to grab her picture as the health "DON'T", and the kids launched into "my" speech about driving safety. She sped away before we caught her picture, so this is me POSING as the driving "DON"T".

BOTTOM LINE: PLEASE, leave your CELL PHONE in the BACK SEAT (or your purse, or the trunk- whatever is safely out of reach) when you drive, so you wont be even tempted to look at your latest text, none the less, respond.

Which Sunscreen is the BEST?

There are so many sunscreen products available that it often feels impossible to choose which type of sunscreen to purchase. I know most kids (& moms) prefer the sprays, because it makes the process so much faster. Unfortunately, I have yet to find a sunscreen with all the ingredients that I look for to ensure the best protection.

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? You might be surprised to hear that it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors!

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...for me, there is not an acceptable spray yet, for several reasons. Primarily, there are few with either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. There is some debate whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use minute portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF.

What do I buy? Our family typically uses Banana Boat's "Baby" lotion. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a measure of success! Probably more importantly, we all use swim shirts, and most of us consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.

PS. NO, I do not have any financial ties to sunscreen makers!

Getting that "Base Tan" for Summer Vacation?

Marketing is everything, isn't it? How many of you have headed to a tanning booth to get that "base tan" before heading out for a beach vacation? Here's a note- that notion has no scientific basis, nor support from dermatologists. In fact, the American Academy of Dermatology (AADA) testified recently at FDA hearings about the risks of indoor tanning. These devices have shared the same low risk category as bandaids and tongue depressors, yet we have had medical evidence for years that they clearly cause skin cancers.

Melanoma rates are increasing across the board, and melanoma is now the number one cancer in young people aged 25-29, and the second most common cancer in 15-29 year olds. Use of a tanning bed before the age of 35 increases your risk of developing melanoma by a whopping 75%! I can personally attest in my own practice that I have diagnosed 3 cases of melanoma just in the past few months, primarily in people younger than I am- which really hits home. (I'm 45.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Tanning beds are not "safe", and they target young people (especially women) with their ads. Many tanning salons promote their "safe" or "harmless" type of UV radiation, but the UVA rays cause damage in the same fashion as UVB rays- only a bit more slowly and more deeply.

The American Academy of Dermatology hopes the FDA will ban indoor tanning devices all together, but at the least, should require a minimum age of 18 for ANY indoor tanning and should mandate obtaining informed consent from clients AFTER educating them about the real risks of skin cancer. The AADA also strongly recommends changing the risk category of these machines to match the health risks they create.

BOTTOM LINE: TANNING is NOT SAFE! Use sunscreen and stay away from tanning beds all together.