UNPLUG Your Kids!

As summer goes on, kids get sucked deeper and deeper into their electronic abyss. Before you know it, they are sleeping past lunch, staying awake all night and receiving all their light rays from a computer screen or their phone. Today's blog is my public service announcement to parents to UNPLUG your kids!! Remember that all the medical academies recommend we limit screen time to LESS than TWO HOURS per day. Yeah, I know- your kid had that much screen time before she ever got out of bed this morning...

I love camps that prohibit all electronics and allow kids to go back to being kids- jumping in lakes, riding horses, crafting or just hanging out and actually talking out loud instead of texting. Kids (yes, teens, especially) seem to come back home recharged and more socially engaged. However, YOU can create (force, whatever!) your OWN electronic fast  for your kid right at home. Create at least a day (or start with a half-day) of UNPLUGGED time. What can they do? Read a book. Talk. Play cards, or maybe a board game. Better yet- make THEM come up with a list of 10 things they could do.

Of course, adults, we could all use this advice, too. So, stop reading this blog & UNPLUG yourself for a few hours!

BOTTOM LINE: Don't let your kids (or yourself) stay "plugged in" to electronics- limit that screen time!

Summer Swimmer's Ear PREVENTION

Swimming all summer is FUN...till someone gets "swimmer's ear". An ounce of prevention here is truly worth the proverbial pound of cure, and the best news is that you can MAKE that "ounce" right in your kitchen!

Swimmers ear is caused by bacteria and fungi, which get access to the ear via the pool or lake water during swimming. (By the way, using q-tips to "clean" the ear serves to cause minor trauma to the ear canal and tends to make it easier to get these outer ear infections, so skip the q-tips, please.) 90% of the time, swimmer's ear only affects one ear. If you wake up with both ears hurting, it is more likely your middle ear causing the problem, and all the topical treatments in the world won't help.

Back to your kitchen- grab a bottle of vinegar and then a bottle of rubbing alcohol, and mix them together half & half. This mixture can be spilled on to a cotton ball and squeezed into the ear canal OR my preference is to use the bottle from the over-the-counter swimmer's ear prevention product and fill it up with my "home brew". Place around six drops in each ear, and allow to drain back out- do this after every swim session, and three times/day if you develop a sore ear. Warming up the bottle in your hands will make it less irritating to your ears. The vinegar kills the bacteria & fungus and the alcohol dries up any remaining moisture. Voila! Prevention & cure- same solution. I would estimate this will treat the vast majority of infections, but if your sore ear isn't improving in a couple days, please call your doctor & let them take a look. We certainly see "swimmer's ear" infections that require topical antibiotics and or topical steroids (to decrease inflammation and swelling.)

BOTTOM LINE: If you (or your kids) are frequent swimmers, don't wait for a sore ear to start using swimmer's ear prevention this summer!

Why Visit Someone with Dementia?

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.

So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.

So, here are a few suggestions for an easier visit:

1. Bring pictures, especially of you and your friend together.

2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.

3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.

4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)

5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.

BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.

Memory Loss Equals Alzheimers?

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Independence Day, Indeed!

July 4th is a wonderful day in America, filled with family celebrations, picnics and fireworks. We are so fortunate to live in a country that allows us so many freedoms! In our family, this day has additional significance, as today marks the 8th anniversary of my mother's independence from Alzheimer's Disease. As we once again visited her grave today, surrounded by the incredible beauty of the wildflowers and the snow-capped mountains, I looked around the cemetery and wondered how many other lives represented there were affected by this disease.

Did you know we have over 5.3 million Americans living with Alzheimer's? Chances are good that you either have a family member or friend affected. We have medications that can improve some behavioral and cognitive functions in people with dementia, but none yet that can stop or cure it. With our aging population, it is clear that this disease alone will consume a progressively larger chunk of our healthcare dollars.

Check out the Alzheimer Association website, and consider participating in a local Memory Walk or other fundraiser.

BOTTOM LINE: Let's celebrate our country's independence today by thinking about the future of our aging population, and pro-actively working towards a cure for Alzheimer's.

Escaping the Heat in the Mountains?

For those families headed to the mountains to escape the heat this summer, remember that mixed in with those gorgeous views and cool weather might come a couple medical challenges. First of all, don't be fooled that cool weather means no sunburns! Check out this month's blogs on base tanning & sunscreen so you don't end up with a high altitude burn. Secondly, be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness).

What elevation causes altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby.

When does it start?

Symptoms usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath

Treatment?

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

PREVENTION:

• Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

Which Sunscreen Works Best?

With summertime here, let's review the basics about sunscreens. There are so many sunscreen products available that it often feels impossible to choose which type of sunscreen to purchase. I know most kids (& parents) 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!