The New Year's Eve Alcohol Myths and Helpful Hints

As the New Year’s Eve Celebration nears, let’s discuss something really important: "The Hangover"

The first and most important point is that all hangovers are preventable: Avoid alcohol and you are guaranteed not to have a hangover.

But for those of us who feel like celebrating and imbibing in the spirits during our New Year’s Eve celebrations, there are the realities behind “common cures” and remedies.

Theory #1

Drink the next day:

Hangovers are triggered when the blood-alcohol level begins to drop a few hours after you finish drinking. Symptoms peak when the level nears zero. We know you can prevent “DT’s” by providing a continuous source of alcohol, but sooner or later, the symptoms will come back when no more alcohol is in the system.

Gradually tapering the alcohol dose as well as staying hydrated during the weaning process can help. This theory is similar to the medieval practice of treating bite wounds with the fur of the offending dog (the hair-of-the-dog approach). Does it work? It can temporarily and you may be able to diminish the symptoms a little; but it will not likely eliminate all of the alcohol withdraw feelings.

Theory #2

Have a grease-fest

The thinking here is that greasy food eaten before bed or the next day soaks up alcohol. Does it work? Only if you eat before drinking or as you are drinking. When you eat, the body has to digest and metabolize the meal. Fatty meals compete with the alcohol for metabolization in the liver and alcohol may enter the bloodstream more slowly. This potentially may cause the alcohol level to rise slower and to peak at a lower level.

Theory #3

Try a hangover potion

There are many potions and pills sold online, in stores, and even in bars that claim to soak up the toxic byproducts of alcohol or to help your body fight alcohol’s bad effects. Most of these contain activated charcoal (a carbon source that binds to many chemicals and prevents absorption) or a mix of vitamins and herbs. These are sold under creative names like “Chaser”, “Drinkin’ Mate”, “NoHang”, and so on.

Do they work? There are limited studies on these products so it’s hard to say, but in some small studies funded by the products, the ones which lists “activated calcium carbonate and charcoal” as ingredients, was better than a placebo at improving 7 hangover symptoms.

Theoretically, these products may help diminish absorption of the alcohol and therefore prevent blood alcohol levels from reaching the same point as they would have without their use.

What really helps?

The key points to remember are the following:

• Don’t drink alcohol on an empty stomach.


• Drink lots of water or other nonalcoholic liquids while you’re drinking alcohol and afterward to maintain your hydration status. Alcohol is a diuretic and will cause you to become dehydrated quicker exacerbating the hangover symptoms.


• Take aspirin or ibuprofen to ease a headache if your stomach can handle it.


• And note that dark liquors such as whiskey and red wine are more apt to leave you hung over than colorless or lighter drinks because of higher levels of congeners, which are the substances produced during fermentation and can have toxic effects by themselves.


• As always, drink responsibly, don’t overindulge and have a designated driver or utilize cabs, buses etc.


• Never drink and drive!

Kids and Sleep

Sleep related problems are not uncommon in children and many parents will tell you that their child/children have had at least one sleep-related problem from the time they are born to about six years old. The most common issues are night terrors, bed wetting, and grinding teeth and most of the time these resolve completely as the child gets older.

But for some kids it can be a problem that persists and some sleep problems will not allow them to sleep for six consecutive hours or more.

Besides the obvious problem of sleep deprivation, researchers from the Université de Montréal are now reporting that they have found a link between sleep-related problems in this age group and being overweight and hyperactive.

The results of the 1,138 children followed and who slept less than 10 hours a night were as follows:

-26% were overweight-18.5% carried extra weight-7.4% were considered obese
The researchers believe one explanation is the correlation in the secretion of hormones that are brought on by a lack of sleep. Less sleep causes our stomach to secrete more of the hormone that stimulates appetite and produce less of the hormone whose function is to reduce the intake of food.

The study also found that inadequate sleep could also lead to hyperactivity, something that does not have the same effect in adults. In adults, inadequate sleep translates into sleepiness, but in children it creates excitement and hyperactivity.

The study also included a cognitive performance test that was given to the children and involved copying a picture using blocks of two colors. Researchers found that, among the children that lacked sleep, 41% performed poorly, compared with 17-21% of children with 10 to 11 hours of sleep per night.

Bottom line is that adequate sleep in the younger age kids is important for a variety of reasons.

Chaos Rehab

Human behavior is extremely variable and variability is inherent within all biological systems and recently has been linked to the health of biological systems.

As we repeat a task, variations occur in our motor performance and this is hypothesized to provide a healthy flexibility of the heart, brain, and other parts of the body.

Many diseases are associated with a loss of this flexibility.

A healthy brain processes motor commands in a chaotic manner, which allows for dynamic movements such as walking whereas individuals with brain damage suffer from reduced brain processing capabilities and no longer have a dynamic gait.

Traditional rehabilitation treatment and training for individuals with motor disorders like stroke, traumatic brain injury (TBI), or cerebral palsy (CP) includes repetitive exercises of the musculoskeletal system, therapy for spasticity, and treatment that imitates normal movement patterns. With this conventional method, patients are unable to transfer motor functions learned in the clinic to real-life situations, resulting in slower recovery and less-than-adequate gait performance.

Based on the chaos theory, Step of Mind developed a non-invasive system that retrains the brain to process motor commands in a variable manner. The computer-controlled walking sandal creates chaotic perturbations in the patient’s walk, records and analyzes walking patterns, and provides instantaneous feedback to the clinician.

This challenges the patient by introducing variable environments that require an active response and forces the patient to solve motor problems in real time.

The outcome is improved walking balance, posture, and motor behavior; quicker recovery time; and the ability to transfer and retain achievements learned in the clinic to natural environments.

There are two versions in development: a professional rehab version for diagnostic and training purposes, and a basic home version. Studies on children with CP in Israel, Jordan, and the Palestinian Authority has been conducted and the results showed that using a variable motor learning approach significantly improved rehabilitation for children diagnosed with CP.

Another project—Self Mobility Improvement in the Elderly by Counteracting Falls—began in January 2008 in Europe and is scheduled to last for 30 months. The anticipated outcome is an advanced prototype system to improve motor functions and mobility of elderly populations who are at an increased risk of falling. It could also be used for stroke rehab as well as other neuromuscular disorders.

A Christmas Wish

I am wishing everyone a very Merry Christmas. I am hopeful we can all enjoy the festivities of the season even if we disagree with theology. I am happy to celebrate the birth of Jesus Christ.

***I'll see you after the Holidays

A Little Holiday Humor

The Christmas Tree

Although there are many varying ideas on the origin of the Christmas Tree, the common thought is that the Christmas tree actually predates Christianity. King Tut may have never seen a Christmas tree, but he would have understood the tradition. The Egyptians were part of a long line of cultures that treasured and worshipped evergreens. When the winter solstice arrives, they brought green date palm leaves into their homes to symbolize life's triumph over death.

We know that Ancient Romans decorated trees with small pieces of metal during Saturnalia (a winter festival in honor of Saturnus, the god of agriculture.) and there is also evidence to suggest that December 25th was chosen as the day to celebrate Christ's birth in order to replace some of the pagan holidays. Historians believe the Emperor Constantine did this around the year 390 to combine Christmas with the Saturn and Mithras celebrations and also with the cult of Sol Invictus which was a form of Sunday worship that had come to Rome from Syria.

There is also evidence that during the middle ages, an evergreen was decorated with apples and called the Paradise tree, as a symbol of the feast of Adam and Eve and was held on December 24th each year.

The modern Christmas trees appeared somewhere in the middle 1500's in or near Strasbourg Germany and the oldest record of a decorated Christmas tree came from a 1605 diary found in Strasburg. The tree was decorated with paper roses, apples and candies.

In the 17th and 18th centuries, we know that the tops of evergreens were cut and hung upside down in a living room corner and the trees were used as a symbol for the Trinity and they were sometimes decorated with apples, nuts and strips of red paper.

Tinsel was invented in Germany around 1610 using real silver. It was very durable, but tarnished quickly, especially with candlelight used at that time. Other materials were used but never caught on because of the weight.

The oldest record of Christmas trees in America was for children in the German Moravian Church's settlement in Bethlehem, Pennsylvania, Christmas 1747. They used wooden pyramids covered with evergreen branches and decorated them with candles.

The custom of the Christmas tree was introduced in the United States during the War of Independence by Hessian troops and there is an early account of a Christmas tree set up by American soldiers at Fort Dearborn, Illinois, the site of Chicago, in 1804. Most other early accounts in the United States were among the German settlers in eastern Pennsylvania and it is known that the Pennsylvanian German settlements had community trees as early as 1747.

Decorations were mainly home-made by young Ladies quilting snowflakes and stars, sewing little pouches for secret gifts and paper baskets with sugared almonds in them. Small bead decorations, silver tinsel from Germany and Angels to sit at the top of the tree were also popular. Candles were often placed into wooden hoops for safety.

Charles Minnegrode introduced the custom of decorating trees in Williamsburg, Virginia in 1842.

Somewhere around 1846 - 48, Queen Victoria's husband, Prince Albert, was credited with bringing the first Christmas tree to Windsor Castle for the Royal Family but some historians state that Queen Charlotte, Victoria's grandmother, had a Christmas tree in the Queen's lodge at Windsor on Christmas Day in 1800. We do know that in the Illustrated London News in 1846, an illustration of Queen Victoria, Prince, Albert and their children around a Christmas tree appeared and the Christmas tree became very fashionable because of the Royal Family.

It became a custom to have several small trees on tables, one for each member of the family, with those persons gifts stacked on the table under the tree.

Early in America’s history, Christmas trees were considered a quaint foreign custom and with the diversity in America there were only pockets' of immigrants using them. It was not until the telegraph communications really got going in the 19th century, that such customs began to spread and references to decorated trees in America before about the middle of the 19th century are very rare.

Companies in Germany seized the opportunity and began making fancy shaped glass bead garlands and other decorations for the trees.

Mark Carr brought trees from the Catskills to the streets of New York in 1851, and opened the first retail Christmas tree lot in the United States and Franklin Pierce was the first president to introduce the Christmas tree to the White House in 1856.

By the 1870's, Glass ornaments were being imported into Britain from Germany and it became a status symbol to have glass ornaments on the tree; the more one had the better ones status!

The glass ornaments started being imported into America around 1880, where they were sold through stores such as FW Woolworth. They were quickly followed by American patents for electric lights (1882), (until this time candles were attached to tree branches - which resulted in a lot of fires!) and metal hooks for safer hanging of decorations onto the trees (1892).

The artificial Christmas tree was invented in the 1880's in Germany, to combat some of the damage being done by so many native Fir trees being chopped for Christmas.

The first national American Christmas Tree was lighted in the year 1923 on the White House lawn by President Calvin Coolidge and a tree from the National Christmas Tree Association has been displayed in the Blue Room of the White House since 1966. See Christmas Trees at the White House.

Christmas trees declined in popularity during the depression but after World War II, the Christmas tree again became popular!

The mid-1960's saw another change. Sammy Davis Jr and the Mod 60's were booming and plastic was everywhere. Silver aluminum trees became popular and the 'Silver Pine' tree, patented in the 1950's, was designed to have a revolving light source under it, with colored gelatin 'windows, which allowed the light to shine in different shades as it revolved under the tree. No decorations were needed for this tree.

In the 1980's Christopher Radko brought back the old art of making glass ornaments for all to enjoy and many of these replicated some of the very old ornaments made in Germany.
Info from the following sites:
The Christmas Archives: Chronological History of the Christmas Tree
http://www.christmas-tree.com/where.html
The History of the Christmas Tree and Other Christmas traditions

Santa Claus History

1600's:. In 1626 the “pilgrims” left Holland for the New World and purchased some land from the Iroquois, for $24, and named the village New (or Nieuw) Amsterdam. They brought with them their patron saint, Nicholas.

Just a few years later, in 1651, the State of Massachusetts was settled by English Puritans and they banned all observation of Christmas. The Puritans made it illegal to mention St. Nicolas' name and people were not allowed to exchange gifts, light a candle, or sing Christmas carols
The legislature passed an act ruling that "whosoever shall be found observing any such day as Christmas … either by forebearing labor, feasting, or in any other way … every such person so offending shall pay a fine for each offense of five shillings to the county." The law was repealed in 1681, but had a profound chilling effect on the celebration of Christmas in New England.
When Charles II of England made a gift of New Amsterdam to the Duke of York in 1664, the city was renamed New York. These new English people were not the same strict Puritans that helped found America (it was Charles II who ousted Cromwell and the Puritans in England in 1660) but were still not as open to the Dutch influence.

17th century: But even as the Dutch influence wained, they had their ultimate revenge when the Dutch Sint Herr Nikolaas would become Sinter Klass and finally Santa Claus in the American culture.

1773: Santa first appeared in the media as St. A Claus.

1804: The New York Historical Society was founded with St. Nicolas as its patron saint. Its members engaged in the Dutch practice of gift-giving at Christmas. Though Christmas is observed, it is seen primarily as a religious celebration unrelated to St. Nicholas Day (Sinterclaas), which is celebrated on December 5th. On Sinterclaas, St. Nicholas arrives by boat from Spain and rides his white pony through towns at night, accompanied by a black slave (!) named Zwaart Piet (literally "black Peter"), who carries an enormous sack of toys and coal. The toys are reserved for children who have behaved well during the previous year, and are placed in wooden shoes left on the back porch for this purpose. Naughty children receive a lump of coal.

1809: Washington Irving, writing under the pseudonym Diedrich Knickerbocker, included Saint Nicolas in his book "A History of New York." Nicolas is described as riding into town on a horse.

1812: Irving, revised his book to include Nicolas riding over the trees in a wagon.

1821: William Gilley printed a poem about "Santeclaus" who was dressed in fur and drove a sleigh drawn by a single reindeer.

1822: Dentist Clement Clarke Moore is believed by many to have written a poem "An Account of a Visit from Saint Nicolas," which became better known as "The Night before Christmas." Santa is portrayed as an elf with a miniature sleigh equipped with eight reindeer which are named in the poem as Blitzem, Comet, Cupid, Dancer, Dasher, Donder, Prancer, and Vixen. Others attribute the poem to a contemporary, Henry Livingston, Jr. Two have since been renamed Donner and Blitzen.

1841: J.W. Parkinson, a Philadelphia merchant, hired a man to dress up in a "Criscringle" outfit and climb the chimney of his store.

1863: Illustrator Thomas Nast created images of Santa for the Christmas editions of Harper's Magazine. These continued through the 1890's.

1860s: President Abraham Lincoln asked Nast to create a drawing of Santa with some Union soldiers. This image of Santa supporting the enemy had a demoralizing influence on the Confederate army -- an early example of psychological warfare.

1897: Francis P Church, Editor of the New York Sun, wrote an editorial in response to a letter from an eight year-old girl, Virginia O'Hanlon. She had written the paper asking whether there really was a Santa Claus. It has become known as the "Yes, Virginia, there is a Santa Claus" letter.

1920's: The image of Santa had been standardized to portray a bearded, over-weight, jolly man dressed in a red suit with white trim.

1931: Haddon Sundblom, illustrator for The Coca-Cola ™ company drew a series of Santa images in their Christmas advertisements until 1964. The company holds the trademark for the Coca-Cola Santa design. Christmas ads including Santa continue to the present day.

1939: Copywriter Robert L. May of the Montgomery Ward Company created a poem about Rudolph, the ninth reindeer. May had been "often taunted as a child for being shy, small and slight." He created an ostracized reindeer with a shiny red nose who became a hero one foggy Christmas eve. Santa was part-way through deliveries when the visibility started to degenerate. Santa added Rudolph to his team of reindeer to help illuminate the path. A copy of the poem was given free to Montgomery Ward customers.

1949: Johnny Marks wrote the song "Rudolph the Red-Nosed Reindeer." Rudolph was relocated to the North Pole where he was initially rejected by the other reindeer who wouldn't let him play in their reindeer games because of his strange looking nose. The song was recorded by Gene Autry and became his all-time best seller. Next to "White Christmas" it is the most popular song of all time.

1993: An urban folk tale began to circulate about a Japanese department store displaying a life-sized Santa Claus being crucified on a cross. It never happened.

1997: Artist Robert Cenedella drew a painting of a crucified Santa Claus. It was displayed in the window of the New York's Art Students League and received intense criticism from some religious groups. His drawing was a protest. He attempted to show how Santa Claus had replaced Jesus Christ as the most important personality at Christmas time.

Reference sites:
The Rise and Fall of Santa Claus - features
Christmas controversy - Wikipedia, the free encyclopedia
http://www.hymnsandcarolsofchristmas.com/santa/the_new_world.htm
Santa Claus in America
Christmas on the Net - The History of Christmas

Memo from Santa:

I regret to inform you that, effective immediately, I will no longer serve Georgia, Florida, West Virginia , Virginia , North and South Carolina , Tennessee , Mississippi , Missouri, Oklahoma , Texas , Louisiana , Arkansas or Alabama on Christmas Eve.

Due to the overwhelming current population of the earth, my contract was renegotiated by North American Fairies and Elves Local 209. As part of the new and better contract, I also get longer breaks for milk and cookies so keep that in mind. However, I'm certain that your children will be in good hands with your local replacement, who happens to be my third cousin, Bubba Claus. His side of the family is from the South Pole. He shares my goal of delivering toys to all the good boys and girls; however, there are a few differences between us.

Differences such as:

1. There is no danger of the Grinch stealing your presents from Bubba Claus. He has a gun rack on his sleigh and a bumper sticker that reads: "These toys insured by Smith and Wesson."

2. Instead of milk and cookies, Bubba Claus prefers that children leave RC cola and pork rinds (or a moon pie) on the fireplace. And Bubba doesn't smoke a pipe. He dips a little snuff, so please have an empty spit can handy.

3. Bubba Claus' sleigh is pulled by floppy-eared, flyin' coon dogs instead of reindeer. I made the mistake of loaning him a couple of my reindeer one time, and Blitzen's head now overlooks Bubba's fireplace.

4. You won't hear "On Comet, on Cupid, on Donner, and Blitzen..." when Bubba Claus arrives. Instead, you'll hear, "On Earnhardt, on Andretti, on Martin and Petty."

5. "Ho, Ho, Ho" has been replaced by "Yee Haw" And you also are likely to hear Bubba's elves respond, "I her'd dat"

6. As required by Southern highway laws, Bubba Claus' sleigh does have a Yosemite Sam safety triangle on the back with the words "Back Off."

7. The usual Christmas movie classics such as "Miracle on 34th Street" and "It's a Wonderful Life" will not be shown in your negotiated viewing area. Instead, you'll see "Boss Hogg Saves Christmas" and "Smokey and the Bandit IV" featuring Burt Reynolds as Bubba Claus and dozens of state patrol cars crashing into each other.

And Finally,

8. Bubba Claus doesn't wear a belt. If I were you, I'd make sure you, the wife, and the kids turn the other way when he bends over to put presents under the tree.

Sincerely yours,

Santa Claus

Healthy Connections with Kids

Obesity and poor lifestyle choices continue to plague our youth. As parents and physicians, we are constantly searching for ways to connect to the kids and get them to respond.

A recent article in the Journal of Nutrition Education and Behavior looked at using mobile phone short message services to help children monitor health-related behaviors.

The initial study results do show some promise in connecting with the kids.

Jennifer R. Shapiro, Ph.D., of the University of North Carolina at Chapel Hill, and colleagues conducted a study of 58 children aged 5 to 13 years, as well as their parents. The participants were given three group education sessions about increasing physical activity, reducing screen time and cutting down on consumption of sugary drinks, and 18 children were then assigned to monitor their target behaviors via text messages, 18 via a personal diary and 22 did not monitor their behavior.

The intervention continued for eight weeks, by which time 13 of the short messaging, seven of the personal diary and 11 of the control group subjects completed the study, giving attrition rates of 28 percent, 61 percent and 50 percent, respectively. You can see the highest dropout rate occurred in those who had to keep a personal diary probably related to the archaic pen and paper that kids seem to abhor.

These results suggest that one potentially effective way of increasing self-monitoring adherence in children is to use novel devices such as cell phones and text messaging.

There is probably an entrepreneur that could develop a software program or other service that parents could sign up for which would facilitate healthier behaviors and lifestyles. The data collection could be used for other research opportunities.

Anyone interested?

Greenspace and Obesity

In this article from the American Journal of Preventive Medicine Neighborhood Greenness and 2-Year Changes in Body Mass Index of Children and Youth, the researchers found that children with more access to green areas are more likely to stay near normal weight for their age and gender.

Janice F. Bell, Ph.D., of the University of Washington in Seattle and colleagues examined the association between body mass index (BMI) z-score (the number of standard deviation units that BMI deviates from the mean reference value for age and gender), greenness and residential density in 3,831 children (3 to 16 years old) who received well-child care in Marion County in Indiana. Greenness was determined from satellite images.

The researchers found that children living in greener areas were significantly more likely to have a lower BMI z-score and less likely to have increases in their BMI z-scores over the two-year period. They also found that residential density was not associated with BMI z-scores regardless of greenness.

The conclusion of the researchers was that these findings support the exploration of the promotion and preservation of greenspace within neighborhoods as a means of addressing childhood obesity.

What a novel idea; get the kids outside and promote some real physical activity. How do we convince kids and parents that TV and video games are not healthy activities? Combine this with junk food and limited physical exercise and we get a generation of overweight kids and adults.

Erosion of Employer-sponsored Health Coverage

If you think that over the past few years fewer individuals are obtaining health insurance through their employers – you’re right.

In this study, http://www.epi.org/briefingpapers/223/bp223.pdf, by the Economic Policy Institute (EPI) they show that while Indiana is doing better than many states, there’s been a substantial decline in employer-sponsored insurance here in recent years.

Between the years 2000 and 2007, there has been a 5.2 percent decline and for children under age 18, the decline is 6.6 percent.

EPI is an independent nonprofit think tank. They reported that nationally 62.9 percent of American workers are covered by employer-provided health insurance which is 3 million fewer than in 2000. As unemployment rises, the percentages are expected to grow.

Without a defined fix in the healthcare system, this problem is likely to worsen and with democrats in power, their solution will likely be more government run programs. This ultimately is not the best solution.

Say AHHHHH

As the cold and flu season nears, doctor’s offices become very busy. Everyone wants a quick diagnosis and many patients want an antibiotic even though most winter illnesses are viral in origin and not bacterial.

Accurately diagnosing viruses and cold and flu bugs has always been difficult and many patients never like it when they are told it is viral and antibiotics won’t help. They are skeptical because of not having an objective lab that validates the clinician’s diagnosis.

With that in mind, there is a new test available called the xTAG respiratory panel. This test can precisely diagnose a dozen winter ailments and reduce unneeded use of antibiotics. It is said to be the most accurate and the most comprehensive available.

It was approved earlier this year by the U.S. Food and Drug Administration and it tests for a dozen viruses, including several types of influenza, two types of respiratory syncytial virus, or RSV, three types of parainfluenza, adenovirus and even rhinovirus, which causes the common cold.

These particular viruses account for about 85% of the viral illnesses in the U.S. during this time of year.

The test requires a swab from the nose or throat and this is sent out to the reference lab. The studies so far show the test detects each virus 78% to 100% of the time, depending on the type, and has few false positives.

All of this sounds great and would certainly help curb the overuse of antibiotics. But like everything, there has to be a downside.

The downside with this test is the cost. The test is very expensive, about $300 to $400, but is covered by most insurers for now. This will likely change as soon as it becomes more widely ordered and would certainly change under a nationalized health system. It also requires extensive processing time in the lab so there will be no quick answer for patients. It could take 1-2 days to get the results.

Why Walk?

Here are 13 Reasons on the Importance of Walking

#1 Walking can add minutes to your life. This enables you at 85 years old to spend an additional 5 months in a nursing home at $7000 per month.

#2 My grandpa started walking Five miles a day when he was 60..Now he's 97 years old and we don't know where he is.

#3 I like long walks, especially when they are taken by people who annoy me.

#4 The only reason I would take up walking is so that I could hear heavy breathing again.

#5 I have to walk early in the morning, before my brain figures out what I'm doing.

#6 I joined a health club last year, spent about 400 bucks. Haven't lost a pound. Apparently you have to go there.

#7 Every time I hear the dirty word 'exercise', I wash my mouth out with chocolate.

#8 I do have flabby thighs, but fortunately my stomach covers them.

#9 The advantage of exercising every day is so when you die, they'll say,'Wow, he looks good doesn't he!'

#10 If you are going to try cross-country skiing, start with a small country.

#11 I know I got a lot of exercise the last few years,......Just getting over the hill.

#12 We all get heavier as we get older, because there's a lot more information in our heads. That's my story and I'm sticking to it..

AND LASTLY

#13 Every time I start thinking too much about how I look, I just find a Happy Hour and by the time I leave, I look jus t fine.

Fireworks injuries for 2008

The 2008 report for fireworks related incidents is complete and for the second straight year, reported fireworks injuries have declined in Indiana.

The Indiana State Department of Health (ISDH) reported 141 fireworks-related injuries, including one death; that’s down 10 percent from last year.

The State is happy with the decline, but is concerned that it may be partly related to incomplete reporting. There is no universal mechanism for reporting and hospital coding only lists the injury and doesn’t include the cause of the injury.

More than 60 percent of the injuries were burns, especially to the fingers and hands and injuries to the eyes were also fairly common. Almost half of the total injuries involved children and adolescents.

The 2008 Fireworks-Related Injuries Report also revealed:

• One out of every four reported injuries involved the eyes, with 75.7 percent of those with eye injuries not using any method of eye protection.


• Ninety percent of those seeking treatment for their injuries were evaluated and released to go home; 9.2 percent were admitted to the hospital or transferred to another hospital.


• Firecrackers, rockets, aerial devices and sparklers were associated with 65.3 percent of all reported injuries.


• Fireworks use on private property accounted for almost 87 percent of reported injuries.

With our County selling fireworks, it is important to watch our kids closely and maintain safety at all times to prevent some serious problems.

Indiana Health Initiatives

Since Indiana is near the bottom of some key health issues compared to other states, Hospitals are joining forces to focus on wellness.

State hospitals will focus on 6 public health measures in an attempt to elevate our low ranking.
The six targeted areas and their rankings are listed here:

• Obesity – rank 31st
  Smoking – rank 50th
  Adult diabetes – rank 38th
  Childhood immunizations – rank 43rd
  Prenatal care in first trimester – rank 33rd
  Self-reported poor mental health – rank 46th

The initial strategies will include targeting hospital employees first to help with some of the reporting data and education for the families. Other strategies include utilizing partnerships with others, aligning hospital initiatives with county or state initiatives, like INShape Indiana, standardizing needs assessments and measurements, and utilizing existing resources and expertise within hospitals.

We should be able to improve these rankings.

*Source: Wellpoint State Health Index of 23 key public health metrics, 2004-05

Female Libido Treatment

One very common complaint nearly all primary care physicians receive is from middle age and older females about their loss of libido and enjoyment is sex. They always want to know when ‘Viagra for women” will be available.

Many physicians use testosterone in some women for this problem but it is not yet FDA approved. Procter & Gamble Co. has worked since 1999 to secure U.S. approval for its Intrinsa patch which is intended to increase sex drive and satisfaction in women after menopause.

The New England Journal of Medicine recently published a company-run study of the patch, which delivers a steady stream of testosterone, a hormone associated with sex drive in men and women.

Intrinsa is already on sale in Europe to treat "hypoactive sexual desire disorder," meaning a lack of interest in sexual activity that leads to unhappiness.

Surveys have shown that between 10% and 30% of post-menopausal women typically report low sexual desire but many in the medical field doubt whether the condition should be considered a medical disorder. I cannot say there is no gender bias in this statement.

Women in the study, who averaged 54 years old, were asked to keep a weekly diary of sexual episodes and note which ones they considered "satisfying." About 264 women wore Intrinsa patches, to be placed near the belly button and changed twice a week, and 277 wore fake patches.

All the women started out with low sexual desire, and reported an average of 2.5 "satisfying sexual episodes" over the previous four weeks. After six months, women wearing Intrinsa reported 4.6 satisfying episodes in the previous four weeks, compared with 3.2 in a group wearing a fake patch.

The results of this study are unlikely to allay concerns about the safety of long-term treatment with hormones such as testosterone and therefore will not likely get FDA approval for a while.

The concern is that three of 264 women with the patch developed breast cancer, compared with none on the placebo patch and in a third group using a low-dose version of the patch, one women developed breast cancer.

Other studies including a 2002 U.S. government study found that hormone-replacement therapy, widely used to treat the symptoms of menopause, increased breast cancer and cardiovascular problems.

The FDA told manufacturers it will require a large "safety" study, likely with several thousand patients, before approving testosterone products to increase women's sex drives and P&G declined to say specifically whether it planned to seek approval again from the FDA.

Vivus Inc., a Mountain View, Calif., pharmaceutical company, also stated they weren’t any closer to introducing its female sexual-satisfaction drug, known as Luramist.
Estimates are that no drug will hit the market until at least 2012 to treat this problem.

Sorry ladies……..and guys

More on E-Rx

Although most pharmacies generally favor e-prescribing, it is not a panacea for everyone. About 70% of the pharmacies in the US are connected to a network and can receive e-prescriptions electronically (most of the remaining 30% can be reached by fax). E-prescribing definitely reduces time spent faxing or calling physicians and it reduces illegible scripts from handwriting which in turns decreases the possibility of errors. Computer interfaces with their in-house computers reduces time and labor spent re-entering prescription information and dispensing errors can be reduced using an electronic system as well as decreasing patient wait times.

But on the down side, pharmacies must pay a transaction fee for each refill request sent out, as well as for each prescription received. This cost is thought to be minimized by the labor savings that an electronic system provides.

Pharmaceutical manufacturers have mixed feelings about e-prescribing. They understand the positive values, but they have expressed concern that e-prescribing could push more prescribers to substitute generic medications for brand name medications. This does happen in my office as well as having a defined list of common drugs that I use regularly which speeds up my process. Choosing alternate or new drugs takes more time in the computer and I therefore am less likely to do so unless there is clear benefit.

Many physicians have been slow to adopt e-prescribing and currently, only about 6% of office-based physicians are e-prescribing. Further, physicians e-prescribe only 2% of the 1.47 billion prescriptions that are eligible for electronic transmission. Reasons cited for this include hardware costs, software costs, and training costs. In addition, it has been said that old habits die hard, and physicians have been reluctant to change their workflows in order to accommodate e-prescribing.

Again, in my office, some of the physicians use it regularly and see the benefits while others like pen and pad. Some believe it is hard for an electronic prescription to beat the convenience of a pen and prescription pad and this is true initially, but once the system is up and running with the common information and drugs being utilized, it is difficult to beat it.

The biggest problem we have remains the current ban on e-prescribing of controlled substances. This is a horrible inconvenience and safety problem and it creates twice as much work for us and the pharmacies. This is a legislative problem that has to be fixed.

A Brown University study suggested that e-prescribing can cut physician time spent on renewals from 35 to 17 minutes per day and staff time spent on renewals from 87 to 43 minutes per day. I would agree that it has saved us both staff and physician time although as stated earlier, initial prescriptions are probably faster with pen and pad.

We have further benefits as our e-prescribing is integrated with our EHR so that the e-prescribing process automatically assists in maintaining an accurate drug list and assists with the medication reconciliation process.

The biggest drawback for physicians is the cost of the software and increasingly, both CMS and other payers are realizing that physicians will need financial incentives to switch to e-prescribing.

THE RULES OF RURAL INDIANA

Listen up City Slickers!

1. Pull your droopy pants up. You look like an idiot.

2. Turn your cap right, your head isn't crooked.

3. Let's get this straight; it's called a "dirt road." I drive a pickup truck because I want to. No matter how slow you drive, you're going to get dust on your Lexus. Drive it or get out of the way.
4. They are cattle. They're live steaks. That's why they smell funny to you. But they smell like money to us. Get over it. Don't like it? Rt. 70 goes east and west; I-65 goes north and south. Pick one.

5. So you have a $60,000 car. We're impressed. We have $150,000 corn pickers and hay balers that are driven only 3 weeks a year.

6. So every person in southern Indiana waves. It's called being friendly. Try to understand the concept.

7. If that cell phone rings while an 8-point buck and 3 does are coming in, we WILL shoot it out of your hand. You better hope you don't have it up to your ear at the time.

8. Yeah, we eat tater & gravy, beans & cornbread. You really want sushi & caviar? It's available at the corner bait shop.

9. The "Opener" refers to the first day of deer season. It's a religious holiday held the closest Saturday to the first of November.

10. We open doors for women. That is applied to all women, regardless of age.

11. No, there's no "vegetarian special" on the menu. Order steak. Or you can order the Chef's Salad and pick off the 2 pounds of ham & turkey.

12. When we fill out a table, there are three main dishes: meats, vegetables, and breads. We use three spices: salt, pepper, and ketchup. Oh, yeah.... We don’t care what you folks in Cincinnati call that stuff you eat... IT AIN'T REAL CHILI!!

13. You bring "coke" into my house, it better be brown, wet and served over ice.

14. You bring "Mary Jane" into my house, she better be cute, know how to shoot, drive a truck, and have long hair.

15. College and High School Football is as important here as the Lakers and the Knicks, and a dang site more fun to watch.

16. Yeah, we have golf courses. But don't hit the water hazards -- it spooks the fish.

17. Colleges? We have them all over. We have State Universities, Community Colleges, and Vo-techs. They come outta there with an education plus a love for God and country, and they still wave at everybody when they come for the holidays.

18. We have a whole ton of folks in the Army, Navy, Air Force, and Marines. So don't mess with us. If you do, you will get whipped by the best.

19. Turn down that blasted car stereo! That thumpity-thump crap ain't music, anyway. We don't want to hear it anymore than we want to see your boxers. Refer back to #1.

20. 4 inches isn't a blizzard - it's a flurry. Drive like you got some sense in it, and DON'T take all our bread, milk, and bleach from the grocery stores. This ain't Alaska, worst case you may have to live a whole day without croissants. The pickups with snow blades will have you out the next day.

The Cancer Cost and Money Management

As everyone is acutely aware, the cost of healthcare continues to rise and the cost of cancer care is rising at the rate of approximately 15% annually.

A universal healthcare system will have to address this and will have to ration care based on some criteria.

New drugs and related drug combination therapies that have improved outcomes and reduced side effects but have brought the cost of cancer care to more than $72 billion in 2004.

Cancer treatment is somewhat unique because there’s no magic bullet and just because you have lung cancer or breast cancer doesn’t mean you take drug A or drug B for a certain duration and then you’re done.

In today’s healthcare environment, patients can have a multitude of different therapies which becomes very expensive.

Every major insurer, from the federal government to any private payer is struggling with trying to manage the cost and complexity of oncology care.

More and more actuarials are beginning to use of cost effectiveness and cost-benefit studies because it is the only economic tool that can help answer the question if whether these additional costs worth it.

One such example of this type of information is with the drug docetaxel, which, when added to the treatment of metastatic breast cancer, adds approximately $2,400 for every additional month of life a patient receives.

With this piece of information, you can than have frank discussions about whether it is worth it, and that is not an easy call.

Insurance companies can and do make decisions about what it will or won’t pay for, but ultimately, it’s the oncologists who are in charge of the therapy for their patients and this becomes the problem.

A group of approximately 180 oncologists in 11 physician groups are beginning to submit information, including chemotherapy planning, chemotherapy-related side effects, pain assessment and control, and specific measures related to the management of colon and rectal cancer, non-Hodgkin’s lymphoma and lung cancer, to a national database to help the physicians identify what works best in cancer care.

One piece of information the oncologists will receive back is the percentage of their patients who receive chemotherapy within the last 2 weeks of life. On group of oncologists from an academic medical center came in at 86 percent on this item and it prompted them to ask themselves whether or not they were providing care that was really in the patients’ best interest just 2 weeks prior to death.

Having this type of information can change how we manage patient’s treatment.

As physicians, we are to first do no harm, but our treatment in an attempt to prolong life may actually not be in the patient or family’s best interest.

Sometimes, we need to help our patients prepare for death because even the best physicians can only prolong life.

Fans and SIDS

In this Denver Post article, Fan use linked to lower risk of sudden baby death - The Denver Post, they do not give the reader much factual information and leave most with more questions than they had before.

The story used terms like “seemed to lower the risk” and “seems to suggest,” which are certainly not very scientific or reassuring.

The story also failed to explain anything about the type of fan or “dose'” of fan use (i.e. box, oscillating, facing into the room, blowing on the child or not, moving air in or out of the window) and therefore the readers got no insight that would enable them to take action.

The authors of this particular article should have given a little more concrete information about how they might reduce the risk of S.I.D.S. and if fans are being recommended than they should also list the potential downfalls.

No treatment is without a downside.

Age and Bipolar Association

We’ve always heard that mothers who have kids over the age of 40 may be at an increased risk of having a child with Down’s syndrome.

There is now a new study showing that older dad’s may have an increased risk of having a child with bipolar disorder. The new report appears in the September issue of Archives of General Psychiatry.

The study identified 13,428 patients in Swedish registers with a diagnosis of bipolar disorder and randomly selected five controls who were the same sex and born in the same year but not diagnosed with bipolar disorder. Once the two groups had been compared, researchers found that the older an individual’s father, the more prone they were to have developed bipolar disorder.

The researchers made adjustments for the number of children, maternal age, socioeconomic status, and family history of psychotic disorders.

They determined that “the offspring of men 55 years and older were 1.37 times more likely to be diagnosed as having bipolar disorder than the offspring of men aged 20 to 24 years.”

They also mentioned that, for early-onset bipolar disorder, the “effect of the father's age was much stronger and there was no association with the mother's age.”

The reasoning suggested for the findings were that more mutations occur in the DNA within the sperm as compared to the eggs.

Music and Endurance

There is some evidence that music may increase physical endurance as well as keeping runners motivated.

The most recent research comes from Dr. Costas Karageorghis’s 20-year-old program conducted at Brunel University West London’s School of Sport and Education where participants were asked to run on a treadmill to the beat of various chosen songs by Queen, Madonna, and the Red Hot Chilli Peppers.

The results showed nearly a 15% increase in endurance while running in strict rhythm with the scientifically selected music. I’m still not sure what scientifically selected music means.

The explanation given was that “synchronous application of music resulted in much higher endurance while the motivational qualities of the music impacted significantly on the interpretation of fatigue symptoms right up to the point of voluntary exhaustion.”

The study results will be published in an upcoming issue of the Journal of Sport & Exercise Psychology.

One of the researchers will put this study to a real trial in a race, Run to the Beat that will feature live music during the entire race. Music was scientifically-selected and it will be played at 17 live music stations to accompany 12,500 runners.

Although not everyone can have live musical performances accompanying their morning run, it seems having upbeat, positive, and energetic music on your iPod just might do the trick.

The bottom line may be to turn on that iPod while you work out and it may improve your cardiovascular health!

I wonder what country music would do to the results?