|
GreenField’s Health Matters: February, 2005
Parenting Seminars: Connect With Your Kids
GreenField is excited about offering three parenting seminars to be presented by Kathy Masarie, MD, Pediatrician, Parent Coach, founder of Full Esteem Ahead, and a GreenField Health patient! Space is limited, so please call GreenField Health at 503-292-9560 to register for these sessions. You need to register for each session individually. We encourage both moms and dads to participate. Each seminar participant will receive a handout and resource guide. The location will be in our conference room at GreenField Health. Seminar 1: Raising Healthy, Responsible Children - Date & Time: Wednesday, March 9, 2005, 7:00 - 8:30 PM
- Location: GreenField Health
- Cost: $25 (or $60 for the series of 3 seminars)
- Adults can connect and communicate with children. Children are frequently surrounded by an unhealthy culture that bombards them with "junk values." They benefit tremendously if they receive "preventive support" in their struggles as they mature into adulthood. This seminar addresses how to build healthy character, communication skills to provide a buffer against these problems and research-proven methods to support children in a positive manner.
Seminar 2: Managing Verbal Bullying and Relational Aggression - Date & Time: Wednesday, April 13, 2005, 7:00 - 9:00 PM
- Location: GreenField Health
- Cost: $25
- Boys commonly use direct verbal aggression to hold power and prestige over others. "Relational aggression" is where girls in particular, but also boys, use their relationships to harm each other. By using covert behavior like exclusion, silent treatment and gossip, children cause real harm both within and outside their friendship circles. Such forms of aggression are harmful to the aggressor as well as the victim. This seminar explores non-physical aggression, its impact on children, and methods of managing these problems.
Seminar 3: What about Boys? - Date & Time: Tuesday, May 10, 2005, 7:00 - 8:30 PM
- Location: at Greenfield Health
- Cost: $25
- Boys live in a tumultuous world today. Many boys conform to a strict "boy code" that does not allow them to express emotions except anger. Boys have higher rates of learning difficulties, school failure and violence. This seminar will address unique ways to connect to, communicate with, and support our boys more effectively.
Important Announcements
Don't forget GreenField's First Tuesdays
On the first Tuesday of each month we host an informational session from 5:30-6:30 PM for prospective patients. One of our doctors gives an overview and tour of the clinic, and answers questions. It is a great way to introduce new people to GreenField. They tend to be relatively well attended, but there is always room for more. Please feel free to send, or bring, people over if they are interested in joining. Art at GreenField
In our nearly 3 years of being open, we've had on loan several rounds of art. Most of the art is by GreenField patients. We know that many of you appreciate it when you are here, as we certainly enjoy having it on our walls. Our last exhibit was by local artist Susan Wagner . We'd like to thank Susan for lending us several of her pieces for the past year. That also means that we have some available wall space. If you have tasteful art that you'd like to display at GreenField, please let us know.
"Dangerous" Drugs
The following piece was adapted from The Medical Letter© newsletter December 2004. At a US Senate hearing prompted by the withdrawal of the pain medication Vioxx from the market, an FDA officer cited 4 additional drugs as potentially dangerous. These medications can be useful in selective situations, but the FDA official warned that they should be used with caution and with a clear understanding of the risks that they carry. They are:
- Accutane (drug name isotretinoin) is a remarkably effective drug for treatment of severe acne. Because it is teratogenic (causes birth defects) and may cause serious depression or psychosis, it requires careful monitoring, especially for pregnancy.
- Serevent (drug name salmeterol) - a long-acting bronchodilator - is effective for patients with asthma who are already using an inhaled corticosteroid, but still require the frequent use of a short-acting bronchodilator. As the name implies, bronchodilators dilate the airways in the lungs relieving the airway constriction characteristic of asthma. Long-acting bronchodilators should not be used for treatment of acute bronchospasm (they do not work quickly enough) or without an inhaled corticosteroid (an inhaled steroid is the most important treatment for asthma).
- Crestor (drug name rosuvastatin) is the newest cholesterol-lowering "statin." There is no convincing evidence to date that it causes more serious myopathy than other available statins, but it is more potent than the others and myopathy is dose-dependent. Except for patients who do not respond adequately to older statins with longer safety records, some experts believe that there is no good reason to use Crestor until greater long term data is available. For a review of statin-related myopathy, see our September 2004 Health Matters.
- Meridia (drug name sibutramine) is a medication modestly effective in promoting weight loss in the short term, but its use is accompanied by dose-related increases in blood pressure and heart rate. Medical Letter consultants advised against using it.
Preventing Jet Lag
Jet lag is physical reaction to a change in time zones. It affects most travelers, including seasoned fliers such as pilots and flight attendants. The most common symptom is difficulty sleeping, but other symptoms include disorientation, irritability, fatigue, headaches, cold-like symptoms, and irregular bowels. Jet lag is caused by the desynchronization of various body rhythms and environmental rhythms such as your sleep-wake (or sleep-activity) cycle and the ambient light in the environment. Internal and external factors interact and affect the regulation of sleep. When these factors are thrown off, the classic physical and mental symptoms of jet lag may result. An example of the interplay between internal and external factors is melatonin - your "body clock" controls melatonin secretion by the pineal gland in the brain and environmental light inhibits this secretion. Studies have also shown that jet lag is worse for travelers heading west, as opposed to those traveling east. Jet lag is worse in those with rigid body clocks and might increase with age. Children generally have fewer problems. A rule of thumb is that it requires one day to adjust for every hour time difference. So, those Portlanders who travel to the East Coast can generally expect three days to fully adjust to the three hour time difference. Very long flights carry their own hazards such as dehydration, sitting in a cramped space and not moving your legs, breathing recycled air, disrupted sleep, and continual low-level noise. These symptoms can occur even when you travel north-south and do not cross a time zone, for example, flying from Portland to Baja. This is not jet lag in the true sense, but the effects of a long flight might mimic jet lag. Here are some tips to help you avoid or minimize the effects of jet lag: - Physical Activity and Exposure to Light: Use activities (eating, exercise, sightseeing) and exposure to light to try to synchronize their body rhythms with those of the environment. Stay well hydrated with water (not alcoholic or caffeinated beverages). Readjust your sleeping and eating patterns rapidly to coincide with the new time zone.
- Melatonin: While the exact mechanism of melatonin's affect on sleep patterns is unclear, several studies have demonstrated its effectiveness in combating jet lag. Melatonin is relatively well tolerated. The side effects are hard to distinguish from jet lag itself and might include day time sleepiness and a reduction in mental acuity.
Adult travelers crossing five or more time zones may benefit from melatonin, particularly if they have a history of jet lag on prior trips. Those crossing fewer time zones might also try melatonin. To affect both sleep quality and adaptation, you can take melatonin 5 mg about 30 minutes before bedtime on the day of travel and for up to four days after arrival. A dose of 0.5 mg has less effect on sleep quality, but appears to help adaptation similarly. Do not use slow release melatonin.
Children seem to have less of a problem with jet lag, and since melatonin has not been adequately studied in kids, its use is not recommended. Note that quality of melatonin is not regulated in many countries, so one should try to purchase the drug from a trustworthy source.
- Sleeping Medications, or Benzodiazepines: Benzodiazepines are the typical sleeping medications such as Valium. Newer agents are short acting in that they attempt to help you get to sleep but wear off quickly so that the affect does not persist for longer periods that desired. It seems logical that short-acting benzodiazepines be used to reduce the sleep disruption of jet lag and to help resynchronization of body clock. In addition to helping to adjust to jet lag, some people do find small doses of short acting benzodiazepines such as triazolam (Halcion) helpful in tolerating overnight, "red-eye" flights by promoting better sleep during the flight.
Unfortunately, while short acting benzodiazepines can improve sleep quality, many people find these benefits to be outweighed by the wide range of unpleasant effects such as having a hang-over or drugged effect after taking these medications. The adverse effects of benzodiazepines can be exacerbated by alcohol consumption.
- Benadryl: Benadryl (diphenhydramine) is an antihistamine that induces sleep in some people. It is the ingredient that is supposed to help you sleep in many over-the-counter sleep medications such as Tylenol-PM. It is available over-the-counter and some may find it helpful. However, like benzodiazepines, many are left feeling miserably groggy after using this drug.
- Alcohol and Caffeine: The affects of alcohol and caffeine on time zone adaptation are not clear, but they may hinder it adaptation so avoidance of these substances is advisable for those who have significant problems with jet lag.
- Specific Diets: Many years ago a so-called "jet lag diet" was popular. In fact, Ronald and Nancy Reagan were known to use it during their presidential years. Studies of diet have not shown any significant positive affect however. It is worth noting that airports are filled with bad food. Try to eat healthily when traveling. We know that this can be a challenge in route, so consider taking your own food, or try hard to eat salads and other health options even in airports. You may need to seek these as most airports are unfortunately filled with fried, fast food and junk food amenities.
Avoiding Cyberchondria
A new condition called cyberchondria is increasingly being noticed. Studies have shown that cyberchondria can be caused by browsing medical sites on the Internet. It is characterized by individuals diagnosing themselves incorrectly and seeking treatment they do not need.
Researchers from the University of Derby spent 18 months browsing web sites that offer medical advice on common symptoms and treatment of a range of illnesses. They found that misleading or vague advice could easily lead people to incorrectly diagnose their symptoms. The researchers found that most web sites sponsored by respected medical societies, charities or professional bodies gave sound advice, while those run by others could include glaring inaccuracies. At GreenField, we're delighted to have informed patients, we encourage our patients to be as educated as possible about their conditions, and we want to do as much as we can to keep you informed so that you can best participate in your decision making and in your care. The sites that we most recommend to our patients for high quality medical information are: UpToDate Patient Information and MedlinePlus. These sites will provide high quality information for the vast majority of your health care concerns. If you cannot find enough information on those sites, then please feel free to email us and we'll assist you with identifying additional content. Our goal is not to control the information that you access, but rather to help assure that it is reputable information.
Sincerely,
Your GreenField Health Team:
Beth Davis, your Benefits Coordinator and Biller (email)
Chuck Kilo, MD (email)
Cynthia Ferrier, MD (email)
Dia Gaede, CMA, your Health Coordinator (email)
Elizabeth Hays, MD (email)
Eric Murray, MD (email)
Jill Arena, your Clinic Administrator (email)
Joel Swartzmiller, IT Manager (email)
Pam Mockenhaupt, CMA, your Health Coordinator (email)
Ron Potrue, Clinic Management Consultant (email)
Shelly Banta, your Clinic Manager (email)
Tiana Schmitt, MA, your Health Coordinator (email) --------------------------- GreenField Health System
9427 SW Barnes Road, Suite 590
Portland, OR 97225
Phone: 503.292.9560
Fax: 503.292.9510
Web: http://www.greenfieldhealth.com questions, concerns, comments appreciated:
questions@greenfieldhealth.com
© 2003-2005 GreenField Health
| | |