Category: Health & Wellness

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Preventing Addiction and Other Calamities

Preventing Addiction

No parent wants to learn that their child is addicted to drugs, yet millions find themselves in this situation. No parent wants their child to be a victim of discrimination, bullying, child abuse, sexual harassment, and other dangerous situations, but it happens every day. Every parent should ask, “What must I do to protect my children? What can I do to prepare them for the future?”

Parents need to equip their children with the necessary knowledge and skills to handle situations of potential danger. From birth on, children and adults are constantly learning new and important life skills. For example, a toddler will master the art of using eating utensils and dressing oneself and over time will learn more needed life skills.

Spending quality time with children has been shown to be most advantageous. Many parents are overloaded because of work, family, and household commitments, but time must be put aside to spend with children in the family, even if it’s only 30 to 60 minutes a month. The infant and toddler can be exposed to lullabies, fairy tales, and stories of family members. As verbalization develops, encourage the child to give a simple analysis of what was presented. For example, after telling the fable of the Three Little Pigs you can ask the child, “What was the story about? What materials would you use to build a house and why?” The parent must be patient and ask age-appropriate questions. The atmosphere of their time spent together should be non-threatening and enjoyable.

After the age of six, life-protecting skills can be introduced, such as the dangers of addiction, how to manage relationships between friends, how to handle discrimination and prejudice, what to do when bullied, sexually molested, and so forth. The information should be repeated and reinforced as the child matures. Some topics may be uncomfortable to discuss and can be tabled to a future time if need be.

For a child from the ages of six to 11, it is easier to convey the necessary feelings and attitudes about a particular subject. An adolescent child may be less prone to have an in-depth discussion with the parent, especially if the teen is rebellious. Parents may initiate discussions on their own, doing basic research beforehand so as to have the correct information.

If giving important life-saving information to our children saves anyone from addiction, physical and sexual abuse, discrimination, bullying, and decreases the number of teenage pregnancies, then the art of parenting will have taken an important step forward and will place our children on the path of achieving a successful and rewarding life.Melvin S. Rosh, MD FAAP www.RewardingLifeInc@gmail.com.

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The Unexpected: Children Can Have Strokes

Edgire Joseph credits Dr. Celso Agner with saving her 11-year-old daughter’s life from a condition many may not associate with children. Stroke.

Strokes are a lot more common – and potentially deadly – in children than people might realize. “It’s the 10th leading cause of mortality in children,” said Agner, who treated Joseph’s daughter, Coral Springs pre-teen Lynn-sah Joseph.

Lynn-say’s symptoms, on the day she suffered a stroke last November, suggested something wasn’t right. At school, she complained about feeling dizzy and had a headache. When Lynn-sah came home her symptoms worsened. EMS personnel rushed her to Broward Health Medical Center. The girl’s condition deteriorated – until she became paralyzed on her left side.

Following her diagnosis, Lynn-sah underwent emergency surgery to remove a blood clot in the middle of her brain. Six days after the operation, Lynn-sah’s neurological test returned normal. She did, however, suffer some residual weakness in her left arm. Lynn-sah returned to school six weeks later.

Her mother recalled feeling “scared” and “shocked” on that November day, when her daughter couldn’t feel her left side. “The second shock that day was when I found out they didn’t have any stroke treatments for children,” Edgire said. “Dr. Agner is the best and he saved my daughter’s life.” The physician is an interventional neurologist at Broward Health Medical Center.

“I didn’t want to believe that I had a stroke,” Lynn-sah said. “Not at my age. I thought it happened to people who are older.”

Agner said strokes are “not very common” in children and teenagers. “Most childhood strokes occur either because the youth has Sickle Cell Disease, or because the youngster had suffered a form of trauma. “Non-traumatic stroke is even more rare, because they are not recognized easily,” Agner said.

In Lynn-sah’s case, “the cause of stroke has not been identified yet,” he added. “We are working on it. The patient has been consulted by specialists in cardiology and hematology.”

Stroke is more likely in the teen years than in earlier childhood. Agner said it’s “hard to talk about numbers because strokes are often missed. It is getting more frequently diagnosed because the awareness on the condition is increasing, so we start seeing more cases.”

Agner said children and their caregivers should be on the lookout for the following symptoms: Difficulty moving limbs on one side, problems with vision, trouble speaking, unresponsiveness, or not being alert. “If any of these things occur without a prior history of occurring, there should be a concern for stroke,” he said. “Children should be taken to the ER immediately. Do not delay or wait. The main problem with pediatric stroke is early recognition.”

According to Broward Health officials, Lynn-sah’s early diagnosis “led to a positive outcome that highlights the importance of timely stroke intervention.”

While better technology exists to treat childhood stroke patients, “approved protocols are currently not approved for children, so it is treated on a case-by-case basis,” Agner said. In Lynn-sah’s case, treatment has resulted in a positive outcome.

“She started off with a complete left-side paralysis,” Agner said. “Now she has a slight left arm weakness but it is almost imperceptible now.”

According to a Broward Health press release, Lynn-sah is back to being a fun-loving, happy pre-teen. “I feel back the way I used to be – active, jumpy, I feel great,” Lynn-sah said.

Lynn-sah is looking toward her future. “When I grow up, I want to be a neurologist like Dr. Agner,” she said.

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Handling the Fear

Walking into a store the other day I, and the woman next to me, stopped when we saw a fire truck, ambulance, and police car outside. We looked at each other and questioned whether it was safe to go inside. The conversation continued, and she told me that even though she works in a busy hospital, she never goes anywhere alone. She has her husband or grown son accompany her. The anxiety of the past year has taken its toll on her and she explained that getting her nails done by herself was a monumental step. If an adult woman struggles to go in the outside world, how do young children step inside of a school? How do we make them feel good about it?

The American Psychological Association urges parents to speak honestly with their children and to keep the level of detail age appropriate. Allow them to speak without interrupting and try to make home a haven where they can have a respite from the outside world. Following a crisis, children’s habits may change including sleep patterns, study patterns, and changes in appetite. Keeping news to a minimum and allowing children to express themselves through forms of art are some of the suggestions to help parents navigate this difficult time.

Christopher Gannon, a music teacher at Eagle Ridge Elementary and a band/color guard instructor at Marjory Stoneman Douglas, has been connecting with children at every age level during the recent crisis. “February 15th feels like it was yesterday,” Gannon said, referring to the day after the shooting. Because of his position as a music teacher, he sees children from pre-k to fifth grade and indicates that many of the children are discussing the tragedy at home.

Recently, the school had a day for children to wear orange for gun violence and Gannon remarked that an overwhelming number of children wore orange. “Maybe some parents just told their children they were wearing orange to school that day, but I think that most of the children were aware of the reason,” Gannon said. The fear, sadness, and awareness differ for each child he said, which may be due to the amount of discussion or exposure at home. “There is no right or wrong how parents handle it,” he said.

Gannon has not witnessed any major changes in his students. While it may be in the back of their minds, he feels that the children believe everyone is doing their best to protect them. One common denominator among children of all ages is their resilience, particularly among high school students. “They are driven by the right things, whatever they believe that is,” Gannon said.

The Marjory Stoneman Douglas band recently gave their last performance for the year and a tribute was played for the victims. The practices were highly emotional, and, at times, students would have to leave the room to collect themselves but would then return. During one of the practices an instrument was dropped and thinking that it was a gunshot there were some screams and a moment of fear, but that the students quickly regained their calm.

Gannon, who comes from a family of musicians, is a firm believer that music has provided a form of release for them. “Being involved in any form of art allows one to creatively express themselves,” he said. Gannon offers a reminder and some reassuring words: “These kids are positive and powerful.”

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Kids and Sodium Intake

Sodium is an essential nutrient that our body needs to perform its metabolic functions each day. When it comes to adults, the consensus is that a high intake of sodium will increase the chances of hypertension and stroke. Decreasing sodium intake to reduce your risk of heart disease is recommended by the American Heart Association and in the 2015-2020 U.S. Dietary Guidelines. Well, what about children and teenagers? While there has been much less research on these age groups, studies have shown that sodium reduction in children and teens is associated with small reductions in blood pressure.

About 90 percent of our sodium intake comes from sodium chloride, or table salt, which is composed of 40 percent sodium and 60 percent chloride. It is absorbed in the intestine and excreted mainly by the kidneys.

While young and old people consume too much sodium, not getting enough can have serious consequences. Excessive fluid intake can cause hyponatremia and this can cause sodium in the blood to be diluted to a dangerously low amount. This can result in seizures, coma, brain damage, and even death. This is an important example how sodium plays an important role in our health, as well as, disease.

 Kids and Sodium Intake

It has been estimated that if Americans decreased their sodium intake to 1,500 mg per day, it could result in a 25 percent decrease in blood pressure. To put that into perspective for youngsters, a single kid’s meal at a fast food restaurant could exceed that amount of sodium. Almost 90 percent of children ages 6 to 18 in the United States consume far more sodium than the current recommended intakes. That is important as the Centers for Disease Control and Prevention has found that one in six children ages 8 to 17 have above normal blood pressure. Several studies have found that high sodium intakes in childhood can lead to prehypertension that can carry over to hypertension as an adult. The association between sodium intake and prehypertension appears to be stronger among children who are overweight or obese.A recent study published in The Journal of Pediatrics found that the incidence of hypertension decreased among children ages 6 to 18 who adhered closely to the DASH-style diet. DASH, which limits sodium to about 2,300 mg per day, includes whole grains, fresh fruits, vegetables, and low-fat dairy products. It also includes poultry, fish, legumes, nuts, and seeds.

Here is a quick breakdown of the sources of sodium in the average US diet: 5 percent is added while cooking, 6 percent is added while eating, 12 percent comes from natural sources, and a whopping 77 percent comes from processed and prepared foods.

A recent study published in the Journal of the Academy of Nutrition and Dietetics reveals some insight into the sodium intake of children and where that sodium comes from. Current recommended sodium intake for school-aged children ranges from 1,900 mg to 2,300 mg per day. Here are a few of the most revealing sodium intake statistics from this study:

  • Almost 90 percent of the children exceeded the upper level of sodium recommended for their age group.
  • The average sodium intake was 3,256 mg per day, not including salt added at the table.
  • Average sodium intake among high school children was comparable to that of adults and about 500 mg higher than younger children.
  • Sodium intakes were highest among teens aged 14 to 18.
  • Girls consumed significantly less sodium than boys.
  • Only ten types of foods make up almost 50 percent of kids’ sodium intake.

These statistics are concerning and make it even more important to reduce sodium consumption among children because taste preferences formed in childhood can influence food choices and salt usage in adulthood. Start teaching your children now about reducing their salt/sodium intake for a healthier lifestyle.
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What is Eating Our Boys?

While it is obvious that mass shootings can only be called “shootings” because they involve guns – and guns are the common factor – there is an elephant in the room of another constant aspect. The only thing these mass shootings have in common is that males, many of who are young men, mainly carry them out. It is true they all have different degrees of criminal history and/or mental health backgrounds, according to Daniel Victor, journalist for the New York Times. Victor adds that their reasons may range from revenge, personal notoriety, or a vendetta over a grievance. My question is since we recognize the obvious, how do we deal with this and move forward in the wake of the most recent tragedy in Parkland?

“It’s not that girls don’t get angry too, but “they tend to be more amenable to processing emotions and talking them through,” said Dr. Steven Stosny, PhD in Psychology Today. “This does give parents an opportunity, if astute enough, to deal with them.” What is Eating Our Boys?
Furthermore, adds Ani Smith, a Licensed Mental Health Counselor, that the ways that boys act out are unique. “Boys don’t just grow up ‘angry,’ but they can become isolated and alienated over time as relationships with caregivers experience strain, challenges with peers increase, and adolescent insecurities peak.”

Dr. Stosny said it’s the testosterone factor. It should be considered in this day and age of violent video games, over-the-top violence in movies and social media, in addition to song lyrics, all of which have influences. “The testosterone surges that boys experience, blunts their fear, while it disinhibits, making them more susceptible to dangerous behaviors that both invoke and result from anger,” Stosny adds.

All of this is very concerning to me, as a mom of two boys. My boys have always been everything to me. Although they have been seemingly sweet for most of their young lives, they are teenagers now, and things are changing. Sure, all teens have attitude and try risky behaviors. Some may even be depressed or angry at times. So how do we as parents decipher when it is a problem or a true mental health emergency? My son, Jake Scott, said, “men handle their problems with violence because that is what they see.” He adds that many kids build up stress from “overloaded pressure and schedules.” Have we as parents, overloaded our kids thinking keeping them busy at every moment would be a good thing? It is a question to ponder. If Dr. Stosny believes that girls talk their problems out to solve them, then how can we do a better job in reaching boys and encouraging them to do the same? Why aren’t boys given outlets to talk their problems out? If they think it is not “acceptable” to discuss problems with other males, how do we make it acceptable? Will it be acceptable if we add more social programs for boys in schools, peer counseling, or maybe an app on the phone?

Smith stated that boys need safe outlets for managing “intense emotions.” Ideas she offers are talking to a trusted adult, playing sports, scout clubs, volunteering, and playing music. “It is important to prioritize and cultivate relationships with trusted adults (dad, uncle, mom, grandpa, teachers, coaches), as it keeps them connected to others and avoids isolation and alienation, both indicators of psychological imbalance,” Smith said.

Other ideas to explore as part of the problem in addition to what has already been mentioned, is sleep, nutrition, and exercise. It is widely known that exercise is used as a therapy for many issues. Food, and sugars in particular, can definitely play a part in causing mood swings. Furthermore, sleep studies suggest that when we operate on less than 6.5 hours of sleep, our reaction time is slowed and we may be operating as if intoxicated.

Finally, it’s clear there are a myriad of culprits to why our boys are having trouble coping in today’s world, but if we come together, we can share more ways to get involved. What will you do? Let’s make this a call to action.

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Coping with Psychological Trauma

On February 14 the City of Parkland was forever transformed following a tragic school shooting at Marjory Stoneman Douglas High School. This traumatic event shook the fabric of a peaceful community and spurred a variety of responses from all of those affected. Understanding trauma, the effects on those impacted by traumatic events, and the importance of developing healthy coping strategies can lessen the psychological impact of trauma and in many cases, prevent the development of more severe and long-lasting post traumatic reactions.

What is Trauma?

Trauma is the psychological response to an event that threatens our physical and/or psychological safety. Some common traumatic events include being exposed to physical or sexual abuse, natural disasters, vehicular accidents, terrorist attacks, and war. Most individuals will experience at least one significant traumatic event in their lifetime. While most individuals will not develop long-lasting post-traumatic symptoms, some studies indicate that 10 to 20 percent of individuals exposed to extremely stressful events may go on to develop acute stress disorder and/or Post Traumatic Stress Disorder (PTSD).

What are Common Responses to a traumatic event?

Individual responses to traumatic events can vary and can manifest themselves differently in children, teens and adults. Some people report feeling scared and fearful, unpredictable shifts in emotions, irritability, anger, grief, and depression. Additionally, some physical reactions include feeling “keyed up,” jumpy, and hypervigilant. This physiological arousal can also affect sleep, appetite, and concentration. These symptoms can last from a few days to a few months before noticing a returning to previous levels of functioning. However, if these symptoms do not improve or worsen and are severe enough to interfere with work, school, family, and other key areas of life, professional help from a trauma-informed therapist may be useful.

 

 Intense fear and feeling unsafe

 Avoiding places and situations associated to the event

 Hypervigilance, panic

 Difficulty sleeping, nightmares

 Intrusive thoughts, memories and/or images of the event

 Deep sadness, grief, survivor’s guilt

 Unpredictable emotions, irritability, rage/anger

 Feeling numb, detached, social isolation

 Risky behaviors, substance use

 Headaches, stomach aches

 

What can you do to cope with trauma?

There are many things you can do to cope with the effects of trauma. First, consider coping strategies that have worked for you in the past when faced with stressful events and also be open to trying something new. Some helpful tips include:

 Understand that what you and your family members are feeling are normal reactions to an abnormal event

 Return to your daily routines as soon as possible

 Try to not avoid places and situations that remind you of the event as this could actually increase anxiety and delay recovery

 Be patient and compassionate with yourself and those affected

 Try to find activities that bring a sense of relaxation and calm

 Exercise and participate in recreational activities

 Seek out opportunities to connect with others

 Avoid unhealthy coping strategies such as alcohol and drug use

 Recognize if you need professional assistance

Where can I go for help?

If you have been affected by trauma and are seeking professional assistance, locating a professional that is trauma-informed and has experience working with individuals affected by trauma is important.

Jessica J. Ruiz, Psy.D. is Chief Psychologist & Director of Clinical Training for Behavioral Health Associates of Broward, Counseling Centers of Goodman JFS.

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How ‘Healthy’ is Florida’s Health care?

Home to thousands of older adults, the tropical paradise of Florida isn’t so sunny in terms of overall health care. In an age where more Americans have access to health care than ever before, Florida still has work to do compared to other states.

 

Determining the “best health care” among states is a result of findings generated by a diverse set of metrics and analytics, and costs vary from state to state based on a population’s overall need, access, technology, and other tangible factors.

 

The U.S. Health System Data Center publishes an annual “Scorecard on State Health System Performance.” This is a measure of access, prevention/treatment, avoidable hospital use and cost, healthy lives, and equity. Its average findings show Florida 39th, with its lowest marks in the category of access (41st.).

 

According to Aiming Higher: Results from a Scorecard on State Health System Performance, 2017 edition, The Commonwealth Fund, March 2017, Florida ranked

44th in prevention and treatment, 45th in avoidable hospital use and costs, 20th in healthy lives, and 33rd in equity The lowest-ranking indicators in the access category were uninsured adults (50th), uninsured children (45th), and adults who went without care due to cost (46th).

 

If Florida were to improve to the level of the best-performing state, the U.S. Health System says that 1, 893,354 more adults would have to be insured; 1,586,865 fewer adults would go without needed care because of cost; and 102,982 fewer emergency room visits would have to occur among Florida’s Medicare population. Its top five states for best health care were Vermont, Minnesota, Hawaii, Rhode Island, and Massachusetts.

 

The Uninsured: A Major Detriment

The number of Americans without health insurance is at an all-time low due to the Affordable Care Act, known as Obamacare, however Florida’s decline in national rankings is tied directly to its uninsured population. According to healthinsurance.org, the numbers of its uninsured continue to be among the nation’s highest.

 

On a political level, Gov. Rick Scott was a vocal opponent of the health care reform law. Florida rejected federal loans to evaluate a state-run exchange and was the lead plaintiff in the U.S. Supreme Court case challenging the ACA and rejected Medicare expansion.

Despite the opposition, the bill contained enough quality provisions that eight insurance companies sold plans within the state, and that generated a higher than expected enrollment.

 

One of the major legislative sticking points is that anyone without health care coverage, either through an employer or a public care program, is subject to a tax penalty. Portions of this politically controversial legislation are targeted for revisions and restructuring in 2018.

 

According to the Florida Policy Institute, Florida ranks 45th in the nation for its rate of uninsured residents. Based on U.S. Census Bureau statistics, 2.6 million are without coverage (13.3 percent of the population). Florida’s rate is three times higher than that of Vermont, where only 3.8 percent are without health care coverage. The only four states with higher rates than Florida are Texas (17.1 percent), Georgia and Oklahoma (13.9 percent each), and Alaska (14.9 percent).

 

Kimberly Leonard, a former health care reporter at U.S. News & World Report, commented on the effect of Obamacare. “The cost of Obamacare rose as millions of low-income people unexpectedly enrolled in public health care coverage rather than private insurance. The numbers indicate that the federal government fell far short in estimating how many people would enroll in government coverage rather than tax-subsidized, private health insurance.” She also reported that 68 million people were enrolled in Medicaid and Children’s Health Insurance programs in 2016—a jump of 16 million above the government’s anticipated figure in 2010.

 

More data…more differences

Another “Best States for Health Care” listing, published by U.S. News & World Report, used data compiled by McKinsey & Company. Its analysis was in the categories of overall health, access to care, availability of preventive medicine, and quality dental treatment. The top five states, according to U.S. News, were: Hawaii, Massachusetts, Minnesota, New Hampshire, and Iowa. Florida ranked 31st.

A broader set of variables, included overall health care, education, crime, infrastructure, opportunity, economy, and government provided a different outcome, with Florida ranking 24th with respective scores of 31, 29, 37, 11, 43, 7, and 9. However, eight hospitals in South Florida were among its Top 20 list: Baptist Hospital of Miami (6); Cleveland Clinic Florida (8); Holy Cross Hospital (10); University of Miami Hospital (12); and Memorial Regional Hospital (14). Boca Raton Regional, South Miami, and West Kendall Baptist were tied (16).

WalletHub.com (owned by Evolution Finance Inc.) is another example of how data and conclusions differ from source to source. Its findings showed Hawaii as the top state for health care (67.36), followed by Iowa (66.62), Minnesota (66.52), New Hampshire (66.54) and the District of Columbia (65.47). Florida ranked 43rd (46.07), and was near the bottom of “Lowest Percentage of Insured Adults Aged 18-64.” WalletHub used 35 different metrics, including cost, access, and outcome analysis.

The Department of Health and Human Services says health care spending will grow at a faster rate than the national economy over the next decade. Projections are $3.35 trillion, or more than $10,000 per person. Five percent of the population (mostly frail or ill) will account for half the spending in any given year.

 

Health care is the Great American Puzzle. How the pieces fall into place will have a long-lasting effect.

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Ketamine Infusion Therapy Shows Benefits

Ketamine is a powerful drug that has been around for 50 years. Much of that time it was used by veterinarians and even by medics as a surgical anesthesia on the battlefield. Today’s battlefield is a landscape comprised of everyday people suffering from a variety of chronic disorders ranging from depression, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), to fibromyalgia, migraines, and complex regional pain syndrome (CRPS). A major weapon in the battle is ketamine infusion therapy.

Board-certified Anesthesiologist and Infusion Specialist Douglas Kornreich, M.D., is a native of South Florida, and founder of KetaMed Health & Wellness in the Village of Rye Brook, NY. “I believe that ketamine infusions help people lead a more stable, less pain-filled life,” he said. “I’ve practiced for 20 years, and for 10 years, ketamine has been used to provide my patients with pain relief.” The doctor reports that the majority of cases using ketamine have proven effective, especially in treating CRPS, a condition that even Oxycontin failed to remedy. Ketamine
CRPS causes pain throughout the limbs, and is extremely debilitating. Many of the most powerful opioid medications have not provided relief, but ketamine has shown significant promise; some patients are pain free up to six months. “Ketamine treatments block pain receptors that lessen nerve sensitivity, and that enables the body to heal itself,” Dr. Kornreich said. “CRPS has no cure, but there are ways to manage pain and nerve sensitivity efficiently.” CRPS can be treated with a variety of protocols. One method is admitting a patient into the ICU and administer high does of ketamine continuously for several days. Most patients reported no pain for up to six months. “Another protocol is a series of daily four-hour infusions for 10 days, and that is the protocol that I use,” Dr. Kornreich said.

The Benefits of Ketamine
About 10 to 15 percent of the population experiences a depression disorder each year, but ketamine is not a first line of medical treatment for depression. Rather, it’s the last line of defense. About 50 percent of patients report a positive improvement after the first medication, but those that experience no improvement are placed on a second drug. If there is no quantifiable improvement after two medication cycles, ketamine infusion therapy can be used on those “treatment resistant” patients. Treatment resistant depression patients require six infusions over a two-week period. According to Dr. Kornreich, 60 to 70 percent benefit from the therapy.

The Federal Drug Administration has given its stamp of approval on ketamine as surgical anesthesia. Yet, despite the benefits of the treatment, it has not been granted approval as a treatment of depression-although the World Health Organization calls it an “essential drug.” The FDA has now placed ketamine on a “fast track” protocol for potential future approval.

Ketamine infusions have also been proven to be an effective treatment for people with suicidal thoughts. “It is so effective that it has greatly curtailed, and in some cases cured, thoughts of suicide in people after just one 40- to 60-minute treatment,” Dr. Kornreich said. “PTSD patients receive up to two weeks of relief from a single 40- to 60-minute session.” The cost of the drug is a minimal, but a host of other fees for nurses, administration, rent, malpractice, infusion pumps, vital signs monitoring, intravenous supplies, legal fees, professional dues, and miscellaneous expenses, can skyrocket the cost to $800 per infusion.

The Infusion Process
A physician and a nurse assistant continually monitor the infusion procedure. Patients are placed in a recliner in a dedicated treatment room and ketamine is infused via an IV tube that runs from the pump into the patient’s arm. During the process, the pump can be programmed to infuse precise amounts of the medication-and dosages can be altered immediately. Having used ketamine for more than 10 years, Dr. Kornreich is an expert in the pharmacological and physiological responses that cause changes in blood pressure and heart rate. EKG pads are positioned and a blood pressure cuff is applied prior to the infusion.

The Challenges
When administered by trained clinicians, ketamine has many potential benefits. In the wrong hands is potentially lethal. The opioid crisis is a result of illegally manufactured drugs being diverted onto our streets, and ketamine (often referred to as “Special K”) is popular. Using it as a recreational drug leads to addiction, cognitive impairment, bladder disease, and potential death. However, the clinical use of ketamine has a long and safe record. When administered properly, the intake of ketamine into the bloodstream can be properly monitored and controlled at significantly lower levels than if it were taken as a recreational street drug.

“Infusions maintain a lower level of the drug in the blood for a longer period of time and that is a great benefit when treating depression and other chronic issues,” Dr. Kornreich said. “Through the use of ketamine we have learned much about OCD, and PTSD and what is going on in the brain “This only leads to better medications that will work as well or better than Ketamine, and will not require an infusion.”
For more information about this topic, visit Ketamineadvocacynetwork.org or ketamedhealth.com.

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Ask Dr. Renae: Should I keep this secret?

Dear Dr. Renae,

My best friend tried cutting herself after she had a big fight with her mother. I promised to keep it a secret as long as she promised never to do it again. I now regret my promise. I keep wondering how I will know that she stopped since she and her mother do not get along. I don’t think she has cut again, but how can I be sure? I spend a lot of time worrying about her but I don’t want to betray my friend by breaking my promise. What should I do?

Stressed 13-Year-Old Friend

 

Dear Stressed 13-Year-Old Friend,

Being a good friend sometimes means doing something your friend might not necessarily like, but you know will keep them healthy and safe in the long run. You must tell an adult about your friend’s situation. Even if she has not cut herself again, the fact that she tried it once implies that she may need help channeling her emotions in a healthy way. It also sounds as though she needs to work on her relationship with her mother. My suggestion is for you to speak with your parents about this if it is something you feel comfortable sharing with them. If not, talk to a teacher, guidance counselor, or another adult you trust. You can ask whomever you speak with to keep this anonymous. They might be able to get your friend the help she needs without revealing that you told her secret. However, if it does come out your friend may be angry with you. If she is, remember this – while she may be angry now, she will thank you in the long run for having kept her safe and healthy.

A Caring Teen

Dear Stressed 13-Year-Old Friend,

I think that if she promises never to do it again, you should both be OK. However, if it happens again I would be concerned with her safety. She was probably just experimenting coping mechanisms to make her feel better, although it does not justify her actions. You are a very good friend for knowing when to keep promises and knowing when to try to get help for your friend. As a good friend, it’s important to have a heart to heart talk with her and see if you both can come up with something else for her to do when she gets angry with her mom. She can FaceTime you so she can vent her anger, journal, color, take a walk, listen to music, or something else your friend may find soothing. Sending love to you.

Your 14-Year-Old Friend

Dear Stressed 13-Year-Old Friend,

I totally understand where you’re coming from. You don’t want to betray her trust and ruin your friendship with her, but cutting yourself is much bigger than any promise or friendship. It is incredibly dangerous. You should talk to your friend and try to get her to agree to get help. You’re in a difficult situation, but keeping quiet may only make the problem worse. Try to reason with her and comfort her. You can also try talking to your parents about it and see if they have any good ideas on what you can do. Your guidance counselor at school can also help. I hope it all turns out OK.

A 16-Year-Old Friend

Dear Stressed 13-Year-Old Friend,

Go to your friend and ask her seriously if she’s been cutting again. You need to let her know that if she is, you are there for her. She is going through a rough time in her life. Help her find alternatives to cutting such as using a stress ball, writing her feelings down on paper, or drawing to calm down. Ask her what is bothering her because she is probably hurting a lot inside and doesn’t have any other way to express it. It’s important to keep promises, but in a situation like this, you could help your friend’s problem by asking your school’s guidance counselor how to handle this. If your friend has a serious cutting problem and you feel like that would be the best option, let your friend know that you care about her too much and you want to get help for her.

A Caring Friend

Dear Stressed 13-Year-Old Friend,

At the time when you made the promise to your friend, it felt like the right thing to do. After experiencing the weight of that worry, you now realize that keeping this secret is not safe or healthy for you and your friend. It will take a lot of courage for you to explain in the sincerest and caring way that you will help her decide the safest way for her to get help. Even if your friend only cut herself once, it is critical for her to be assessed by a professional for risk of suicide, depression, or effects of previous trauma that you might not know about. Medical care for her cuts may also be needed. Without the proper treatment for the problems she is experiencing, your friend may be robbed of a lifetime of success and happiness. Your School Counselor, School Social Worker or School Family Therapist will be able to help her improve her relationship with her mother and find other trusting supportive adults. Being a good friend means looking out for your friend’s best interest, especially when she is not able to look out for herself. If you keep this secret, you will be letting her down and letting your self down as well.

Dr. Renae

 

 

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Safety Always Comes First

Safety first. It is vital, it is important, and it is necessary.

A recent issue of the Parklander featured a cover photo of a woman operating a power tool without any protective eyewear, leather gloves, or long-sleeved shirt. The intent was for artistic purposes only, and meant to catch the eye of its readers. Based on the number of responses received, the magazine certainly accomplished that goal.

The use of the image opened the door for additional dialogue and input from readers who correctly pointed out that the cover photo was not compatible with the content contained in the article. We appreciate the valid input, and welcome constructive comments and suggestions from our community of readers.

One member of the community was Jerry Lozinski, a semi-retired engineer who worked in factories that adhered to strict OSHA guidelines. “I worked in product development, and it was our job to make sure they met the highest standards,” he said. “Sometimes people feel the product is the problem, but if you put a heater in a bedroom next to drapes and it starts a fire, you can’t blame the product. The same holds true for tools used when working around the house. Be sure you have the right tools and be sure you know how to use them.” He said that the cover photo was an example of how not to protect yourself when using a power tool.

“When you do a job, be protected,” Lozinski said. “Wear leather gloves, safety glasses, proper clothing and shoes (and in some cases head covering and a mask). Use common sense and make sure you are knowledgeable enough to perform the project.”

Sheets of plywood, ladders, drills, and saws were the order of the day as preparations were made for Hurricane Irma. The basic tools: a circular saw, a hammer drill (and charger), a regular wood drill, Tapcon screws, proper drill bits for the masonry, hex-head screws, and ladders. Note that it is important when drilling into cement, as masonry bits can overheat and sometimes break— depending on the density of quartz contained in the gravel composition of the cement.

Lozinski used a small electric chain saw to cut the root and limbs of a tree that had fallen in his yard. “I wore a complete shirt and long pants, heavy leather gloves, and steel-towed boots,” he said. “It’s important to cut at a proper angle so limbs fall in the right direction. If you don’t have the equipment you need, call someone who does. Don’t be afraid to ask for help.”

Joe Albers, a principal engineer at South Florida Water Management District, said men could be victims of their own machismo. “A lot of guys think they are supposed to know all this stuff about repairs, but it is better to be safe than sorry,” he said. “Don’t be too humble to ask questions about the right tool and the proper safety gear.” Albers, who does the bulk of his home’s repairs, said wearing personal protective equipment is vital. “Without the proper safety precautions you can easily end up in the emergency room,” he said.

The cover photo showed particles of wood flying dangerously close to the woman’s face. Albers said that circular saws could have a dust catcher or a vacuum connection to reduce the amount of exposure. “A dust respirator is good too, because once the dust gets into your nostrils it becomes a respiratory irritant,” he said. The woman pictured wore a chocker necklace and a tank top. The necklace didn’t necessarily pose a safety issue, but rings and bracelets do. “I came from a farming background and we didn’t wear rings,” Albers said. “Most famers and ranchers don’t wear wedding rings because they can be caught on something.” According to Albers, the photo didn’t convey the appropriate message.

Key questions to ask before any home project should be: What does the job entail? Do I have the skills to do it? Do I have the proper equipment required? What are the hazards? Albers admits he does not get involved with anything electrical, but he does simple plumbing. “When it comes to copper piping and soldering, I’ll hire someone,” he said. “I know my limitations.”

He advises wearing leather gloves for a better grip and hand protection, and to use a ladder planted on solid ground to prevent tipping. Also, use both hands when using a chainsaw. “It is one of the most dangerous tools you can own, so be sure there is a stable surface, and keep both hands on it to protect against kickback,” Albers said. He also said that hearing is also a part of safety, so wearing earplugs to listen to music when working isn’t advisable.

In summary, wear protective clothing, proper footwear, and glasses, use the right tools and drill bits, know the risks, know your strengths and weaknesses, and don’t be afraid to ask for help.

 

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Dr. Renae: The truth about Homework

Dear Dr. Renae,

My parents continue to suspect me of not being truthful when I tell them that I do not have homework. Most of my teachers allow us to complete assignments during class time, which I usually do. I always do my best work and I get good grades. How did the amount of homework assigned ever become the measure of a good teacher?

6th grade student

Hello 6th grade student,

Parents can be frustrating to deal with. However, I’d recommend possibly showing them the completed homework and maybe going over one of the problems with them to show you understand the work. The amount of homework doesn’t equal the measure of a good teacher, but sometimes parents are worried and don’t understand where you’re coming from. In most cases, your parents want to help you and want what is best.

A concerned individual

Dear 6th grade student,

You are absolutely right in saying that the amount of homework should not determine the quality of a teacher. However, parents expect to see their children to have homework assignments. When your parents see you without work to do, they might think that it’s because you’re procrastinating. My suggestion would be to enact a “to-do list” system. Every day, when you come home from school, show your parents a list of everything you need to get done. Put anything on it, from a history project to cleaning your bedroom floor. That way, when you don’t have any school work to do, your parents will see that it’s genuinely the case because had you been given an assignment, it would be on your list.

A caring friend

Dear 6th grade student,

I feel that you should be honest with your parents and tell them everything you said in the letter. I would also ask your parents why they feel the way they do and if they are that concerned, to talk to your teacher. Since you do your homework, the teacher knows you are a responsible student and will make sure your parents understand that. Have you ever done anything that would lose your parents trust? If so, ask them how to regain it, and if not, it is silly for them not to believe you. Just keep working hard and your grades will help you go far.

Your friend, the 9th grader

Dear 6th grade student,

I know exactly where you are coming from. If you are getting good grades that’s great and you have nothing to worry about. Make sure you show your parents your grades, so they are aware that you have completed your assignments. If you have a school planner, I suggest writing down all the homework that you have to do in the planner. Once you finish your assignments whether it’s in school or at home, cross them out. Then, show your parents the planner daily and when they see all your assignments crossed out they will understand that they are done. If they still seem to have a problem after trying that, it would be time set up a conference with your parents and your teachers to work out the issue.

An understanding friend

Dear 6th grade student,

To begin, I understand that feeling. A lot of teachers do allow their students to complete assignments during class. Do your parents know you have good grades? Try sitting down with them and telling them you would not lie to them about assignments and tell them your grades are important to you. Tell them your grades are good and won’t allow them to slip. I would make them understand that you have time to complete it in class as you do, and maybe show them the assignments you completed.

A friend who understands

Dear 6th grade student,

Your parents may have had a more traditional education, which entailed many homework assignments daily as well as weekends and holidays. Teaching has evolved into more creative methods that help promote learning instead of repetition. Your parents may be considering their educational experience as a measure of a good teacher. Completed assignments and good grades might not be enough to convince your parents that you are learning. I suggest that you share with your parents what you have learned in school each day with a sentence or two for each subject. In addition, I advise you to assign yourself nightly homework which consists of reviewing your notes, organizing your notebooks, reading your textbook, studying for upcoming tests, working on assigned long-term projects, and researching information that spark your interest. Your parents might shift their focus from school homework to your learning and maturing. That will help build their trust in you.

Dr. Renae

 

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Seek Help Sooner

Suicide among young people continues to be a serious issue. According to the American Academy of Child and Adolescent Psychiatry, thousands of teenagers commit suicide each year. Suicide is the third leading cause of death for 15 to 25-year olds, and the sixth leading cause of death for 5 to 14-year olds.

“Teenagers, experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other feelings while growing up. For some teenagers, divorce, the formation of a new family with stepparents and stepsiblings, or moving to a new community can be very unsettling and can intensify self-doubt. For many teens, suicide may seem like a remedy or a solution to their problems and stress,” the AACAP states on its website, aacap.org.

Jackie Rosen is the executive director for the Florida Initiative for Suicide Prevention program. She said there are three main causes of depression:

  1. DNA. The tendency of brain disorders can be transferred by DNA.
  2. Chemistry or psychological changes in the brain. These changes can now be detected by a MRI.
  3. Trauma. The earlier trauma occurs in life, the more it affects the diseases of the brain functioning. It’s this combination that can lead to suicide.

Jackie feels the brain is like a cup of water. “If you add one extra drop to a full glass of water, the water spills over. The same goes for people who are suicidal. They feel helpless and hopeless, the only option is to die, to stop the pain, kill themselves. Trauma changes the way the brain functions. It changes the chemical functioning of the brain, and hence, the person cannot handle the trauma,” she said.

 

For most kids, the average brain disorder starts at about 14 years old. This is the same time many teenagers start to “lose themselves, or act out.” People pass their behavior off as just a part of growing up. For the young people who suffer from depression, they can get worse and commit suicide. In order to overcome depression, and ultimately to prevent much of the suicide cases, proper medical attention is needed and may include medication and therapy.

Jackie started the Hope Sunshine Club, which takes place in 28 middle and high schools in North Broward and South Palm Beach. This club is an after school optional curriculum, that meets once a week and is part of a school approved curriculum.

Within these clubs, they have developed Solutions Unlimited Now or SUN. The purpose of the group is to help each other solve problems. FISP SUN is a ten step, structured group program, which teaches problem solving, coping, and social skills to enhance protective factors and resiliency. It is designed to help members reduce self-destructive behaviors and enhance feelings of self-worth.

FISP SUN groups meet once a week for one and a half hours for ten weeks. Each participant receives a brochure with the explanation of the program, snacks at each meeting, and a completion certificate after the ten weeks. The groups are completely confidential with the only exception being if someone is at risk for self-destructive behavior or dangerously destructive behavior towards others.

Edwin Shneidma is a clinical psychologist and a leading authority on suicide. “One of the most harmful myths about suicide is the notion that people who really want to kill themselves don’t talk about it. Most people who commit suicide have told other people about their plans. Many have made previous suicidal gestures,” he said. Schneidman estimates that in at least 80 percent of completed suicides, the people provide verbal or behavioral clues that indicate clearly their lethal intentions.

That is why it is important to pay close attention to your children and their behavior. The sooner you detect somethingis wrong, the sooner you can get professional help. For more information and help, visit fisp.org.

 

Signs of Suicide

fisponline.org

Verbal

  • “I wish I was dead.” • “You don’t have to worry about me anymore.” • “How do you leave your body to science?” • “Why is there such unhappiness in life?” • “Everyone would be better without me here”

Feelings

  • Feeling like a burden to others. • Depression. • Sadness. • Loneliness. • Extreme boredom.

Behaviors

  • Previous suicide attempt. • Giving away prized possessions. • Arranging to donate organs. • Making a will. • Alcohol or other drug use. • Careless, risk-taking behavior. • Withdrawal from family and friends. • Running away from home or responsibilities. • Change in school or work performance. • Extreme irritability, guilt, crying, inability to concentrate. • Violent and rebellious behavior. • Collecting pills, razor blades, knives, ropes or firearms. • Sudden happiness after a long period of depression

Situations

  • Recent suicide or death of a loved one or someone close to person. • Being a victim of physical or sexual abuse or rape. • Troubled family life. • Social isolation, lack of close friends. • Recent loss of job, friendships. • Failing or dropping out of school, losing job or divorce. • Not making a team, getting a promotion or membership in an organization. • Unwanted pregnancy or abortion, illness, or accident and losing ability to take care of self. • Being a “perfectionist.” Not living up to their standards or someone else’s expectations.
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