Coffee and Kids: Wonder Beverage or Devil’s Brew?

There has recently been a lot of talk about a very old beverage, coffee.

The occasion for this has been the admission by seemingly responsible parents that they actually give their young child a cup of coffee with breakfast. Egads – what is the world coming to?

With some guilt, I admit my 8-year-old had a cup with her Fruit Loops this morning, as she does most mornings. (Please don’t report me to CPS).

So is coffee bad for kids? The old cup-a-joe has a long and somewhat sordid history. Going back to the days of dirt and plague, coffee was associated with all manner of dark things, like most of what went on in the Middle Ages, with no scientific basis.

Yet coffee is one of the most studied beverages on the planet, not surprisingly as there are nearly 1000 organic chemicals in a cup of brew. Caffeine is the one that everyone talks about. This is an interesting chemical, a mild stimulant in the methyl xanthene family. This is closely related to adrenalin and medications that are used to treat asthma. Coffee is a well known bronchodilator. So coffee certainly isn’t bad for kids with asthma.

One of the other effects of coffee is to mildly raise dopamine levels in the brain. You’ve heard of raising dopamine in talking about antidepressants, like Prozac. In fact kids who drink a cup of coffee with milk per day have a significantly lower rate of depression. So coffee isn’t bad for sad kids.

Caffeine is a stimulant and recently parents of kids with attention deficit disorder have been experimenting on their kids.

The thought goes something like this: if the stimulant amphetamine helps kid with ADHD focus and concentrate, maybe a good cup of coffee will do the same. Funny thing is, it does seem to help. We don’t have any huge definitive studies to quote, but limited research shows coffee helps kids with ADHD focus and concentrate. It doesn’t help as much as Adderall, but it does help. For some kids, coffee is all they need. For other kids who don’t get enough benefit from medications, adding a cup of coffee helps. So coffee isn’t bad for kids with attention deficit disorder.

What about other kids? My daughter had a cup this morning. She isn’t challenged by ADD, or depression, thankfully. She just likes a cup in the morning like I do. Coffee doesn’t stunt your growth or hurt your development in any way we have found. It actually does some good stuff. Parkinson’s disease is reduced in coffee drinkers as is colon cancer, liver disease and Type 2 diabetes. All well proven. Early research on Alzheimer’s disease suggests its occurrence is reduced in coffee drinkers.

For those still thinking coffee is an adult only vice, I invite you to consider normal kid breakfast drink alternatives. What do your kids drink for breakfast? Popular orange drinks have many times the sugar of coffee. Other beverage choices have higher fat or cholesterol content. In this epidemic of obesity, nobody ever got fat on coffee.

So tomorrow morning when I pour my cup, I will cheerfully give some to my 8-year-old; she gets her own cup because I don’t like to share.

Take care

Dr B

Best of Our Blog: Rusty Nails and Working the Late Shift

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

Rusty Nails, Dirty Wounds and Tetanus

This morning I heard a newscaster lament, “I was cut with rusty metal, and there is a national shortage of tetanus vaccine.”

Despite his concerns, this is not exactly certain death. Growing up in Southern California, I spent most of my youth barefoot, tangled with more than a few rusty nails and was on the tetanus-shot-a-year plan. This experience prompted an interest in the whole rusty nail tetanus connection.Read more

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.
Read more

Update: Head Injuries Remain a Major Concern for Football Players

Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal, occurring both emotionally and intellectually.

Traumatic brain injury can result in short term symptoms as well as problems that are more serious and may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual, and personality traits of the injured person.

The more blows to the head that occur – even small ones – increase the risk for mental deficiencies. Significant head trauma to a football player occurs hundreds of times a week during practice and games. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A study in 2000 surveyed 1,090 former NFL players and found more than sixty percent had suffered at least one concussion in their careers. Twenty six percent had three or more. The survey revealed that players who had concussions reported more problems with memory, concentration, speech impediments, headaches, and other neurological problems than those who had not. Because these professional players had spent many prior years playing football in high school and college, the frequency of head trauma is likely under-reported. Head trauma is a problem for many of the non-contact sports as well.

Other common medical problems are being discovered as we examine concussions more closely. Depression, insomnia, attention deficit and personality changes all occur with similar frequency among high school athletes. These kinds of problems have been found to be more frequent in those who have had even one episode of head trauma.

Long-term problems may take eight years or more to develop or worsen. Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits, regardless of how quickly they subside on the sidelines. It is widely accepted that concussion symptoms can reappear hours or days after the injury, indicating that the player had not healed properly from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur.

But the question remains – how much healing time is enough? A health care provider should be involved in examining and investigating these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to serious consequences for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. One recommendation is reducing the numerous head blows by enforcing practices that involve no contact. Research has shown the number of head blows during a college football season totals in the thousands for an individual player. Many football collisions have forces comparable to driving a car into a concrete wall at 40 miles per hour.

Teaching better techniques to reduce the head leading contact in tackling and blocking and providing better equipment can help reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to protect athletes of all ages. Athletes themselves should be encouraged to seek medical attention for head injures – even if they seem mild and there is no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early, and be the basis for ongoing treatment and peace of mind.

Dr. Bruce Kaler

Acne, Chocolate, Shaving and Hair – Medical Truth Behind the Myths

One of the small joys of medical school is finding out a bunch of the stuff you’ve been told is wrong.

That may not be the noblest of intentions, but joy nonetheless. My first startling discovery of this type was on the health of your eyeballs and the illumination of your reading material. Who doesn’t have memories of Mom turning on lights with the exclamation: “Quit reading in the dark; you’ll ruin your eyes!” Few of us questioned the wisdom of the advice, even if the lesson didn’t seem to stick.

I still remember cheerfully calling home and explaining to my parents the workings of the eye and the complete lack of damage from reading in poor light. Just like a camera, poor light gives bad pictures, but it doesn’t damage the camera. Yes, these were the same parents that were paying for medical school.

Another bit of mistaken medical folklore involves swimming after eating.

I remember dutifully waiting a good 30 minutes, which seemed like three hours, before swimming after eating, as advised by all sensible adults.

Living in California I heard countless stories of careless people going for a dip too soon after eating, only to be incapacitated by a cramp, and sinking like a stone into the murky depths – that would be the 8-foot end of the pool. I spent months going through every last organ in my cadaver specimen and assure you there is no cramp organ. Swim 10 seconds after your last bite, and use pool water to wash it down and you still won’t get a cramp.

Moving on to teenage years there were lots of well intentioned dietary advice for a teenager with pimples. Chocolate was the favorite food to blame for acne. This myth is so pervasive in society that one of my medical school professors specifically addressed this mistaken notion.

She told us to please find some chocolate that really caused acne (good luck, there isn’t any). She theorized that if it could be found, with a little analysis we could find the specific culprit, and remove it. That would allow us to make acne free chocolate. Think of the sales, I could pay off medical school. This perhaps takes some of the guilty pleasure out of chocolate, even more so now that we know a little dark chocolate is good for you.

About the time we were getting over the worst of our acne, we were giving our young livers a work-out with the new found joys of alcohol. I have vague memories of getting drunk on the most ridiculous beverages, cheap wine, sloe gin or anything else we could get our hands on.

Who has not poured coffee into a drunk friend expecting to sober him up enough to not be killed by his parents? Perhaps you have tried the coffee cure on yourself. Alas, coffee will not speed up the metabolism of alcohol even a little bit. You are just as drunk after 5 cups of coffee – and you have to go to the bathroom even more. The caffeine might wake you up enough to do something stupid, like drink more, or call your ex.

Getting a little older, arthritis seems more like reality, and colds are not shrugged off with the vigor of youth.

If you do get some hand arthritis, don’t blame it on cracking knuckles. Cracking knuckles causes zero joint damage, and produces no increased risk of arthritis. It’s harmless, although quite irritating to most of the people around you, which may be the point.

What about wet hair and colds? Colds are caused by viruses and not cold air or a wet scalp. Wet hair doesn’t even weaken your immune system and make you more susceptible to the first germ that passes by. The dangers of wet hair are clearly overstated.

Shaving causes hair to grow back thicker and darker. Everybody knows that. This also is medical fantasy. Bunches of studies have been done on this very subject. Shave or grow a beard, the whiskers stay the same. Same goes for legs.

How about the healthy glow from 8 glasses of water a day? Another medical myth. The origins of this belief are obscure, but the evidence is clear. Drink when you are thirsty, a little more if you are exercising.

Medical myths are common in society, and always have been. Partly it’s magical thinking, partly American pragmatism. We have only recently started making decisions based on evidence. As that gathers speed, it may spell the end for sewer dwelling alligators, or maybe not.

Take care,

Dr B (aka Dr Don Bucklin)

Radiation, Cancer and Medicine

Lately everybody is talking about the Japanese nuclear accident, radiation and the risk of cancer. In the midst of one of these conversations, I was asked, “If radiation causes cancer, how come cancer is treated with radiation?” Another version is, “Since radiation breaks down DNA, which can cause cancer, how come we give radiation to treat cancer? Doesn’t it just break down more DNA?” That actually is a pretty good question.

Radiation therapy is commonly used to treat cancer. It is pretty effective for cancers that are localized (in one place). It is also very effective at treating more widespread cancers like Hodgkin’s Lymphoma.

For localized disease, it’s all in the focus. Radiation therapy can be focused like a laser flashlight beam. Very high levels of radiation are put in the area of the tumor and not much anywhere else. So any damage from radiation therapy is limited to the tumor – not exactly, of course, but pretty closely. Damaging tumor cells is the point, and we hardly need to worry about tumor cells becoming cancerous.

Some radiation treatments expose much more of the body to radiation. Treatments for Lymphoma are one example of this. People are given what would be concerning amounts of radiation if they got it working in a Japanese damaged nuclear facility. Here’s the interesting part: cancer cells and normal cells react differently to radiation. The way radiation damages cells is by causing breaks in DNA, the blueprint of life. It turns out that cancer cells are not very good at repairing their DNA. Normal cells are much better at successfully repairing the damaged DNA. So the damaged cancer cells die, and most of the damaged normal cells don’t.

If this sounds a bit imprecise, it is. Usually the difference between the cancer cell and the normal cell isn’t 100%. Most cancer cells don’t survive high-dose radiation, and most normal cells survive, repair themselves or die a clean death – just as long as they don’t turn into cancer.

This actually is the basis of cancer treatment of any kind. An important difference between the cancer and normal cells needs to be found and capitalized on.

But radiation is radiation. It damages DNA, and occasionally DNA is repaired badly – sometimes so badly it acquires something unpleasant like uncontrolled growth.

Studies do suggest to an increased risk of disease 20 or 30 years after radiation treatment. Cancer usually occurs in the middle years and later so many patients are cured of their cancer and are at the end of their natural life span before enough years have gone by to see any ill effects from the radiation treatment.

But ultimately, we worry about today and let tomorrow take care of itself. The prospect of not treating today’s cancer is so bleak that a future risk seems a small price to pay. Radiation, like so many other things in life, has its pros and cons.

Take care,

Dr. B

Physical Therapy: The Medicine that Cures

When people are injured, it’s important to as soon as possible restore function and movement to some reasonable form.

Everyone is eager to get back to their life, job or recreational activities, but the pain of injury is difficult, disruptive and discouraging to one’s normal activities. And the longer the injury drags out, the more likely depression will ensue.

The ticket to success in overcoming an injury is early mobilization. But this has to be done within reason, with patience and with an understanding of the body mechanics relevant to the injured body part.

The plan tailored to the injury and level of conditioning is the physical therapy. It remains the cornerstone of recovery and preventing further injury. Coaching by a physical therapist is critical to planning the recovery and doing no further harm. A good plan and continued mentoring by the therapist will ensure a speedy recovery.

photo © 2008 The U.S. Army | more info (via: Wylio)

The basics of therapy during the initial acute phase are well known: rest, ice, compression and elevation (R.I.C.E.). Early mobilization of the injured part within reason, as well as the rest of the body, is beneficial. It continues to maintain muscle tone, which starts to atrophy after 24 hours of inactivity. The additional weakness and stiffness needs to be minimized rather than creating an additional liability. Essentially, increased circulation helps promote healing.

Convalescence from a significant injury is often frustrating and has its ups and downs. During the recovery phase, it’s key to remain within certain boundaries to avoid over-training.

Nonetheless, several variables have to be monitored by a physical therapist and your healthcare provider to stay on course. Recapturing strength, endurance and range of motion are the goals for recovery. Although some common patterns emerge for certain injuries, we are all individuals who bring different considerations to the challenge. We often think of these as baby steps to recovery.

When the pain of the acute phase subsides, typically there is weakness that remains. Getting back to a functional level of activity can take more time than you wish. Listening to your body is important. Also, using the expertise of the physical therapist and maintaining an open dialogue with the therapist will get you to your goals as soon as possible.

Remember, it does take time to regain your normal level of endurance. Along the way, learning the best body mechanics for your activities, and getting and maintaining a level of strength suitable for the job are critical to getting better and staying that way. Physical therapy is the medicine that cures.

– Dr. Bruce Kaler

Are Blood Pressure Pills Addicting?

A high blood pressure reading is occasionally seen when someone comes in for an unrelated reason (sprained ankle, cough, VD). When I mention this to the patient and ask if they have had high readings in the past, the answer is often “Yes.” When asked if they were under treatment, the answer is too often “No.”

Now, one elevated blood pressure reading does not a hypertensive make. But often people have had several medical providers tell them their reading was “a little high.”

So, in a moment of curiosity, I ask, “Why not?” One surprising answer is the following: “Once you start, you have to keep taking them.” In a rare moment of clarity, I ask, “You think blood pressure pills are addicting?” I get a nod. It does seem reasonable from the dire warning to not stop your BP medication (deep serious voice), that you may not even want to start it.

So let’s talk about blood pressure and BP medications for a minute. Blood pressure is just a pressure, like in your car tire or your garden hose. What would happen if you have too much pressure in your tire or your hose? It pops. There, that’s most of what you need to know.

How do you make pressure go down? Let out some air, close the garden valve (or hose bib for those who like technical words). So BP medications work in some pretty common sense ways. Let some air out, is just another way of saying diuretic. By making you pee a lot, the pressure in your body is reduced – you can almost feel the pressure go down. Or we can slightly slow the heart rate, kind of like turning down the garden hose valve. Sometimes we want to make the heart beat less forcefully, making a smaller pump, if you will. There are a few other ways to turn down the blood pressure, but you get the idea.

So, are blood pressure medications addicting? No. They make your blood pressure go down and keep it lower as long as you keep taking the medication. If you stop taking your meds, your blood pressure will just go back up to where ever it would be if you didn’t treat it. Blood pressure is just maintenance, like changing your oil. It’s a good idea to keep changing your oil as long as you want your car to keep running. Your car is not addicted to oil changes – it will just run longer if you do them. Same with your heart. It isn’t addicted to BP meds – it just will run longer if you take them.

Generic BP pills are available, so they don’t need to be too expensive. They don’t make you tired or weak, give you headaches, or hurt sexual function. There are enough different types of medications that there is truly something for everyone.

But medications aren’t the only way to control blood pressure. It unfortunately often works out that the patient isn’t doing all the life changes that will get the blood pressure down. Sometimes the doctor doesn’t even tell you about this stuff.

If you lose 20 lbs. and start an exercise program, we can always stop the medications. Weight loss helps control blood pressure, along with sweating and reducing stress.

Blood pressure medications aren’t addicting or magic. They work in pretty straightforward ways. The next time you have a high reading, ask your doctor about specific treatment, whether it be medication, lifestyle or both. No sense walking around waiting for something to “go pop.”

– Dr. B

Does It Hurt to Get a Flu Shot?

Our own Dr. B demonstrates how easy – and relatively painless – it is to get a flu shot.  Watch:

Hit Me with Your Best (Tdap) Shot

We’re all aware of the importance of tetanus shots, and now there’s a vaccine to prevent tetanus while also fighting other serious ailments at the same time.

Multiple health organizations are now recommending that adults have a one-time dose of something called Tdap. This is a combination vaccine that contains tetanus, diphtheria and pertussis vaccines. The Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) all recommend this vaccine.

As usual, something prompts me to think about certain topics. Why this one? Ok, I admit it…I was not paying attention and I grabbed some papers with a partially closed staple in them. As it ripped through the tip of my finger, I knew I would need to recall when my last tetanus vaccine was. And, as a healthcare worker, I did know that I had not yet had a Tdap. So, my weekend included a sore arm….

There is no vaccine for just pertussis alone, and this ailment, like tetanus, is one I’m sure we’d all like to avoid. Pertussis is known as the “whooping cough,” and this bacterial infection is passed from person to person. It’s generally not serious in adolescents and adults, but can be very dangerous to young children.

The symptoms of whooping cough come in 3 stages:

• The first begins much like your common cold – runny nose, sneezing and coughing. The cough will last 1-2 weeks, getting worse instead of better.
• In the second stage, you will have uncontrollable coughing spells, frequently vomiting after coughing, and you will emit a “whopping” noise when you breathe in. Patients can even stop breathing or turn blue in the face from lack of air during these cough episodes. This can last 2-6 weeks.
• During the last stage, the symptoms actually start to lessen. The coughing spells decrease in frequency and severity.

The course of this illness can be 6-10 weeks. Adults, teens and vaccinated children will generally have milder symptoms, like those of bronchitis.

Pertussis is spread by the “spray” of our secretions in the air, when we sneeze, cough or talk. We can also get it from sharing our cups and silverware. Initial symptoms will appear in 7-10 days after the exposure, and we will be contagious from 2 weeks prior to the start of the cough until 3 weeks after the cough starts, or until we have completed a 5-day course of appropriate antibiotic therapy.

Here is an information sheet on Tdap from the CDC. It discusses who should and shouldn’t have the vaccine, as well as the side effects.

If you are due for a tetanus vaccine and have not had your Tdap, consider receiving one at your nearest U.S. HealthWorks center. Then the only whooping you will hear is out of glee because you know you’ll be pertussis and tetanus-free.

- Alesia J. Wagner, Regional Medical Director, Southern California

Watch Your Step: How Businesses Can Avoid Common Workplace Injuries

By Dr. Leonard M. Okun

Businesses usually know how to play it safe when it comes to injuries on the job, but recent trends show that mid-size companies haven’t been so careful. 

According to the most recent U.S. Bureau of Labor Statistics (BLS), the total injury and illness incidence rate is highest among private businesses with 50 – 249 workers.

Since April is Injury Prevention Month, there’s no better time to remind employees – and refresh employers – about the most common injuries and how to avoid them. 

As an occupational doctor for more than 30 years, I’ve seen a broad range of injuries, but the most common – and completely avoidable – injuries are strains, cuts, punctures, bruises, contusions, and, of course, fractures. 

So how do employees fall into the accident trap? 

Many times the culprit that leads to injury is an object that the employee hits, like a misplaced table that connects with the knee or a heavy box that they misjudge and comes crashing down on their head.

Also not properly using or maintaining equipment – no matter how mundane – often leads to injury.

Not watching where they’re walking, tripping and falling, especially on carpeted stairways if you’re wearing heels.        

Another common one — exposure to known harmful substances or environments like chemicals and pesticides. 

Most, if not all of these, are preventable.

As an employer, ensuring that employees follow all health and safety procedures is a must, but there are many other common sense preventative measures businesses can take to help avoid injuries.

For example, the statistics show that floors and walkways are the most common sources for workplace injuries, so some precautions employers can take include hiding cables that could be in the way, providing warning signs if an area is temporarily slippery or wet, cleaning the floor regularly and providing sufficient lighting and hand rails wherever applicable.

Strains to the neck and back are commonly seen when workers are performing either a repetitive motion or lifting heavy objects. To avoid this, workers should first consider the following:

• Assess the weight of the object
• Know your lifting limit
• Examine the object for potential hazards
• Ask for help if needed, or divide the load to make it lighter
• Make sure the area around you is free of clutter
• Lift with your legs and keep the object close to your body 

While not always severe, ailments from working at a desk are common and can be debilitating to employees. To avoid injuries such as soreness or fatigue, it’s crucial to keep in mind the following:

• Sit fully back in your chair
• Your elbows should be bent to 90 degrees with your wrists in a neutral position
• Your mouse should be located at the same level as the keyboard, immediately beside
• The top of your monitor screen should be at eye level, except if you’re wearing bifocals
• For optimum viewing distance, your monitor should be an arm’s length away
• Incorporate stretching or exercising breaks throughout the workday to reduce neck, lower back and upper extremity fatigue

No matter how minor or severe an injury may be, avoiding workplace dangers is best done through awareness and preventative measures. And while this month may be the time for injury prevention, keeping your employees and workplace safe is something to celebrate every day.

And, in these days when every business is watching its costs, it may also lighten your company’s workers’ compensation claims.

Dr. Leonard M. Okun is the national medical director for Valencia, Calif.-based U.S. HealthWorks, which has 159 clinics and worksites in 15 states.