Friday, March 8, 2019

Parents: How smart are you about antibiotics?

One of the more typical reasons for a trip to the emergency department on Thanksgiving Day (and most days, frankly) is accidental cuts to the hands. Be careful cutting up that turkey! Always use a carving fork, and although the household might be busy, try to avoid distractions when working with knives. Thankfully most such injuries can be repaired in the ED, but occasionally are bad enough to warrant being seen by a hand surgeon. For simple cuts to the hand, we generally place non-absorbable stitches that need to be removed in about 10 days. Most of the time, antibiotics are not needed — just a really good washout and cleaning prior to stitching.

Everyone “knows” about the dangers of cooking turkey, yet somehow nationwide, each year, the rate of residential fires more than doubles during this time frame. Never leave the house with the oven on, and check on the turkey frequently. If you choose to deep-fry a turkey, always do this outside, and always make sure the turkey has thawed first. Placing a frozen turkey into a deep fryer can cause explosions of hot oil, which can lead to third-degree burns and other serious injuries. If you’re frying a turkey, always wear good footwear, practice fire safety, and monitor children in the area.

Most birds carry bacteria, and the turkey is no exception. The most common pathogen is Salmonella. If cooked properly, this poses no harm. Under-cooked, the bacteria can cause diarrhea, vomiting, fever, and general illness that ranges from uncomfortable to life-threatening. The recommended temperature for a cooked turkey is at least 165° F, and should be checked by thermometer. Did you know that if you have any questions about cooking your turkey, you can call the Butterball hotline? Even on Thanksgiving Day! (800-BUTTERBALL/800-288-8372)

Delicious holiday foods are usually well seasoned …with salt. For most adults this does little more than make you thirsty, but for people with congestive heart failure or chronic edema (water retention), extra salt can place increased stress on the body. If you have these conditions, please be careful with what and how much you eat. Inevitably, we will see a few patients with episodes of worsening heart failure in the emergency department … usually the day after a holiday.

Last but not least, be careful about driving. It’s all too common to see drunk drivers during Thanksgiving time. It is historically the most dangerous time of the year for car accidents and subsequent fatalities. Monitor how much you drink, and remember that even if you are sober, unfortunately not everyone else out there is. Be extra attentive. Drive safe! When we think of anxiety disorders, we generally think of them as uncomfortable emotional responses to threat. These responses may include symptoms such as palpitations, shortness of breath, sweating, trembling, or absolute paralysis. While there is nothing inherently wrong in thinking about anxiety this way, a recent study pointed out that there is an entirely different way of thinking about anxiety that may be even more helpful. According to psychologist Kalina Christoff and her colleagues, anxiety may be more appropriately thought of as “mind-wandering gone awry.”
The advantages of mind-wandering

In your brain, there are circuits that promote mind-wandering and they are not all bad. In fact, these very circuits help you maintain a sense of self, understand what others are thinking more accurately, become more creative, and even predict the future. Without your mind-wandering circuits, your brain’s ability to focus would become depleted, and you would be disconnected from yourself and others too.

In addition to the natural and frequent tendency for your mind to stray, it also has automatic constraints too, to ensure that it does not stray too far. When daydreaming during a boring lecture, for example, your brain may jerk you back into reality.
When mind-wandering goes awry

One of the things that a wandering mind is in search of is meaning. By connecting the past, present, and future, it helps you compose a narrative to connect the dots in your life. This narrative is constantly being updated. But sometimes, the wandering mind can encounter threats. Rather than proverbially “whistling in the dark,” the brain can overreact to these threats.

In the brain of an individual with generalized anxiety disorder, for example, the anxiety processor (the amygdala) is disrupted. Although it has strong connections to the “inner eye” (attention), it lacks a connection to the brain circuits that signal how important or significant a threat is. Without the ability to assess the significance of threats, they can all feel the same.

As a result, the “inner eye” gets fixated on negative thoughts. This fixation is a way of constraining the mind too, but it is not actually helpful. Anxious people focus more on external threats in an exaggerated way. They become glued to the threats. Anything from being teased to being ticked off feels much more troubling than it would to someone without an anxiety disorder. And it’s not just conscious threats that grab your attention. It’s subliminal threats too! Threats, of which you are completely unaware, capture your brain’s attention. A mind, once free to wander, is desperately forced to stop in its tracks in what can be construed as a catastrophic confusion of constraints.
Let your mind wander away from perceived threats

When your brain has automatically grabbed your wandering mind, and fixed your attention on threat, rather than getting a proverbial “grip” on reality, you actually have to loosen your grip on your threat-focused reality — allow your mind to wander! As Christoff and colleagues put it, you de-automatize your constraints.

Because your brain’s inner eye has its resources fixed on the threat, it gets progressively exhausted too. You can’t really summon it to help you suppress the anxiety, or get your mind off of it. Instead, you have to reactivate your mind-wandering circuits to give your attention a break.

Practically speaking, there are a few ways to do this. First, identify the negative spiral that has occurred like a pothole into which you have fallen on a mind-wandering journey. Simply name the feeling you are feeling and recognize that you need a mental reset. Rather than deliberately trying to suppress the feeling, accept that your mind is wandering, and that the fixation on threat is not the constraint solution you are looking for.

To counter this constraint, up the ante on the mind wandering — wander even more. If you’re at work, you could keep a knitting kit and start using it just when anxiety strikes, or if at home, you could go out and do some gardening. Meditation is also an effective way to get out of the fixed threat hole.

So when you’re next feeling anxious or wired, try allowing your mind to do what it naturally does — wander! You can bring it back to task gently, without fearing that you have lost your way. Or you can expect that it is wired to switch between wandering and focused states, and it will eventually come back on its own. The more you mindfully interact with this switch, the more adept your brain will become at initiating it. A pair of recent studies provides useful information to men facing challenging decisions about what to do after being diagnosed with early prostate cancer. Researchers tracked men for 10 years and found that virtually none died of the illness, even if they decided against treating it.

Early prostate tumors confined to the prostate gland often grow slowly and may not need immediate treatment. Instead, these tumors can be monitored and treated only if they begin to progress.

In one of the studies, British researchers randomly assigned 1,643 men with early prostate cancer into three groups: one group had surgery to remove the prostate, another had radiation treatment, and a third had “active monitoring,” meaning that doctors tried to predict if the cancer was spreading by measuring their prostate-specific antigen (PSA) levels every few months. Treatment could start if PSA levels jumped by 50% or more over the course of a year. It’s important to note that active monitoring differs from “active surveillance” for early prostate cancer, which relies on routine biopsies as well as PSA measurements to monitor for spreading cancer.

After 10 years, only 1% of the men had died of prostate cancer, regardless of which group they were assigned to. But tumors did spread, or metastasize, more frequently in the active monitoring group. According to the results, the cancer progressed in one in five men being monitored, compared to less than one in 10 men who received surgery or radiation. Some of the men in the monitoring group had what’s known as “intermediate-risk” prostate cancer that has a higher grade and progresses more often than low-risk prostate cancer. Laurence Klotz, a professor at the Sunnybrook Health Sciences Centre, in Toronto, Canada, who was not involved in the study, says it’s likely that most of the men who progressed on active monitoring were in the intermediate-risk category, although the authors did not report this. As time went on, more and more of the monitored men wound up being treated.

In an accompanying study with the same group of men, those treated with surgery reported more long-term problems with sexual performance and urinary continence. Conversely, the radiation-treated men reported more bowel problems, while the urinary and sexual side effects from radiation treatment typically resolved within six months. Both the monitored and treated men reported the same amount of anxiety and depression.

Taken together, the studies bolster a growing consensus that men with organ-confined prostate cancer can safely avoid treatment for some period of time. The results show that one case of metastatic cancer was prevented for every 27 men treated with surgery and every 33 men treated with radiation. “These studies again confirm the lack of evidence that treatment interventions for so-called early prostate cancer lead to any meaningful benefits in survival,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “Additional analyses will be required to see if we can identify those men in each group who did develop metastases and then design treatment programs to see if we can modify that risk.” I come from a long line of skilled soup makers. In the late 1800s, my great-grandmother Enrichetta Cavagnolo, newly arrived from northern Italy, was a soup chef at Delmonico’s in New York City. Enrichetta’s daughter and granddaughters (my grandmother, mother, and aunts) were talented soup makers as well, to the delight of our well-fed family.

But the soup-making gene seemed to skip me. I was never interested in boiling bones for broth, chopping mounds of vegetables, and stirring soup — with love — for hours. It was too much fuss, I thought — until I learned the shortcut.
Fast and healthy

Turns out, making a delicious batch of soup doesn’t require homemade bone broth or all-day simmering. Just boil your favorite vegetables and spices in some water and low-sodium (store-bought) soup stock. There’s no right or wrong combo of ingredients; it’s whatever appeals to you. Want a small batch? Use two cups of liquid. Want a big batch? Use four. Add more liquid to make it soupier, or less liquid to make a stew. Boil, add the ingredients, and you’re in business in about 20-30 minutes.

It’s also easy to go a step further, and make soup a complete meal. “Add protein such as lentils or beans, fish, extra-lean beef, turkey, or chicken,” says registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital. She recommends increasing the nutrient power and fiber by adding as many vegetables as possible, such as peppers, asparagus, broccoli, spinach, onions, and carrots.
Too busy? Beware

Knowing the shortcut is important in an age when soup tops the list of culturally cool comfort food. It’s featured in trendy soup “bars,” tiny take-out windows, and all varieties of grocery stores. While it’s tempting to skip the stove and buy prepared soups, you should note that they often contain preservatives and other unhealthy ingredients. In particular, be on the lookout for these:

    Saturated fat. Any soup with a cream base, such as cream of tomato, is made with cream and butter, which contain unhealthy saturated fat. Too much saturated fat in your diet may drive up your cholesterol and lead to blockages in arteries.
    Sodium. Canned soups often contain high amounts of sodium. Too much sodium in your diet can lead to high blood pressure, heart attack, stroke, and heart failure. Federal guidelines limit sodium intake to 2,300 mg per day for most people.
    Sugar. Added sugar is found in chilled fruit soups and even some vegetable soups. The American Heart Association recommends limiting added sugars to no more than 24 grams per day for women and 36 grams for men.
    Calories. Soups are generally lower in calories than other entrée choices, but that changes when you top soup with cheese, sour cream, or croutons, or pair it with a piece of bread.

Keep it healthy

McManus recommends avoiding prepared soups for the most part. “They’re okay in a pinch and on occasion, as long as you set limits. Aim for less than 500 calories, 600 mg of sodium, 5 grams of saturated fat, and 5 grams of added sugar in a bowl of soup,” she says, “and cut that in half for a cup of soup.”

It’ll take some detective work to stick to those limits and find healthier prepared soups. Look at the nutrition information on a restaurant’s menu or website, or on a product’s Nutrition Facts label. If it’s too much work to hunt down healthy soups, then consider making the soup from scratch, like I do now. You’ll find some healthy soup recipes to get you started here. You can control the ingredients, and you can give it your own special flair. And trust me, it doesn’t take a soup-making pedigree to be good at it.

No comments:

Leave a comment