Dr. Howard Smith Reports

Vidcast:  https://youtu.be/7PXOk2UMWz0

Sixty percent of children having their tonsils removed are prescribed opioids for 6 to 10 days following the surgery.  This fact comes from study by University of Michigan of nearly 16,000 children ages 1 to 18 years who underwent surgery from 2016 until 2018.

This prescribing pattern flies in the face of American Academy of Otolaryngology guidelines that suggest using NSAIDS such as ibuprofen in place of narcotics.  The study confirms that use of these addicting pain killers does not reduce post-operative hospital visits for pain or dehydration.  The data instead show that narcotics do cause painful constipation and sometimes tragic overdoses.

Having performed thousands of tonsillectomies myself during my 40 years practicing pediatric otolaryngology, I know that narcotic pain medicine can be avoided with the appropriate use of  the T&T plan: Tylenol and Twinkies, a sugar and carb-laden postoperative diet.  I also reject the use of blood-thinning NSAIDs which studies now show do drive a higher rate of post-operative bleeding.

Kao-Ping Chua, Calista M. Harbaugh, Chad M. Brummett, Lauren A. Bohm, Karen A. Cooper, Aaron L. Thatcher, Michael J. Brenner. Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children. JAMA Otolaryngology–Head & Neck Surgery, 2019; DOI: 10.1001/jamaoto.2019.2107

#Tonsillectomy #analgesics #opioids #Tylenol #NSAIDS

Vidcast:  https://youtu.be/7PXOk2UMWz0

Sixty percent of children having their tonsils removed are prescribed opioids for 6 to 10 days following the surgery.  This fact comes from study by University of Michigan of nearly 16,000 children ages 1 to 18 years who underwent surgery from 2016 until 2018.

This prescribing pattern flies in the face of American Academy of Otolaryngology guidelines that suggest using NSAIDS such as ibuprofen in place of narcotics.  The study confirms that use of these addicting pain killers does not reduce post-operative hospital visits for pain or dehydration.  The data instead show that narcotics do cause painful constipation and sometimes tragic overdoses.

Having performed thousands of tonsillectomies myself during my 40 years practicing pediatric otolaryngology, I know that narcotic pain medicine can be avoided with the appropriate use of  the T&T plan: Tylenol and Twinkies, a sugar and carb-laden postoperative diet.  I also reject the use of blood-thinning NSAIDs which studies now show do drive a higher rate of post-operative bleeding.

Kao-Ping Chua, Calista M. Harbaugh, Chad M. Brummett, Lauren A. Bohm, Karen A. Cooper, Aaron L. Thatcher, Michael J. Brenner. Association of Perioperative Opioid Prescriptions With Risk of Complications After Tonsillectomy in Children. JAMA Otolaryngology–Head & Neck Surgery, 2019; DOI: 10.1001/jamaoto.2019.2107

#Tonsillectomy #analgesics #opioids #Tylenol #NSAIDS

Vidcast:  https://youtu.be/M8KGl6VRPSk

A whopping 48% of persons who are victims of the big four, domestic violence, sexual assault, depression, or suicidal thoughts refuse to reveal this fact and ask for help.  A collaborative study of some 4500 subjects questioned in two online surveys was just published in JAMA Open Network.

Digging deeper into the data, the investigators showed that 70% of those concealing these vital pieces of information did so due to embarrassment and fear of being judged.  Then, about half of those avoiding disclosure did so because they didn’t want to commit to follow-up therapy such as counseling sessions or anti-depression medications or they fearing having such information in their medical records.

These findings show the need for better sensitivity and communication skill training for clinicians so that patients feel comfortable sharing their intimate secrets.  Beyond that, there must be iron-clad guarantees of confidentiality.  The clinician-patient privilege must become as solid as the lawyer-client privilege by enforcing the HIPAA regulations and stopping the illegal leakage of personal medical information to third parties including employers who pay for medical and psychiatric services.

Andrea Gurmankin Levy et al. Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9277

#Violence #abuse #depression #suicide #HIPAA

Vidcast:  https://youtu.be/M8KGl6VRPSk

A whopping 48% of persons who are victims of the big four, domestic violence, sexual assault, depression, or suicidal thoughts refuse to reveal this fact and ask for help.  A collaborative study of some 4500 subjects questioned in two online surveys was just published in JAMA Open Network.

Digging deeper into the data, the investigators showed that 70% of those concealing these vital pieces of information did so due to embarrassment and fear of being judged.  Then, about half of those avoiding disclosure did so because they didn’t want to commit to follow-up therapy such as counseling sessions or anti-depression medications or they fearing having such information in their medical records.

These findings show the need for better sensitivity and communication skill training for clinicians so that patients feel comfortable sharing their intimate secrets.  Beyond that, there must be iron-clad guarantees of confidentiality.  The clinician-patient privilege must become as solid as the lawyer-client privilege by enforcing the HIPAA regulations and stopping the illegal leakage of personal medical information to third parties including employers who pay for medical and psychiatric services.

Andrea Gurmankin Levy et al. Assessment of Patient Nondisclosures to Clinicians of Experiencing Imminent Threats. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9277

#Violence #abuse #depression #suicide #HIPAA

Vidcast:  https://youtu.be/j0AMNiPTals

One in every 14 persons over the age of 65 who undergoes even seemingly risk-free elective surgery may suffer a silent or covert stroke that can permanently impair their cognitive powers or worse.  This warning comes from a Canadian study just published in The Lancet.

Covert strokes are those without obvious symptoms including paralysis, weakness, speech degradation, or visual problems.

Population health scientists at McMaster University studied more than 1100 patients treated in the Americas, Europe, Asia, and New Zealand.  All patients underwent brain MRI scanning within 9 days of their surgery and were followed for a year to determine their cognitive abilities.  Of the 7% of patients that sustained silent strokes, 42% demonstrated a cognitive decline.  Even worse, 29% of those who didn’t suffer a stroke also developed impaired brain function.

Adding it all up, nearly 30% of the elders undergoing elective surgery developed post-operative mental decline.  If you or a family member in the golden years are told that surgery or a general anesthetic should be performed, be certain that the procedure is absolutely necessary.  If you do go ahead, ask your doctors and your family to monitor you carefully afterwards to detect mental changes that may warrant prompt intervention.

Marko Mrkobrada, Matthew T.V. Chan, David Cowan, etal. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. The Lancet, 2019; DOI: 10.1016/S0140-6736(19)31795-7

#Surgery #anesthesia #stroke #mentaldecline 

Vidcast:  https://youtu.be/j0AMNiPTals

One in every 14 persons over the age of 65 who undergoes even seemingly risk-free elective surgery may suffer a silent or covert stroke that can permanently impair their cognitive powers or worse.  This warning comes from a Canadian study just published in The Lancet.

Covert strokes are those without obvious symptoms including paralysis, weakness, speech degradation, or visual problems.

Population health scientists at McMaster University studied more than 1100 patients treated in the Americas, Europe, Asia, and New Zealand.  All patients underwent brain MRI scanning within 9 days of their surgery and were followed for a year to determine their cognitive abilities.  Of the 7% of patients that sustained silent strokes, 42% demonstrated a cognitive decline.  Even worse, 29% of those who didn’t suffer a stroke also developed impaired brain function.

Adding it all up, nearly 30% of the elders undergoing elective surgery developed post-operative mental decline.  If you or a family member in the golden years are told that surgery or a general anesthetic should be performed, be certain that the procedure is absolutely necessary.  If you do go ahead, ask your doctors and your family to monitor you carefully afterwards to detect mental changes that may warrant prompt intervention.

Marko Mrkobrada, Matthew T.V. Chan, David Cowan, etal. Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. The Lancet, 2019; DOI: 10.1016/S0140-6736(19)31795-7

#Surgery #anesthesia #stroke #mentaldecline 

Vidcast:  https://youtu.be/MatgZ2Jd0-U

Teens who have been bullied are 3 times more likely to have attempted suicide than those who have not be victimized.  This fact is true for adolescents around the world according to a recently published data analysis culled from more than 130,000 adolescents 12 through 15 years by the World Health Organizations Student Health Survey.

The risk of suicide increases with the numbers of bullying incidents a child has sustained.  In the most extreme cases, being bullied on the majority of school days drives up the suicide risk more than 5 times.

This study shows that bullying can be a death sentence for the victims.  Its findings will serve as a basis for convicting bullies of felony murder thereby ruining the lives of at least two teens and their families. 

If you are aware that your child is a bully, put an immediate stop to their behavior before they too become victim of their own bad acts.

Ai Koyanagi, Hans Oh, Andre F. Carvalho, Lee Smith, Josep Maria Haro, Davy Vancampfort, Brendon Stubbs, Jordan E. DeVylder. Bullying Victimization and Suicide Attempt Among Adolescents Aged 12–15 Years From 48 Countries. Journal of the American Academy of Child & Adolescent Psychiatry, 2019; DOI: 10.1016/j.jaac.2018.10.018

#Suicide, bullying, teens

Vidcast:  https://youtu.be/MatgZ2Jd0-U

Teens who have been bullied are 3 times more likely to have attempted suicide than those who have not be victimized.  This fact is true for adolescents around the world according to a recently published data analysis culled from more than 130,000 adolescents 12 through 15 years by the World Health Organizations Student Health Survey.

The risk of suicide increases with the numbers of bullying incidents a child has sustained.  In the most extreme cases, being bullied on the majority of school days drives up the suicide risk more than 5 times.

This study shows that bullying can be a death sentence for the victims.  Its findings will serve as a basis for convicting bullies of felony murder thereby ruining the lives of at least two teens and their families. 

If you are aware that your child is a bully, put an immediate stop to their behavior before they too become victim of their own bad acts.

Ai Koyanagi, Hans Oh, Andre F. Carvalho, Lee Smith, Josep Maria Haro, Davy Vancampfort, Brendon Stubbs, Jordan E. DeVylder. Bullying Victimization and Suicide Attempt Among Adolescents Aged 12–15 Years From 48 Countries. Journal of the American Academy of Child & Adolescent Psychiatry, 2019; DOI: 10.1016/j.jaac.2018.10.018

#Suicide, bullying, teens

Vidcast:  https://youtu.be/sSbGUgcsl68

As medical and recreational cannabis are increasingly legalized, poison control centers are fielding more calls from emergency rooms and desperate parents.  A report from UMass-Amherst just published in JAMA looks at the rise in calls following legalization of medical marijuana in Massachusetts. 

Legalization of medicinal weed was followed by a 140% increase in poisoning calls with nearly 20% of the calls involving children infancy through 4 years of age.  Calls regarding edible marijuana increased for all age groups reflecting the misconception that edible versus smokable marijuana is less potent and dangerous.

Now remember that Massachusetts only legalized marijuana for medical purposes.  Recreational marijuana remains restricted, yet carelessness is permitting this drug to get into the hands of young children and abused by teens.  

You cannot legislate morality or common sense so cannabis will soon be as available as alcohol.  We as parents must be certain to protect our children from accidental poisonings and overdoses.

Jennifer M. Whitehill, Calla Harrington, Cheryl J. Lang, Michael Chary, Waqaas A. Bhutta, Michele M. Burns. Incidence of Pediatric Cannabis Exposure Among Children and Teenagers Aged 0 to 19 Years Before and After Medical Marijuana Legalization in Massachusetts. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9456

#Cannabis #poisonings #parenting

Vidcast:  https://youtu.be/sSbGUgcsl68

As medical and recreational cannabis are increasingly legalized, poison control centers are fielding more calls from emergency rooms and desperate parents.  A report from UMass-Amherst just published in JAMA looks at the rise in calls following legalization of medical marijuana in Massachusetts. 

Legalization of medicinal weed was followed by a 140% increase in poisoning calls with nearly 20% of the calls involving children infancy through 4 years of age.  Calls regarding edible marijuana increased for all age groups reflecting the misconception that edible versus smokable marijuana is less potent and dangerous.

Now remember that Massachusetts only legalized marijuana for medical purposes.  Recreational marijuana remains restricted, yet carelessness is permitting this drug to get into the hands of young children and abused by teens.  

You cannot legislate morality or common sense so cannabis will soon be as available as alcohol.  We as parents must be certain to protect our children from accidental poisonings and overdoses.

Jennifer M. Whitehill, Calla Harrington, Cheryl J. Lang, Michael Chary, Waqaas A. Bhutta, Michele M. Burns. Incidence of Pediatric Cannabis Exposure Among Children and Teenagers Aged 0 to 19 Years Before and After Medical Marijuana Legalization in Massachusetts. JAMA Network Open, 2019 DOI: 10.1001/jamanetworkopen.2019.9456

#Cannabis #poisonings #parenting