Childhood Injuries

July 20, 2008

My youngest son recently reminded me how difficult it was to grow up in the home of an emergency physician. All activities were ranked on a scale of 1-10 with 1 being almost no risk of injury, such as finger painting with non toxic paint to 10 being a good chance of injury, such as riding behind a neighbor’s car on a sled. There was always the reminder that high ranking injury activities would bring them into my ED on a stretcher. I was constantly telling them that the leading cause of death in children from 1-18 was unintentional injury and that injuries were not “accidents”.

Before the birth of my first child, I had childproofed the house with plugs in all outlets and no poisons in lower cabinets. I had posted the number for poison control on the refrigerator and removed all toxic houseplants. Bike riding was helmets only and when in a boat life preservers were mandatory. As they reached adolescence we had a driving contract which prohibited driving after dark for the first year. Since I had seen my share of underage drinking in patients, they were not allowed to stay with friends whose parents were not at home.

Did they have injuries…sure. Two anterior cruciate ligament injuries from team sports, a cut tendon from a knife, a smashed thumb caught in a car door ( A Volvo, of course) and an unavoidable auto crash ( in a 1990 Volvo).

So now that they are adults, I hope they remember the 1-10 injury grading scale when they are making their own decisions. We recently went swimming at a quarry with my oldest son and he was remarking how dangerous it was to dive off the rocks. I think he remembered.


Where does your food come from and how did it get to you?

May 24, 2008

I subscribe to Community Sponsored Agriculture (CSA) , Mattawoman Creek Farms, a local certified organic farm on the Eastern Shore of Virginia. CSA connects local farmers with local consumers. The subscriber purchases a share of the the harvest and in return receives a large bag of fresh local produce weekly during the growing season. In addition to supporting local farmers, CSA provides a direct link between the growing and the consumption of food. I now know how, where, and by whom my food was grown.

CSA gives me the opportunity to try many new local foods such as mizuna, bok choi, and tatsoi. I eagerly look forward to my weekly supply of fresh produce delivered directly from the farm. The iceberg lettuce wrapped in cellophane at the supermarket will have to wait until winter.

Flu Vaccine – Who gives the shot?

May 17, 2008

According to CIDRAP, the recent National Influenza Vaccine Summit led to some heated discussion over where patients receive their flu vaccine – public health clinics, personal physician, or alternative vaccination sites such as grocery stores, workplaces, pharmacies. Some physicians argue that alternative sites leads to fragmentation of health care and steers patients away from their “medical home”

One of the basic problems is who gets vaccine early and who has vaccine left when flu peaks late in the season. Primary care physicians argue that the alternative sites get vaccine first and their patients are tempted to go elsewhere for vaccination. In 15 of the past 25 flu seasons in the U.S. flu peaked in February or March and it is hard to locate providers with vaccine late in the season.

The summit was attended by many participants in the vaccination process such as manufacturers, clinicians, and public health. Hopefully this type of discussion can lead to innovative methods to improve vaccination rates.

Gun Control Legislation

February 17, 2008

On April 16 2007 thirty three people were killed on the campus of Virginia Tech. The NY Times called this the “deadliest shooting rampage in American history”. The killer had a long history of mental illness.

On Jan 18 2008 the Virginia General Assembly House Militia, Police and Public Safety Committee  killed the “gun show loophole” (HB 745 and HB 592) that would have prevented private vendors from selling weapons at gun shows without background checks.

What is wrong here?

Smoking in Restaurants

December 15, 2007

The Governor of Virginia is in favor of a statewide ban on smoking in restaurants and bars. This would protect both the dining public and restaurant employees. In early 2007, a House of Delegates subcommittee rejected a bill passed by the Senate that would have made Virginia restaurants smoke free. Health groups are in favor of the ban but in Virginia business decisions trumped an obvious public health measure.

In June 2006 the U.S.Surgeon General reported that there is no safe level of exposure to second hand smoke.

U.S. Surgeon General Richard H. Carmona today issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. The finding is of major public health concern due to the fact that nearly half of all nonsmoking Americans are still regularly exposed to secondhand smoke.”

The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults. “

Now local city councils in Hampton Roads are attempting to do what should have been done at the state level. They are attempting to ban smoking in restaurants. If the General Assembly is too afraid to pass this bill, they should at least allow the local city councils to act to protect the health of their citizens.

Persons who would benefit the most are restaurant employees who have no control over the air in their workplace. I certainly would not enter a smoke filled restaurant but the staff does not have that choice.

Vaccine Safety – Spoilage

December 6, 2007

The AP reported today that children in several cities have been called back for repeat vaccination after being administered shots using vaccines that have not been maintained at a temperature to prevent spoilage. Inadequate refrigeration can cause vaccines to lose potency. The AP story describes thousands of children requiring re-immunization in several states over the past few years.

An organization called PATH has solved this problem for third world countries. For the past 10 years they have been using a vial monitor sticker about the size of a dime that adheres to the vaccine vial and changes color as the vaccine is exposed to heat. The color alerts the health-care worker if the vaccine is not safe to use for immunizations. PATH worked with WHO and TEMPTIME Corportion to develop the the monitors called (HEATmarker – TM) which are printed on the vaccine vial labels and add only a few cents to the price of the vial. These monitors have saved immunization programs world wide, millions of dollars .

If PATH can solve the problem in remote villages with sporadic electricity in Ghana, we should be able to do as well in the US.

The Purple Room

October 18, 2007

I recently returned from a trip to Coastal Mississippi  working with Habitat for Humanity.  We were building new houses and rehabilitating old houses for Katrina victims. It has been over two years and many people in this area still do not have a place to live other than FEMA trailers. One woman’s house stood out for me. “B” is  a 40 year old woman who is  the primary wage earner for her family. She is  about to move out of a FEMA trailer into a new home on her father’s  land. Her old  house had been washed away by Katrina.  The final job was to paint the walls. The paint she had picked out for her bedroom was purple. I was reminded of the poem by Jenny Joseph “When I am old I will wear purple”. The smile on her face when she saw the room was overwhelming.  I thought,  she has  survived Katrina and lived for over 2 years with her  family in a FEMA trainer, she has earned this room.