Friday, March 28, 2008


Second hand smoke is a significant health risk to children

When a 2-year-old with severe asthma symptoms was recently released from the hospital, one of the things I discussed with his mother was the dangers of a second hand smoke.

General warnings from the surgeon general and the media mainly focus on smokers themselves. Enactment of laws in recent years banning smoking from restaurants and bars were done to prevent exposure to smoke by the general public. However, there is still no major initiative to educate people about the hazards of smoking for household members, especially children.

What is second hand smoke?

Smoke inhaled by non-smokers is referred to as second hand smoke. At present, 1.1 billion adults worldwide are smokers, making it inevitable that children and the two-thirds of adults who do not smoke are being exposed in some fashion.

Second hand smoke is a mixture of side stream smoke given off by the smoldering cigarette (or pipe or cigar) and of the mainstream smoke that is blown out in to the air by active smokers. Side stream smoke generated under the lower temperature conditions in the smoldering cigarette has a higher concentration of many of the toxic compounds, including nicotine and carbon monoxide. Effects can be much worse in the winter months because of indoor environments and cars with closed windows.

What are the consequences of second hand smoke?

There have been multiple public health reports in the United States and worldwide identifying the specific health risks associated with second hand smoke in children as well as in adults.

Risks for children include:
• Premature births and deaths among newborns
• Reduced birth weight
• Sudden infant syndrome (SIDS)
• Multiple chest infections
• Long lasting colds and chest infections
• Worsening of asthma and other chest conditions and poor lung function
• Multiple ear infections

Exposure to second hand smoke is a significant public health issue and affects both quality of life and healthcare costs.

On average, studies have shown that children exposed to smoke are more likely to be sick and miss school compared to children of non-smoking parents. Adverse effects of smoking by pregnant mothers and to mothers that are exposed to second hand smoking include reduced birth weights, more birth defects as well as an estimated 20-40% increase in sudden infant death syndrome, to name a few. The risk of Sudden Infant Death Syndrome increases with the number of cigarettes smoked per day.

There is increased incidence of cough, phlegm, and wheezing in the children of smokers. The risk of developing chest infection is as high as 50 % if either parent smokes compared to children of non-smoking parents. Those children who have asthma suffer from many more exacerbations (asthma attacks). Their asthma is much more severe and they end up having many more emergency room visits, hospital admissions and missed school days.

Other effects of the second hand smoke include increased incidence of dental problems and childhood cancers including leukemia, lymphoma and brain tumors.

What needs to be done?

Parents should consult their doctors and get help to quit smoking. Partners of pregnant women should avoid smoking around them, especially those with children with asthmas and allergies.

I cannot stress enough that the bad effects of exposure to smoke begin inside the uterus and continue throughout childhood. Avoid smoking at all costs -- your children’s health depends on it.

Ravi Prakash, MD, is a pediatrician on the Backus Hospital Medical Staff with a private practice in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Prakash and all of the Healthy Living columnists at

Thursday, March 20, 2008


Children and adults are vulnerable to poisonings, usually involving meds

Last year more than two million poisonings were reported to poison control centers around the country.

Accidental poisoning is the second-leading cause of home-injury death, and the risk is not just in homes with young children. Although children under the age of five have the highest rate of poisonings, adults account for 35% of all poisonings. The most common substances involved are medications.

Young children are naturally curious and often explore their environment by placing things in their mouth. Make-up, household cleaners and medications (including vitamins and herbal products) are common items in all homes that can be dangerous when ingested. Older children who cannot yet read labels will often mistake medicine for candy and bright colored cleaning agents for juice.

If left in an accessible area to little hands, disaster can occur.

Using child-resistant containers and keeping medicines and cleaners locked-up are important steps to take to keep little ones safe.

When struggling to get a young child to take their medicine, never refer to it as “candy”. Young children need to be taught that medicine is important and should only be used when given by an adult.

It also is not enough to just child-proof your own home; neighbors’ and grandparents’ homes, any home were the child spends time, needs to be safe. If you are a woman and keep medication in your purse, be especially cautious around toddlers. They love to search through bags looking for goodies and may find a non-child resistant pill box.

Older adults, especially those taking multiple medications, are also at a high risk for poisoning. Accidently taking the wrong medication, taking someone else’s medication, and taking a medication twice are common reasons for adult poisonings. Multiple distractions, poor lighting and hard to read prescription labels are often the cause.

Many seniors also save unused medications thinking they may be able to use them again in the future. This leads to overflowing medicine cabinets and pill bottle confusion. Not to mention the poisonous drug interactions that can occur when searching for old medications that may not safely mix with new ones you now have.

Using a pill box to keep track of medications, communicating with your doctor and pharmacist about over the counter and herbal medications you use, and properly disposing of unneeded medications are key steps in preventing medication poisonings in adults.

Only take medications in well lit areas and decrease the number of distractions that can occur. Never share your medications with friends; what works for your headache could be deadly for your friend.

Backus Hospital will host a poison prevention seminar in honor of Poison Prevention Week on March 26 at 6 p.m. in the hospital auditorium. “Poison Prevention for the Whole Family” will offer tips for both young and old, the family pet too, as well as suggestions for safe and proper medication disposal. To register, call 823-6374.

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Smith and all of the Healthy Living columnists at

Friday, March 14, 2008


Eating right on St. Patrick’s Day takes more than just the luck of the Irish

Being part Irish I grew up celebrating St. Patrick’s Day with the traditional feast of corned beef and cabbage. The enticing aromas and flavors from this dish made it a holiday favorite in my family. Many restaurants, no doubt, will offer this dish as a special on March 17.

But before you place that order, consider what the term “corned” really means. It has nothing to do with the vegetable you can eat on or off the cob, but everything to do with salt.

Back in Anglo-Saxon times meat was preserved by dry curing it with coarse “corns” of salt. Pellets of salt (some as large as corn kernels) were rubbed into beef to keep it from spoiling. Dry-curing has now been replaced with the process of “brining” or using a salt-water bath to flavor and preserve meat.

In practice I have had patients ask me if they should avoid corned beef on a low salt diet.

I think this is best answered by providing some basic facts: According to the U.S. Dietary Guidelines (2005), individuals with hypertension, African Americans, and middle aged and older adults may be more “salt sensitive” than others and should aim to consume less than 1500 mg of sodium per day. For younger individuals and those without hypertension, consume less than 2300 mg per day. Consider that a 3 oz piece of cured, cooked corned beef brisket contains 964 mg of sodium. If you go for seconds on the corned beef and you have high blood pressure you could easily exceed your recommended sodium allowance for the day.

What to do?
 Look for lower sodium brands of corned beef; have a small portion (2 oz) and forego adding additional salt in cooking, at the table, or in the form of condiments (like relish and mustard).
 Think beyond corned beef and cabbage and celebrate St. Patrick’s Day by eating vegetables in shades of green. Green veggies will not only help you get in the spirit, they’ll provide color, texture and flavor to your meals. Low in calories, green vegetables can be a good source of nutrients like Vitamin C, folate, potassium and Vitamin K, to name a few. Protective compounds found in green vegetables may promote eye health and lower your risk of heart disease and some cancers, too.

There are many ways to incorporate more green vegetables into your St. Patrick’s Day feast, or any other meal for that matter:
 Serve grilled or roasted fish, chicken or meat on a bed of wilted greens like
 Snack on raw broccoli spears or green peppers.
 Experiment by adding different lettuces to sandwiches i.e., romaine, green-leaf, baby spinach.
 Add broccoli slaw to salads, sandwiches or stir-fries.
 Enjoy sides of steamed asparagus, crisp snow-peas, or sautéed collard greens.
 Add chopped broccoli or spinach to lasagna or manicotti fillings.

However you celebrate St. Patrick’s Day, keep your healthy eating goals in sight and you just may find good luck at the end of the rainbow.

Catherine Schneider is a Registered Dietitian in the Food and Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Ms. Schneider and all of the Healthy Living columnists at

Friday, March 07, 2008


Parkinson’s Disease

The term “Parkinson’s disease” elicits images of old, feeble patients unable to move enough to care for themselves. When Michael J. Fox became afflicted with Parkinson’s disease, that image changed.

Parkinson’s disease is part of a broad category of neurological illnesses termed neuro-degenerative diseases. Sadly, they are chronic and slowly progressive. Neuro-degenerative diseases are primarily seen in the elderly. As longevity increases, the numbers of those afflicted will continue to rise. Parkinson’s disease specifically affects motor function and is classified as a movement disorder. Over one million people in the United States alone suffer from Parkinson’s disease.

Cells deep in the brain produce a neurotransmitter called dopamine. They are the principal targets in Parkinson’s disease and become either lost or blocked. Dopamine is crucial for motor nerves to coordinate muscle movement. A lack of dopamine results in uncontrollable shaking (tremors), slowed movements (bradykinesia), and joint stiffness (rigidity). Dopamine replacement with a drug called L-DOPA has been the basis for treatment during the past 50 years. Over time, L-DOPA becomes ineffective.

In 1982, Parkinson’s research changed dramatically. Until then, there were no models for testing new treatments. It was in 1982 that a chemical called MPPP was manufactured in primitive home laboratories and sold on the streets of San Francisco as synthetic heroine. MPPP was easily contaminated and could become MPTP. When MPTP is injected, it immediately destroys the cells which produce dopamine. Hospitals began admitting young people with severe, advanced Parkinsonian symptoms. This created that needed model and an urgency for the development of new treatments.

Today, there are many drugs that are used in various combinations to improve motor function in patients with Parkinson’s disease:

• Carbidopa/Levodopa boosts the level of dopamine in the brain.
• Rasagiline slows the enzymes which breakdown dopamine in the brain.
• Ropinirole increases the sensitivity of dopamine receptors.

“This is a very exciting and encouraging time to be involved in treating Parkinson’s disease,” said Dr. Maria L. Moro-de-Casillas, a neurologist who specializes in the treatment of Parkinson’s disease. “Over 70 percent of my patients are able to function independently.”

In addition to a vast armamentarium of medications, surgical treatments including deep brain stimulation hold great promise.

In tomorrow’s Healthy Sports column, some unconventional treatments for Parkinson’s disease will be discussed.

Anthony G. Alessi, MD, is a neurologist on The William W. Backus Hospital Medical Staff in private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Dr. Alessi, or any of the Healthy Living columnists at

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