Lil' Wayne and I have some things in common. We were both good students, smart kids, who, at the age of 13, handled the gun of an older relative. Holding the handle, I avoided the trigger, but silently, stared down the barrel until I could make out the bullet. I put the gun back in it's worn paper bag, and back into my Grandmother's nightstand.
Lil' Wayne's gun went off and the bullet went through his chest, just missing his heart. He described slipping in his own blood trying to get help.
Many people believe that having a gun in the home provides safety in the case of home invasion. In 2009 it was estimated that 1/2 of American homes have guns. Pediatrics' Gun Safety Guide states that a firearm in the home is up to 43 times more likely to kill or injure a family member or friend than an intruder.
Picture a curious child. See that spouse in a fit of rage against the other, or suicidal thoughts brought on by alcohol and drug use, poor health, poor finances. According to the 7/17/1989 Time magazine article, covering the week of 5/1/89 to 5/7/89, during which 464 U.S. gun deaths occurred, "Despite the cry over street gangs and drug dealers, the week's homicides typically involved people who loved, or hated each other....People in the grip of despondency or disease who turned their weapons on themselves accounted for 216 deaths, nearly half the total. This article, published before my senior year in high school, with its stories of suicide, unintentional gun deaths and so many faces to go with them, convinced me to pursue a career in medicine.
These figures are old I know, and fortunately, the numbers have gone down, but any gun death, with suicide and unintentional gun deaths being especially preventable, is one too many. In 2005, 68% of unintentional gun deaths and 75% of suicides using firearms occurred in the home, occurred in the home according to the CDC's Morbidity and Mortality World Report (MMWR) in April, 2008.
In May, 2010, the MMWR reported that in 2007, 57% of deaths were suicides, and 0.7% were unintentional gun deaths. How many occurred in the home? An average of seventy percent occurred in the home and 51% involved guns.
The highest number of unintentional gun deaths that year occurred in ages 15-19. Parents probably assume kids in this age group know better. Twenty-three percent of those deaths occurred while playing with the gun.
Numerous intellectual outlets, have found that the trend in the data found was that, "both firearm prevalence and questionable storage practices (i.e. storing firearms loaded and unlocked) were associated with higher rates of unintentional firearm deaths." This quote is from the Harvard Injury Control Center, which did a review of 24 articles featured in publications such as Aggression and Violent Behavior, Journal of Trauma, American Journal of Public Health, Pediatrics, and Injury Prevention. This of course also applied to completed suicide attempts and homicide. Lastly, thousands of guns are stolen every year.
What can you do?
1. Lock your handguns. Check for local gun shows for information or even a free lock.
2. Store them unloaded
3. Separate ammunition from the gun and store in a locked container.
4. Apply external safety devices to your gun. Your local police dept. might provide them.
5. Address the curiosity of children in the house, and alert them to the dangers of handling a gun, so they don't find out on their own, alone or with friends.
The Eddie Eagle Program sponsored by the National Rifle Association has advice for children when they come across a gun:
1. STOP!
2. Do not touch it!
3. Leave the area.
4. Tell an adult!
Had I not been so lucky during my few minutes of very poor judgment, I may not have been able to give you this information. I may not have been here at all. Too many loving and talented people were not so fortunate, and we'll never know what they had to offer.
For more information, see About.com's Pediatrics Gun Safety Guide and the Kids' Health's Gun Safety page.
Be safe. Be successful.
Rapp, M.D.
Sunday, August 22, 2010
Friday, August 20, 2010
Children's Eyes More Susceptible to Long Term Damage from UV Rays
August is Children's Eye Health and Safety Month. According to Prevent Blindness America, the nation's oldest volunteer eye health and safety organization, children's eyes are more susceptible to damage from ultraviolet rays.
Why?
They spend more time outside than adults, their lenses allow more light to enter the eye, which allows more UV rays to reach the back of the interior of the eye, the retina. UV damage is cumulative over time and has been associated with cataracts, and macular degeneration among other eye problems.
To help protect the eyes of children, Prevent Blindness America has been educating the public on eye protection since 1908. It advises only purchasing sunglasses with 99-100% UV protection, as those not providing such protection may shade the eyes but allow more rays to enter the eye due to dilation of the pupils. PBA advises that we all wear wide brimmed hats and proper sunglasses.
The organization provides these tips:
1. Only wear sunglasses offering 99-100% UV protection
2. Make sure the glasses fit and shield the eye from all angles.
3. Choose impact resistant lenses made of polycarbonate, never glass, unless prescribed by a doctor.
4. Always check lenses for scratches and other damage.
5. Buy wraparound glasses to protect the eyes and the delicate surrounding skin.
6. Wear them all year round. UV rays reflecting off snow as well as water are "extremely dangerous" says PBA's president Hugh R. Parry.
Where can you get such sunglasses?
Real Kids Shades, a company that manufactures quality shades for infants and toddlers, and older, provides shades offering 99-100 UV protection. They offer infant sunglasses starting art $14.99, and all money goes to fund the Star Pupils program, the new children's eye health and education program of Prevent Blindness America. Call 1-800-331-2020
Enjoy the sun for a lifetime!
Rapp, M.D.
380 Million Eggs Recalled Due to Salmonella Outbreak.
Although no deaths have been reported, almost 2,000 cases of Salmonella (S. Enteritidis) poisoning, have been reported between May and July of this year, 1,300 more than usual, and more cases are expected as the Centers for Disease Control gather more information from the state health departments. It was this outbreak that led to the recall of Wright Country Eggs.Which brands are on the recall list?
Albertson's
Bayview
Boomsma's
Dutch Farms
Farm Fresh
Glenview
Hillandale
James Farms
Kemps
Lucerne
Lund
Moutain Dairy
Nulaid
Pacific Coast
Ralph's
Shoreland
Sunshine
Sun Valley
Trafficanda
There are specific plant ID numbers and Julian dates for recalled brands. This means that not every egg produced by a particular brand has been recalled. Go the the Egg Safety Center for that information.
According to MSNBC, new rules requiring egg producers to do more testing for Salmonella and to take other precautions did not go into effect until July. These rules apparently were in limbo for 10 years after President Clinton first proposed raising egg standards. The Food and Drug Administration says that these new regulations could lower the number of Salmonella cases by 60 percent. More specific information is not available due to an ongoing FDA investigation.
Bayview
Boomsma's
Dutch Farms
Farm Fresh
Glenview
Hillandale
James Farms
Kemps
Lucerne
Lund
Moutain Dairy
Nulaid
Pacific Coast
Ralph's
Shoreland
Sunshine
Sun Valley
Trafficanda
There are specific plant ID numbers and Julian dates for recalled brands. This means that not every egg produced by a particular brand has been recalled. Go the the Egg Safety Center for that information.
According to MSNBC, new rules requiring egg producers to do more testing for Salmonella and to take other precautions did not go into effect until July. These rules apparently were in limbo for 10 years after President Clinton first proposed raising egg standards. The Food and Drug Administration says that these new regulations could lower the number of Salmonella cases by 60 percent. More specific information is not available due to an ongoing FDA investigation.
What is S. Enteritidis? 
Salmonella, along with Campylobacter and E. Coli, is one of the most common causes of bacterial food poisoning. Consumer Reports released a survey in January of this year after purchasing 382 chickens from 100 supermarkets. They included the top 3 brands, Foster Farm, Perdue and Tyson, and organic brands. Perdue was the cleanest name brand, with 56 percent of their chickens infected. They reported that 2/3 of the chickens contained Salmonella and/or Campylobacter. Salmonella lines the intestines of animals like chickens, so infected fecal matter easily contact the shells in the hen's nest. Salmonella can also infect the ovaries of otherwise healthy looking chickens, existing in the eggs before the shell is even formed!
How can I get S. Enteritidis?
A person gets Salmonella by eating foods of animal origin, such as raw or undercooked eggs or chicken. The symptoms of fever, abdominal cramping, and diarrhea, typically start 12-72 hours after eating or drinking contaminated food. A person is usually ill for 4-7 days and most people recover without antibiotic treatment.
What's the worst case scenario?
The worse that happens with Salmonella poisoning is hospitalization, usually needed when diarrhea is severe, causing dehydration. Infants, the elderly, and people with weak immune systems are vulnerable more severe forms of the illness, sometimes called Enteric Fever, which is systemic (in the blood). It is characterized by fever and the abdominal symptoms, a rash, muscle aches, anorexia, and a sore throat. The death rate is about 15 percent, but with antibiotics (ex. Ciprofloxacin, and Beta-lactam antibiotics) is usually less than one percent.
How do you prevent illness?
1. Wash hands, utensils, countertops with soap and water after contact with raw eggs.
2. Don't eat recalled eggs. They may still be in grocery stores, restaurants, and homes. If you have them take them back to your place of purchase for a refund or discard them.
3. Keep eggs refrigerated at less than 45 degrees at all times.
4. Refrigerate all egg containing foods promptly.
5. Don't eat raw eggs. Cook eggs until both the white and yolk are firm. Eat promptly after cooking.
6. Don't keep them warm or at room temperature for more than 2 hours.
7. Avoid restuarant dishes made with raw or undercooked eggs, such as Hollandaise sauce or Caesar salad dressing. Restaurants should always use pasteurized eggs but nothing is 100 percent.
8. Contact your health provider if you have eaten eggs and have become ill.
9. Have young children, the elderly, and people with debilitating illnesses or weakened immune systems avoid eggs.
Salmonella, along with Campylobacter and E. Coli, is one of the most common causes of bacterial food poisoning. Consumer Reports released a survey in January of this year after purchasing 382 chickens from 100 supermarkets. They included the top 3 brands, Foster Farm, Perdue and Tyson, and organic brands. Perdue was the cleanest name brand, with 56 percent of their chickens infected. They reported that 2/3 of the chickens contained Salmonella and/or Campylobacter. Salmonella lines the intestines of animals like chickens, so infected fecal matter easily contact the shells in the hen's nest. Salmonella can also infect the ovaries of otherwise healthy looking chickens, existing in the eggs before the shell is even formed!
How can I get S. Enteritidis?
A person gets Salmonella by eating foods of animal origin, such as raw or undercooked eggs or chicken. The symptoms of fever, abdominal cramping, and diarrhea, typically start 12-72 hours after eating or drinking contaminated food. A person is usually ill for 4-7 days and most people recover without antibiotic treatment.
What's the worst case scenario?
The worse that happens with Salmonella poisoning is hospitalization, usually needed when diarrhea is severe, causing dehydration. Infants, the elderly, and people with weak immune systems are vulnerable more severe forms of the illness, sometimes called Enteric Fever, which is systemic (in the blood). It is characterized by fever and the abdominal symptoms, a rash, muscle aches, anorexia, and a sore throat. The death rate is about 15 percent, but with antibiotics (ex. Ciprofloxacin, and Beta-lactam antibiotics) is usually less than one percent.
How do you prevent illness?
1. Wash hands, utensils, countertops with soap and water after contact with raw eggs.
2. Don't eat recalled eggs. They may still be in grocery stores, restaurants, and homes. If you have them take them back to your place of purchase for a refund or discard them.
3. Keep eggs refrigerated at less than 45 degrees at all times.
4. Refrigerate all egg containing foods promptly.
5. Don't eat raw eggs. Cook eggs until both the white and yolk are firm. Eat promptly after cooking.
6. Don't keep them warm or at room temperature for more than 2 hours.
7. Avoid restuarant dishes made with raw or undercooked eggs, such as Hollandaise sauce or Caesar salad dressing. Restaurants should always use pasteurized eggs but nothing is 100 percent.
8. Contact your health provider if you have eaten eggs and have become ill.
9. Have young children, the elderly, and people with debilitating illnesses or weakened immune systems avoid eggs.
Wednesday, August 11, 2010
Fantasia, For Real?
Did you want to die...or just "escape"?
I must ask this question every time I face a person who has overdosed. A major breakdown in coping mechanisms has occurred, allowing that person to cross an important line: that which kept them from intentionally causing themselves harm until now . How I treat it could mean life or death even after the person has made it to the ER and survived.
The blogs and news reports are saying that Fantasia's overdose was not life threatening. One went so far as to say that she's been through worse than this. I see where the blogger was coming from, she's been through and accomplished a many things, but more thought should be given to that statement.
You cannot minimize going into a closet and taking a bottle of aspirin and sleeping pills in any way, ever.
Aspirin and Tylenol overdoses are so common and so dangerous that whenever I call the National Poison Control Center (1-800-222-1222) to report an overdose, the center usually advises that I get blood aspirin and tylenol levels, even if the person took pills that have nothing to do with the two.
Why? Aspirin and sleeping pill overdoses can cause kidney failure, coma, seizures, disturbances in the rhythm of your heartbeat (dysrhythmias, arrhythmias), and drowning in your own fluids as your lungs become overwhelmed by said fluid. Many of these can lead to death. This is what we ER Dr's have to consider, prevent, and treat for a person who overdosed the way Fantasia did. The amount of aspirin and sleeping pills Fantasia took may not have been life threatening, but the behavior certainly was.
Once a person crosses the line that kept him or her from hurting themselves, in seriously considering or attempting suicide, or merely dealing with stress, the risk of it happening again is higher. This is why the mind must be addressed once the body has recovered. One cannot just wake up and go home. The situation that caused the person to do it usually has not changed, and now the person has a lower threshold for doing it again. The reason does not matter. I committed a man old enough to be my father to 3 days in a mental facility because he told his family, the paramedics, and me that he was suicidal. "I only did it to upset my daughters," he said. Too late.
Healthy stress management and coping skills must be taught and reinforced. If you or someone you know ever feels this way, talk to someone, a friend, parents, counselor, pastor, rabbi, anyone you trust. Try to let go of things you cannot control. Attempt to resolve conflicts with the source of it in a calm manner. Remember, nothing is worth inflicting permanent damage upon your own body, or taking a life. The problem is usually temporary. The physical and mental damage you cause yourself may not be.
Be safe, be successful,
RAPP M.D.
Monday, August 9, 2010
Subconjunctival Hemorrage
A subconjunctival hemorrhage is bleeding below the transparent layer of the eye called the conjunctiva.
Causes
What causes it? Violent sneezing, coughing, vomiting, heavy lifting and minor blunt trauma. People at risk for this condition are those with diabetes, high blood pressure, and those who take blood thinners such as aspirin and coumadin (warfarin). Subconjunctival hemorrhages may sometimes present without a known cause.
Symptoms
The most discomforting aspect of a subconjunctival hemorrhage is its appearance. You may not realize that you have a subconjunctival hemorrhage until you see yourself in the mirror. The blood is tends to be bright red, and is flat, meaning it does not bulge against your eyelids. It is often painless, but one may experience a slight itching sensation. Your vision is not affected.
Evaluation
While subconjunctival hemorrhages are benign, it is important to distinguish it from more serious conditions such as a bloody chemosis which is more likely to bulge, and is associated with rupture of the sclera (white part of the eye), and cavernous sinus thrombosis (blood clot in a blood vessel of the brain). Also, in the setting of trauma, if a subconjunctival hemorrhage is located at the far lateral (toward the ear versus the nose) portion of the eye, it can mean a person has a fracture of the zygomatic arch (cheekbone).
Treatment
No treatment is required. The body will absorb the blood over 10-14 days. Recurring episodes require evaluation for bleeding disorders or uncontrolled high blood pressure.
For this and more information, check out the Mayo Clinic, American Optometric Association websites, and Knoop, Stack, and Storrow's Atlas of Emergency Medicine, 2nd Edition.
Causes
What causes it? Violent sneezing, coughing, vomiting, heavy lifting and minor blunt trauma. People at risk for this condition are those with diabetes, high blood pressure, and those who take blood thinners such as aspirin and coumadin (warfarin). Subconjunctival hemorrhages may sometimes present without a known cause.
Symptoms
The most discomforting aspect of a subconjunctival hemorrhage is its appearance. You may not realize that you have a subconjunctival hemorrhage until you see yourself in the mirror. The blood is tends to be bright red, and is flat, meaning it does not bulge against your eyelids. It is often painless, but one may experience a slight itching sensation. Your vision is not affected.
Evaluation
While subconjunctival hemorrhages are benign, it is important to distinguish it from more serious conditions such as a bloody chemosis which is more likely to bulge, and is associated with rupture of the sclera (white part of the eye), and cavernous sinus thrombosis (blood clot in a blood vessel of the brain). Also, in the setting of trauma, if a subconjunctival hemorrhage is located at the far lateral (toward the ear versus the nose) portion of the eye, it can mean a person has a fracture of the zygomatic arch (cheekbone).
Treatment
No treatment is required. The body will absorb the blood over 10-14 days. Recurring episodes require evaluation for bleeding disorders or uncontrolled high blood pressure.
For this and more information, check out the Mayo Clinic, American Optometric Association websites, and Knoop, Stack, and Storrow's Atlas of Emergency Medicine, 2nd Edition.
Monday, August 2, 2010
Let's Talk Blood Pressure
I know, you think you've heard all there is about hypertension ( high blood pressure). You think every one has heard enough. I start to think the same but then I have yet another another patient present for cold and allergy symptoms, and I end up treating him or her for their dangerously high blood pressure.
What is blood pressure?
Our blood pressure is the force created by our blood against the walls of our arteries as it circulates through our bodies. If changes constantly throughout the day. If it stays high for a long time, it becomes dangerous, putting us at risk for heart disease and stroke, which are the 1st and 3rd leading killers of people in the U.S. Another dangerous thing about high blood pressure is that it may have nonspecific symptoms, such as a headache, fatigue, blurred vision, or nosebleeds, or absolutely no symptoms at all.
What is high blood pressure? Who is at risk?
Normal blood pressure is less than 120/80, at risk is 120-139/ 80-89, and high is 140/90 or higher.
One in every 3 American adults has high blood pressure. According the the American Heart Association, in 2006, the death rate for black men was 51.1 per 100,000 people. For white men, it was 15.6 per 100,000. For black women it was 37.7, and for white women it was 14.3.
Within the black community, those at most risk tend to be middle aged or older, less educated, overweight or obese, physically inactive, and have diabetes.
What can be done to reduce that risk?
Eat a healthy diet, containing plenty of fruits and vegetables. Exercise. Start with a walk around the block. Limit alcohol use. Stop smoking. Prevent or manage your diabetes. See your doctor, go to your nearest Harris County Health Center, or www.CDC.gov for this and more information.
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