Hypothermia and Frostbite

As I was walking through the neighborhood tonight, I realized that winter has finally come to east Tennessee. No longer do we have the wet and balmy weather as we did over the holidays. The clear, starry sky appears beautiful until I realize my cheeks sting. And though we live south of the Mason-Dixon line, we can still be struck by such winter hazards as hypothermia and frostbite. Whether playing in the backyard, hiking the local trails, or fishing in the nearby streams and lakes, the cold weather can cause our body temperature to drop from 98.6 degrees to 95 degrees or less. This temperature change can cause shivering, clumsiness, and poor hand coordination. In addition, cognitive functioning slips with confusion, memory loss, slurred speech, and exhaustion. This state of lower body temperature with some or all of these symptoms is called hypothermia.Frostbite is a localized injury to the body where the tissue starts to freeze. The signs start with redness and pain to skin which then can become numb, white and firm. See the following articles, “Winter Weather Frequently Asked Question” and “Cold Weather Injuries” for further information on hypothermia and frostbite including prevention and management:


Two other factors besides temperature increase the risk for hypothermia and frostbite: wind and water. Wind can make the ambient temperature drop significantly – causing exposed skin to develop frostbite and core body temperature to drop to 95 degrees (hypothermia). For example, a 40 degree day with 30 mph winds generates a windchill temperature of 28 degrees; a 15 degree day with 20 mph winds generates a windchill temperature of -2 degrees. Wind can make a day much colder than the thermometer indicates. Be sure to take wind into account when planning outdoor excursions. Have clothing to block the wind, and avoid exposed skin on very cold and windy days. See the following National Weather Service Windchill Chart:


Water can also hasten temperature loss and increase the risk for hypothermia. Whether drenched by rain, by snow, or by accidental immersion in a stream or pond, our wet bodies will drop their temperature much more quickly than when they remain dry. Cold and water are not a good mixture. When outdoors during cold and wet weather, avoid cotton (as it absorbs moisture and loses its insulatory properties). Rather, dress in layers with a wicking base layer, an insulating middle layer of fleece or synthetic material, and a windproof, waterproof outer layer. Furthermore, even during a warm day, an unfortunate plunge or fall in very cold water like the Little River or Chilhowee Lake can lead to hypothermia. Review the following article, “”Hypothermia Prevention: Survival in Cold Water” for further information on hypothermia and water exposure:


Winter is a wonderful time of year to explore the outdoors at home and afield, but remember to practice these safety tips.

Family Resolutions for a Healthier 2016

It’s a new year!  Why not get the entire family involved in living a healthier lifestyle?  This can be done using the 0-5 easy steps listed below: 

0:  Eliminate sugary beverages to zero (none) in your family’s diet.

1:  Incorporate one hour of physical activity per day into everyone’s daily routine.

2:  Limit screen time for you and your children to less than two hours per day.  This includes televisions,     computers, and cell phones.

3.  Eat three servings of low-fat milk products daily.  Skim milk, yogurt, and cheese are examples.

4.  Drink four servings of water every day.  A serving size is 4-6 ounces for young children and 10-12 ounces     for older children and adults.

5.  Eat five servings of fruits and / or vegetables each day.

To make these lifestyle changes easier to become habits for your family, try to introduce 1 or 2 each month.   Becoming physically active as a family can be a simple as playing ball, hiking local trails, riding bikes, roller skating, dancing, or walking the dog.  It may be more practical to “get moving” in short 15-20 minute segments.  Keep food portions the size of the individual’s fist.  Only fruits or vegetables should be offered for second helpings. 

http://www.choosemyplate.gov provides practical information to individuals to help build healthier diets with resources and tools for dietary assessment, nutrition education, and other user-friendly nutrition information. The online resources can empower parents and guardians to make healthier food choices for themselves and their children.

Here’s to a healthier 2016!  Good luck!


Ski Season, Head Protection and How to Avoid Injury

I’ve been thinking a lot about head protection lately. My Mom knocked her head pretty hard a couple of years ago and although some people might argue that she always was a little forgetful before she hit her head, she sure has some memory problems now. My friend’s father had a garage door fall on his head. He developed a head bleed and subsequent dementia. Dr Robert Atkins, the creator of the Atkins Diet, slipped on the ice in New York City and hit his head. He died a week later from his head injury. It makes me think that we should all be wearing helmets. On my 65th birthday (which isn’t too far away) I plan to wear a helmet to work. When people ask who your pediatrician is, you can tell them it’s that weird guy that’s always wearing a helmet!

Being a pediatrician, of course, I’m more interested in protecting children’s heads. With ski season upon us, I would like to urge skiers to wear a helmet. The National Ski Areas Association (NSAA) reported that in 2003 only 25% of skiers wore helmets, their data shows that in 2012:

91% of children 9 years old or younger wore ski/snowboard helmets

81% of children 10 to 14 wore helmets

53% of adults 18 to 24 wore helmets

78% of adults over the age of 65 wore helmets

According to Dr Jasper Shealy, Professor Emeritus of the Rochester Institute of Technology in Rochester, NY, the use of a helmet while skiing or snowboarding reduces the chance of head injury by 30 to 50%.  The best way to avoid any injury however is to follow the steps of Your Responsibility Code including:  stay in control, stop in a safe place for you and others and when starting downhill or merging, look uphill and yield. It is also important to obey signs designating slow zones and intersecting areas. It is recommended that all skiers and snowboarders share the slopes and always show respect for others-which we should do all the time anyway.

Why Do Young People Begin to Use Mood Altering Drugs?

Working in the field of addiction medicine for the last 35 years and as a practicing pediatrician for the last 20 years has allowed me to draw several conclusions about substance abuse and addiction in adolescents and young adults.  Is adolescent addiction a recent disease of the new millennium? Certainly not. Have the reasons that adolescents begin to abuse drugs changed in the last 50 years? No, the reasons are the same.  Have the substances of abuse morphed over the last decade. Yes, and that is a particular concern for myself and other practicing pediatricians.

Why do young people begin to use mood altering drugs?  Most people assume that young people begin to abuse drugs to feel good.  And that is certainly the case for many.  The young adult goes away to college and joins a fraternity and begins to use alcohol and pot and nicotine and other gateway drugs to feel good and to have a good time.  That’s why they are called mood altering drugs.  What most people do not understand is for the vast majority of young adults who progress to addiction, these individuals more commonly begin to use mood altering drugs to relieve pain. Perhaps as a child they suffered from an undiagnosed and untreated attention deficit disorder or learning disability.  We know that both of these disorders lead to low self-esteem in a young person. If a child doesn’t feel good about himself, doesn’t feel like he fits in or belongs he will invariably gravitate to others in the school with the same low self-esteem. These young people will often begin to look for substances that make them feel better. Children can be physically abused, sexually abused or more commonly emotionally abused. Any type of abuse in childhood will also predictably lead to a feeling of reduced self worth which again frequently results in the child looking for a substance to make him feel whole again.

Other examples might be the child who has an emotionally ill parent.  When a parent is depressed, that parent is unable to be emotionally available to the child.  This lack of emotional attachment will cause the child to feel empty inside, like there is something missing.  This situation will also lead the young adult to look for something to fill that hole.  Im not placing blame here. The parent desperately does not want to be depressed.  But the bottom line is that the parents depression does negatively affect a child. A parent could be addicted to alcohol, drugs, gambling, or work.  A parent who is actively addicted cannot be emotionally available so this child too feels empty and will eventually look for a substance to fill that void.

Young people begin to use mood altering drugs to feel good or more commonly to relieve pain.  They learns the principle “better living through chemistry”.  For a while, the gateway drug will work just fine but as the child develops a tolerance for the drug and the drug becomes less effective he will usually move on to another drug and that drug will work for a while but then quit working.  Eventually the young person will progress to the point that no matter what he uses the drugs do not work anymore. When the drugs quit working, why doesn’t he just stop?  Because as the substance abuse has progressed over months or years many of these children will cross the wall to become chemically dependent.  Chemical dependency is a chronic, progressive, biogenetic disease.  How do we know when a child has crossed this wall?  He’s developed the primary compulsion to use the drug.  He no longer uses the drug to to feel good or to relieve pain.  He uses the drug because he has a compulsion to use.  He will lie, steal, cheat, whatever it takes to get the drug.  He hasn’t suddenly become a sociopath or a bad person.  His compulsion to use the drug causes him to violate his own moral code fuleing his feelings of low self-worth and emptiness.

Different drugs have different addition potentials and variable levels of compulsivity.  Alcohol and pot may take many months or even years to activate addiction.  While cocaine and opiates can activate addiction in a matter of weeks or a few months. The reality is that usually when a young person begins to abuse cocaine and opiates he has already crossed the wall.  The problem with the “harder” drugs in general and the opiates in particular is that the compulsivity is extreme. Every waking moment the young person is thinking about where can I get my next dose.

And that brings me to events I have witnessed over the last 5 years in addiction medicine. Many young people entering treatment for chemical dependency are dependent on opiates.  Up until a couple of years ago the opiate dependency was usually limited to oral narcotics like hydrocodone. More recently, however, I’ve worked with a number of young people addicted to IV heroin.  IV heroin addiction causes the disease to progress at an exponential rate and will frequently lead to death in less than 2 years.

If there is any good news here, it’s that  chemical dependency is a very treatable though not curable disease.  With help and appropriate treatment and support young people can and do recover from this disease.  Recovery is also progressive.  As the young person gets better “one day at a time” he will reach that point that he loses all compulsion to use drugs.  And as long as he has internalized the first step of his recovery program “I am powerless over drugs” and chooses not to use mood altering drugs again he will be forever free of the compulsion to use.


Gardening, Endorphins and Dishes

I like weeding. There, I’ve said it. That feeling of satisfaction when a dandelion pulls right out, roots and all and leaves my beloved Shooting Star intact, is hard to match. I know there are others of you out there that know what I mean. Gardening has a way of leaving me with a sense of satisfaction and calmness that few other things do. Watching my garden evolve though the seasons always brings a smile to my face. An empty bed is just sleeping waiting on the warmth of spring to inspire the plants there to bring on their show. A freshly weeded bed will actually stay nice and neat for weeks, unlike my house. Dishes and clothes propagate in my house just like the weeds in my garden but seem to reappear in a matter of minutes instead of weeks after they are cleared. I just read an article that says natural endorphins are
released when you dig in the dirt. Maybe that is part of it.