All Children Bump their Heads, Not all Children Should Get a CT Scan if they Do

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All Children Bump their Heads, 
Not all Children Should Get a CT Scan if they Do


Whenever a child bumps their head, we have to ask- "Are they OK?"


This is a very fair question.


The main reason they might not be, is that when you bump your head,
you bump your brain.  So when you bump your head, we want to be 
sure the brain is OK.


Now and then, stories of seemingly minor head injuries end with 
tragic loss of brain function.


This is a real problem, because every child will bump their head, 
and far, far more than 99% will experience no injury to their brain at all.


The key is to know when to worry, and recently, an article was published
in The Lancet (Sept. 15, 2009) that helps.  In this study, about 42,000
children, ages 18 and younger, had an accident with a bike, car, or 
serious fall.  About 15,000 had a CT scan done, and only 780 or
5% of them had anything wrong with their CT scan.


The real value of the article is that they were able to list 6 items, 
that if your child does not have one, the CT scan was normal.


For kids 2 and older the six signs were:

• Loss of consciousness (can't be awakened at all)
• Altered mental state (can't stay awake or act normally)
• Signs of a skull fracture
• Vomiting
• Headaches
• A high speed impact (like a car accident)

For kids under 2 years old the six signs were:

• Loss of consciousness (can't be awakened at all)
• Altered mental state (can't stay awake or act normally)
• Signs of a skull fracture
• Scalp swelling (beyond just a goosegg)
• Unusual behavior
• A high speed impact (like a car accident)

It is estimated by just not getting a CT scan after a head injury, about 

20-25% of all CT scans for head injury could be avoided, while not missing

any problem with the brain.

BOTTOM LINE

• Every child will hit his or her head during childhood
• The main concern is brain safety after a bump
• Hitting your head while on the ground, while standing, without any change in behavior, alertness, vomiting, severe pain, or unusual swelling almost never results in any injury to the brain that can be seen on a CT scan.
• The situation to worry about is mainly when something increases the impact, such as:
• Falling from a height
• Two fast runners colliding
• Skating rapidly on ice
• HIt in or by a car, bicycle,  other vehicle
• Again, a slow bump with no symptoms means the brain should be fine.

Feel free to call if you ever are unsure.

Dr. Arthur Lavin

A couple of point

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

www.chefsgarden.com A Source of Truly Great Food

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www.chefsgarden.com  
A New Source of Truly Great Food


Dear Families,

Over the years, we have discussed what is a good diet.

Today, I would like to let you know about a source of some of the
best food in the world, right in Northern Ohio.

Many have heard me state that the answer is fairly straightforward.


The best foods are:

• Fruits and vegetables
• Whole grains

Unfortunately, the situation can get far more complicated when

you seek foods that also are free of toxins, taste good, and

are raised in an environmentally safe process.

Today, I had the pleasure and honor to visit a truly extraordinary

farm and source of food: Chef's Garden.

Located in Huron, OH, Chef's Garden was established by the Jones

family, and in the 1980's developed an approach to growing

vegetables that has captured the attention of some of the world's

greatest chefs.

For example, Chef Alain Ducasse, is the only chef in the world to own five, five-star

restaurants. When he opened his NYC restaurant, he turned to Chef's Garden

as the place in the United States offering the best tasting vegetables.

Many of America, and the world's truly outstanding chefs insist on having their

vegetables grown at Chef's Garden.

What makes these vegetables different?

• It turns out the soil and environment near Lake Erie are ideal for farming vegetables and herbs
• The Chef's Garden approach uses no chemicals, no fertilizers, no manure.
• The soil nutrients are developed over time by use of fallow technique, cover crops, and vegetable composting.

These techniques, as well as many others, create a soil that has a rich and varied

set of normally occurring soil bacteria and fungi, each critical to the development of

nutrition in each vegetable and to the development of stunning flavors.

Chef's Garden also culls the world's seed supply for outstanding varieties, many

of which date back many, many years.

For those who recoil at the mention of bacteria and fungi, keep in mind that the use

of fertilizers over the last 70 years has decreased the nutritive value of American

vegetables by 47% and rendered them essentially without flavor.

The techniques used by Chef's Garden has restored this lost nutritive value

while, at the same time, removing any and all dangerous chemicals from

these foods.

I also learned these important points regarding the safety and taste of foods you buy:


Certified organic foods. This designation reflects standards set by agencies
that do not cover all the concerns noted above. This designation has nothing to
say about whether the foods are exposed to chemicals after harvest. For example, 
pest poison could be spread on the foods during transport. Organic foods are not 
nearly as free of chemical exposure as the foods from Chef's Garden, which are 
completely chemical free from planting to delivery.


Washing is no guarantee of safety. Chemicals in the soil enter the plant, and no
amount of washing will remove them.


Foreign vegetables. Sometimes a sign that a vegetable or fruit is from an exotic
country brings to mind bucolic, safer agriculture. Beware. It more often means that
there is no, or far less, regulation on the use of chemicals. Fertilizer, pesticide, and other chemicals are actually used to a far, far greater extent outside the US.

These and other points make choosing safe and tasty food for your family like
jumping through an obstacle course!

This is what makes the food at Chef's Garden such an extraordinary resource, and within

a hundred miles of your home!

So please, I invite you to go to www.chefs-garden.com, explore the site. I do not know their

prices, but I do encourage you to take a look. There is no question this is some of the

best-tasting, safest, most nutritious food you could find.

While at the site, also check out the Veggie U, an extraordinary set of materials, seeds,

and curriculum for 4th graders that promotes good nutrition and food choices.

This great program has been offered at over 5000 classrooms across 24 states, and

is quite reasonable in cost.

Here is to healthy, great-tasting food.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Stomach Flu: A Primer

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Stomach Flu:

What it is

When to worry

What to do

Stomach flu comes in seasons, and Cleveland has just entered its winter season

of stomach flu.  So here is some guidance to help you if your family catches it.

What it is

• Stomach flu is an infection.
• The germ is a virus.
• The infected part of the body is the gut- typically the stomach,
• small intestine, and large intestine.

The virus this time of year is a species called rotavirus.

Rotavirus has the very curious property of traveling in waves

across the US every year.

Every year waves of rotavirus sweep across the United States,

starting in the Southwest, ending up in the Northeast.

Our part of the country sees it arrive usually sometime in January, 

and leave sometime by May.

This year it hit Cleveland sometime around January 4-5.

You can only get rotavirus infection, or really any stomach flu,

by having the virus land in your gut, and that has to happen 

by swallowing the virus.  The virus can only come from another person.

So like all viruses, the only cause is catching the virus.

You cannot get stomach flu by getting chilled, or wet, or any other

way but catching the virus.

Once the virus is in your gut, here is how it makes you sick.

The virus is quite good at getting inside your cells, taking them

over, forcing them to make billions of new viruses, and thereby

popping or killing the cell.  The infection only ends when your 

immune system kills every cell of yours that has a virus in it.

When the virus kills the cells of the gut, it kills mainly the cells on the

lining of the gut.  This leaves the lining greatly damaged, very similar

to being burned, and is main event explaining nearly all the symptoms of stomach flu. 

When the virus is in the stomach, the burn of the lining

mainly causes vomiting.

When the virus is in the intestines, the burn of the lining

mainly causes diarrhea.

Wherever the lining is damaged or burned, the inflammation

that results makes you feel awful and also causes fever.

As with every illness, when you feel lousy you:

• Don't eat well
• Don't sleep well
• Don't act well

When to worry

With stomach flu, the main things to watch out for are:

1. Dehydration
2. Severe abdominal pain
3. Bloody diarrhea

Dehydration

Dehydration is the state of lacking enough water to function well.

Our bodies are about 66-70% water, so each of us is a bag 

made up mostly of water.  That is why getting water all the time 

is so important.

Dehydration is not the same problem as vomiting alot or having loads 

of diarrhea.  You can be terribly dehydrated with very little vomiting or diarrhea, 

and you have quiet severe vomiting and/or diarrhea and not be dehydrated.

So how do you know if you are dehydrated?

You should worry about dehydration if you see these signs appear:

• Very decreased or no urination
• Sunken eyes 
• Dry cracked lips and mouth
• A wilted appearance, like a plant that has not been watered for weeks

Dehydrated kids are often very irritable, but so are kids who are ill but not dehydrated.

But if your child  is acting well, not irritable, it is unlikely they are dehydrated.

Severe abdominal pain
Everyone gets stomach aches with stomach flu, but you need to worry when the 
pain gets severe.


How do you know?  Severe abdominal pain has some important features:

• It really hurts alot, more than the usual tummy ache
• It keeps going and does not stop
• It gets worse every hour
• It seems to happen at one specific spot that you can touch with your finger

If you see these features, call for guidance and help.

If your pain is not that severe, comes and goes completely, does not get worse 

over time, and feels lousy all over the tummy area, it is less severe.

Bloody diarrhea

That's easy to know if present or not:

No blood, no bloody diarrhea,

Blood in the stool means bloody diarrhea.

What to do

In General

As with any viral illness, there is no medication that will cure the illness
or heal the burn-like impact on the lining of the gut.


In the absence of a cure, all efforts to help fall into the category of comforts.


Cures have to be taken no matter how they taste or feel.

Comforts are only helpful if they comfort, so your child has total
say over whether they work.


The key comforts for stomach flu are:

• Fever control and pain relief- with ibuprofen or acetaminophen
• Fluid- water, flat soda, pedialyte, they all work well.
• Being held or massaged

Notice that eating food itself is less important than taking fluids.  See below for more

on this important point.

During heavy vomiting

If your child is vomiting enough that he or she cannot drink fluids, try 
giving 1 teaspoon of fluid every 5 minutes


If you do this for 8 hours, you will get 16 ounces of fluid in, plenty to avoid 
dehydration.


Why a teaspoon- it's enough to get 16 ounces in a day, and small enough to be 
absorbed before it hits the stomach and get expelled.


Heavy vomiting lasts about 2-3 days on average and since the stomach is at the 
start of the gut, usually comes before the diarrhea or with it.


During diarrhea, after vomiting
Once vomiting stops, you can feed your child any fluid, including water, flat soda,
soup, pedialyte,  but also food.


Bland foods like potatoes, bananas, rice, applesauce, and toast are well-tolerated.


Avoid hot spicy foods, but most kids do anyway.


Diarrhea is just like the runny nose of a cold.  In both situations, a lining 
is damaged/burned, and fluid leaks out.


Just as with a runny nose, sometimes the lining heals in a day, sometimes
in a week, sometimes in a month.


Typically diarrhea goes on for 1-2 weeks, but if your child looks well in a week
or two, eating well, good energy, no fever, no blood in the stool, but still has loose
stools for a month, that is not too worrisome.


Do call if they continue to act ill after 2 weeks, or anytime you see bloody diarrhea, 
anytime you think there is dehydration (see above), or if the diarrhea goes on 
beyond one month.


Bottom Line

• Stomach flu is viral disease.  In January-April around here it is caused by the rotavirus
• By far, nearly all kids with stomach flu come to no harm, just like with colds, the other viral illness
• The key items to watch out for are dehydration, severe abdominal pain, and bloody diarrhea
• Call if you think these are developing
• If not, look at our approach to giving fluids and comfort measures.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Music and Your Brain- A Summary of an Important Lecture

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Music and Your Brain- A Summary of an 
Important Lecture
by Dr. Robert Zatorre of McGill University
presented by The Cleveland Orchestra


Dr. Robert J. Zatorre is one of the world's leading authorities on
music and the brain.

His two key questions are:

1. How does what we know about music reveal how the brain works?
2. How does what we know about the brain reveal how music works?

He has explored these questions to great depths at his laboratory in 
McGill University in Montreal, Canada, the Brain, Music and Sound
Research Center.

The Cleveland Orchestra has been very interested in these questions as well.
Our music director, Franz Welser-Most, has pursued these interests with
formal seminars on the subject, the most recent in Salzburg, Austria, and
featured Dr. Zatorre as well as leading researchers from Case and the
Cleveland Clinic.

On November 23, 2009, Dr. Zatorre presented findings from his work
under the auspices of the SAGE undergraduate seminar program at Case,
and The Cleveland Orchestra. I had the privilege of attending.

A few basics

Reading was invented by humanity, and was invented roughly
5-6,000 years ago.

Music goes back to at least 40,000 years
There are some indicators that the Neandertal people
made music.

Bone flutes from China have been found that are
7-10,000 years old, and they play haunting tones
in the traditional Chinese pentatonic scale.

The deep, deep history of human music suggests it is not an
invention, but as much a biologic event as walking. The
fact that animals use music, particularly birds, is further evidence
that music is a biologic, not invented, function.

Over time, neuroscience has established that the brain contains
areas or modules of specific function, and that complex brain
function results from these areas creating complex connections
between their various functions.

Simple cognitive tasks such as bending one finger may require
only a handful of brain areas.


Complex cognitive tasks require far more areas. How they occur
is not well understood even today.

Examples of complex cognitive tasks include:
perception, motor skills, creativity, emotions, and memory

Evidence That Music is

a Biologic, Hard-Wired Function

Consider pitch.

Pitch is the quality of a sound that tells you if it is higher or lower than another

sound. It is closely related to how rapidly each second the air vibrates in a sound,

its frequency.

The human mind can perceive astoundingly small difference of pitch, down

to close to one 5,000th of an octave!

In the 1800's the great scientist, Dr. Helmholtz, proved that humans

"fill in" pitches. You can play a tune with key pitches missing, but the mind

will re-create how it should have been.

If you remove a piece of someone's brain on the right side, near the ear,

the right auditory cortex, you can no longer fill-in a pitch.

If you play a tune missing a pitch to a monkey, an area of the brain in the R

auditory cortex starts firing, suggesting monkey's fill-in pitch too.

If you do a special MRI that shows what part of the brain is active during 
an activity, a functional MRI, or fMRI, you will see the R lateral auditory cortex
light up when a person tries to fill-in a pitch.

Does musical training impact R lateral auditory cortex function?

The density of grey matter in the R lateral auditory cortex is much higher in

trained musicians.

Now, play a very simple tune.  Then play it backwards with one note altered.

How well can someone identify the original tune backwards from the altered

tunes backwards.

Testing hundreds of subjects, Dr. Zatorre found the level of activity the

R lateral auditory cortex was highly correlated (r=0.48) with the ability

to tell the original from its imposters.

Others have figured out just how thick a small area of the brain is at any moment,

and found those with a thicker R lateral cortex, independent of musical training,

did better on this task.

Conclusion:

The fact that animals rely on music, that humans have as well for perhaps longer

than they have talked, as well as evidence that areas of the brain physically

change as they manage the perception of pitch, all highly suggest music is

indeed a hard-wired, basic, physical property of how our brains work.

Music and emotion

Emotion is one of the most powerful properties of music.

Music activates a vast range of emotions.

Music alters moods.

How powerful is the emotional force of music?

In one study, students were asked which of several experiences gave them the most

powerful pleasure.

Top 5 evokers of pleasure were: romance , sex, success- each 98.4%, the sun 96.7%,

and music  95.1%.

Below music came good grades 91%, food, 88%, money 83%, sports 73%, art 69%.

Notice that music was rated as nearly as pleasurable as sex and more pleasurable

than food or money!

We now know what parts of the brain light up when we feel pleasure, from any cause:

an area of the brain tucked under the mantle of the overlying cortex, but sitting well

above the spinal cord:  the mesolimbic system.

In particular, networks that are run with the neurotransmitter dopamine seem to

be creating our sensations of pleasure.  The names of the structures where many

of these networks reside are:  the caudate, putamen, and nucleus accumbens.

Typically, these systems are activated by events that our very life depends on.

Our life as an individual ,and as a species, namely:  food and sex.

It makes great sense that we would have a system that would grant us the

powerful incentive to eat enough to survive, and mate enough to reproduce.

This same system can be activated for reasons having nothing to do with

the survival imperative.  A wide variety of drugs, gambling, smoking, and video

games all activate this system quite powerfully.

What about music?

 Dr. Zatorre looked for something that could measure the presence of a jolt of

pleasure, of strong emotion.  He found he could measure the presence of

a sense of chills.  That is, when subjects reported that a piece of music "gave them

the chills,"  he found their heart rate went up, their palms got a bit sweaty, he could

measure if chills occurred or not.

In studying music and its chills, he found that it is experienced by everyone.

Musicians and non-musicians alike have a similar intensity of emotional

response to music.

He also found there is no one type of music that can generate emotion.

That is a product of culture, the sort of music you have learned, have heard,

and in turn, love.

  

When an fMRI is done to see what part of the brain lights up when you experience

the chills from music, he found that  the striatum, thalamus, insula, and anterior cingulate

light up.

A PET scan allows scientists to actually track when a dopamine receptor gets active, a

very precise way of knowing just when, and where, the brain's pleasure wires get activated.

With this level of detail, it was found that there are really two types of pleasure music

generates, and very strongly.

One is actually anticipation.  If you hear a piece of music and think a great bit of music

is about to be heard, your caudate will activate.

The other is the actual chill, a savoring.  When you actually hear the bit of music

you love, a separate area of the dopamine system activates- the nucleus accumbens.

Once the chills cease, no dopamine activity is seen.

Dr. David Huron at OSU describes how many composers use the difference between

anticipation and savoring to heighten our emotional response to the music.

A dearly loved theme will be delayed, or a cadence slowed, to heighten the pleasure

of anticipation, which, in turn, strengthens the savoring when it arrives.

Conclusion:  

Music clearly creates emotion.  It creates emotions as strong as any we can experience.

We are learning where, physically, the brain creates the emotions that music provokes.

Anticipation and savoring are two distinct emotional responses to music.  Music, then,

also helps us understand how our brain works.

BOTTOM LINE

1. Music is a physical, very real part of our biology.
2. We now know parts of the brain that generate our sense of properties such as pitch.
3. The notion music generates strong emotion is clearly true, and we now know the parts of the brain that respond to music with emotion.
4. The emotions that music generates are as powerful a source of pleasure as any we ever will experience.
5. The nature of our emotional response to music is helping us understand how our minds actually work, what is emotion, and how it operates.

Music is a central part of being human.

Enjoy it, make sure your children get plenty of chances to enjoy it.

Cleveland offers some of the greatest music in the world, including

one of the world's best orchestras, just down the block.

So come to the Cleveland Orchestra, let your mind and family

have a powerfully great time.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.