Go get your dang VACCINE

Vaccine hesitancy is rampant. I don't understand why.  Herd immunity is the key to getting us back to normal.  Young healthy adults and kids are some of the most hesitant to get vaccinated.  I admit, they are the group least likely to be affected by the virus, but they are also the most likely to be spreading it.  We owe it to our fellow humans to get vaccinated right now!  The vaccine is safe.  The longer the virus mutates through unvaccinated individuals the more strains we will be dealing with and the harder it will be to predict the next epidemic.  

Vaccines are considered by historians and medical professionals to be the greatest inventions of all time.  Vaccines have saved millions of lives.  The history of vaccines and inoculation goes back hundreds of years beginning with measles and small pox preventions.  Diseases of the past have been virtually eliminated due to vaccines for polio, pertussis, meningitis, cholera and yellow fever among others.  Travel between continents was one of the greatest causes of new disease until the past 2 centuries when universal vaccines helped boost our immunity.  Explorers and conquerors were spreading disease to new places for hundreds of years.  With the global nature of our modern economy, now we can all see the impact of a pandemic.  

The Covid-19 vaccine is based on years of science.  It is NOT a new idea, and should not scare anyone.  We got extremely lucky in this pandemic.  Scientists were doing the groundwork to prepare for the world's next super virus way before Covid hit.  The technology that went into mRNA vaccine has been around for almost thirty years.  It all started at the Salk Institute (Jonas Salk is the guy who invented the polio vaccine).  Look up Katalin Kariko and why she is so important.  She was working on this in 1990, and her work has spawned billions of dollars of research to get us where we are.  We would not have been able to produce such a rapid supply of the Pfizer, Moderna, and Johnson and Johnson Vaccine if not for years of vaccine research. 

Covid-19 Response

The clinic is still operating during Covid-19, but I have been doing 100% telemedicine as of mid-March.  I see a mix of Zoom evaluations and phone calls.  I feel incredibly blessed to be able to continue operating a business during the pandemic.  I am seeing fewer new clients, mostly follow-ups.  The impact of the virus on the kids has been quite variable.  Some have reduced stress due to social distancing.  Some have increased fears especially kids with germophobia and separation anxiety if parents are essential workers.  The response to telemedicine has been immense gratitude.  We have no idea when we will see patients in the office again, but hoping to make some decisions by June. 

Can We Predict Dementia by Personality as a Teenager?

Investigators assessed personality traits in more than 80,000 individuals from a national sample of high school students in 1960 and found that adolescents who rated higher on the "vigor" scale were 7% less likely to be diagnosed with dementia 5 decades later.  Vigor was defined as having a more energetic disposition and more extroversion.  Calmness and maturity in teens also transferred a reduced risk of dementia.  

The interpretation highlights the importance of child mental health with specific reference to encouraging calming techniques and physical activity.  This study meshes well with other studies that have indicated relief from anxiety as well as healthy lifestyle habits have a dramatic positive impact on the prevention of mental illness. 

Chapman BP, Huang A, Peters K, et al. Association between high school personality phenotype and dementia 54 years later in results from a national US sample. JAMA Psychiatry. 2019. 

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752387

Dank Vapes are not so dank

I have treated kids who have had the lung injury from vaping.  The major culprit is counterfeit THC oil inside of vape cartridges.  These generally come from illegitimate dealers who are making a profit off of gullible children.  The Dank Vapes is not an actual company that makes the cartridge.  They make the packaging that looks appealing to kids.  The dealer can put any type of hardware into the packaging.  There have been high profile arrests of dealers who had thousands of the packages empty and ready to be filled with counterfeit cartridges containing who knows what.

Pharmacogenetic Testing

Many of my families are asking about pharmacogenetic testing (PGT).  Some families are coming with the results of testing and asking for my interpretation.  I often see a child whose parent had the test and their result can help in my recommendations to the child.  PGT is particularly helpful in antidepressant and antianxiety medication.  The tests are primarily of genes for liver enzymes called cytochrome P450s (CYPs).  We know which CYP chops up which medication.  You can be normal for one enzyme, low for another and high for another.  Other tests are related to serotonin and dopamine receptors.  These can help predict response to certain categories of medication.  Methylfolatereductase (MTHFR) is typically in the panel of tests.  MTHFR is an enzyme that helps folate get into your brain.  Folate is used to help make various neurotransmitters and reduce inflammation in the body.  If MTHFR is low, a client can take a special supplement called l-methylfolate or folinic acid because regular folate in diet or vitamins won't help. 

Pharmacogenetic testing should not be used as the sole determinant for choosing medication.  It will not tell you which medication will work.  The test is more helpful in telling me what not to use or why you got side effects.  The reports are typically simplified into categories of green "use as directed", yellow "use with caution" and red "use with extreme caution".  However, the best medication might be in the red zone.  We just might need to start a very low dose of a medication that you metabolize slowly.

There are multiple companies providing similar tests.  All of them are either oral swabs or saliva tests (no needles).  I have used Genesight and Millenium the most and both are great.  Insurance companies often do not cover this test.  PGT tends to save a lot of trial and error so my hope is that insurance will cover it more often.  The benefit is usually a more targeted approach to medication and less time spent switching between meds.  All of the companies allow you to pay for the test privately for about 250$.  The test comes back in less than a week. 

Cannabis

I am seeing a rise in cannabis issues that are probably going to get worse once Arkansas has established dispensaries.  My personal feelings about cannabis are similar to my sense of other recreational substances: some ADULTS can responsibly use these substances and some can't.  Children definitely cannot responsibly use recreational substances especially cannabis.  However, the passing of medical cannabis laws seems to elicit a sense of social acceptance and safety that has detrimental effects on our kids.  Much of the cannabis is coming from legal sources in states with recreational cannabis where an Arkansan buys a large quantity and brings it back to our state.  There are many sources available on dark web shopping sites.  These dealers are typically shipping a large number of dabpens that are preloaded with cartridges of concentrated cannabis oil.  Many parents mistake these as typical vapes or e-cigarettes.  Getting to the root of the cannabis issue is often part of my job.  Some kids are purely using for pleasure.  Some kids are treating an underlying depression or anxiety disorder.  Some kids are very susceptible to peer pressure and can't say no.  If you have a child struggling with cannabis abuse, you are not alone.  My typical recommendation is to drug screen twice weekly and base your child's privileges on passing.  Know where your cash is going, get a receipt.  Check their Venmo.  Check their DMs and Snapchat.  Check your mailbox and their backpack.  Verify your child has not established their own P.O. Box.  Good luck out there.

Fitness in Mid-life reduces dementia in elderly

A recent study reports a 36% reduced rate of dementia in individuals whose fitness was tested 25 years earlier.