Sleep well (and safely), little one

When bringing their baby home for the first time, new parents have a lot of things to worry about.

Am I strapping my baby into the car seat correctly? Is my baby getting enough to eat? Why are diapers so expensive? Speaking of diapers, what’s that smell? Didn’t I just change this baby 10 minutes ago? Will I ever sleep again?

Sleep, while important for parents, is absolutely essential for healthy babies, and safe sleep should be a high priority for parents whether they are raising their first child or their fifth.

Why it’s important

Establishing a safe sleep environment for your baby can be a matter of life or death. Every year in Louisiana, there are about 100 sleep-related infant deaths. That’s the equivalent of five kindergarten classrooms.

Although some of those deaths are classified as Sudden Infant Death Syndrome (SIDS), nearly 50 percent of all sudden unexpected deaths of infants (SUID) are determined to be due to accidental suffocation or strangulation while sleeping, so they are preventable.

Most sleep-related infant deaths take place in an unsafe setting like an adult bed or a couch or cushion.

Creating a safe sleep space

Here are some helpful safe sleep guidelines from giveyourbabyspace.org. Every sleep is different, so families should do as much as they can to build in these safe sleep practices and decrease the risks for SUID for bedtime and naptime. Make sure everyone taking care of the baby knows this information.

• Babies should always sleep on their backs, not their tummies or sides, EVERY time they sleep: naptime and bedtime.  
• Babies should sleep alone, in their own sleep space, not together with an adult, child or pet. 
• Babies should sleep in a safety-approved crib with a firm mattress and tightly fitted sheet, or a Pack 'n Play with a firm base. Never place a baby to sleep on a couch, sofa or recliner. 
• Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, bumper pads, stuffed toys and any clutter. 
• Babies should sleep where their caregiver can see and hear them. Share a room with your baby if you can.  
• Babies can lay or cuddle with you to breastfeed and bond, but when it’s time to fall asleep, or if you get drowsy, return them to their OWN sleep space.  
• Babies should sleep in smoke-free homes, both where they live and where they visit. If you can, make it a rule that your home is smoke-free.  
• Babies’ sleep spaces should be away from windows with cords that hang down from curtains and blinds.  
• Babies shouldn’t overheat. Keep room temperature at what would be comfortable for a lightly dressed adult. If the room is cold, dress baby in an infant sleep sack right for their size and age. 
• Car seats, swings and other furniture were not made for routine, extended sleep for a baby. Don't let the baby sleep in these devices for too long, and make sure you're keeping a close watch while they do.

For more information, visit these safe sleep resources online:

• Give Your Baby Space! 
• Centers for Disease Control and Prevention 
• American Academy of Pediatrics
• First Candle
• Safe to Sleep
  

  

Take Care of Yourself: Don’t Skip That Mammogram

By DR. REBEKAH GEE | Secretary, Louisiana Department of Health

Breast cancer first touched my life at the age of 12, when my mother was diagnosed. Initially, her prospects looked promising, and treatment led to remission, buying us additional precious time together.

But three short years later, it re-emerged, and she passed away at the age of 46.

Her bravery, strength and grace through breast cancer left an indelible mark upon my life. She was my inspiration to study medicine, in particular women’s health. As a practicing obstetrician and gynecologist, my passion for my patients is infused with the memory of my mother and her struggle with breast cancer.

She is a constant presence in my mind every October, which is Breast Cancer Awareness Month. I don’t want to see anyone else lose a loved one to a disease that has become curable. Take the time to learn about the signs, symptoms and risk factors, and make preventive care a priority.

Signs and symptoms

Every person is different when it comes to breast cancer. Some women and men – yes, men can have breast cancer, too – may not display any signs or symptoms, while others may encounter a mix of any or all of the following:

·         New lump in the breast or armpit

·         Thickening or swelling of part of the breast

·         Irritation or dimpling of breast skin

·         Redness or flaky skin in the nipple area or the breast

·         Pulling in of the nipple or pain in the nipple area

·         Nipple discharge other than breast milk, including blood

·         Any change in size or shape of the breast

·         Pain in any area of the breast

It’s important to remember that these symptoms may not necessarily be an indication of breast cancer, as they can occur with other conditions, especially lumps. Breast lumps are most commonly caused by fibrocystic breast condition, a noncancerous change in the breast that causes lumps, tenderness and soreness, and cysts, small, fluid-filled sacs that can develop in breast tissue.

If you are concerned, schedule an appointment with your health care provider right away. Of course, if you are 45 or older, I encourage you to make an annual breast exam a part of your regular care plan.

Risk factors

A person’s risk for breast cancer depends on a combination of factors, according to numerous studies, with gender and age as the main determinants. Most breast cancers are found in women who are age 50 or older, according to the Centers for Disease Control and Prevention.
The CDC lists these risk factors that cannot be changed:

·         Aging: risk increases with age, with most breast cancers diagnosed after age 50

·         Genetic mutations: inherited changes to certain genes, including BRCA1 and BRCA2

·         Reproductive history: women who began menstruating before age 12 or start menopause after age 55 are exposed to hormones longer

·         Having dense breasts: tumors can be harder to detect on a mammogram because dense breasts have more connective tissue than fatty tissue

·         Personal history of breast cancer or certain non-cancerous breast diseases: women with a history of breast cancer are more likely to have a reoccurrence; non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher breast cancer risk

·         Family history of breast cancer: women who have a mother, sister or daughter (first-degree relative) or multiple family members on either side of the family who have had breast cancer are at increased risk; a first-degree male relative with breast cancer also increases risk

·         Previous treatment using radiation therapy: radiation therapy to the chest or breasts before age 30 increases the risk of breast cancer later in life

·         Women who took the drug diethylstilbestrol (DES): some pregnant women in the United States received this drug from 1940 to 1971 to prevent miscarriage; women who took this drug and daughters born to them while taking the drug are at risk

Risk factors that you can change:

·         Not being physically active: physical activity can lower the risk of breast cancer

·         Being overweight or obese after menopause: older women at a healthy weight are less likely to develop breast cancer than those who carry extra pounds

·         Taking hormones: hormone replacement therapies including both estrogen and progesterone taken during menopause can raise risk when taken for more than five years; certain birth control pills also have been found to increase breast cancer risk

·         Reproductive history: women who first become pregnant after age 30, don’t breastfeed or never carry a pregnancy to full term are more at risk

·         Drinking alcohol: the more alcohol a woman drinks, the more her risk of breast cancer rises

Other factors that may increase the risk of breast cancer include smoking, being exposed to cancer-causing chemicals and hormonal changes due to working a night shift.

Get your mammogram

As I mentioned earlier, I urge every woman to take care of yourself and have a regular mammogram. This X-ray of the breast is a simple, relatively quick procedure that could save your life. The CDC even offers free or low-cost mammograms to those who may not be able to afford one through its National Breast and Cervical Cancer Early Detection Program.

Having had my share of mammograms – in fact, I’m scheduled for one this month – I know that it may not be the most comfortable procedure and you may want to skip it because you find it painful. Just remember that any discomfort you may experience is temporary. It also helps not to schedule your mammogram for the week before or during your period, because that’s when your breasts are more likely to be tender or swollen.

Avoid wearing perfume, powder or deodorant on the day of your mammogram because these products can show up as white spots on the X-ray. You will need to undress from the waist up for the procedure, so maybe save your dresses for another day. A top with a skirt or pants will make the process easier.

Such a simple test can save a life. Don’t skip yours.

To learn more about breast cancer, visit the CDC and American Cancer Society webpages.

Louisiana Department of Health’s School Water Lead Testing Program Has Good News

By JIMMY GUIDRY, MD | Louisiana State Health Officer

Safe drinking water has been in the public eye since the crisis in Flint, Mich., where insufficient water treatment exposed more than 100,000 residents to lead. The lead had leached from pipes into the water supply after the city changed water sources and did not properly treat the drinking water.

Taking note of Flint’s water crisis, as well as a situation in St. Joseph, La., where the aging water system had lead problems, the 2018 Louisiana Legislature passed Act 632. This law requires sampling and testing of drinking water in selected elementary schools on an annual basis. 

Last month, the Department of Health responded, launching the pilot program for water testing at 12 schools. Far from finding elevated levels of lead in the water, I was encouraged by the results.

None of the schools were found to have lead in the drinking water in excess of 15 parts per billion (ppb). (Note: the federal safe drinking water requirement is 20 ppb, but to be extra cautious, the Louisiana pilot program set a more strict level.) 

It would be safe to say that I was surprised by these results. In fact, our program included a communications component that was premised on the belief we would find some schools with elevated levels of lead.

This is because many Louisiana communities, as well as their school systems, have water systems with aging infrastructure. These conditions make it more likely to find lead in water due to old plumbing. As we designed the testing program, we selected older schools with older pipes and that had not had recent plumbing upgrades. With us purposefully looking at older schools, we fully expected to find some instance of elevated lead. The fact that we did not find this is extremely encouraging.

The testing process

All of the schools selected for this testing program were constructed prior to 1986 and had aging pipes and fixtures, points where lead could leach into the water. These are the schools we tested:

·         Barkdull Faulk Elementary School, Monroe

·         Bayou Blue Elementary School, Houma

·         Bernard Terrace Elementary School, Baton Rouge

·         Cherokee Elementary School, Alexandria

·         Covington Elementary School, Covington

·         Creswell Elementary School, Shreveport

·         Drew Elementary School, West Monroe

·         Dwight D. Eisenhower Academy of Global Studies, New Orleans

·         Harahan Elementary School, Harahan

·         Loranger Elementary School, Loranger

·         Prairie Elementary School, Lafayette

·         Prien Lake Elementary School, Lake Charles

Over a two-week period, our team collected water samples from several locations at each school, including sources before the drinking water enters the school and from taps within the school. The multiple sample points gave us the information to determine whether lead, if it was present, came from the water source, the plumbing fixtures or the plumbing within the school.

Corrosion is the most common cause of lead in drinking water, caused by a chemical reaction between the water and the lead pipes and solder. Proper water treatment can prevent corrosion.

After the samples were taken, they were analyzed at our LDH water testing lab in Baton Rouge. The full testing results are available here.

The hazards of lead exposure

People who are most at risk for health problems because of lead exposure are children under the age of 6. In fact, the Centers for Disease Control and Prevention (CDC) says there is no safe level of lead in blood for young children. Lead also presents a great risk to fetuses.

Childhood lead poisoning can cause damage to the brain and nervous system, slow growth and development, and cause problems with learning, behavior, hearing and speech. Effects of such problems include lower IQ, decreased ability to pay attention and underperformance in school.

At lower levels, there can be effects on the central nervous system, kidneys and hematopoietic system, involved in the production of blood (includes bone marrow, spleen, tonsils and lymph nodes). Very severe exposure to lead can result in coma, convulsions and death. 

Lead is invisible to the naked eye and has no smell. Exposure often occurs with no obvious symptoms, allowing it to slip under the radar. It is for this reason that Louisiana law requires physicians to conduct lead blood level screenings for their patients under the age of 6.

Also, there is no way to correct the effects of lead poisoning.

Protecting children from exposure

The Department of Health has provided the testing results from its pilot program to the individual schools. If lead had been discovered at elevated levels, it would be the responsibility of the school to address the problem.

There are also steps parents and guardians can take to reduce lead exposure in the home. The most widespread and dangerous source of lead exposure is lead-based paint, found mostly in homes built before 1978, the year such paints were banned. Other sources include water, soil, consumer products such as toys and jewelry, candies imported from other countries, traditional home remedies and exposure from parents with jobs and hobbies involved in working with lead-based products, such as stained glass.

The CDC offers these guidelines for lead-based paint:

·         Talk to your state or local health department about testing paint and dust from your home for lead. 

·         Make sure your child does not have access to peeling paint or chewable surfaces painted with lead-based paint. 

·         Children and pregnant women should not be present in housing built before 1978 that is undergoing renovation. They should not participate in activities that disturb old paint or in cleaning up paint debris after work is completed. 

·         Create barriers between living/play areas and lead sources. Until environmental clean-up is completed, you should clean and isolate all sources of lead. Close and lock doors to keep children away from chipping or peeling paint on walls. You can also apply temporary barriers such as contact paper or duct tape, to cover holes in walls or to block children’s access to other sources of lead. 

·         Regularly wash children’s hands and toys. Hands and toys can become contaminated from household dust or exterior soil. Both are known lead sources. 

·         Regularly wet-mop floors and wet-wipe window components. Because household dust is a major source of lead, you should wet-mop floors and wet-wipe horizontal surfaces every two to three weeks. Windowsills and wells can contain high levels of leaded dust. They should be kept clean. If feasible, windows should be shut to prevent abrasion of painted surfaces or opened from the top sash. Take off shoes when entering the house to prevent bringing lead-contaminated soil in from outside. 

·         Prevent children from playing in bare soil; if possible, provide them with sandboxes. Plant grass on areas of bare soil or cover the soil with grass seed, mulch or wood chips, if possible. Until the bare soil is covered, move play areas away from bare soil and away from the sides of the house. If you have a sandbox, cover the box when not in use to prevent cats from using it as a litter box. That will help protect children from exposure to animal waste.

Guidelines for reducing lead exposure from non-paint sources include:

·         Avoid using traditional folk medicine and cosmetics that may contain lead.

·         Avoid eating candies imported from Mexico.

·         Avoid using containers, cookware or tableware that are not shown to be lead free.

·         Remove recalled toys and toy jewelry immediately from children.

·         Use only cold water from the tap for drinking, cooking and making baby formula. Hot water is more likely to contain higher levels of lead.

·         Shower and change clothes after finishing a task that involves working with lead-based products such as stained glass, making bullets or using a firing range.

For more information on lead, click here.

Flu Season is On Its Way: Are You Prepared?

Fall is a time for cooler temperatures, crisp leaves, pumpkin spice everything – and flu season.

The 2017-2018 flu season was an active one, with flu and pneumonia hitting Louisiana hard. Statistics from the Louisiana Department of Health, Office of Public Health show 1,600 deaths from flu illnesses, including five pediatric deaths, and more than 15,000 hospitalizations.

Know the Signs

Flu shares many symptoms with a cold but is far more serious. Flu usually comes on suddenly with some or all of these symptoms:

·         Fever or feeling feverish/chills

·         Cough

·         Sore throat

·         Runny or stuffy nose

·         Muscle or body aches

·         Headaches

·         Fatigue (tiredness)

·         Vomiting and diarrhea (more common in children than adults)

The Flu Vaccine

Get your flu shot before the season gets going, preferably by the end of October. It protects against three or four different flu viruses depending on the vaccine you receive. The vaccine is your best chance at reducing flu and related illnesses, doctor visits, hospitalizations and time missed from work and school.

All people ages 6 months and older are recommended to receive a flu shot, especially people at high risk for serious flu-related complications and their close contacts. Those at high risk include infants, pregnant women, children, adults ages 65 and older, and adults with chronic medical conditions such as asthma, diabetes or heart disease.

The most common side effects are soreness, redness and/or swelling at the injection site, headache, fever, nausea and muscle aches. Side effects are generally mild and clear up on their own within days.

The flu vaccine is available from your primary care physician, many pharmacies, parish health units, school health clinics, rural health clinics and federally qualified health centers, or find a vaccination site at vaccinefinder.org.

Prevent the Spread

Besides the flu vaccine, there are several easy steps you can take to help prevent the spread of flu and other respiratory viruses:

·         DON’T COUGH OR SNEEZE INTO YOUR HANDS.

·         Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away after you use it. Alternately, cough or sneeze into the crook of your elbow.

·         Stay away as much as you can from people who are sick.

·         If you get the flu, stay home from work or school. If you are sick, do not go near other people so that you don't make them sick too.

·         Wash your hands often with soap and water, especially after you cough or sneeze. If you are not near water, use an alcohol-based hand cleaner.

·         Try not to touch your eyes, nose or mouth. Germs often spread this way.

For more flu information, visit Fight the Flu LA or the CDC’s flu page.

Ovarian Cancer Awareness Month: Know the Signs and Symptoms

By MINDY FACIANE | Public Information Officer

September is recognized as Ovarian Cancer Awareness Month, a time to raise awareness of what’s often called a silent killer among women. It’s called a silent killer because its symptoms are often mistaken for other, more benign conditions. By the time it’s diagnosed, it’s often too advanced for treatment to be effective.

I was one of the lucky ones. 

I was 32 and engaged to my fiancé for just a month when I was diagnosed. I found out about it through a complete fluke, too. I’ve had severe back problems since I was 18, including two major surgeries, so I thought the low back pain I was experiencing was tied to my ongoing problems. My doctor sent me for an MRI to see if my back problems were getting worse. That’s how we found the tumor.

Being told I had cancer was incredibly frightening, especially since I had just started planning my wedding. My fiancé and I were discussing our future together and eventually starting a family. I had also lost my beloved grandpa to cancer 10 years earlier. 

Surgery revealed the cancer was caught at an early stage, giving me a good prognosis. The next five months were filled with fertility preservation so that I could try for a family someday, six rounds of chemotherapy and doctor appointments – oh, so many doctor appointments. Hair loss. Uncontrollable pain. Medications for the pain. Nausea. Medications for the nausea. Fear. Exhaustion. But I pulled through with the help of my fiancé, family, friends, co-workers and an amazing medical team. 

My hair grew back. The pain eased. I was able to eat the foods that nauseated me during chemotherapy. I married the man who stood by my side through cancer. And, best of all, despite losing an ovary and Fallopian tube to cancer, I was able to give birth to a happy, healthy son who’s now 2½.

September 10 marked the fifth year since the surgery that saved my life.

I was one of the lucky ones.

There are many women out there who aren’t nearly as lucky.

Ovarian cancer is one of the most deadly cancers to affect women. American Cancer Society statistics show ovarian cancer accounts for only 2.5 percent of all female cancer cases in the U.S. but 5 percent of cancer deaths. That’s because of its low survival rate.

It is the 14^th most common cancer and eighth leading cause of cancer death in Louisiana women from 2010 to 2014, according to the American Cancer Society.

Signs and symptoms

The early stages of ovarian cancer usually display no obvious symptoms, which is why it’s often not detected until it’s at an advanced stage. Signs and symptoms include:

·         Vaginal bleeding, especially post-menopause, or discharge from the vagina that is not normal for you

·         Pelvic pain or pressure

·         Abdominal or back pain

·         Bloating

·         Feeling full too quickly, or difficulty eating

·         Change in bathroom habits, such as more frequent or urgent need to urinate and/or constipation

It’s important to listen to your body and know what is normal for you. See a doctor immediately if you are experiencing unusual vaginal bleeding. If you are experiencing any of the other signs for two weeks or longer and they are not normal for you, see a doctor. The symptoms may not mean you have ovarian cancer, but the only way to know is to consult a doctor.

The Centers for Disease Control and Prevention offers this diary to track any symptoms you may notice over a two-week timespan.

Risk factors

There is no sure way to know whether a woman will develop ovarian cancer, and most women who have it were not considered high risk before diagnosis. The CDC says these factors may increase risk:

·         Being middle-aged or older

·         Having close family members (such as a mother, sister, aunt or grandmother) who have had ovarian cancer on either your mother’s or your father’s side

·         Having a genetic mutation called BRCA1 or BRCA2, or one associated with Lynch syndrome

·         Having had breast, uterine or colorectal cancer

·         Having an Eastern European or Ashkenazi Jewish background

·         Having endometriosis, a condition in which tissue from the uterine lining grows elsewhere in the body

·         Having never given birth or having had trouble getting pregnant

Some studies have suggested taking estrogen by itself (without progesterone) for 10 years or more may lead to an increased risk of ovarian cancer.

Talk with your doctor about your risk factors. If you or a family member has a history of ovarian cancer, you may want to consider genetic counseling, a process that advises of the consequences and nature of a disorder, the probability of developing or transmitting it, and available options in management and family planning.

Things you can do to reduce your risk of ovarian cancer include:

·         Using birth control pills for five years or more

·         Having a tubal ligation (tubes tied), both ovaries removed or hysterectomy (removal of the uterus and sometimes the cervix)

·         Giving birth

·         Breastfeeding

These options may not be recommended for all women, so it’s best to talk with your doctor about ways to reduce your chances of ovarian cancer.

For more information, visit the CDC and American Cancer Society ovarian cancer webpages.