Holiday stress, depression and blues

By DR. JAMES E. HUSSEY | Medical Director, LDH Office of Behavioral Health

Holidays are often seen as a time of celebration, family gatherings, gift-giving, joy and other happy moments. But, for some, it is a time of additional stress, anxiety, blues or depression. In one survey conducted by the American Psychological Association, 38% responded that their stress levels increased during holidays (including lack of time, money, commercialism, gift pressures) and 56% responded that they experience most stress at work (only 29% at home).

There may be several reasons why people become more anxious, sad or depressed during the holidays:

• SOCIAL ISOLATION: Those with small social circles or minimal family support due to few or no relatives living close by sometimes begin to feel lonely, unsupported, and left out and isolated. Winter/cold/bad weather also contributes to staying inside.
• GRIEVING: For those gathering with relatives, they may become more aware of those who are no longer part of the gatherings or celebrations due to severe illness or death during the prior year.
• INCREASED WORK DEMANDS: With holidays, vacations, end-of-year deadlines, reports, taxes and other demands, there can be real increases in work demands, leading to stress and anxiety.
• FINANCIAL STRESS: Money issues can become very obvious during holidays. Finding the money to provide gifts for everyone is stressful. Worries about debt or not providing enough for family, kids and others can lead to despair, sadness, depression and anxiety. Maybe as many as 53% of people report this as a source of stress, according to a Principal Financial Group survey.
• SEASONAL AFFECTIVE DISORDER/DEPRESSION (MAJOR DEPRESSION WITH SEASONAL PATTERN): It should be noted that there are depressive episodes that can go beyond the blues, become more sustained, and sometimes occur more frequently during the fall and develop during the winter. Most people stop having these symptoms during the spring and summer, but some may persist. This may have to do with the length of the days being shorter, decreased exposure to light or other factors. For more severe symptoms of depression, treatment should be sought, such as light therapy, talk therapy or medications.
• HEALTH AND WELLNESS: Overeating, weight gain and bloating can be problematic for some.

Dealing with holiday depression

• Talk to your doctor if dealing with depression or sadness for long periods of time, or if it begins to affect your functioning, activities of daily living, appetite or sleep, or if suicidal thoughts come into play.
• There are resource help lines such as the National Suicide Prevention Lifeline (1-800-273-8255), Veterans Crisis Line (1-800-273-8255) and the Crisis Text Line (www.crisistextline.org). For emergencies, call 911.
• Otherwise:
• Make sure you get enough sleep.
• Eat healthy.
• Exercise 30 minutes per day (if tolerated).
• Continue or begin new holiday traditions like family gatherings, outings or vacations instead of staying home.
• Be mindful of holiday pressures.
• Volunteer at soup kitchens, church activities, gift drives, helping elderly neighbors with yard tasks, etc.
• Get back to nature with walks in the woods, parks along a lakeshore, etc.

Contrary to popular belief, suicides do NOT spike during holidays. November, December and January are actually low months for suicide. Peak months may be more like April through August.

Vaping use among Louisiana students triples since 2015

E-cigarette and vaping devices come in an array of sizes and shapes.

By ANGELA VANVECKHOEVEN | Health Education Manager, Well-Ahead Louisiana

A recently released report compiled by Well-Ahead Louisiana and the Louisiana Campaign for Tobacco-Free Living shows that vaping among the state’s middle and high school students has doubled since 2017 and tripled since 2015. 2019 E-Cigarette Use Among Louisiana Youth reveals that 32% of high school students and 15% of middle school students vape, which follows the national trend of increased vaping among youth and youth adults.

These numbers are especially alarming in light of the current outbreak of lung injury (EVALI) associated with e-cigarette use, also known as vaping. The CDC launched an investigation into the outbreak on Aug. 1, and as of Dec. 4 has confirmed 2,291 cases in 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, with 48 of the patients dying because of the illness. In Louisiana, 32 cases have been confirmed, with two deaths. The median age of victims is 24 nationally and 28 within the state.

As of Nov. 8, the CDC found vitamin E acetate in lung fluid samples from 29 patients from 10 states, the first detection of a potential chemical concern in biologic samples from EVALI patients. Vitamin E acetate usually does not cause harm when ingested as a vitamin supplement or applied to the skin. However, previous research suggests when vitamin E acetate is inhaled, it may interfere with normal lung functioning. Vitamin E acetate is used as an additive in the production of e-cigarettes because it resembles THC (tetrahydrocannabinol) oil, and it’s also used as a thickening ingredient in e-liquids. Click the links to learn more about the national outbreak and the Louisiana cases.

Action steps

Even without the threat of EVALI, vaping can harm a teenager's still-developing brain and negatively affect memory, learning and concentration. To effectively protect young people from all forms of tobacco — including e-cigarettes, cigarettes, cigars, little cigars and hookah — Well-Ahead Louisiana offers the following resources and encourages adults to take action.

• KNOW WHY TEENS VAPE: According to the new report, 45% of middle school students and nearly 37% of high school students said the reason they vape is because a friend or family member does. More than 14% of middle school students and nearly 21% of high school students like that vape products are available in flavors. Nearly 7% of the middle school students and almost 15% of the high school students believe that vaping is less harmful than other tobacco products.
• KNOW THE RISKS AND EDUCATE YOUTH: In addition to harming brain development, nicotine exposure in youth can increase the risk for future addiction to other drugs. Well-Ahead has compiled resources to educate parents, teachers, coaches, etc. about the harmful effects of these products, as well as how to talk to teens about vaping.
• HELP YOUTH QUIT: Youth who vape are four times more likely to go on to smoke cigarettes. Quitting nicotine isn't easy, but it can be done with the right support. Find access to youth cessation resources here.
• IMPLEMENT EFFECTIVE, 100% TOBACCO-FREE SCHOOL POLICIES: Every Louisiana school district is required to have a written 100% tobacco-free school policy that prohibits the use of any tobacco products, including e-cigarettes, on campus and at school-related events for students, staff and visitors. It is important to educate and promote compliance among school staff to support this policy. Visit wellaheadla.com to ensure your school’s policy complies with Louisiana law and to find resources for effective implementation.

The bottom line

Because nicotine and other chemicals in e-cigarettes can be damaging to the development of a teen's brain, yet youth do not see vaping as being harmful, it's important for adults to understand the products youth are using and be prepared to talk about their effects. For more information, visit wellaheadla.com or contact us at wellahead@la.gov.

Vaccines save lives. Period.

By DR. DAWN R. MARCELLE | Region 2 Medical Director, LDH Office of Public Health

Keeping our children safe and healthy rank among the highest of parents’ concerns — and where safety and health meet, the topic of vaccines will often arise. While parents have the right to make decisions about their children’s health, as a pediatrician and a mother of two, I can confidently say without hesitation that overall, vaccines are safe and effective.

Vaccines are the best way to protect your child against a number of illnesses, including measles, whooping cough (pertussis) and mumps, all of which have made a comeback in recent years due to a drop in vaccination rates. Other vaccine-preventable illnesses include tetanus, diphtheria, varicella (chickenpox), rubella, hepatitis B, polio, meningococcal meningitis and influenza, especially now with flu season in full swing across Louisiana.

How they work

A vaccine contains a version of the bacterium or virus responsible for a particular disease. Vaccines can be live (containing a weakened form of the bacterium or virus) or inactivated (containing a killed version of the bacterium or virus).

For example; if you receive a chickenpox vaccine, the presence of the chickenpox virus in the vaccine causes the body to think that it’s under attack. This activates the immune system, which treats the weakened/dead chickenpox virus (antigen) like a full-blown infection and makes antibodies to fight off the disease. These chickenpox antibodies remain in the person’s immune system, ready to provide active protection if you come into future contact with live chickenpox virus.

Immunization schedules

With so many vaccines out there, how is a parent to know which vaccine is needed and when? That’s where immunization schedules are helpful. Developed with your child’s safety in mind, immunization schedules show which vaccines are given at which stages of your child’s life. Following such schedules provides immunity early in life before most infants and children are exposed to life-threatening diseases.

Vaccination schedules are developed by the CDC’s Advisory Committee on Immunization Practices (ACIP). The committee includes physicians and public health practitioners who are dedicated to keeping children safe and healthy. All vaccines listed on immunization schedules have been exhaustively tested to be sure they are safe and effective. Sometimes multiple vaccines will be given at a single pediatric visit, and this is safe and normal. There’s not enough antigens in vaccines to overload a healthy baby’s immune system. In fact, during an average day a baby will encounter more antigens than they will receive in a vaccine.

Some parents, expressing concern about the number of vaccines their children receive from infancy to school age, may wish to follow an alternative schedule that spreads out vaccines or even skips some entirely. This practice is discouraged by the American Academy of Pediatrics, which recommends parents follow established immunization schedules. These schedules are for your child’s protection, and following them gives your child immunity early in life, before they can be exposed to potentially deadly diseases like measles.

Keep in mind that some children can’t be vaccinated, such as those with weakened immune systems due to an illness or medical treatment. The best protection for these children is for everyone around them to be vaccinated — that includes parents, grandparents, siblings, aunts, uncles and any caregivers.

Life savers

As a pediatrician, let me say once again that vaccines are overwhelmingly proven safe and effective. I encourage parents to follow the recommended immunization schedules to give their children the best possible protection against a number of serious diseases.

The American Academy of Pediatrics considers vaccines to be one of the the most significant medical innovations of our time. Considering the countless lives saved thanks to vaccines, I couldn’t agree more.

Helpful links

• View the Centers for Disease Control and Prevention (CDC) immunization schedule: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
• View the State of Louisiana’s 2019 immunization schedule: https://lalinks.org/linksweb/pdf/Immunization%20Schedule_January%202019.pdf
• Review and print your child’s official immunization records at any time, free of charge: https://la.myir.net/
• Free vaccines for qualified children younger than 19 years of age: http://www.ldh.la.gov/index.cfm/page/3015

Friends and family will be thankful for these healthy Thanksgiving dishes

Thanksgiving is famously known as a time for good eating. Your eyes are often bigger than your stomach, and you may be eating special foods that only come around once or twice a year. In anticipation of packing so many delicious dishes into your belly, you may even bring out your “fat pants” so you have extra room.

But, instead of letting temptations run free, why not make a healthy and delicious contribution to the Thanksgiving table? A little planning and preparation can go a long way toward giving you and your loved ones’ waistlines something to be thankful for, like one of these better-for-you side dishes from Well-Ahead Louisiana.

If you’re serving a larger group than what the recipe calls for, no worries — just double or even triple the recipe to meet your needs. Click on any recipe card to enlarge it.

When Thanksgiving is over, what can you do with leftover turkey besides sandwiches? Try a hot, comforting and healthy cup of soup. To make this soup lower in saturated fat, prepare it ahead of time to cool and skim off the fat that rises to the top.

For more healthy lifestyle advice, visit Well-Ahead Louisiana.

Happy Thanksgiving!

Time to travel, but do it safely

By DR. DAVID J. HOLCOMBE | Medical Director, LDH Region 6

With summer well behind us and school in session, it is a great time to travel. Seniors, with time and disposable income, can devote more of their life to exploring the U.S. and abroad. In fact, world travel for all ages has exploded in the last few decades, with more people traveling to more and more exotic locations, often remote and underdeveloped.

Travelers need to consider many precautions, however, prior to any long-distance, prolonged voyage in order to have a safe experience.

Precautions start in the airplane. Reduced cabin pressure, prolonged inactivity and close quarters predispose travelers to reduced oxygen, deep venous thromboses and increases in airborne or contact transmitted infections.

Once on site, exotic foods, wild animals and insect-borne illnesses all pose threats to travelers. Avoiding unfiltered water and raw or undercooked foods, especially from street vendors, can go a long way toward preventing food- and water-borne diseases. Never touch or approach any dogs, cats, or other domestic or wild animals, since rabies is common around the world.

Safe driving, safe sex and mosquito avoidance can prevent a whole host of serious health issues.

High altitude carries its own danger of altitude-related sickness, a significant risk for older travelers and those with chronic heart or lung diseases. Careful acclimatization or the use of medications such as Diamox may be required.

Remember to use caution when climbing the steps of that wonderful, ancient pyramid or magnificent cathedral.

Vaccinations

Vaccinations largely depend on the location of travel. All travelers need to consult www.cde.gov/travel for site-specific vaccination recommendations.

• Yellow fever vaccination is required for multiple areas of Africa and South America. Unfortunately, stocks of the vaccine are severely limited worldwide and there is only a single site in Louisiana — in Metairie — with consistent availability.
• Hepatitis A and B vaccines should be up to date since both diseases remain widespread in developing countries. Because both vaccines are administered in a series that takes from four to six months to complete, do not wait until the last minute. That being said, it is better to be partially vaccinated than not vaccinated at all.
• Meningitis vaccine remains necessary for most of Sub-Saharan Africa, especially in the dry winter season from December through June.
• Typhoid vaccine, as either an injection or four capsules taken over seven days, offers protection, especially for travelers in Southeast Asia.
• Japanese encephalitis vaccine is also recommended in some parts of Asia, especially rural areas.
• Cholera, transmitted by contaminated food and water, remains a danger and travelers to countries where it occurs should be vaccinated with a single oral dose of the vaccine.
• Influenza (flu) varies depending on the season, which differs in the Northern (winter) and Southern (summer) hemispheres. Annual vaccination against the flu protects in either hemisphere although variations occur in the organism due to genetic shifts in the virus.
• Measles, mumps and rubella remain worldwide threats and that particular vaccine (MMR) should be administered to those born from 1957 to 1989. Measles is highly contagious and rates are much higher outside the U.S., even in Europe.
• Poliomyelitis and TdaP (tetanus, diphtheria and pertussis or whooping cough) vaccines should be up to date prior to any travel.

Pregnant women and those with complex medical conditions should always consult a physician prior to travel. Both MMR and varicella are live vaccines and should not be given to pregnant women.

Medications and insurance

Everyone should carry enough medication for the entire trip as well as a complete list of his or her medications (with commercial and generic nomenclature) and the doses.

For older travelers, remember that Medicare does not work overseas. Some private insurances do cover clients out of the U.S. but this coverage varies significantly. Supplemental health insurance for travelers is available for a price, often hefty in senior citizens.

Travel should be a mind-expanding experience and not one ending in costly medical problems or death. See the world, have fun, but be sure to take all the necessary precautions for safe travel. Prevention is always the best medicine at any age and anywhere in the world.