Month: August 2021

Concussions are very common — in fact, they are the most common kind of traumatic brain injury (TBI). While most people recover completely, concussions sometimes lead to lifelong problems, as we’ve learned from the experiences of former National Football League players.

That’s why it’s important that we do everything we can to not just prevent concussions in children and teens, but to give them the right treatment when a concussion happens.

The problem for doctors, parents, and coaches has been that while we want to do the right thing when a child gets a concussion, it’s not always easy to know what the right thing is. To help, the Centers for Disease Control and Prevention (CDC) reviews all the research and makes recommendations to help guide us as we care for children with concussions.

Every child is different, and concussion care should reflect that

The recommendations reflect the fact that every child who has a concussion is different. Every injury is different, obviously, but it’s more than that. Some children are more likely to have trouble, such as those who have had prior concussions or have learning problems, mental health problems, or neurological problems.

Interestingly, children whose families are stressed for reasons such as poverty can take a longer time to recover from concussions. And there is a bit of a wild-card factor too: sometimes children unexpectedly take a long time to recover — or, conversely, recover very quickly.

What are the concussion care recommendations?

Practice guidelines developed by the CDC for health providers include these points:

• Most children with concussions don’t need CT or MRI scans. If there was a severe injury or the child is having severe or unusual symptoms, then it’s worth doing to be sure there isn’t internal bleeding, a fracture, or some other injury. Most of the time with concussions, there is nothing to see — and it’s not worth the risk or expense involved in these imaging studies.
• Use the right tool to make the diagnosis. There are some symptoms we associate with concussion, like bad headache, dizziness, loss of memory of the accident. But because it isn’t always clear, it’s helpful to use a checklist or questionnaire that is validated, meaning that it’s been shown to accurately pick out those with a concussion from those who simply have a bad clunk to the head and not a concussion.
• When a child has a concussion, assess for risk factors for a prolonged recovery. As I said above, some children take longer to get better — and while we can never predict for sure, it’s important to think about that at the time of the injury.

What should parents know about concussions?

• Most children and teens with concussions get completely better within one to three months. But it’s important that children, families, and coaches know what all the symptoms are after a concussion, and understand what’s normal and what is a sign of a problem. For example, trouble sleeping, dizziness, and moodiness can be normal, but if any of those symptoms are getting worse, it’s important to call the doctor.
• Parents can help children return to normal activities after a concussion. Rest — of not just the body, but the mind too — is important for the first two to three days after a concussion, but after that it’s important to start getting back to normal. When people rest completely for longer than that, it actually takes them longer to get better.

Getting back to normal after a concussion

We used to think that total rest of the brain and body after a concussion was the best treatment. Increasingly, research shows that resuming normal activities is the better treatment. For example, recent research analyzing many studies showed that exercise can help speed recovery from concussion. The tricky part is figuring out how best to resume normal activities, because it is different for each child.

The basic idea is to start slow and see how the child does. If they do okay, they can do a bit more schoolwork or exercise. If they don’t do okay — meaning they have more symptoms — they should do less and go more slowly.

The process of getting back to normal life can take a few days, or a few months. It has to be tailored to each child and each situation, which is why collaboration with your pediatrician is so important. It’s also really important not to rush the process, especially when it comes to returning to a sport where concussions are common, such as football, hockey, or soccer. If a child gets another concussion while they are still recovering, it will take them much longer to get better, and put them at risk of permanent disabilities.

To learn more, visit the CDC’s Heads Up page.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy writes about health and parenting for Boston Children’s Hospital, Boston.com, and the Huffington Post. View all posts by Claire McCarthy, MD

Who are you today? Who were you a decade ago?  For many of us, shifts in our lives — relationships, jobs, friendships, where we live, what we believe — are the only constant. Yet it’s a common misconception that sexual orientation develops at an early age and then remains stable throughout one’s life.

Rather, changes in sexual orientation are a common thread in many people’s lives. People may experience changes in who they are attracted to, who they have sex with, and which labels they use to describe their sexual orientation. Such changes in sexual orientation are called sexual fluidity.

Attraction, identity, and behavior

While anyone can experience changes in their sexual orientation, sexually fluidity is more common in younger people and among people who are LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and additional identities).

Sexual fluidity might include

• changes in attractions: Someone may be attracted to one gender at one time point and attracted to a different gender or more than one gender at another time point.
• changes in identity labels: Someone may identify as lesbian at one time point and as bisexual at another time point.
• changes in sexual behavior: Someone may have a sexual partner at one time point who is a cisgender woman and then have another sexual partner at a different time point who is nonbinary. (A cisgender woman is a person assigned as a female at birth and who identifies as a woman. Someone who is nonbinary was assigned either female or male at birth and identifies as neither a woman nor a man.)

Sexual fluidity happens for many different reasons. For some people, sexual fluidity occurs when they meet people and discover new attractions. For other people, sexual fluidity may occur when they learn a new identity label that better fits their experience.

Misconceptions and stigma about sexual fluidity

Many people may have questions and biases about sexual fluidity. Let’s explore a few.

Are people who identify as bisexual sexually fluid? Some are and others are not. Sexual fluidity is distinct from bisexuality. Sexual fluidity may be experienced by people with any sexual orientation identity, including people who identify as bisexual, lesbian, gay, or heterosexual.

Stigma directed at sexual fluidity (and similar stigma surrounding bisexuality) may stem from misconceptions about changes in sexual orientation. Consciously or unconsciously, some people may believe that anyone who experiences changes in their sexual orientation is promiscuous or incapable of being monogamous. However, such beliefs are untrue.

Misconceptions and stigma can hurt. Growing evidence links different forms of stigma experienced by people who are sexually fluid with more depression and poor mental health. Yet it’s not the change in sexual orientation that raises this risk, nor is it automatic, genetic, or otherwise predestined. The higher risk of mental health concerns among people who experience sexual fluidity is more likely to be related to minority stress — that is, because sexual fluidity is stigmatized, people who experience that stigma may also experience stress that negatively affects their mental health.

Changing misconceptions and stigma about sexual fluidity

We can help normalize sexual fluidity in several ways. First, we can introduce the possibility of changes in sexual orientation as part of sex education in schools and in the doctor’s office. Second, we can work toward responding to sexual fluidity with openness and curiosity rather than making assumptions and viewing these changes as negative. Third, we can move beyond preconceived notions of sexual orientation as stable to expecting change in sexual orientation for some people.

As people experience the world and learn more about themselves, their views, beliefs, and feelings may change. Sexual fluidity reflects one possible change over time, a change that fits into the greater diversity of sexuality. We can all hold space for this diversity by letting go of misconceptions about the stability of sexual orientation over a lifespan and staying open instead to the possibility of change.

About the Author

Sabra L. Katz-Wise, PhD, Contributor

Sabra L. Katz-Wise, PhD (she/her) is an assistant professor in adolescent/young adult medicine at Boston Children’s Hospital, in pediatrics at Harvard Medical School, and in social and behavioral sciences at the Harvard T.H. Chan School of Public Health. She co-directs the Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative. Her research investigates sexual orientation and gender identity development, sexual fluidity, health inequities related to sexual orientation and gender identity, and psychosocial functioning in families with transgender youth. Dr. Katz-Wise also advocates to improve workplace climate, medical education, and patient care for LGBTQ individuals, as co-chair for the BCH Rainbow Consortium on Sexual and Gender Diversity, as an HMS LGBT Advisory Committee member, and as HMS Sexual and Gender Minority Curriculum Development Fellow. View all posts by Sabra L. Katz-Wise, PhD

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

• Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
• Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
• Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
• Wash clothing and bathe or shower after being outdoors to remove pollen.
• Close windows during peak allergy season or on windy days.
• Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
• If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
• Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

About the Author

Peter Grinspoon, MD, Contributor

Peter Grinspoon, M.D. is the author of the memoir Free Refills: A Doctor Confronts His Addiction. He currently practices as a primary care physician at an inner-city clinic in Boston and is on staff at Massachusetts General Hospital. He teaches medicine at Harvard Medical School. He spent two years as an Associate Director for the Physician Health Service, part of the Massachusetts Medical Society, working with physicians who suffer from substance use disorders. Dr. Grinspoon graduated with honors in philosophy from Swarthmore College. Before medical school, he spent five years as a Campaign Director at Greenpeace, working on the nuclear free seas campaign. He attended medical school at Boston University School of Medicine. His internship and residency were in Internal Medicine at Brigham and Women’s Hospital. Today he is proudly 10 years clean. He lives in Newton, MA with his wife Liz Grinspoon, and his blended family.” View all posts by Peter Grinspoon, MD