Albert Provocateur: December 2009

Sunday, December 13, 2009

Green Teen

Teens will be teens! While parents seem to understand this, the motivation behind adolescent action is dubious. In fact, it is not the raging hormones that make teenagers do what they do, but rather the teen brain itself. The issue becomes of paramount importance when focus is directed at teen driving and the influence of alcohol, substance abuse, and cellular telephone usage on its performance and dangers. Biology and physiology don’t lie, and brain scans indicate that the adolescent brain undergoes a thinning of the gray matter or thinking part of the brain around puberty. While motor and sensory areas of the teen brain, as well as reward centers, mature early, the areas of a teenager’s brain controlling plans, decision-making, and impulses and emotions remain immature until the middle 20s. Voilà, parents, educators, and the general public at large are faced with a potential recipe for disaster when the immaturity of the teenage brain, a propensity for high-risk behaviors and potential substance abuse, and the inexperience of adolescent drivers are all combined. So, how does this all translate? The KISS (“Keep it simple, Stupid!”) principle, in this particular case, leaves no room for misinterpretation when it states that teen brain changes can result in high-risk behaviors, substance abuse, and mental illness, that control over high-risk behaviors is still maturing during the teenage years, and that over 2.7 million children and adolescents suffer from behavioral or emotional ills.

The statistics are sobering! Each year 5,000 teens die in automobile accidents, and 400,000 are seriously injured. Teenagers are only 10% of the U.S. population, but account for 12% of all fatal car crashes. It is as if Russian roulette is being played on our roads, with 16-19-year-olds four times more likely than others to “crash and burn,” and with risk of a car crash highest during the first year of driving. Teenagers cost society 30% or $26 billion in annual automobile costs. This fact must be impressed upon them, and the only way to do so and put the financial downside in perspective is by comparison with something teens know and love dearly, namely the cost of a Microsoft Xbox® or a Sony PlayStation®.

Machismo and machines don’t mix, but try telling that to a teenager. If he or she gives you the time of day, you can explain that teenage drivers are more likely to speed, tailgate, and drive hazardously. Will teens listen, however? There seems to be a gender difference also, with teen male drivers 1.5 times more likely than teen females to die in automobile accidents. In these days of “super-sizing” and everything being bigger in Texas, teens are as likely to run into the jaws of life as they are to jaw a quarter-pounder in a fast-food joint. It is a well-known fact that adolescents have the lowest rate of seatbelt use. Statistics demonstrate that of 15-20-year-old male drivers killed in auto accidents, 38% were speeding and 24% were drinking and driving. Male teen “co-pilots” who egg the young driver on make matters no easier!

We are faced with what might be called the “booze blues,” although this is no light matter, by any means. The numbers bear this out. Seventy percent of high school seniors have been found to use alcohol in the previous year. Twenty-three percent of 15-20-year-old drivers who die in car crashes have blood alcohol contents greater than or equal to 0.08, which is comparable to four drinks. Of teen drivers killed in auto crashes after drinking and driving, 74% did not wear seatbelts. And if all this were not bad enough, 33% of teenagers report riding with teen drivers who drink, and 10% drive themselves while drinking. That will certainly give mothers and fathers out there something to think about!

We’ve all heard the expression that a brain is a terrible thing to waste, and nowhere is this idiom more applicable than in consideration of the wasted potential of the teenage brain. Studies show that the adolescent brain is particularly vulnerable to the negative effects of alcohol and other drugs and to addiction later in life, and more so than the brains of people not using such substances before age 21. We can only say “holey smoke” at this, as we learn that large amounts of alcohol close up blood vessels in the brain, causing brain cells to die in decision-making areas and resulting in “dead spots,” craters, or holes. Future shock is a terrible thing, and getting an early jump on the future is not always a good idea, especially when it comes to the devastating effects of alcohol consumption. Teenage binge drinking causes the brain to become inflamed and lose cells, with massive brain shrinkage and behavioral problems arising later in life, as a result. Even the gladiators and charioteers of Ancient Rome knew better than to drink “vino” before battle or high-speed races, which is more than can be said for their modern-day counterparts!

And lest we forget the “green, green grass of home” and the almighty cellular, we are once again confronted with a brick wall. Cars are the second most popular place for smoking marijuana, and more than 2.9 million driving-age teens have reported lifetime use of marijuana. In 2005, more than 750,000 16-17-year-olds reported driving under the influence of illicit drugs, with 1 in 6 teens (15%) reporting driving under the influence of marijuana, and 16% under the influence of alcohol. Driving and talking on a cell phone is still another major distraction and possible cause of car crashes, no less serious than substance abuse. Drivers who use a wireless telephone while driving can lose situational awareness and experience inattention blindness. Parents who give their teens cellulars and teenagers themselves must come to grips with the fact that automobile accidents are the leading cause of death in 15-20-year-olds. Drastic steps, measures, and laws are, indeed, warranted!

If parents and teenagers cannot police themselves, then local, state, and federal authorities must intervene to administer acute and chronic remedies that go far beyond provision of a symbolic Band-Aid®. Current proposals have run the gamut from graduated driver licensing laws and nighttime restrictions, comprehensive underage drinking and driving laws, and restrictions on the number of teen passengers traveling with young novice drivers to restrictions on the use of cell phones, education of parents on the impairment of concentration, coordination, perception, and reaction time for up to 24 hours with marijuana, and national anti-drug media campaigns referring specifically to drugged driving.

Teens are “green,” but the brutal reality of the matter is that we’d rather have them green with envy than green and six feet under!

Bleep Sleep

I have a problem, a problem that is probably going to take years off my life, as well as contribute to my descent into what is called the “grouchy old man” syndrome. I don’t sleep at night. The years of stress, trials and tribulations, utter rancor and dissatisfaction with my station in life, and bitter taste in the mouth from one too many battles lost have taken their toll on my sleep-wake cycle. I have been known to literally pass out in the middle of a conversation, fall sound asleep after eating an average-sized meal in the early evening, nod off at the wheel of my car on the highway on my daily drive home from work, and start to full wakefulness at 2:00 a.m. when average Joes and Josephines are at rest under warm blankets, souls of the departed find repose and sustenance in communal camaraderie, and not a creature is stirring, not even a mouse. In short, I have “bleeped sleep,” and do what I will, I cannot reverse the tide of chronic fatigue I feel and the vicious circle I have created. Simple daily survival has become my mantra, as I no longer take pleasure in the little things in life, and I subsist solely on the caffeine or battery of other stimulants that buttress a circadian rhythm gone awry. I find myself thinking that if I can only get from the “vampire hours” to the early evening, then my day is complete, and I can surrender completely to the narcolepsy and little brother catalepsy that medical science, in all its infinite wisdom, is just now beginning to understand.

I think time would be well spent here explaining and understanding the simple workings of normal sleep, in order to arrive at a solution to my, and possibly your, problem. It is a well-known fact that insomnia, whether it be trouble falling asleep or staying asleep, affects one third of American adults. Wow! To make matters worse, insomnia can result in excessive daytime sleeping, increased appetite, reduced mental abilities, a diminished immune system, growing frustration, and a decline in daytime productivity. Now, while the amount of sleep a person requires is relative, there is a general consensus that seven to eight hours a night is needed to feel fully alert during the day. No one in this life is without worries, and an occasional bout with sleeplessness is normal. When sleep problems persist, however, beyond a few weeks, it becomes necessary to call in the heavy artillery, namely, one’s family doctor. The latter, if a lack of drowsiness on one’s part permits an understanding of the knowledge imparted, can explain the difference between the two states of a normal sleep cycle, and that is that REM (rapid eye movement) sleep is the period in which dreams occur, as opposed to deeper non-REM sleep. The number 65 is something to remember, for at that age the sleep-wake cycle begins to function inefficiently, sleeping for long periods of time occurs less frequently, and illness, pain, medicines, or a frequent urge to urinate take their toll on ZZZZs and prolong the counting of sheep.

While I understand the problem at hand, there must be some reason why I find it hard to sleep. I refuse to believe that the motive is hidden and mysterious. Whatever the latter may be, there are things I can do to combat the utter desolation of tossing and turning, as the rest of the world regenerates its corporeal fuel cells for the coming day. An attempt at inner calmness on my part breeds a game plan from which I must deviate little. First and foremost, a bedtime routine is called for, in which I do the same thing every night before going to sleep. A quiet and dark bedroom helps and, if my inner demons don’t allow my repose in a reasonable amount of time, say 30 minutes, then a brief trip to another room before returning to bed may help. A light snack, such as warm milk or some crackers, before going to bed may be just what the doctor ordered, but knowing myself and my tendency to do everything in excess, I must remain vigilant against eating too much. A “worry wart” I am, so if I can just leave my problems outside the bedroom, and use the latter for sleeping and sex (and a lot of that!), not eating, talking on the phone, or watching television in bed, then I can become a worthy adversary to insomnia. That’s not all, however. Exercising a little each day, at the expense of daytime naps longer than 30 minutes, and avoiding alcohol, caffeine, and nicotine in the evening can’t hurt. Finally, and perhaps most importantly, I must learn to retrain my body to sleep at night. What does that mean? It means that if I can go to bed and wake up at the same time every day, then maybe this Count Dracula can transform himself into an innocuous Rip Van Winkle.

If none of the above measures bring somniferous satisfaction, then “oneth by land and twoeth by sea” sleep studies are warranted to discriminate between periodic limb movement disorder (PLMD) in which legs are kicked many times during sleep, sleep apnea with repeated breathing cessation during sleep, and narcolepsy with its sudden “sleep attacks” without warning, as well as to determine the source of insomnia, snoring, or teeth grinding. I’ve been told that thorough sleep clinic monitoring of my brain activity, body temperature, breathing rates, and muscle movements during sleep can help get to the bottom of this mess I find myself in.

I’ll keep you posted as to my daily daytime quest to uncensor my “bleep sleep,” that is, if I can stay awake long enough.

Weight-less

Why do we hate fat people? Why do we look at them with disdain, with holier than thou attitudes? We are all guilty of their perceived sin, and, to boot, when blinds are drawn and monitor screens glow, we are the first to type “diet” into search engines of choice. Food companies spend millions of annual dollars hawking the latest miracle aliments promising to lower LDL (“bad”) cholesterol, raise HDL (“good”) cholesterol, and increase energy, libido, and everything short of our bank accounts. The high-fat, high-protein, low-carbohydrate (HPLC) diet of yesteryear has been touted from its throne on high for years, until recent research demonstrated its hand in promoting plaque buildup in the highways and byways of our bodies, otherwise known as arteries. While it is obvious that becoming “weight-less” is difficult at best, it certainly isn’t brain surgery. If the solution to the obesity epidemic, however, is as simple as eating more healthily and being more active, then how do we explain the plethora of unsuccessful fad diets and even crash dives into unnatural decreased calorie intake that can leave our bodies in physiologic starvation modes, eat away at healthy muscle, burden our minds with fatigue, grouchiness, and irritability, and disfigure waistlines with that all-too-common B-word, “binge” eating?

We all know the problem. We’ve been victims of it time and time again. What can we do about it? In this case, we are not talking about an ounce of prevention. Pounds are the name of the game, with a new lease on life coming at as simple a cost as a change in eating habits, albeit a small change at first. Let this short piece serve as both a primer to our initial foray into the realms of salubrious diet and healthy weight, and as a rematch between ourselves and past New Years’ resolutions kicked to the curb. While any good change in diet and eating habits begins with our family doctor, we must realize that the men and women in white simply do not have the time to completely overhaul our current lifestyles. They are underpaid, overworked, and, in many cases, more concerned with drugs and “pharmacologic surgery” of the problem than preventive medicine and patient education. We must become creative ourselves, and look to our own proactivity.

First and foremost, we must examine the good, the bad, and the downright ugly. In other words, we must make a concerted effort to assess our own dietary strong and weak points. Are we eating five to seven servings of fruits and vegetables every single day? Is calcium part of our diet and a plan to preempt brittle bones? Do regular whole-grain, high-fiber foods bring up the rear (no pun intended!), contributing to our regularity and preventing unwelcome house guests such as colon cancer, diverticulosis, and something as inconsequential, yet troublesome, as chronic constipation? Will we never learn that too much sugar, salt, and saturated fat is just plain no good? We’ve heard ad nauseam that fatty meats, cakes, cookies, potato chips, biscuits, and sweets not only increase calorie counts, obesity, and weight, but also lead to high cholesterol and heart disease. Nonetheless, we desist from limiting them in our diets and making those small changes, such as adding fresh fruit or vegetables to every meal, or getting more fiber in our diets, that would make hospital emergency rooms, cardiologists, and funeral directors quite unhappy. While keeping food diaries to that end is an exercise in persistence and healthy obsession that many of us do not possess, something as simple as a kindly reminding refrigerator magnet can reap untold economic and quality of life-preserving windfalls.

Lest we forget portion size and the gentle admonishments of our parents who cajoled the benefits of cleaning one’s plate, we may have taken this too far. Current statistics bear this out, and they’re not pretty. The American Institute for Cancer Research has reminded us of what we already know to be true, and that being that more Americans than ever are making Jack Sprat proud, by “licking their platters clean.” Were that not enough, the public is grossly unaware that we unconsciously consume 56% more calories when we are served larger portions, and that more than 78% of Americans are deluded into thinking that the specific food they eat is more important in losing weight than the amount they ingest. God help us!

With Christmas and New Year’s Eve on the horizon, and a change in waistline in the cards unless we act now, here are some “no-brainers” and food swaps that may not trim food expenses in the short term, but will most certainly balance the future medical budget, both personally and nationally speaking. Substituting low-fat, whole breads for white breads, English muffins for doughnuts, baked potatoes for French fries, turkey dogs for regular hot dogs, low-fat cheese for Cheddar, and non-fat for regular mayonnaise may not entirely please the palate, but will certainly keep us around long enough to see our loved ones grow and prosper. And we’ve saved the best for last, as we urge blind obedience to the eight commandments of clever food choice, and those being: have a healthy side dish with meals; go easy on the butter or margarine; avoid high-fat sauces and gravies; serve fresh fruit with the skin on; eat more fresh fish than beef or chicken; consume five or more portions of fruit and vegetables daily; bake, broil, roast, or steam instead of frying; and, finally, substitute dry beans, peas, or lentils as often as possible for red meat in favorite recipes. Impossible, you say! Start slowly, and build up to a crescendo.

Do as we say, and not as we’ve done in the past, and we can liberate the term “weight-less” from the exclusive lexicon of NASA.

Albert Provocateur

Sunday, December 13, 2009

Green Teen

Bleep Sleep

Weight-less

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