Shoes, Uniform, Ball … Mouthguard?

Mouth-Guard

By Polly Blake Buckey, D.D.S., M.S.

 

Mouthguards are a vital, often overlooked, piece of equipment in the athlete’s arsenal, particularly when competing in contact sports.  This is not an outrageous claim, considering that dental injuries are the most common type of injuries sustained in sports.  Anyone participating in a contact sport has at least a 10 percent chance of sustaining an orofacial injury.  You are 60 times more likely to be injured when not wearing a mouthguard.

The teeth most often traumatized by these facial injuries are the central and lateral incisors (front four teeth), which account for four-fifths of all cases.  A total of five million teeth are knocked out each year.  If these teeth are not properly preserved and replanted, dental costs to treat these traumatized teeth can range from $10,000 to $15,000 each, not including the costs of treating the gums and bone around the teeth.

Mouthguards prevent teeth from perforating soft tissues, such as the lips, tongue and cheeks.  They also play a crucial role in stabilizing the temporomandibular joints and are helpful in preventing jaw fractures.  However, the biggest asset of wearing a mouthguard may not be the protection that they offer to the teeth; a properly designed mouthguard reduces the incidence of concussion by absorbing the majority of the impact dealt to the mandible during a sharp blow.

 

Three types of mouthguards available:

  • Stock mouthguards are fairly rigid shells designed to be worn without further modification.  Often they have adequate mechanical properties, but the generally poor fit hinders speaking and breathing.  This likely leads to low user compliance.
  • Mouth-formed guards tend to be bulky and deteriorate fairly quickly.  These guards are formed by boiling the material in water, cooling it slightly and biting into it to adapt it to the teeth.  Initially the mouthguard may fit, but repeated usage causes lost retention as the unit slowly hardens.
  • Custom-made mouthguards are fabricated by the dentist by molding thermoplastic sheets to a cast of your child’s mouth.  This type of mouthguard provides the most optimal comfort and fit, with the close adaptation allowing for ease of speech and breathing.  The only drawback to custom mouthguards is a greater cost.

The success of the mouthguard speaks for itself.  In sports where the use of a mouthguard is mandated, there are simply fewer injuries than in other sports where no such rule exists.  But why are orofacial injuries not completely eliminated?  Often it is not a lack of rules, but a lack in enforcement of the rules.  In college hockey, a referee will not stop play simply because a player isn’t wearing his mouthpiece; however, referees in NCAA football watch for mouthguard use and will throw the penalty flag if there is an infraction.

Mouthguards should be introduced to children, as they are more willing to comply with usage and can develop positive attitudes about wearing them in order to reduce the number of orofacial injuries sustained during their athletic endeavors.  As a child’s mouth continues to change in size and number of teeth, a new custom-made mouthguard will need to be fabricated.  Check with your child’s dentist to see if he or she recommends a mouthguard to help protect your child while playing a sport.

 

Polly Blake Buckey, D.D.S., M.S., is a pediatric dentist.  She graduated from the University of Michigan’s School of Dentistry in 2000 and earned a master’s degree in pediatric dentistry from the University of Michigan in 2002.  She was the director of the dental clinic at Kosair Children’s Hospital from 2003 to 2006.  She loves working with children and making sure every child has the best care possible. 

Dealing with the Picky Eater – The Battle Between Parents and Children

picky girl

By Barbara Day, M.S., R.D., C.N.

Winning the war on what the child should eat or not eat is a continuing issue in every family in every generation.  Strategies such as, “You’ll sit here until you finish every bite on your plate” and “What do you want to eat – whatever you want, darling,” have not proven effective in ensuring that children eat healthier.

These strategies may help you survive the battle.

  1. Avoid the power struggle.  Don’t say, “Do it, because I’m the parent.”  The child needs to understand the why behind the rules, which may help lay the groundwork for lifelong, sound food choices.
  2. Let children participate in the meal preparation.
  3. Children under five are selective eaters.  That’s a fact.
  4. Introduce new foods slowly. Studies have shown children need to be exposed to a new food 10 to 15 times before they will accept it. Limit exposure to one or two new foods a week. When introducing a new food, serve it alongside familiar foods your child likes.
  5. Never use food as a reward.  Rather than using food as a reward, use something physical and fun – such as a trip to the park or a game of catch or basketball.
  6. Beware of over-snacking.  Knowing how many calories your child needs to eat and keeping track of those calories periodically can help ensure they are getting enough calories, but not too many. (See “How Many Calories Should Your Child Eat Each Day?”)
  7. Don’t label foods as “good” or “bad.”  Tie certain foods with things the child might care about , such as, lean protein helps build muscles and bones, whole grains energize sports performance, and antioxidants in fruits and vegetables help keep skin radiant and hair shiny and healthy.
  8. Be a good role model.  If you don’t eat fruits and vegetables, how can you expect the children to do so?  Your mealtime attitudes have a strong influence on your child’s eating behavior.
  9. Keep healthy foods available and accessible.  Your child can only choose foods that you purchase and bring into your home. Keep a low shelf in the refrigerator stocked with cut-up fresh fruit and other healthy food choices.
  10. Be more creative in your food design and preparation.If a child won’t drink milk, add it to oatmeal, pudding or mashed potatoes.  If a child won’t eat vegetables, serve fresh vegetables with low-fat dressing or puree the vegetables and add them to main dishes or side dishes. Don’t give up.
  11. Give your children small portions.  Children don’t need to eat the same portion sizes as adults.  Too much food can be overwhelming; they can always take seconds.
  12. Make sure the food looks and tastes good.
  13. Some children have food jags.  They will only eat certain foods.  Fortunately, children can thrive on a boring diet.
  14. If your child definitely won’t eat vegetables then boost their vitamin and mineral intake by serving more nutrient-dense fruits such as cantaloupes, berries, red or purple grapes, raisins, kiwi and oranges.
  15. If your child won’t eat meatyou can also puree the meat and add it to sauces.  You can also add gravy to meat, serve it with ketchup or mix it into mashed potatoes. A healthy diet doesn’t have to include meat but needs to include enough dairy products, beans and legumes or soy-based products, which can provide adequate amounts of protein, iron and B vitamins.

Image from: www.babble.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHEALTHWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.     

Fueling on a Budget for Traveling Sports Teams

sports teams

By Nancy Clark MS RD CSSD

“When we travel as a team, we eat at fast food places because they fit with our small budget.What’s the best fast food for athletes…?”

“After my workout, the last thing I want to do is cook dinner. Where can I buy affordable but healthy sports meals…?”

A limited food budget creates a fueling challenge for many athletes, including college teams traveling to games, students responsible for their own meals, parents of active kids, and semi-pro players hoping to get to the next level. The name of the fueling game is: How can you buy enough healthy calories with the least amount of money? These practical tips can help optimize a low-budget sports diet.

1. Encourage the team bus (or your car) to stop at a large supermarket.

Everyone can find something they like: vegetarians,  gluten-free eaters, picky eaters who want to lose weight, and chowhounds who need lots of calories. By walking around the inside perimeter of the store, you will find the makings for a balanced meal—even hot meals, if desired. Shop for:

Fresh fruit: Banana, apple, pear, grapes. Buy what’s on sale.

Fresh veggies: While you can easily create a colorful salad at the salad bar area, it might be a bit pricey. The simpler option is to simply buy: a green  or red pepper (eat it whole, as you might eat an apple), a bag of baby carrots (along with a container of hummus), or a container of cherry tomatoes. Enjoy the whole thing; a hefty dose of veggies on one day can help compensate for another day when you have none.

(To clean the fresh produce, plan ahead. Pack extra water to rinse the produce before getting on the bus. Or nicely ask  an employee in the store’s produce area if he or she could help you by giving the fresh produce a quick rinse.)

Protein: Buy a quarter-pound of deli turkey, roast beef, or ham along with a few whole wheat rolls to make sandwiches. Small or large tubs of cottage cheese, tuna packets, and peanut butter are other popular protein options. Share a rotisserie chicken with friends (or save the leftovers if you can refrigerate them within an hour.)

Grains and other carbs: Pita, wraps, baked chips, whole-grain crackers and  pretzels are carb-based options that refuel your muscles. Look for freshly baked whole-wheat rolls, hearty breads, and whole-grain bagels. You might be able to find a plastic knife at the salad bar so you can slice the rolls to make a nice sandwich with deli meat and lowfat cheese. Pop a few cherry tomatoes between bites, and you’ll have a balanced meal with all 4 foods groups: 1) lean meats/beans/nuts, 2) lowfat dairy or calcium-alternative, 3) fruit/vegetable, 4) grain.

Calcium-rich foods: You can easily buy a small or large tub of lowfat yogurt, a single milk chug—or even a whole a quart of chocolate milk if you are really hungry. For athletes who are dairy-free, soymilk is a fine alternative. Pick up some pre-sliced lowfat cheese in the dairy or deli area. (Note: Hard cheese, such as cheddar, is lactose-free and comes in convenient single portions.) Add an apple and whole grain crackers—voila, a balanced sports meal! While it may not be the hot meal your mom had in mind, it will do the job of contributing needed nutrients to refuel from the day’s event, fuel-up for tomorrow, and invest in future good health.

Beverages: You can save a lot of money (plus save space in landfills) by packing your own gallon jug of water. To spend money on plain water (void of calories, carbs, and vitamins) seems wasteful when tap water is free. Instead buy 100% juice (orange, grape, carrot, V-8) to boost your fruit/veggie intake and simultaneously boost your immune system with anti-inflammatory phytochemicals. Plus, 100% juice is a strong source of carbohydrate to refuel depleted muscles, as well as fluid to replace sweat losses. Chocolate milk is another winning beverage, with protein to build and repair exhausted muscles, as well as carbs to refuel them.

If the team bus (or your car) is pulling into a fast food restaurant, at least choose one that will support the nutritional needs of athletes. Here are a few suggestions:

• At Taco Bell, you can get the most amount of healthy calories for a bargain price when you order their bean burrito. Two bean burritos cost only $2.20 and provide 750 (mostly quality) calories.

• At a burger place, choose a grilled chicken sandwich (no fries). It will be more expensive and offer fewer calories than a burger, so plan to supplement the sandwich with some Fig Newtons, pretzels or raisins that you pre-packed from home.

•At a pizza place, order the cheese pizza, preferably with veggie toppings like mushroom, pepper, and/or onion. Nix the pepperoni, sausage and other greasy meat options, as well as the double cheese. You’d end up fat-loading with that type of pizza. It would fill your stomach but leave your muscles poorly fueled. Remember: muscles need carbs (such as thick pizza crust) to replenish glycogen stores.

• Be cautious of super salads. While they have a seemingly healthy glow, they can be unfriendly for many sports diets, particularly if you are weight-conscious.Making a substantial salad with not only colorful veggies but also grated cheese, chopped egg, diced chicken, slivered almonds, pumpkin seeds, and olives offers you a hefty dose of calories, but not enough grains/carbs to refuel your muscles. Adding even a little bit of dressing to a big salad often adds  400 or more calories. A sandwich can have fewer calories….

• Hungry athletes who need lots of inexpensive calories can do well by packing sandwiches made with peanut butter & jelly (or PB & jam, honey, raisins, banana, pickles or even cottage cheese—whatever tastes good to you). Peanut butter is versatile and a great sports food because it offers protein, B-vitamins, and good fats that knock down inflammation. It’s inexpensive, travels well without refrigeration, is good for you, and tastes great! It’s even good for dieters because it keeps you feeling fed, and curbs the urge to eat cookies. For the $2 needed to slap together a hefty 600-calorie PB&J (made with 2 slices Pepperidge Farm Bread, 3 Tbsp. Teddie all-natural peanut butter, and 2 Tbsp. Welch’s grape jelly), you couldn’t even buy a Muscle Milk ($3.69 for 230 calories). Shop wisely and fuel well!

Image from: www.sheknows.com/parenting/articles/809104/how-to-deal-with-over-competitive-coaches

Boston-area sports nutritionist Nancy Clark MS RD counsels both casual and competitive athletes at her private practice in Newton (617-795-1875). Her Sports Nutrition Guidebook and her food guides for runners, cyclists and soccer players are available at www.nancyclarkrd.com. For online education, visit www.sportsnutritionworkshop.com and www.NutritionSportsExerciseCEUS.com.

What is Trigger Point Dry Needling and Can It Help Me?

By Janelle Ciolek, PT, DPT, OCS

Trigger Point Dry Needling (TDN) is a treatment technique utilized by specially trained Physical Therapists to help treat neurogenic and musculoskeletal pain of either chronic or acute nature.  Many people with pain conditions are found to have active Trigger Points (TPs) in muscles, which exacerbate their pain.  Trigger points are taut, banded, irritable spots within skeletal muscle that cause pain, especially when they are compressed.  In scientific studies, trigger points have been found to demonstrate irregular electrical activity and shortened muscle structure, along with having pain causing chemicals within the muscle tissue.  These trigger points will often cause pain referral to other adjacent areas.  For example, a trigger point on the back of the shoulder blade, when compressed, may reproduce pain in the front of the shoulder or down the arm.

During treatment with dry needling, the physical therapist inserts a flexible, thin filament needle directly into the painful trigger point. The patient can feel a variety of sensations, most notably a deep aching or cramping sensation, and often will experience a localized muscle “twitch” sensation.  These sensory experiences help guide the treatment and let the therapist know they are treating a problematic area.  Dry needling, through scientific research, has been shown to promote healing in the affected painful areas.  It does this by releasing muscle tension, quieting electrical activity in the trigger points, and decreasing the chemical factors in the trigger points that cause pain.

Trigger point dry needling, in the hands of the trained and capable physical therapist, can be used to treat almost any musculoskeletal condition, including back pain, whiplash, frozen shoulder, elbow tendonitis, and plantar fasciitis, amongst many others.  It can even be used post-surgically to treat hypertrophic or adhered scar tissue.  Dry needling is used as valuable part of the whole physical therapy “package” which can include therapeutic exercises, joint mobilization or manipulation, patient education, and modalities.  Every patient has a unique program developed specifically for them, based on their symptoms and needs.

The American Physical Therapy Association as well as the Kentucky Physical Therapy Association support the use of trigger point dry needling in the hands of trained and licensed physical therapist.  For more information, please visit www.kort.com.

Image from: www.dryneedlingcourse.com

Janelle Ciolek PT, DPT, OCS, is the Clinic Director and has been part of our KORT team since 2005. Janelle is a 2004 graduate of the Doctor of Physical Therapy program at Bellarmine University, a Board-Certified Orthopedic Specialist (OCS), a certified  IASTM therapist, practitioner of Functional Dry Needling (FDN) and is a Clinical Instructor for the American Physical Therapy Association (APTA). Janelle also serves as adjunct faculty in the Bellarmine University Physical Therapy Department. Janelle loves the fast-pace and challenges of outpatient orthopedic physical therapy and has substantial experience in this area. Her clinical interests include manual therapy, sports injuries, and knee and shoulder reconstruction.

 

What is Fifth Disease?

By Ashli Collins, M.D.

My patients and parents often give me help in ideas for this column. This month, when I informed a dad that his child had Fifth Disease, he responded by saying, “Well, Doc, I don’t know…I’ll have to check with my wife to see if he’s had the first four yet.” Confusion over names of diseases is common but by adding a number, instead of a descriptive term (like hand, foot and mouth disease), makes it hard on both parents and medical students trying to learn all the different childhood illnesses!

Years ago, when diseases were being categorized and named, “first disease” was measles. Thankfully, with the help of vaccines, that is no longer a common illness we see. Second disease was scarlet fever or strep throat with a rash. Rubella, also vaccine preventable, was third disease, and fourth disease honors go to Staph aureus infections. Fifth disease has remained without a common name in our culture and mystifies parents with its name.

Fifth disease also goes by erythema infectiosum or slapped cheek disease. To our infectious disease physicians, it is parvovirus B19. I always thought that sounded like a parasite with a vitamin deficiency. With all this confusion and funny naming, a description of this common childhood illness follows.

Fifth’s is a viral illness that has infected around 50-60% of people by adulthood. In children, agesfour to tenare most affected. It can affect girls and boys equally and is most common in the winter and spring months.

Symptoms of fifth disease can range from mild to severe. Many adults who test positive as having the disease before do not recall ever having the illness. The most common symptoms are fevers and mild joint/muscle achiness followed by a slapped cheek appearing rash with a lacy rash on arms and legs. The rash itself may last five to seven days (on average), but it is not uncommon to see it last for a few weeks. While the child has the fever, it is often difficult to differentiate from many other viruses. It is the classic rash that makes the diagnosis.

Some children will have fairly severe myalgias and pain. Rarely, but occasionally, children will have lingering arthritis type pain for weeks to months. Knees, fingers and wrists are the most common joints to have arthritis, but interestingly, the arthritis is usually symmetric with both sides of the body affected.

While a child has the fever, they are generally considered contagious. However, once the fever dissipates and the rash occurs, they are no longer able to spread the disease. During the contagious period, the virus is spread via droplets. Sneezing, coughing, drooling and runny nose are all mechanisms to pass on the virus.

One major concern with this disease is for pregnant women. Pregnant women who have not had the disease should avoid people with fifth’s disease. Fifth disease virus can cause miscarriages in 2-10% of unprotected (not previously infected) moms. Protecting these moms from infected children is tricky in that the diagnosis is usually made at the time the rash appears, but during the rash phase, a patient is no longer contagious. If you are pregnant and find out a child you have had close contact with has fifth disease, you should contact your obstetrician.

Treatment for fifth disease is mostly supportive. Rest, acetaminophen and fluids are the mainstay. As with any virus, antibiotics will not be helpful. If there is significant joint pain/arthritis, anti-inflammatories, such as ibuprofen (Advil/Motrin) or naproxen (Aleve), may be helpful.

Image from: www.drdavidgeier.com/playing-outside-could-lead-to-healthier-children/

Dr. Collins is a pediatrician with Oldham County Pediatrics, PLLC. They have offices in LaGrange and in Louisville near the Summit. For more information, call 502-225-6277 or www.oldhamcountypeds.com.

 

Healthy Back. Healthy Life.

By Julie L. Lyles, DC

One of the least understood but most important parts of the human body is the spine.  The spine is the lattice work and foundation for every other soft tissue and organ.  The spine is composed of 26 moveable segments.  Hear that?  Moveable! Each joint is angled in a certain way to provide optimal motion and optimal protection.  When loaded correctly and free of fixation, there is nothing more brilliant!   So, why such confusion?  Why such a lack of respect?  Why so little education on the value and importance of healthy joint mobility and postural balance?  Maybe it’s a lack of understanding of the complex simplicity of the spine and its care.

When a child is born, she has 2 curves in her spine:  the mid-back and the sacrum.  As the child starts to get nosey, she lifts her head while on her belly and starts to develop the curve in her neck.  The forces that the back part of her neck feels is what triggers her body to pour calcium in the right places until the age of 25.  (Wolff’s Law” of Physics states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal-weight structure that is ‘adapted’ to its applied stresses.”)

Later on, she gets a little more nosey and goes to all fours, dropping her belly with her head lifted up, developing the curve in her low back.  And, off she goes…through a stage of crawling, building necessary brain and body strength, and mechanical and neurological synchronization.  Then, only when she and her spine are ready, she will start to pull up, with ideally, a properly curved spine that has been fortified by normal instinctive motions and body positions.

When the curves in the spine are not properly formed, as is becoming the norm due to a decrease in “belly-time,” walking too soon without first crawling, more sedentary lifestyles and of course, technology posture, the body reacts profoundly!  Look at the body this way, the back or posterior, is the foundational structure, whereas, the front or the anterior, is where all of the organs and pipes are that supply the body with nutrition and eliminate waste.  If you place the weight of your head, shoulders, and hips in the back and heels, you are correctly putting stress in the purposefully larger, denser bones intended to carry such weight and leaving the front to “flow.”  If you place the weight of the head, shoulders, and pelvis in the front, you are blocking flow of nerve supply, blood supply, and lymphatic supply and compressing all of your vital organs, ultimately leading to dysfunction and disease.

What are common symptoms of joint fixation and postural distortion?  Headaches, neck and back pain, numbness, tingling, and weakness in the upper and lower extremities.  Big deal?  Motrin or Tylenol can help you live with those symptoms, right?  Well, every seven years when the body remodels bone and every year when your organs try to replace their tissues, you are allowing dysfunction and disease to continue…until, of course, you get the symptoms that you can no longer cover up and no longer live with.  What are some conditions that are on the rise, linked to postural distortion and joint fixation: hypertension, migraine headaches, ADD/ADHD, sinusitis/allergies/asthma, reflux and GERD, osteopenia/osteoporosis, infertility, and constipation to name a few.  All of these conditions typically lead to a less active you.  The decreased motion in your body further accelerates the deterioration of the joints and the organs through fixation and stagnation.

What can you do?  Look at yourself and your family and notice if the center of your ear is close to the back of your neck and in line with your shoulders?  Are your shoulders lined up with your hips?  Are your hips lined up with your heels?  Do you have any of the aforementioned conditions and use a lot of over the counter medications? Do you have trouble turning your head or bending it forward, backward, or sideways?  Do you avoid bending over or leaning back? Have you become less active and accepted “feeling bad” as your norm?  Or, has disease set in?

Seek out a health care professional whose specialty is the structure and function of the human form, one whose skills, through manual correction, proper education, and physical retraining can help restore your body to the strong balanced flowing structure capable of brilliant healing powers: The Doctor of Chiropractic.

Image from: www.masharosen.com

Dr. Julie Lyles, DC is a doctor of chiropractic who practices chiropractic care and also owns GetWell Solutions which is focused on Nutrition Counseling, Well Coaching, and Corporate Wellness Programs. For more information, contact Dr. Lyle directly at drjulie@askdoctorjulie.net.  

 

 

 

‘Tis the Season…for Allergies

By Ashli Collins, MD

As springtime comes to our area, local doctors offices are filling up with itchy, watery eyes, runny noses, sneezing and coughing.  Adults certainly know the telltale signs of allergies in theOhioValleybut for our younger counterparts, the symptoms are sometimes less obvious. Louisvilleand the surrounding areas often rank in the top five of highest allergy sufferers.  Many families that move to the area are amazed at just how much of an impact allergies can cause on their lives.  An estimated 44 million Americans suffer from allergies-a lot of which are kids.  Allergies rank as the sixth leading cause of chronic disease!

For children, the single most important factor for having allergies is the family history.  A strong family history of allergies, asthma or eczema predisposes the child significantly.  It is estimated by theAmerican Academyof Allergy, Asthma and Immunology that if one parent suffers from allergic disease, the child’s risk is 48% and if both parents are sufferers, that risk is 70%.

Allergies are triggered by allergens-pollens, molds, pet dander, foods to name a few.  When a susceptible child encounters the offending allergen, the immune response occurs and a series of reactions occur causing the typical allergic responses.

The most common allergic symptoms in children are clear nasal discharge, sneezing, sniffing, watery eyes, scratchy throat and nasal itching.  Parents are often greeted with the “allergic salute”, which is the child rubbing their nose vertically to alleviate the itching and stuffiness.  Other frequent symptoms are eye blinking, itchy watery eyes, headaches, restless sleep, coughing, rashes and post nasal drip.  These children often have dark circles under their eyes and stuffy swollen nasal passages.  For some children, ongoing nasal symptoms with stuffiness can lead to sinus infections or ear infections.  Allergies can trigger asthma attacks in some children.

Diagnosing allergies is usually made by the history and physical exam of the child.  Sometimes a referral to an allergist will help the child’s pediatrician make an accurate diagnosis.  There is occasionally the history of “frequent colds” or recurrent ear infections that will prompt the referral as well.  In infancy, rashes and reactions to certain foods often trigger an earlier referral to the allergist whereas in toddlerhood it is more commonly the constant drippy nose or watery eyes.  As children get to school age, full blown allergy symptoms are usually observed.

Testing for allergies is often done by skin testing.  This test is very useful in identifying certain allergens that can potentiate a child’s symptoms.  There are blood-based tests that are used, but skin or scratch testing has remained the gold standard.

Once a diagnosis of allergies has been made, a treatment plan is established.  For many allergens, strict avoidance is preferred, however, it is nearly impossible to eliminate all allergens from a child’s environment.  House dust, or dust mites, is the most common trigger of year round allergies in children.  Frequent vacuuming, encasing pillows and mattresses in dust-proof plastic will help.  Carpet tends to harbor these mites so for many, changing to hardwood floors may be beneficial.

Other common triggers, including pets and pollen are hard to avoid.  10-15 percent of the population suffers from pet allergies.  Pet dander, or microscopic flakes of the pets skin are the main component of the allergic reaction with cats being twice as likely to cause allergies as dogs.  If the pets are in the home to stay, keep them out of the child’s room and frequently change the air conditioner filters.  For pollen sufferers, keep children inside in late afternoon as that is when pollen falls from its source.  Also, monitor for high pollen count days and keep children indoors.

Many allergy sufferers, including children, rely heavily on their pharmacy to help them cope with their symptoms.  The most commonly used medicine is an antihistamine.  These medicines work by blocking the chemicals released in an allergic reaction.  There are now 24 hour, non-sedating antihistamines available for children.  Intranasal sprays are also very helpful in calming the chronic drippy nose allergy sufferers and will also help stop the allergic reaction before it gets started.  Allergy shots are also available for some sufferers.  Newer medicines are also available and may be discussed with your child’s doctor.

Children suffering from allergies are able to live happy, healthy lives.  Often times avoidance of potential allergens is all that is needed, however, if further evaluation is needed, speak to your child’s doctor or allergist for an in depth evaluation.

Image from: moms.popsugar.com

Ashli Colins, MD.  Dr. Collins is a pediatrician with Oldham County Pediatrics, PLLC.  They have offices in LaGrange and in Louisville near the Summit.  Dr. Collins is the mother of  twins, Sarah and P.J.  For more information call 502-225-6277 or www.oldhamcountypeds.com

 

How Many Calories Do You Need Each Day?

By Barbara Day, M.S., R.D., C.N.

There’s an App for this!

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home or lose weight.  There are some FREE apps that you can use to help to determine how many calories you need each day.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: www.myfitnesspal.com/tools/bmr-calculator and how many calories you burn when playing soccer or lifting weights: www.myfitnesspal.com/exercise/lookup. Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast.

Other excellent apps and websites to determine calories are: LOSE IT! (www.loseit.com), SPARK PEOPLE (www.sparkpeople.com).

The Old Fashion Way to Determine Your Calories

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate (RMR) then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation

MALE:

RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)

FEMALE:

RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1.  Activity Factors. Choose your activity level from the table below. Then do the math.

EXERCISE

FACTOR

Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned during exercise. (Not all heart rate monitors calculate calories). Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.  So, you could safely eat at least 1800 calories without gaining weight.

Again, it’s just an estimate. Weigh only once a week about the same time.  I suggest weigh after the first void in the morning before drinking anything with as few clothes as possible.

 Using Oxygen Consumption to Calculate your Personal RMR

The BodyGem Resting Metabolic Rate device is the handheld, portable and an effective tool that gives you an accurate RMR measurement result in 10 minutes or less. To perform a measurement, you simply breathe into the indirect calorimeter, which measures their oxygen consumption (VO2), the resulting RMR number is clearly displayed on the device’s LCD screen. It has been validated against the gold standard Douglas Bag, and other commonly used metabolic carts. The test costs anywhere from $75 to $150 per test. For the best results, you should take the test when you are fasted. But you still need to estimate the active calories you burn.

Body Media FIT™ On-Body Wellness Core Armband Monitor

The BodyMedia FIT CORE which is promoted by Biggest Loser is another way to determine how many calories you burn each day. The CORE’s biggest plus is that it track calories burned for 24/7. It cost about $119.  Unlike other fitness trackers, which estimate calories burned using an algorithm of steps and weight, the CORE uses special sensors to track not just your activity but also your body’s reaction to that activity. This makes it much more accurate as a calorie tracker, so you can realistically see how many calories you’re burning. But you have to buy subscription-based Activity Tracker in order to find out how many calories you have burned in the 24 hours.  The CORE Armband does not display any information on the device itself.  That will cost you  $6.95/month or you can opt to purchase a $69 optional display, which syncs with the CORE and lets you see a quick view of progress toward your daily goals. If you want to track your progress, you’ll still need to purchase the Activity Tracker.

What’s the Take Home Message?

I think it’s helpful to know how many calories you need each day so you can manage your health. In today’s world, lifestyle is the major contributor to increasing your risk of many diseases like heart disease, stroke, diabetes, and cancer.  Lifestyle includes your diet and also your daily activity.

Image from: www.greatist.com

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  The former publisher of Kentuckiana HealthFitness Magazine, Kentuckiana Healthy Woman magazine and radio show host of Health News You Can Use, Barbara has over 30 years of experience in promoting healthy lifestyles to consumers.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Visit Barbara’s new website which is an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes nutrition and health columns for www.LiveStrong.com as well as a weekly nutrition column for the Southeast Outlook. She also designs and presents employee wellness programs to small and large businesses. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    

 

Maximizing Performance & Minimizing Injuries in Soccer Players

By Sports Dietitian, Barbara Day, M.S., R.D., C.N.

Nutrition is the key to providing energy which can maximize performance and minimize injuries that are caused by an early onset of fatigue.  Let’s face it, how much energy the soccer player has determines how much work can be effectively done on the field & in the weight room. Getting enough calories to cover the demands of your sport & your growth will help to prevent fatigue.  But many athletes may not eat an adequate amount of calories because of their active lifestyles and this situation can have a negative effect on performance. Two other important challenges for soccer players are maintaining adequate fluid status before, during and after practice and matches as well as maintaining adequate glycogen levels which is the storage carbohydrate (CHO) by making good food and beverage choices. But the key is knowing how much is required. Parents and players can check out the specifics that follow which can help impact a player’s performance in a positive manner.     

The Soccer Player’s Daily Training Diet Specifics

How Many Calories Does a Soccer Player Need Each Day?

Knowing how many calories you need each day will help keep you energized while you are training for your event and doing all the things you need to do each day: work, manage a family, take care our your home.  There are some FREE apps that you can use to help to determine how many calories you need each day. Eating too few calories consistently, the player may find they are losing weight which might be a goal but they may also battle with fatigue and then ultimately an injury or an immune related illness.

A FREE app, My Fitness Pal, for your smart phone or online at can help to determine how many calories you need each day: www.myfitnesspal.com/tools/bmr-calculator and how many calories you burn when playing soccer or lifting weights: www.myfitnesspal.com/exercise/lookup. Add the calories plus the calories you burned practicing to get how many calories you need on most days.

Once you determine how many calories you need each day, the timing of your food intake is also important. Eating 5 – 6 times per day will help give you bullets of energy but keeping the calories in line with your overall calorie needs will maximize your performance. Never skip breakfast. Eat or drink something before early morning workouts to get the most effective workout.

To determine how many calories you need each day, you can calculate the calories the OLD FASHION WAY by using the HARRIS BENEDICT EQUATION to determine your resting metabolic rate then choosing an activity factor to estimate the total calories per day.

Harris Benedict Equation

MALE:

RMR = 88.362 + [1.889 X HT (in)] + [6.089 X WT (lbs)] – (5.677 X Age)

FEMALE:

RMR = 447.593 + [(1.219 X HT (in)] + [(4.20 X WT (lbs)] – (4.7 X Age)

HT = height in inches   WT = weight in pounds   age = age in years

Activity Levels

Very Light-seating and standing activities, driving, no regular exercise.

Light – child care, walking on a level surface 2.5 – 3 miles per hour, some regular exercise.

Moderate – walking/running 3.5 to 4 mph, cycling, regular exercise 3 to 4 times/week -30 to 40 minutes duration.

Heavy – walking uphill with a load, basketball, soccer, regular exercise 4 times/week 40 minutes or more in duration.

Very Heavy – distance running, hiking with backpack up and down hills, regular exercise 5 times/week for at least 1 hour in duration.

TABLE 1. Activity Factors. Choose your activity level from the table below. Then do the math.

EXERCISE

FACTOR

Little to no exercise

RMR X 1.2

Light (1 – 3 days per week)

RMR X 1.375

Moderate exercise (3 -5 days/week)

RMR X 1.55

Heavy exercise (6-7 days/week)

RMR X 1.725

Very heavy (twice/day heavy workouts)

RMR X 1.9 

Example, 1300 X 1.55 (moderate) = 2015 calories/day

You can also determine how many calories you burned by wearing a heart rate monitor that determines calories burned. Then you can add those calories to your resting metabolic rate calories to get an estimate of active calories burned while exercising.  Example, 1300 X 500 calories = 1800 calories.

Daily Fluid Needs for the Soccer Player

One can determine their fluid needs, based on their daily calorie needs.  This is just a rough estimate however.  For example, if the 110-pound soccer player who needs 2,200 calories, then divide that number by 30. The athlete’s daily fluid intake should be about 73 ounces.  In very hot climates, multiply the calories by 1.5 and divide that number by 30.  In very hot climates, the 110-pound athlete will need at least 110 ounces to maintain adequate hydration. For example, 2,200/30 = 73 ounces; 1.5 X 2,200 = 3,300/30 = 110 ounces.

But, this is only part of the equation.  Soccer players can also check out the color of their urine periodically to determine adequate hydration.  The day after long practices or hot practices would be a time to monitor urine color. The first void of the day is usually yellow, however, as the day continues the urine color should be pale yellow.  If the urine continues to be yellow throughout the day, then you may be dehydrated.  Unfortunately, dehydration does not go away, but it continues to worsen and the athlete’s performance decreases.  A player can weigh themselves before and after long hot practices or tournament play. For every pound of weight the soccer player loses during practice or a match, 20 ounces of caffeine free fluid is required to restore proper hydration.  A loss of only 1-2% of weight due to dehydration which can occur 15 minutes under intense playing in the sun or after 30 minutes intense playing in normal weather conditions could cause premature fatigue thus affecting performance in a negative way.

Daily Carbohydrate Needs for the Soccer Player

 

Carbohydrate (CHO), called the athlete’s nutrient, has three main functions in the body.  It provides fuel for the body, dietary fiber, plus is a source valuable vitamins and minerals.  The CHO you eat has two fates:  it will be either burned for energy or it will be stored for future use in the form of muscle glycogen or liver glycogen. CHO is the body’s preferred source of energy and is used to replenish muscle glycogen which helps to ensure you have lots of energy to run up and down the playing field.

Table 2. Daily Carbohydrate Recommendations for Soccer Players

●        2.27 – 3.18 g of CHO/lb/day: athletes engaging in moderate-intensity practice or matches lasting for 60 to 90 minutes per day.

●        3.18 – 5.45 g of CHO/lb/day: athletes engaging in moderate-to-high practices or matches lasting for two to three hours.

 

Soccer players should consume 2.27 – 5.45 grams of CHO per pound of body weight if they practice for 1 to 3 hours per day.  For example, the 110-pound female soccer player who practices for 2 hours would need about 350 grams of CHO per day.  The 170-pound soccer player would need 557 grams of CHO per day.

Recommended CHOs are whole grains such as cereal like oatmeal or Wheaties™, Kashi™ or other dry cereal, whole grain & dark bread, bagels & English muffins, spaghetti, brown rice, quinoa, popcorn, fruits, vegetables, etc. Read the food label to determine how many grams of carbohydrate is included in each food or use the apps that were earlier discussed to find out how many grams of carbohydrates are in the foods you eat each day.

Protein:  Builds and Repairs Muscles for Tip Top Performance

Protein is important for growth and development, required for healing injuries, and necessary for the maintenance of body tissues. As our body grows, it uses protein to manufacture cells.  For example, the protein, collagen, serves as both building and mending material in tissues such as ligaments and tendons.  Enzymes, hormones, and antibodies are synthesized from protein.   Proteins within each cell are also constantly turning over – being made and being broken down. Protein is composed of individual amino acids strung together in chains. The constant synthesis and breaking down of protein is known as protein turnover. When protein breaks down, they free amino acids to join the general circulation.  Some are recycled into other proteins; others may be stripped of their nitrogen and used for energy.  Protein provides 4 calories per gram. Although protein is not a major source of energy, an active growing soccer player needs for protein may be slightly higher than the needs of a sedentary person.

So how much protein do you need each day? 

Players need to consume an adequate amount of protein for healing, for recovery from soccer practice, for growth, for the formation of red blood cells and hormones. The active growing soccer players needs between 0.7 to 0.9 grams of protein per pound of body weight. Example, a 110-pound soccer player would need between 77 and 99 grams of protein per day.

The best way to find out how many grams of protein a food contains is to check out the Nutrition Facts on the food label but most meats do not contain the nutritional information on the label but you can use the My Fitness Pal app to find out the protein amount in your food. Remember to look at the serving size on the label and compare it to the amount in your actual serving.

Table 3. Protein Found in Basic Foods. Read the Food Labels to get an Accurate Count.

  • A small 3-ounce piece of meat about the size of a deck of cards after          cooking has about 21 grams of protein.
  • A typical 8-ounce piece of meat could have over 50 grams of protein.
  • One 8-ounce container of yogurt has about 11 grams of protein.
  • One cup of milk has 8 grams of protein.
  • One cup of dry beans has about 16 grams of protein.

The Take Home Message

A combination of consuming the proper amount of calories, CHO, fluids, and protein each day can help soccer players to enhance their level of play and help to minimize injuries that are caused by fatigue. 

 

Barbara Day, M.S., R.D., C.N., is a registered dietitian with a Master’s Degree in clinical nutrition.  Barbara worked as Nutrition Consultant to the Navy SEALs (8 years) and the University of Louisville Athletic Department (10 years). Barbara has private practice, DayByDay Nutrition, www.DayByDayNutrition.com, where she counsels clients on weight loss, cholesterol management, performance nutrition and an array of other medical issues.  Barbara publishes an on-line health & wellness magazine, www.KentuckianaHealthWellness.com. Barbara writes weekly nutrition column for the Southeast Outlook. Barbara is a runner, cyclist, hiker and a mother and grandmother to 13 grandchildren.    

 

Delousing Head Lice

By Ashli Collins, M.D.

For anyone with a preschool through high school aged child, you have certainly received the dreaded “head lice identified in a classmate” letter.  This letter usually instills fear and parents start digging thru their children’s hair immediately.  This article will hopefully help you understand head lice, its lifecycle, the symptoms it can cause and its treatment.  I will also hope to dispel a few common myths that continue to be heard.

 

Just to raise the anxiety a little more, head lice causes6 to 12million infestations each year.  It is extremely common, especially in kids ages 3-12 and thankfully does not spread disease or pose a health hazard.  It also is NOT a sign of uncleanliness, but just an outcome from sharing a hat, comb, pillow or close acquaintance with someone who has an infestation.

 

The tiny louse grows to a length of 2-3mm and usually appears like a grey or brown sesame seed.  The female lives only 3-4 weeks but in that time lays between 5-10 eggs, or nits a day.  These eggs are essentially glued to the hair shaft near the scalp.  The most common place to visualize the nits is behind the ears and at the neckline as temperature and humidity are more suitable there.  The eggs hatch around 10-14 days later and leave behind a white casing on the hair shaft.  The nymphs then grow for 9-12 days, mate and then the females begin laying eggs.  If the hair is not treated, this cycle will then restart every 3 weeks.

 

The louse lives by injecting small amounts of saliva and taking small amounts of blood from the scalp of its human host every few hours.  Many believe that it is the saliva that causes the intense itching commonly seen with an infestation of head lice.  A louse cannot live off of its human host for more than 24-36 hours as it needs human blood to survive.  It also does not jump, fly, parachute or hop to get to another host; the louse does not have wings and has legs only built to grasp hairs.  Head lice does not live on pets, it requires a human host.

 

Head lice are spread by close contact with a person with an infestation.  Brushes, combs, hats, pillows, helmets and hair accessories have been theorized to cause spread but actual head to head contact is the most common.  Many children will bring lice home and then share it with the family.

 

The main symptom with head lice is itching.  Schools/teachers are taught to watch for children who are constantly scratching their head.  Secondary infections from the itching may occur such as impetigo or swollen lymph nodes.

 

Diagnosing head lice is not always easy.  Retrieving a live louse is the most definitive tool but an adult louse can climb 6 to 30 cm per minute making them hard to catch.  Nits are usually found by the school nurse, pediatrician or parent but these are easily confused with dandruff, hairspray residue and hair casts.  If the presumed nits are not within an inch of the scalp they are less likely lice.  One suggestion to try and find lice is to have the child hold their head over a white towel and brush the child’s hair from the scalp towards the towel to see if any lice are dislodged.

 

Once lice are identified, treatment needs to take place and notification of the school and other close contacts should be given.  Several over the counter (OTC) and prescription treatments are available.  Rid (pyrethrin) is OTC and is made from chrysanthemums, thus people with an allergy to that should avoid it.  This shampoo is applied to dry hair, let sit for 10 minutes and then rinsed out.  Shampoo treatments should always be performed over a sink with cool water to minimize contact and absorption to the rest of the skin.  Pyrethrins are not 100% effective against lice with 20-30% of the eggs remaining viable after the treatment, thus reapplication in 7-10 days to kill any newly emerged nymphs.

 

Another common OTC treatment is Nix (permethrin 1%).  It works well and has fewer allergic problems than pyrethrins.  It is applied to shampooed (with non-conditioning shampoo), towel-dried hair.  It is left on for 10 minutes and then rinsed off.  Again, this treatment is not 100% ovicidal and should be repeated in 7-10 days to work against any new nymphs.

 

Other medicines such as ovide, kwell, elemite are also available but carry more side effects and should be discussed with your health care provider.  Antibiotics, ivermectin and some natural products have also been used with limited scientific studies to back them.  Some parents have asked me about olive oil, mayonnaise and petrolatum (Vaseline or aquaphor) as possible agents to use.  There aren’t any studies to demonstrate effectiveness of these but the residue left behind can be problematic.

 

Removal of the nits is arguable.  Most schools still want children to be “nit free” although that is not a guideline supported by theAmericanAcademyof Pediatrics.  From a practical standpoint, most feel that removal of nits found within a centimeter of the scalp, after treatment with a pediculicide is appropriate.  This is tedious and time-consuming but often results in a quicker return to school.  It is easiest to remove them while the hair is damp.  Nit combs are available but manual removal by fingernails or tweezers is often more effective.

 

All household contacts should be checked and those with live lice or nits should be treated.  If another person shares a bed with the infected child, that person should be treated.  It is wise to clean all bedding, brushes, towels, and other personal items in water >120 degrees.  Clothing, furniture, carpets, etc that have been in contact with the infected person in the 24-48 hours before treatment should be cleaned/vacuumed remembering that the louse cannot live away from its human host more than 24-36 hours.  Items which can’t be washed can be placed in a plastic bag for two weeks.

 

Return to school is based on your school’s policy.  The AAP maintains that after initial treatment, a child may return.  However, many schools remain “nit free” and thus, manual removal of all nits must be done.

Image from: lancaster.unl.edu/pest/lice/

Ashli Colins, MD.  Dr. Collins is a pediatrician with Oldham County Pediatrics, PLLC.  They have offices in LaGrange and in Louisville near the Summit.  Dr. Collins is the mother to twins, Sarah and P.J.  For more information call 502-225-6277 or www.oldhamcountypeds.com