New Year’s Resolutions

Did you skip making a New Year's resolution for 2021? Did you make a resolution and have trouble sticking with it? Read on…

New Year's resolutions may have started with the ancient Babylonians about 4,000 years ago. One has to wonder if they were any more successful than we are in setting and keeping New Year's resolutions. Approximately 45% of adults set goals for the new year. However, research shows that only 8% keep those resolutions. 

You can do better by following a few straightforward tips. Enter the SMARTER goal. The SMART goal is not a new concept, it was first published by George Doran in 1981 and later expanded to include the Evaluated and Reviewed portion. Here is an overview:

• Specific: Target a specific area that you want to improve.
• Measurable: What is your indicator of progress? Put a number on it.
• Achievable: Can you do it?
• Realistic: What result can you realistically achieve with available resources?
• Time-related: When will you reach your intended result?
• Evaluate: Assess how well you achieved your goal.
• Review: Reflect on achievements. If necessary, adjust your approach or behavior to reach your goal.

Another strategy is to make a goal a habit, as proposed by James Clear in his best-selling book Atomic Habits. Think of your goal as a "habit loop" with three easy processes in mind.

• CUE. First set up a CUE (signal, prompt, or reminder) for your desired habit. For example, let's say your goal is to begin a habit of daily meditation. After you have established the SMARTER goal, select a cue that reminds you to follow through with your goal. This may be placing your favorite book in your favorite chair in which you will meditate. 
• CRAVING. The CUE sets up the second step in your habit loop - the CRAVING for the new habit. Make your new habit of meditation attractive and appealing so that you will feel that something is missing if you skip this part of your day. 
• REWARD. The final step in the habit loop is to REWARD yourself with something simple and meaningful for sticking with your meditation practice. 

After you set your goal, sticking with it is the more challenging part. Make your new habit obvious. Don't let your habit fade into the background of your daily routine. Sometimes life requires you to skip a day of your new habit. But try to avoid missing two days in a row. Set one goal at a time, keeping it easy and satisfying. Few people stick with difficult goals or goals that are not personally satisfying.

An important consideration in being successful is the behavioral process underlying such goals. For example, two people set a goal of meditating for five minutes daily. One person is successful; the other is not. The underlying processes are what differentiates the success or non-success. As Clear noted, we do not rise to the level of our successes, we fall to the level of our processes. We do better when we focus more on our underlying processes, not getting stuck on setting our goals. 

This can be the best of previous years. Ask yourself what and who is really important in your life? It is OK to be surprised, when you take a few moments to dig deep in your personal values and hear what rises to the top.  We often set goals without thoughtful and reflective consideration of what is most important in our lives. Think carefully about changes you want to make in this new year. 

Wishing you a healthy, happy, and wholesome 2021!

If you have any questions about New Year resolutions, please log into your account and send us your question. We are here to help.

Dr. Joe Banken PhD

Performance-Enhancing Substances: Should we be worried?

Performance-Enhancing Substances (PES) are used by children, teens, and adults to improve their athletic performance and for appearance changes. These can be dietary supplements, legal and illegal drugs, such as anabolic steroids, human growth hormone, creatinine, and stimulants.

Which are common PES? What do they do and how do they harm our children or us?

1. Anabolic steroids
   Used to increase muscle mass and strength.
   The main anabolic from our body is Testosterone.  Many athletes take a synthetic modification of testosterone. 
   A particularly dangerous class of anabolic steroids are the so-called designer drugs. These are synthetic steroids that have been illicitly created to be undetectable by current drug tests.
   Risks:
   -Male: prominent breasts, shrunken testicles, infertility and prostate enlargement.
   -Female: baldness (could be irreversible), deeper voice, enlarged clitoris, increased body hair, irregular periods.
   -Male and female: severe acne, high blood pressure, aggressive behavior, liver abnormalities and tumors, changes in cholesterol, psychiatric disorder (depression), drug dependence.
   -Taking anabolic steroids is prohibited by must sports organizations and it is illegal. 
2. Human Growth Hormone (HGH)
   Human growth hormone has an anabolic effect. Athletes take it to improve their muscle mass and performance. It is available with a prescription and administered by injection.
   Adverse effects: muscle weakness, fluid retention, joint pain, diabetes, vision changes, carpal tunnel syndrome, enlargement in heart and high blood pressure.
3. Creatine
   Creatine is a naturally occurring compound produced by your body that helps your muscles release energy. Creatine appears to help muscles make more adenosine triphosphate (ATP), which stores and transports energy in cells, and is used for quick bursts of activity, such as weightlifting or sprinting. It is available over-the-counter as a supplement.
   Adverse effects: abdominal pain, muscle cramps, weight gain.
   It appears safe if used at the recommended dose, but there are no long-term studies.
4. Stimulants
   Common stimulants include caffeine and amphetamines. Cold remedies often contain the stimulants ephedrine or pseudoephedrine hydrochloride. Energy drinks contain high doses of caffeine and other stimulants. The street drugs cocaine and methamphetamine are also stimulants.
   Stimulants can improve endurance, reduce fatigue, decrease appetite, and increase concentration.
   Adverse effects: irritability, insomnia, dehydration, heatstroke, dependence or addiction, palpitations, heart rhythm abnormalities, weight loss, high blood pressure, stroke, hallucinations, and heart attack.

What can we do as parents?

The American Academy of Pediatrics recommends the following to parents:

Guidance for Parents with Concerns About PES Use: 

1. Get involved...
   •  Be aware of new pressures as athletes progress through different levels of  participation and competition
   •  Emphasize the basics of hard work, pushing limits, teamwork, respect for competitors 
   •  Give options for alternative ways to achieve peak performance
   •  Monitor any use of supplements or shakes
   •  Do not hesitate to ask directly about supplement use
   •  Provide a counterpoint for prodrug and prosupplement messages
   •  Become knowledgeable about PES
   •  Be persistent 
2. Stay connected and create a strong partnership with your child's coach...
   • Get to know the team rules
   • Keep coach informed of any pertinent issues that may be occurring in    athlete's life
   • Respect role of coach
   • Talk to coach before or after practice, avoid sensitive discussions on game days
3. Keep lines of communication open with the athlete...
   • a. Emphasize the importance of good health
   • b. Use the news as a starting point for discussions on PES use 
   • c. Emphasize that there are no shortcuts to peak performance 
4. Engage health care providers if you are concerned about PES use...
   • Call provider before check-up and request that possibility of PES use be addressed during examination.
5. Know the warning signs of PES use, which include the following:
• Rapid changes in body shape
• Aggressive behavior or atypical mood swings 
• Extreme hair growth or acne
• Excessive time in weight room
• Voice changes (especially for girls) 
6. If you discover that your child is using PES...
   • Keep lines of communication open
   • Seek outside help

Should our children use PES?

Some athletes may appear to improve their performance with certain supplements or drugs, but at what cost? The list of side effects is very extensive, and some are irreversible. The short-term benefits are evident in some cases, but with a risk that outweighs the benefit. Doping is prohibited by most sports organizations. Taking performance-enhancing substances is very risky.

If you have any questions about performance-enhancing substances, please log into your account and send us your question. We are here to help.

Valerie C. Hines, MD, FAAP

Substance Abuse in Teenagers

Drug use, including alcohol and tobacco, is very common in teenagers. Parents have a major role in prevention, they are the strongest influence children have.  Talking to our children at an early age, such as grade school, can help prevent such use and abuse of drugs. To be able to talk to our children, we need to be informed.

Statistics

According to the CDC, updated 02/2020:

• Alcohol, marijuana, and tobacco are substances most commonly used by adolescents. 
• By 12th grade, about two-thirds of students have tried alcohol. 
• About half of 9th through 12th grade students reported ever having used marijuana. 
• About 4 in 10 9th through 12th grade students reported having tried cigarettes. 
• Among 12th graders, close to 2 in 10 reported using prescription medicine without a prescription. 
• Although it is illegal for people under 21 years of age to drink alcohol, the findings show that people from 12 to 20 years of age consume about one-tenth of all alcohol consumed in the United States.

Why do teenagers use drugs?

Multiple factors can lead teenagers to use or abuse drugs. Usually the first use is in a social setting and is alcohol or cigarettes. The continued use is commonly related to insecurities and social acceptance between peers. 

Common risk factors for drug abuse are:

• Family history of drug abuse 
• History of a traumatic events such as any child abuse including sexual abuse, car accident, parental death. 
• Mental health condition such as depression, attention deficit-hyperactivity disorder (ADHD), impulsivity and/or anxiety.
• Low self-esteem or feeling of social rejection.

What are the signs of substance abuse?

There are many different signs of drug use or abuse. It varies between teenagers and by the drug used.  Some common signs are:

• Change in behavior, secretive behavior
• Mood swings
• Increased tiredness
• Poor grades or decline in grades
• Poor hygiene and diminished personal appearance
• Bloodshot eyes
• Laughing for no reason
• “Munchies” or very hungry
• Odor: alcohol, marijuana

What drugs are used among teenagers?

The following are percentages for 12th graders’ drugs used in a lifetime by type:

• Alcohol - 58.5%
• Marijuana - 43.7%
• Vaping (any drug, including marijuana and nicotine) – 45.6%
• Cigarettes – 22.3%
• Amphetamines - 7.7%
• Hallucinogens/LSD – 6.9% 
• Tranquilizers - 6.1%
• Narcotics other than heroin - 5.3% (Heroin – 0.6%)
• Ecstasy - 4.9 %
• Inhalants – 5.3%
• Cocaine – 3.8%
• Steroids – 1.6%

What are the consequences of drug use?

• Drugs adversely affect the teenagers’ brain development
• Poor school performance
• Worsening of mental health conditions such as anxiety and depression.
• Higher levels of risky behavior such as impaired driving and unprotected sex.
• Long term health problems such as heart disease, sleep disorders, high blood pressure. 
• Higher chances of having addictions as an adult. 

Health effects of specific drugs:

1. Alcohol: risk of liver failure, heart failure, and dementia.
2. Marijuana: Risk of impairment of memory, learning, concentration. Risk of psychosis later in life with early and frequent use. 
3. Electronic cigarettes (vaping): Risk of lung damage depending on substance used, nicotine dependence.
4. Cocaine: Risk of heart attack, seizures and stroke.
5. Ecstasy: Risk of heart failure and liver failure.
6. Inhalants: Risk of damage to heart, lungs, liver and kidneys with long-term use.
7. Methamphetamine: Risk of psychotic behaviors from high doses and long-term use.
8. Opioids: Risk of respiratory distress, death from overdose.

What can I do as a parent?

It is very important to talk to grade school children and teenagers about drug and alcohol use. You might have multiple conversation about this through the years. Here are some tips that can help:

• Hear them. It can be helpful to let them do the talking first so it can give you a sense of where they are at about drugs, how much they know, what is their perception about them and if their friends are using or abusing drugs.
• Educate them. Let them know the damage drugs can do, immediate and long term. Not by scaring them but by educating them about these effects. 
• Social media. Ask them where do they hear about drugs, what they know and check what message social media is giving them about drugs. You can review these messages together and correct them if needed. 
• Peer pressure. This is a huge factor in drug use and it is important to discuss how to resist it. How to turn down drug offers. Saying NO is not being weak but strong. Discuss with them what would be ways to turn drugs down so they are prepared if they get to that point (which they all most likely will).
• What about you? Your teenager might ask you questions about your drug use and be ready to answer these questions. If you have not used them, explain why. If you have used them, explain your experience.

Other PREVENTIVE strategies:

• Set the example. We can talk to our teenagers, but most of what we teach is by example. If you drink, do it with moderation. Don’t use other drugs, or abuse prescription medication. 
• Know your teenager’s activities. Knowing his schedule, location, activities helps you know when these have changed (possible sign of drug use). Encourage adult-supervised activities that he enjoys.
• Friends. Know your teenager’s friends, their parents and environment. If their friend’s use drugs your teen might feel that pressure.
• Rules and consequences. Discuss rules and consequences. Place specific examples of family rules such as riding with someone under the influence, going to parties where drugs are used. If rules are broken, consequences are held.
• Track your prescription drugs.
• Positive reinforcement. When your teenager has handled difficult situations with drugs, or offerings, encourage and praise your teen.

A close bond and easy conversation with your teen are very important for drug use prevention.

If you have any questions about substance abuse in teenagers, please log into your account and send us your question. We are here to help.

Valerie Hines, MD FAAP