Facts About High School Sports and Concussions

Facts About High School Sports and Concussions

Many high school students look forward to participating in high school sports and other physical activities as part of their high school experience. While school may be ending for the year, many athletes will be practicing over the summer for next years games. Football is one example of a sport where the players practice the entire summer in order to be ready for the next school year’s season. Typically most people look at the fun and the positive experience these activities provide for students. However, high school athletes do get hurt, sometimes seriously. High school athletes do suffer broken arms and legs, but they also suffer concussions, traumatic brain injuries and spinal cord injuries. Parents are now learning that “basic” concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression. Unfortunately, this year we had example of these issues, when a wrestler from College Park High School suffered a spinal cord injury and was paralyzed.

As a result of these head injuries, many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions, Traumatic Brain Injuries and Spinal Cord Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions, traumatic brain injuries or spinal cord injuries. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A research study from Boston University released shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions or other serious injuries. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions and other serious injuries. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than football players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/.

Parents need to talk to their teenagers’ school and coaches regarding making sure that they use the latest safety equipment for their sport. Parents may even want to research what the latest safety equipment so if your teen’s school is not using the latest safety equipment, you can inform the school. The ultimate goal is we want high school sports to be fun and safe for high school students.

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino’s work or private practice, where he treats Post Concussion Syndrome, please visit his website at www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

New Drugs Teenagers are Using

New Drugs Teenagers are Using

As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing. I have been hearing from many teens about new designer drugs they are taking. Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana. These new drugs can be very dangerous, even deadly. However, many teenagers are not aware of the dangers.

Spring Break is occurring and summer break is around the corner and for many teenagers this means partying and using drugs. One major issue is many Emergency Room physicians cannot keep up with all the new drugs. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor recently had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen. The article discusses these new dangerous drugs and how deadly these drugs can be. I have included her article below so parents can be aware of the dangers facing their teenagers. Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts. For more information about Dr. Rubino’s work or his private practice visit his website www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

Signs of Teenage Depression

Signs of Teenage Depression

I often have parents ask me what warning signs they need to watch for in their teenagers that may indicate their teen is depressed. I recently ready an article by Dr. Jerome Yelder, Sr. He did a very good job of breaking down the basic symptoms adults and teens experience when they are depressed. I have included the list for parents below so they know what to watch for in their teenagers.

Sleep Problems

Depression can affect your body as well as your mind. Trouble falling or staying asleep is common in people who are depressed. But some may find that they get too much shut-eye.

Chest Pain

It can be a sign of heart, lung, or stomach problems, so see your doctor to rule out those causes. Sometimes, though, it’s a symptom of depression.

Depression can also raise your risk of heart disease. Plus, people who’ve had heart attacks are more likely to be depressed.

Fatigue and Exhaustion

If you feel so tired that you don’t have energy for everyday tasks — even when you sleep or rest a lot — it may be a sign that you’re depressed. Depression and fatigue together tend to make both conditions seem worse.

Aching Muscles and Joints

When you live with ongoing pain it can raise your risk of depression.

Depression may also lead to pain because the two conditions share chemical messengers in the brain. People who are depressed are three times as likely to get regular pain.

Digestive Problems

Our brains and digestive systems are strongly connected, which is why many of us get stomachaches or nausea when we’re stressed or worried. Depression can get you in your gut too — causing nausea, indigestion, diarrhea, or constipation.

Headaches

One study shows that people with major depression are three times more likely to have migraines, and people with migraines are five times more likely to get depressed.

Changes in Appetite or Weight

Some people feel less hungry when they get depressed. Others can’t stop eating. The result can be weight gain or loss, along with lack of energy. Depression has been linked to eating disorders like bulimia, anorexia, or binge eating.

Back Pain

When it hurts you there on a regular basis, it may contribute to depression. And people who are depressed may be four times more likely to get intense, disabling neck or back pain.

Agitated and Restless

Sleep problems or other depression symptoms can make you feel this way. Men are more likely than women to be irritable when they’re depressed.

Sexual Problems

Hopefully your teenager is not sexually active. While they may not have the sexual problems adults do, when they are depressed, they may show a lack of interest in dating or relationships and tend to isolate. They also may feel they are sexually unattractive.

If you’re depressed, you might lose your interest in sex. Some prescription drugs that treat depression can also take away your drive and affect performance. Talk to your doctor about your medicine options.

Exercise

Research suggests that if you do it regularly, it releases chemicals in your brain that make you feel good, improve your mood, and reduce your sensitivity to pain. Although physical activity alone won’t cure depression, it can help ease it over the long term. If you’re depressed, it can sometimes be hard to get the energy to exercise. But try to remember that it can ease fatigue and help you sleep better.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and children. For more information about Dr. Rubino’s work and private practice visit his website www.RubinoCounseling.com or on Twitter @RubinoTherapy

Helping Teenagers Cope with Grief and the Death of Friends

Helping Teenagers Cope with Grief and the Death of Friends

Unfortunately in our area we have experienced several teenage deaths and a teen being paralyzed at a school wrestling match. This also means teenagers have to deal with death and grief much sooner than expected. We expect a grandparent to pass away, but we don’t expect a 15 year old or 4 year old child to die or be killed accidently. When this occurs no one knows what to say or do. Many patients have asked me about what to do in these situations. While doing research regarding grief for patients, I found this information from the grief center. I think it is very good information and very easy to understand. Therefore, I will present the information in three sections.

The 10 Best and 10 Worst Things to Say to Someone in Grief

Sheryl Sandberg’s post on Facebook gave us much insight into how those in grief feel about the responses of others to loss. Many of us have said “The Best” and “The Worst.” We meant no harm, in fact the opposite. We were trying to comfort. A grieving person may say one of the worst ones about themselves and it’s OK. It may make sense for a member of the clergy to say, “He is in a better place” when someone comes to them for guidance. Where as an acquaintance saying it may not feel good.

You would also not want to say to someone, you are in the stages of grief. In our work, On Grief and Grieving, Elisabeth Kubler-Ross and I share that the stages were never meant to tuck messy emotions into neat packages. While some of these things to say have been helpful to some people, the way in which they are often said has the exact opposite effect than what was originally intended.

The Best Things to Say to Someone in Grief

1. I am so sorry for your loss.

2. I wish I had the right words, just know I care.

3. I don’t know how you feel, but I am here to help in anyway I can.

4. You and your loved one will be in my thoughts and prayers.

5. My favorite memory of your loved one is…

6. I am always just a phone call away

7. Give a hug instead of saying something

8. We all need help at times like this, I am here for you

9. I am usually up early or late, if you need anything

10. Saying nothing, just be with the person

The Worst Things to Say to Someone in Grief

1. At least she lived a long life, many people die young

2. He is in a better place

3. She brought this on herself

4. There is a reason for everything

5. Aren’t you over him yet, he has been dead for awhile now

6. You can have another child still

7. She was such a good person God wanted her to be with him

8. I know how you feel

9. She did what she came here to do and it was her time to go

10. Be strong

Best & Worst Traits of people just trying to help

When in the position of wanting to help a friend or loved one in grief, often times our first desire is to try to “fix” the situation, when in all actuality our good intentions can lead to nothing but more grief. Knowing the right thing to say is only half of the responsibility of being a supportive emotional caregiver. We have comprised two lists which examine both the GOOD and the NOT SO GOOD traits of people just trying to help.

The Best Traits

Supportive, but not trying to fix it

About feelings

Non active, not telling anyone what to do

Admitting can’t make it better

Not asking for something or someone to change feelings

Recognize loss

Not time limited

The Worst Traits

They want to fix the loss

They are about our discomfort

They are directive in nature

They rationalize or try to explain loss/li>

They may be judgmental

May minimize the loss

Put a timeline on loss

The above information is meant to be used as a guideline. Everyone goes through the grieving process in their own way. It is very important to understand that point. It is also important to remember while the above is a guideline, the most important thing is your intent. So if you say a worse thing but you said it out of love the person will understand. The guideline will hopefully make you more comfortable to offer support to your grieving loved one or friend. Because someone who is grieving need people to talk to without people feeling awkward. Also everyone is around immediately after the death and through the funeral services. Most people then go back to their normal lives. However, those who were really close to the person are still grieving and trying to figure out how to proceed with life. So don’t forget the person who is grieving can use emotional support for the first year especially. Therefore, do not forget to call, send a card or stop by occasionally. Especially around the holidays and birthdays.

Dr. Michael Rubino has over 20 years experience treating adolescents, children and their families. For more information regarding Dr. Rubino visit his website www.rcs-ca.com or on Twitter @RubinoTherapy

Cough Medicine the New Drug Teens are Abusing

Cough Medicine the New Drug Teens are Abusing

Many parents who are raising teenagers know they need to be concerned that their teenager may abuse alcohol, marijuana, ecstasy and many other drugs. However, many parents do not think they need to worry about their teenager abusing cough medicine. Some parents may be concerned because some cough medicines contain alcohol. However, teenagers are abusing Robitussin on a frequent basis. They are not abusing it for the alcohol, they are abusing it for the dextromethorphan (DXM). This substance is high dosages can cause hallucinations and symptoms similar to using LSD.

Teenagers have been using Robitussin for a while and the amount of teenagers abusing DXM has been increasing. A study in 2008, showed the overall use of DXM since 2000 increased by a factor of 10. However, for teenagers the increase is by a factor of 15. In order for a teenager to have hallucinations from DXM, they have to use 10 to 50 times the recommended amount to use. Many parents may wonder will this amount of DXM be enough to cause their teen to overdose. Most teenagers do not overdose on DXM. However, many teenagers typically use alcohol or other drugs along with DXM. This combination can be lethal.

DXM has been around since the 1950’s. However, as I stated above since 2008 the amount of teens using DXM has increased by a factor of 15. Also DXM is used in many over the counter drugs for the cold and flu. So Robitussin is the most common over the counter medication teenagers are using, there are many other over the counter drugs that contain DXM and that teenagers are abusing.

One of the primary reasons teenagers are abusing DXM is that it is cheaper than LSD or other drugs that create hallucinations. Also because these medications are over the counter it was a very easy way for them to obtain the DXM. However, now most drugs containing DXM are kept behind the pharmacy desk and in order to buy them you need to show identification to the pharmacy. Most pharmacies require people to be 18 years or older in order to purchase medicine containing DXM.

Even with these medicines being kept behind the pharmacy counters, many teenagers have figured out ways to obtain over the counter medications containing DXM. Many teenagers know that pharmacists are aware that they are watching Robitussin so they are using other over the counter medications containing DXM. Teenagers have developed their own terms for these medications so parents may not know if their teenager is using DXM because their teenager is using different terms than referring to specific medications. I have included a link to the slang terms that teenagers are using to refer to DXM. The slang terms can be found in the following article https://www.webmd.com/parenting/glossary-dxm-drug-abuse. Parents I would strongly recommend reading this article so you can be aware if your teen is using DXM but referring to it with a different name.

Since DXM has been around for a while and more and more teenagers are using it because it is cheap and easy to get, in addition that it is in many over the counter medications, parents may have a difficult time knowing if their teenager is abusing DXM. Therefore, I have also included a link to an article which lists the symptoms you would see when someone is under the influence of DXM. Besides listing the symptoms of being under the influence, this article also lists the daily behavior changes you will see in a teenager who is abusing DXM. Here is the link to the article with the symptoms and behavior changes associated with DXM abuse https://drugabuse.com/library/dextromethorphan-abuse/#signs-and-symptoms.

As a psychotherapist who specializes in treating teenagers, I can say I have seen a significant increase in the number of teenagers using DXM. Ten years ago, occasionally one of the teenagers I would be working with had a history of using or were currently using DXM. Today it is very common. In fact it is almost as common as marijuana. Therefore, my recommendation to parents is to take the time and read the links I have provided and do your own research. While by its self alone DXM is not typically lethal, teenagers combine this drug with other drugs which can cause someone’s death. Also what I have observed is that DXM tends to lead to teenagers trying other drugs that can be very deadly.

Dr. Michael Rubino is a psychotherapist with over 20 years experience. He is recognized as an expert in the treatment of children and teenagers. For more information regarding his work or private practice visit his website www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

Suggestions for a Safe and Fun Super Bowl Party

Suggestions for a Safe and Fun Super Bowl Party

This weekend is Super Bowl Sunday. As I stated in my previous article for many it is a day to party and have fun, but it is also the day when most domestic violence occurs. This statistic is for adults and teenagers. So, how do you have a safe, fun Super Bowl Sunday? You need to develop a plan that reduces stress and too much drinking.

First, remember that it is just a day and just a football game. Therefore, if everything is not perfect such as you don’t have all the food you wanted or things are not arranged how you wanted, do not stress over it. You can still enjoy the game without a lot food or alcohol. Also if everything is not arranged perfectly, you can still enjoy the game. In other words, do not stress and argue over minor details.

If you are going to have small children around, set up a separate room with food and activities for them. Many children under 10 years old will lose interest in the game and if there is nothing else for them to do, they will want attention and distract people from the game. Therefore, set up another room where they can watch other television shows and have games to play. This way they are not bored and they can enjoy themselves.

People drinking too much is a common problem during Super Bowl parties. Therefore, when your friends arrive, tell them you care about them and their safety. Therefore, you want everyone to put their car keys in the basket as they enter. This way if someone accidentally has too much to drink, you can give them a ride home. This way if someone has too much to drink, you don’t have to argue about them driving if they are not safe to drive. This can help avoid an argument and a possible physical fight.

Also watch how much alcohol you are serving. If you are serving alcohol, serve food to decrease the likelihood that someone will drink too much. Also towards the end of the game stop serving alcohol and switch to sodas. If someone has had too much to drink, this gives them a chance for their body to process the alcohol they consumed so they can lower their blood alcohol level.

Another good idea is to set rules for your party. Announce to your guests that you want everyone to have a good time and no arguing or fighting. Therefore, cheering for their team or favorite player is fine, but you do not want any name calling nor is there to be any insulting other people at the party. Also good nature teasing is fine but no swearing and if someone asks you to stop the joking, respect their request. Bottom line, state that regardless of who wins or loses, you expect everyone to act like adults and to treat each other respectfully so it is a fun day for everyone.

It would also be helpful to remember the acronym HALT:

H – hungry

A – angry

L – lonely

T – tired, too much alcohol

If you notice someone expressing these emotions or drinking too much, this is a situation which could result in an argument or violence. Therefore, if you notice a potential violent situation, try talking to the person to see what is bothering them. If you notice a couple arguing try having one person step outside with you for a time out so they can calm down. You may want to let them know that they seem slightly upset and you are just checking-in to see if there is a problem and if you can help. Instead of ignoring the situation try to offer some help so people can calm down. This can help a great deal.

At the end of your party, if someone is not sober enough to drive, offer to drive them home. Remember all the car keys are in a basket so you do not have to argue to get the car keys. Remind them that you are only offering to drive because you care about them. You do not want to see them arrested for driving under the influence, you do not want to see them get into a car accident and you definitely do not want to see them kill someone else or themselves in a car accident.

If you notice a couple who appear to be arguing, offer to allow one person to stay for a while and you will drive them home later. Giving them a chance to calm down could help avoid a domestic violent incident. If after a little while the person at your house or the person who went home tells you they do not feel safe around the other person right now – listen to them! Offer to let the person stay at your house for the night. You do not want to assign blame to anyone. Simply state that they seem to be having a stressful day and instead of them both staying in the same house that night and arguing all night and arguing in front of the children is not a good idea. It is okay if they need to take a break for the night and talk about tomorrow. You are providing them and the children with a safe environment and hopefully avoiding a domestic violent incident. Many people are afraid to step in and offer help when they see a potential domestic violent situation. However, if more people offered to help and did not shame the family, the incidence of domestic violence could decrease and more people may be willing to seek help.

Hopefully these suggestions help and you can enjoy the game in a fun peaceful environment.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers and he is certified to assess and treat domestic violence. If you want additional information regarding Dr. Rubino’s work or his private practice visit his website www.rcs-ca.com or his other website http://www.RubinoCounseling.com.

Risks Associated with High School Sports

Risks Associated with High School Sports

Many high school students are currently busy practicing their sport or playing games. Typically most people look at the fun and the positive experience it provides for students. However, high school athletes do get hurt, sometimes seriously. High school athletes do suffer broken arms and legs, but they also suffer concussion, traumatic brain injuries and spinal cord injuries. Parents are now learning that “basic” Concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression. Unfortunately we had another example a week ago, when a wrestler from College Park High School suffered a spinal cord injury and is paralyzed from the neck down.

As a result of these head injuries, many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions, Traumatic Brain Injuries and Spinal Cord Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions, traumatic brain injuries or spinal cord injuries. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A new research study from Boston University released shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, conducted last year showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions or other serious injuries. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions and other serious injuries. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than football players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/.

Parents need to talk to their teenagers’ school and coaches regarding making sure that they use the latest safety equipment for their sport. Parents may even want to research what the latest safety equipment so if your teen’s school is not using the latest safety equipment, you can inform the school. The ultimate goal is we want high school sports to be fun and safe for high school students.

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino or his work please visit his website at www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

Why is The United States Risking the Lives of Thousands of Children

Why is The United States Risking the Lives of Thousands of Children

Many people may not be aware but there is a program called CHIP which provides life saving medical care for children whose parents make to much to qualify for Medi-Cal. Many middle class or lower middle class families make to much to qualify for Medi-Cal. However, they do not make enough to pay for health insurance or what their insurance does not cover. The CHIP program helps parents pay for their child’s life saving surgery or medication.

I wrote an article a couple weeks ago about how this program is in danger of being cut financially. It is still in danger today because nothing has been done. It is in danger of being cut due to Trump’s proposed income tax program. Due to cutting the tax rates on corporation and lowering the tax bracket for people who make more than a million dollars a year, there are not enough funds to cover this program.

For this to happen in the United States is insane. We are supposed to be the super power in the world and the United States is supposed to be the advocate for human rights. We go to counties which violate human rights and threaten to impose sanctions. However, in our on country we are violating the rights of children to life saving medical care. This is the first time that this program is in danger of being cut.

To show you how important this program is to children and their families, I am including a link to a newspaper story. The story discusses a boy who is in danger of having his medical care terminate because CHIP has not been funded. It also describes the agony that his parents are experiencing. They are facing a situation of seeing their son being denied the life saving medical care he needs because CHIP has not been funded. As a parent how would you feel if this was your son? Here is the link, please read the story http://www.latimes.com/politics/la-na-pol-childrens-health-insurance-20180109-story.html

Also Jimmy Kimmel discussed this issue on his show. His son was born with a life threatening heart condition and needed several life saving surgeries. He can afford it, but he has seen many families who cannot afford their child’s health care. Please watch this video of Jimmy Kimmel with his son so you can really understand this issue. Here is how Jimmy Kimmel explained this very serious situation on his show https://youtu.be/MmWWoMcGmo0

If you have a child or care about children call your Congressperson and Senator and urge them not to pass income tax reform without the CHIP program.

Dr. Michael Rubino is a psychotherapist who has 20 years experience treating children and teenagers. For more information about Dr. Rubino’s work or his private practice visit his website http://www.RubinoCounseling.com.

Saving the CHIP Program

Saving the CHIP Program

Many people may not be aware but there is a program called CHIP which provides life saving medical care for children whose parents make to much to qualify for Medi-Cal. Many middle class or lower middle class families make to much to qualify for Medi-Cal. However, they do not make enough to pay for health insurance or what their insurance does not cover. The CHIP program helps parents pay for their child’s life saving surgery or medication.

It is in danger of being cut due to Trump’s proposed income tax program. Due to cutting the tax rates on corporation and lowering the tax bracket for people who make more than a million dollars a year, there are not enough funds to cover this program.

For this to happen in the United States is insane. We are supposed to be the super power in the world and the United States is supposed to be the advocate for human rights. We go to counties which violate human rights and threaten to impose sanctions. However, in our on country we are violating the rights of children to life saving medical care. This is the first time that this program is in danger of being cut.

Jimmy Kimmel discusses this issue on his show. His son was born with a life threatening heart condition and has needed several surgeries. He can afford it, but he has seen many families who cannot afford their child’s health care. Please watch this video of Jimmy Kimmel with his son so you can really understand this issue. Here is how Jimmy Kimmel explained this very serious situation https://youtu.be/yqulWPljawo.

If you have a child or care about children call your Congressperson and Senator and urge them not to pass income tax reform without the CHIP program.

Dr. Michael Rubino is a psychotherapist who has 20 years experience treating children and teenagers. For more information about Dr. Rubino’s work or his private practice visit his website http://www.RubinoCounseling.com.

New Information about High School Sports and Concussions

New Information about High School Sports and Concussions

Schools are back in session and many high school students are either trying out or getting ready for try outs for their sport. Parents are learning that “basic” Concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression.

Many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions and Traumatic Brain Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

A new research study from Boston University released this week shows that boys who play football before the age of 12 years old are more likely to have memory problems and problems making decisions as adults. This study also shows that boys who play football before age 12 are three times more likely to develop clinical depression as an adult. The study suggests the reason this occurs is because around the age of 12, a child’s brain is undergoing a great deal of development at this age. Robert Stern, one of the authors of the study, explained that “the brain is going through this incredible time of growth between the years of 10 and 12, and if you subject that developing brain to repetitive head impacts, it may cause problems later in life.”

Another MRI study, by the Wakes Forest School of Medicine, conducted last year showed that boys between the ages of 8 years old to 13 years old who played even just one season of football showed signs of diminished brain function.

High school athletes are not the only teenagers at risk for concussions. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions too. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than foot players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino or his work please visit his website at www.rcs-ca.com or follow him on Twitter @RubinoTherapy.