Guns: the leading cause of injury-related deaths among U.S. children

 Note: I wrote this post a few weeks before the Uvalde school shooting. Little did I know....

For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among young people. Beginning in 2017, however, gun-related injuries took their place to become the common cause of death from injury. Between 2000 and 2020, the number of gun-related deaths among children, adolescents, and young adults increased from 6998 to 10,186.

Substantial federal funding has been devoted to research on motor vehicle crashes as well as automobile safety. We have the National Highway Traffic Safety Administration, a federal agency whose mission is to save lives and prevent injuries caused by road-traffic crashes. This agency collects data on motor-vehicle related deaths, conducts research such as crash tests, implements vehicular safety improvements, and much more. Seat belts, airbags, automatic emergency braking, and rear-facing cameras are among the improvements that have made cars safer. What’s more, drivers must be licensed, and vehicles registered.

In contrast, guns are one of the few products for which safety isn’t regulated by a designated federal agency, and it’s taken 20 years to build a firearm-related database that includes data from all 50 states. To make matters worse, many states have made it easier for children and young adults, as well as adults with criminal records, to gain access to firearms, not to mention allowing people to carry a concealed weapon without a permit. And the firearms available to civilians have become more lethal, in part because manufacturers are increasingly selling weapons designed for military use.

Of course, you knew most of this. Still, I think it's worth mentioning.

Another note: I'm doing fine following my knee replacement surgery on May 17. Today, May 27, I climbed stairs for the first time so I could get to my desktop computer.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

More on not using ice on injuries

 In an earlier post, I reported on studies showing that applying ice packs to sore and damaged muscles is counterproductive. I recently came across more studies that refuted this practice. Here’s what they found:

• People who iced a torn calf muscle felt just as much leg pain later as those who left their sore leg alone. In addition, they were not able to return to their normal activities any sooner than those who iced their wounds.
• Athletes who iced sore muscles after strenuous exercise regained strength and power more slowly than those who didn’t.
•  A 2015 study on weight training found that men who regularly applied ice packs after workouts developed less muscular strength, size, and endurance than those who recovered without ice.

Recently, scientists have figured out why, on a molecular level, icing is not helpful. Researchers subjected mice—whose muscles are like ours—to simulated exertion, after which they applied ice to some mice and left others alone. After the exertion, they collected tissue samples, scrutinized them microscopically, and found evidence of damage to muscle fibers.

Normally, in the healing process, pro-inflammatory immune cells rush to the afflicted area, where they fight off invading germs or mop up damaged bits of tissues and cellular debris. Anti-inflammatory cells then move in, quieting the inflammation and encouraging healthy new tissues to form.

In the mice experiment, this healing process worked properly for the mice who had not received ice treatment. That is, pro-inflammatory cells immediately began removing cellular debris until, by day three, most of the damaged fibers had been cleared away. After that, anti-inflammatory cells showed up along with specialized muscle cells that rebuild tissues. By the end of two weeks, the muscles had fully healed. In contrast, for the mice whose muscles were iced, it took seven days to reach the same levels of pro-inflammatory cells as on day three for the non-iced mice. Even after two weeks, their muscles showed lingering molecular signs of tissue damage and incomplete healing.

I wrote this before my knee replacement surgery. I was supposed to apply ice to reduce swelling. I'll let you know later whether I complied or not.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

I’m getting my knees rebuilt

My left knee is swollen and doesn’t want to bend. My right knee seems to be impinging on a branch of my sciatic nerve that travels on the outside of the knee. It affects my whole leg. My x-ray shows severe arthritis. Oddly, my knees don’t hurt when I’m just walking on flat ground. But if I stand too long, or do yard or housework, my legs hurt enough to drive me toward surgery. It’s scheduled for May 17^th.

"The knees are the first thing to go."

I will be going to The Institute for Joint Restoration in Fremont, an hour’s drive from home. Dr. Alexander Sah will be doing the surgery. He comes highly recommended by friends and others in the know, including big shot docs at Stanford, and is routinely listed in various publications as one of the best orthopedic surgeons.  I called his office on a Friday and left a message inquiring about doing both knees at once. On Saturday, he returned the call and was willing to talk as long as I wanted. Unusual surgeon! (He advised against doing both at once.)

The surgery is described as “minimally invasive,” meaning they don’t cut through muscle, etc. I watched a video of the surgery. It includes sawing, hammering, and glue. Maybe not "invasive," but....! It takes an hour. If all goes well, I’ll go home he same day.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Choosing Wisely

According to the American Board of Internal Medicine Foundation, “Overuse, or care that has a greater potential for harm than benefit, is widespread in American medicine, with severe effects on both quality of care and health care costs.” For this reason, ten years ago this foundation initiated the Choosing Wisely campaign “…to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures.” The idea was to promote conversations between patients and clinicians. More than 80 specialty societies, such as the American College of Cardiology, have signed on. Together, they have created a list of more than 600 treatments that do not improve patients’ health.

Unfortunately, the campaign hasn’t been terribly successful. Unnecessary medical services continue to account for an estimated 10 to 20% of healthcare in the U.S., costing $75 billion to $101 billion a year. The lack of success is partly because doctors are uncomfortable with uncertainty, fear malpractice suits, and lack the time to counsel patients. More importantly, perhaps, patients prefer to get the tests and treatments. Surveys have shown that patients choose the procedures, as reported by one doctor, “…as a means to improve communication with their clinician.” In other words, more treatments give patients more opportunity to interact with their health care provider.

You can go to the Choosing Wisely website to see the lists of “low value” treatments and tests. For patients, a user-friendly page allows you to scroll through recommendations. Here’s a portion of one having to do with taking statin drugs to lower cholesterol: “…for older people, there is no clear evidence that high cholesterol leads to heart disease or death. In fact, some studies show the opposite—that older people with the lowest cholesterol levels actually have the highest risk of death.” Here’s one that has to do with annual checkups: “…healthy people often don’t need annual physicals, and they can even do more harm than good.” Of course, I choose the recommendations that agree with my opinions.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

 

Why deep breathing calms us

 Five years ago I wrote a post in which I stated that deep breathing “is beneficial in lots of ways, including reducing stress, increasing alertness, boosting your immune system, and reducing symptoms associated with anxiety, insomnia, PTSD, and depression.” The explanation, I wrote, is that “this kind of breathing sends signals to your brain that all is well. In response, your brain adjusts your parasympathetic nervous system—the system that controls unconscious processes such as heart rate and digestion as well as your body’s stress response.”

New research, performed on mice, has refined this idea. The research focuses on a small bundle of about 3,000 interlinked neurons inside our brains that controls most aspects of breathing. It’s called the “breathing pacemaker.” Different types of cells in this bundle regulate different types of breathing, such as yawning, sighing, and rapid breathing. When we’re in an anxiety-producing situation we begin to breathe rapidly. That’s because certain types of cells in our breathing pacemakers are directly linked to the part of the brain associated with arousal, including anxiety and panic. Deep breathing counteracts this effect. That is, it does not activate the neurons that communicate with the brain’s arousal center.

As to sighing, I was surprised to learn that we sigh about every five minutes. A sigh is essentially a double breath that allows our lungs to fully inflate. This is important because the many tiny air sacs (alveoli) in our lungs begin to collapse in the course of normal breathing. Sighing reinflates them.

Even though I don’t practice deep breathing very often, I think it’s a good idea. As to sighing every five minutes, I’ve never noticed. I’m glad I don’t have to think about it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.