Thursday, April 17, 2014
Inquirer Daily News

Rima Himelstein

POSTED: Tuesday, September 10, 2013, 5:30 AM
(iStockphoto)

When Cory Monteith died in July of an accidental overdose of heroin and alcohol, people were shocked because the 31-year-old actor, well known for his portrayal of a high school athlete on the TV show, “Glee,” didn’t fit the stereotype of a heroin user.

The fact is that 3 in 100 U.S. high school students have used heroin. This alarming statistic comes from the Centers for Disease Control’s most recent survey of 15,425 students in grades 9-12 from 42 states. Keep in mind that the students surveyed were in school — teenagers who are truant may be at higher risk.

Derived from a plant, but lethal as a gun. Synthesized from the opium poppy for the first time in 1874, heroin is one of a group of very strong pain-killing drugs called narcotic analgesics or opioids. Heroin turned out to be so addictive that it has been illegal in the United States since 1924. Today, heroin is smuggled into the United States from Southeast Asia, Southwest Asia, Latin America and Mexico.

POSTED: Thursday, August 22, 2013, 6:00 AM
(iStockphoto)

"Why do we need B.O.? What is the function of it? Everything in nature has a reason, has a purpose, except B.O. Doesn't make any sense: do something good, hard work, exercise, smell very bad. This is the way the human being is designed. You move, you stink. Why can't our bodies help us? Why can't sweat smell good?" — Jerry Seinfeld

Why do we need B.O.? B.O., a.k.a. bromhidrosis, results from sweating. Sweating is your body’s way of cooling down when overheated.  Although sweating is part of the way the human being is designed, it can be a real pain. Unfortunately, B.O. usually starts becoming a problem during puberty – a time when teens’ bodies are changing and they’re already extremely self-conscious.

Why can’t sweat smell good? The answer lies in the sweat glands. During puberty, the increasing androgen hormones in boys and girls increase the activity of the sweat glands and alter the chemistry of the sweat. When sweat comes in contact with normal skin bacteria, the sweat serves as food for bacteria, and body odor develops. It’s not just the underarms that are the offenders. With puberty, teens start perspiring in places like the scalp, upper thighs, groin, anal area, and even the feet. Who knew that all of these areas had sweat glands?

POSTED: Thursday, August 1, 2013, 6:00 AM
(iStockphoto)

After placing my items on the belt at a small grocery store in New Jersey, I was quite surprised to look up and see a teenage girl in front of me getting handcuffed by the police.  Last summer the store was not selling alcoholic beverages.  This year they are. The employee at the cash register was herself a teenager, and when I asked her what was going on, she told me the girl was buying alcohol and “Well, it’s against the law.”

It is against the law. The legal age for drinking is 21 —no ifs, ands, or buts.  Well, maybe one “but:” In New Jersey , parents can serve alcohol to their own teens within their own residence.  In Pennsylvania, there are no exceptions

One of my patients got drunk at a high school party and was taken to the hospital and then the police department. Not being allowed to remain the captain of her sports team was the least of the problems that ensued.



POSTED: Thursday, July 4, 2013, 6:00 AM
(iStockphoto)

7:30 a.m.  My 16-year-old son wakes up on a beautiful summer morning after 9 hours of sleep. He’s singing in the shower, a sign that he has had enough sleep.

8:00 a.m.  He sets out a tasty breakfast of cereal, low fat milk and whole wheat toast.   He’s also taking his calcium with vitamin D pill. He’s even cleaning up his dishes. Wait! Is it my birthday?  No.  That was last week.

8:30 a.m. Headphones on (he heard me when I explained to him about noise-induced hearing loss and why he should ditch the ear buds), iPod on his favorite music, and he’s off!  He’s headed to his volunteer job at the children’s hospital. He loves volunteering.  Not only does he feel more positive about himself since he started volunteering, but I also noticed he’s doing better in school. No complaints here! 

POSTED: Tuesday, June 18, 2013, 6:00 AM

As Groucho Marx once said, “Getting older is no problem. You just have to live long enough.

If only getting older were so simple.  For some teens and their families, the teenage years are filled with stress and turmoil. And why wouldn’t they be? After all, the child is becoming an adult, moving from dependence on parents to independence and greater self-reliance. This transition may involve indecision, anxiety, conflict and rebelliousness. If you are a parent of a teenager living through these experiences, hopefully you will find comfort in knowing that you are not alone.

In early adolescence, they may argue with you. Teens begin to analyze the world around them and compare their values with those communicated by friends and the media. As a result, they may argue with their parents and challenge their authority. The same child who idolized his or her parents just a short time ago now thinks of them as ordinary human beings, capable of making mistakes.

POSTED: Tuesday, June 4, 2013, 9:22 AM

In medical school we had a joke:  What is the biggest organ in the body? The answer, “skin,” made us chuckle.  Little did I know that skin would end up being the cause of so much distress to my teenage patients.   

Why do teens get acne? Here’s what my teen son says: “It’s a ball of pus caused by hormones going crazy.” Interestingly, he’s right. The “ball of pus” is a pilosebaceous unit (sebaceous gland and hair follicle) that has become blocked with sebum (an oily substance), dead skin cells and the bacteria Propionibacterium acnes.  These changes are induced in normal puberty by “hormones going crazy”—the increase in testosterone seen in both boys and girls. 

Acne is common in teens: 80 percent have had it at some point. Unfortunately, “misery loves company” doesn’t make a teenager feel better about his or her own acne.  In fact, one study found that teens with severe acne were two to three times more likely to think about suicide than those with little or no acne.  

POSTED: Wednesday, May 15, 2013, 6:00 AM
Filed Under: Growing Pains | Rima Himelstein | Sex
(iStockphoto)

Most of my teenage patients have one hand attached to their cell phones during their medical visits. Sometimes they’re answering their parents’ texts about what time they will be done, and sometimes they’re texting their partners to tell them they have chlamydia.

Given that texting has entered exam rooms in my office, I was not surprised to read the results from the 2011 Pew Internet & American Life Project. Pew surveyed 799 U.S. teens 12 to 17 years of age and their parents; they carried out focus groups with 57 teens. Here is what they found:

  • 75 percent text and 63 percent say they text every day.
  • Texting is trending up: the median number of texts rose from 50 per day in 2009 to 60 per day in 2011.
  • Older girls text the most, with a median of 100 texts a day—more than 3,000 texts a month!—compared with 50 texts per day for boys their age.

And then there are hyper-texters. One in 5 teens are “hyper-texters,” texting more than 120 times a day.  Hyper-texters are more likely to have sex, engage in binge drinking, use illegal drugs or be in a physical fight than teens who text less. 

POSTED: Monday, April 29, 2013, 10:37 AM
(iStockphoto)

It’s difficult to hide: multiple slash marks on the forearm. Many try to cover-up the painful reminders of a very bad day while some tell me openly all of the details. Either way these are the patients that are amongst the most distressing to me as a doctor and as a mother.  And at the same time they are the most intriguing. They almost all say the same thing: they were not trying to kill themselves…but they cut themselves for other reasons.

Cutting is one type of “non-suicidal self-injury” (NSSI). In teens, NSSI most often involves cutting, but also can be burning themselves or banging their heads. Cutting is usually done on the arms, stomach, or thighs with a sharp object like a razor blade, knife, or scissors. To parents it may be out of the expected, but it’s usually not out of the blue. 

NSSI is an outward sign of an inward pain. Teens often cut themselves in response to emotional pain or distress. When they cut, they feel a rapid physical release of emotional pain that is otherwise too difficult to tolerate. Surprisingly, studies have shown that people who self-injure have little or no physical pain even when tissue damage is severe.  After cutting, they still feel badly, but they feel calmer and better able to manage their feelings.  It often begins as an impulse, but cutting can quickly become a habit that is difficult to stop.   

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
Also on Philly.com:
Stay Connected