To understand the sun’s harmful effects, it’s important to understand that sunlight includes three types of UV rays: UVA, UVB, and UVC.

UVA rays penetrate the skin contributing to aging of the skin and wrinkles. They are also an underlying cause melanoma, the most deadly form of skin cancer. “These harmful rays are predominately found in tanning beds and booths,” says Dr. Galen.

UVB rays can cause sunburn, cataracts, and immune system damage, as well as skin cancer. Melanoma is thought to be associated with severe UVB burns before age 20. Sunburns in early childhood are also associated with an increased number of moles which can lead to atypical moles and melanoma.

UVC rays, the most dangerous, are largely blocked by the ozone layer and rarely reach the earth.

Protect Your ChildrenWith the right precautions, kids can safely play in the sun. First, avoid sun exposure for prolonged periods of time. “Children should be kept out of the sun between 10 a.m. and 4 p.m. when the sun is the strongest,” advises Dr. Galen, who often shares an important rule with her young patients: “If your shadow is shorter than you are, it’s time to get out of the sun.” Apply generous amounts of sunscreen – even on cloudy, cool, overcast days. Clouds don’t filter out UV rays and provide a false sense of protection.

Most importantly, use the right degree of sunscreen and apply it correctly. All children – regardless of their skin tone – should wear sunscreen with a SPF of 15 or higher.

Be sure to:
*Use sunscreen whenever your child will be in the sun.

*Apply sunscreen approximately 30 minutes before going outside so that a good layer of protection can form. Don’t forget to protect lips, ears, feet, shoulders, and behind the neck. Lift up bathing suit straps and apply sunscreen underneath them.
*Don’t try to stretch out a bottle of sunscreen; apply the sunscreen generously and reapply every 2 to 3 hours. Be sure to reapply after your child has been sweating or swimming.
*Apply waterproof sunscreen if your child will be around water or swimming. Water reflects and intensifies the sun’s rays, so kids need protection that lasts. Waterproof sunscreen may last up to 80 minutes in the water, and some are also sweat and rub proof.

How to Care For Your Child’s Sunburn
The best way to care for your child’s sunburn is to treat the symptoms immediately to prevent further problems. Typical symptoms include redness, swelling, pain, blisters, and sometimes fever, chills, and weakness. Several days after the burn, the skin may become itchy and peel.

*Avoid repeated exposure to the sun until the burn heals.
*Take a cool (not cold) bath or use a cool compress on the sunburned area.
*Take acetaminophen or ibuprofen for discomfort.
*Apply pure aloe vera gel – available at most pharmacies or taken directly from within the leaves of the plant – to any   sunburned area. It’s an excellent way of relieving sunburn pain and helping skin heal quicker.
*Apply topical moisturizers, aloe gel, hydrocortisone cream, or a topical pain reliever to the sunburned area. Avoid products that contain Benzocaine or Benadryl because of the possibility of skin irritation or allergy.
*To avoid infection tell your child not to scratch, pop, or squeeze the blisters, which can become easily infected and can result in scarring.Most sunburns do not require medical attention, but Dr. Galen recommends a number of ways you can relieve symptoms.

Call your physician if the sunburn causes severe pain or widespread blistering or if you experience symptoms of heat stress, such as fever, chills, nausea, vomiting, or faintness.

Wesley King Galen, M.D., dermatologist, practices with Children’s Hospital at Erlanger.

By Susan Sawyer

             Summer Cobb steps into the CT Ranch at Children’s Hospital at Erlanger, and her face lights up with a big smile.  Unlike most sterile medical settings, the whimsical western motif in the new Emily Ransom Pediatric CT Ranch immediately puts kids like five-year-old Summer at ease. 

            Colorful wall murals and comfortable furniture carry the western theme throughout the kid-friendly space. The cartoon-like characters on the walls take away some of the intimidation and stress that sometimes occurs when children are exposed to an unfamiliar medical environment.

            The daughter of Jennifer and Clinton Cobb of Chattanooga, Summer undergoes CT scans four times a year. A cancerous tumor robbed the child of her right kidney shortly before her third birthday, and regular CT scans now help physicians make sure that Summer’s remaining kidney continues to function properly.

            The new 64-slice scanner at the CT Ranch is dedicated to making tests easier for kids like Summer. Since it’s tough for kids to stay still, the lightning-fast speed of the scanner makes it much easier to obtain an accurate detailed image in the shortest amount of time. This advanced equipment can scan a child’s abdomen in an average of four seconds.

            Young patients also benefit from the knowledge of physicians working behind the scenes at the CT Ranch. Three full-time, board-certified pediatric radiologists at Children’s Hospital are experts in interpreting and performing pediatric imaging studies.

            “We’ve implemented low radiation dose protocols for the new CT scanner,” explains Marla Sammer, MD, pediatric radiologist at Children’s Hospital. “And we’re also helping clinicians choose appropriate alternatives to radiation, such as ultrasounds or MRIs.”

            During routine quarterly CT scans at Erlanger over the last two years, Summer received the lowest possible dose of radiation. But her first trip to the new pediatric CT scanner at the CT Ranch means that her radiation dosage would be 45 percent lower than previous trips.

            And the lower dosage puts her mother’s mind at ease. “I’ve been worried about the long-term effects of so much radiation exposure,” explains Jennifer Cobb. “After all, who knows how long she’ll have to have CT scans? The lower the dosage, the better.”

            Equipped with a special software package, the CT scanner performs exams at lower radiation, but with the same image quality as higher dose exams. “And we tailor the exam to the patient’s size and health condition,” Dr. Sammer explains.

            Tailoring the exam is a collaboration between the patient’s physician, the pediatric radiologist, and the pediatric CT technologist – all working together at Children’s Hospital to provide exceptional care for patients like Summer.

The Emily Ransom Pediatric CT Ranch, named in memory of Jonathon and Wendy Ransom’s daughter, opened earlier this year. During Emily Ransom’s battle against a rare form of cancer called neuroblastoma, the two-year-old had routine scans at Erlanger. Wanting to provide a pediatric CT scanner at Children’s Hospital in Emily’s memory, the Ransoms and the community helped to raise funds to purchase the scanner.

            Now kids like Summer fearlessly enter the CT Ranch, and parents have the assurance of knowing that Children’s Hospital at Erlanger is the right place for kids…right here at home.

The condition is called celiac disease (pronounced see-lee-ack), and many people don’t even realize they have it. When people with celiac disease eat foods with gluten, their immune system attacks their small intestine. That means nutrients from food aren’t absorbed into your bloodstream, and your body can’t get enough nutrients no matter how much food you eat. The resulting malnutrition can be a serious problem—particularly for children, who need adequate nutrition to grow and develop properly.

The symptoms of celiac disease can vary, ranging from gas, diarrhea and belly pain to delayed growth, certain skin rashes, infertility and osteoporosis. One person might have diarrhea and belly pain, while another may be irritable or depressed. Some people with the disease don’t even have any symptoms. With or without symptoms, people with celiac disease are at risk for the complications of the disease.

The longer a person with celiac disease goes undiagnosed and untreated, the greater their chance of developing malnutrition and other serious problems. A blood test can reveal if you have celiac disease. Before being tested, continue to eat a regular diet that includes foods with gluten. If you stop eating these foods before being tested, the results may be negative for celiac disease even if you have it. If your tests are positive, your doctor will likely perform a small-bowel biopsy, during which a tiny piece of tissue from the small intestine is removed to check for damage. For most people, following a gluten-free diet will stop symptoms, heal existing intestinal damage and prevent further damage.

Improvements usually begin within days of eliminating gluten. The small intestine usually heals completely within months in children and young adults, and within two years for older adults. If you’re diagnosed with celiac disease, your doctor will probably ask you to work with a dietitian on a gluten-free diet plan. People with celiac disease have to be very careful about what they buy for lunch at school or work, what they buy at the grocery store, what they eat at restaurants or parties and what they grab for a snack. The dietitian can teach you how to read ingredient lists and identify foods that contain gluten.

Safe Kids Greater Chattanooga and FedEx are partnering in a task force that includes representatives and community leaders promoting child pedestrian safety. The committee’s goal is to identify and physically alter a specific environmental problem that causes unsafe walking conditions for children and adults in high-risk locations. The grant money will provide an opportunity for the City of Chattanooga to make environmental changes towards improving pedestrian safety in several neighbors.

Some of the recommendations include:

• A solar-powered sign for reading vehicle speeds on 3rd Street near Orchard Knob Elementary to alert drivers to decrease speeds near the school.
• Pedestrian signals and countdown timers will be added to the crosswalk at the intersection of Wilcox and Dodson ensuring pedestrians a safer crossing to Avondale Recreation Center and the convenience store.
• Street stencils will be added on Orchard Knob in front of Carver Recreation Center and on Dodson Ave in front of East Chattanooga Recreation Center to notify drivers of these pedestrian crossing areas.
• Battle Academy will have a sidewalk added to the premises to better connect street crosswalks that are already in place.
• Street stencils added to Market Street and W.16th Street to better inform drivers of the school zone.

Pedestrian education and enforcement will also be implemented in the above areas.

“We are fortunate to receive this grant for the second year in a row,” said Clay Carlock with Children’s Hospital Safe and Sound Program. “We are seeing significant improvements and a decrease in the number of accidents with the projects we implemented in other high risk areas last year.”

Each year in the United States, approximately 630 children die from pedestrian crashes and more than 39,000 sustain nonfatal pedestrian injuries. In 2009, there were 59 pedestrian crashes among all ages in Chattanooga; ten of which were fatal. And, in 2010, Children’s Hospital at Erlanger saw 31 patients for pedestrian injuries; nine of which were admitted to Children’s Hospital with an average stay of 6.6 days and a hospital bill averaging $57,000.
“There have been a lot of complaints in the community about the dangerous intersections,” added James Moreland, Chairman of East Chattanooga Improvement and Neighborhood Association President. “We are excited to partner with these individuals to create a much safer environment for the children.”

Safe Kids Greater Chattanooga Area activities are designed to help children walk safely all year round. Safe Kids Worldwide and program sponsor, FedEx, created the Safe Kids Walk This Way Program in the United States to teach safe behaviors to motorists and child pedestrians and create safer, more walkable communities. Safe & Sound, an injury prevention service of Children’s Hospital at Erlanger and lead agency for Safe Kids Greater Chattanooga Area, works to prevent accidental childhood injury, the leading cause of death and disability for children ages 1 to 14. Safe Kids Greater Chattanooga Area is a member of Safe Kids USA, a global network of organizations dedicated to preventing accidental injury. For more information, visit www.safekids.org.

Pictured are Ben Taylor, City of Chattanooga traffic engineer; Gerald Perry, Avondale Community Center director; Lt. David Frye, Chattanooga Police Department; James Moreland, Chairman of East Chattanooga Improvement and Neighborhood Association President; Clay Carlock and Cindy Jackson, Children’s Hospital at Erlanger Safe and Sound Program; Lt. Brian Cotter, Chattanooga Police Department; and Christy Smith, Hamilton County Health Department.

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Screening tests can find diseases early when they are easier to treat. Health experts from the U.S. Preventive Services Task Force have made recommendations for women, based on scientific evidence, about testing for the conditions below. Talk to your doctor about which ones apply to you and when and how often you should be tested.

Mammogram: Starting at age 50, it’s recommended that you get screened every 2 years. After age 75, ask your doctor or nurse if you need to be screened. Individual cases may start screening earlier or more frequently depending on risk factors.

Cervical cancer screening (PAP test): It’s recommended that all women, ages 21 or older and who are sexually active be tested every three years.

High cholesterol: Have your cholesterol checked regularly starting at age 35. If you have diabetes or high blood pressure, smoke, or have family members with heart disease, your doctor may want to check your cholesterol beginning at age 20.

High blood pressure: Your blood pressure should be checked at least every 2 years. High blood pressure is 140/90 or higher.

Colorectal cancer: Testing for colorectal cancer should start at age 50. Your doctor may help you decide which colorectal cancer test is right for you. If you have a family history of colorectal cancer, you may need to be screened earlier.

Diabetes: Have a test for diabetes if you have high blood pressure or high cholesterol.

Depression: Your emotional health is as important as your physical health. If you have felt “down,” sad, or hopeless over the last two weeks or have felt little interest or pleasure in doing things, you may be depressed. Talk to your doctor about being screened for depression.

Sexually transmitted infections and HIV: Talk to your doctor to see whether you should be tested for sexually transmitted infections. You may also need to be tested for HIV, especially if you had a blood transfusion between 1978 and 1985, are currently being treated for sexually transmitted diseases, or have had unprotected sex with partners who are HIV-infected, bisexual, or use injection drugs.

Bone density test (osteoporosis screening): Get this test at least once at age 65 or older. Speak with your doctor or nurse about the need for repeat testing. Those at risk for osteoporosis should discuss the need for this testing beginning at age 50.

For more information on women’s health, visit:

• Erlanger Health System – www.erlanger.org
• American Heart Association – www.heart.org
• U.S. Preventive Services Task Force – www.uspreventiveservicestaskforce.org
• American Diabetes Association – www.diabetes.org
• National Cancer Institute – www.cancer.gov

Melanie Blake, M.D., is an internal medicine physician with Academic Internal Medicine (AIM), conveniently located on the second floor, B elevator, of Erlanger’s Medical Mall. For more information or to make an appointment with Dr. Blake call, 423.778.8179.

by Gabe Tallent, M.D.

Anyone—including children—can have a sleeping disorder known as sleep apnea.  Also known as sleep disordered breathing, sleep apnea brings repetitive periods of difficulty breathing and sleeping. 

Sleep apnea is often caused by a temporary obstruction to the airway opening at the back of the mouth.  In children, it could be large tonsils; in adults, the tongue.  Or it could stem from weight gain, as the airway passage narrows because of thickened fat pads. 

The muscles that normally keep the airway stiff and open while awake may relax during sleep, causing the airway to narrow or even close. In rare cases, the brain occasionally fails to send signals to the muscles, telling them to breathe.

Whatever the cause, when your breathing stops or becomes very shallow, the oxygen level in your blood goes down.  Your brain senses an emergency and takes action to wake you up, doing whatever it takes to get air into your lungs and restore your breathing.

Common symptoms

Trying to force air past an airway obstruction can cause loud snoring.  In fact, one of the most common ways people discover they have sleep apnea is that their bed partner complains about the noise.  Some people may also gasp for air.  Most disturbing, however, may be the silence when there is no breathing during the apnea.

The most common signs of sleep apnea are:

• Loud, chronic snoring
• Choking or gasping during sleep
• Fighting sleepiness during the day when you thought you’d gotten enough sleep the night before
• Morning headaches
• Memory or learning problems
• Feeling irritable
• Unable to concentrate on your work
• Mood swings, personality changes, or depression
• Dry throat when you wake up

Risk factors

If someone in your family has sleep apnea, you’re more likely to develop it than someone without a family history of the condition.  It’s more common in African Americans, Hispanics and Pacific Islanders than in Caucasians.  The reasons for these differences are unknown.

Treatment options

Treatment includes making lifestyle changes, such as sleeping on your side instead of your back, and losing weight if you are overweight. 

For adults with moderate or severe sleep apnea, continuous positive airway pressure (CPAP) is the most common treatment.  For CPAP, you wear a mask over your nose or mouth during sleep that blows air into your throat at a pressure level just high enough to prevent airway obstruction. Other treatments are also available.

Gabe Tallent, M.D., Board-certified in sleep medicine and neurology, sees patients at three convenient locations in the Chattanooga area – Erlanger North Sleep Disorders Center, the Erlanger East Campus, and Erlanger at Volkswagen Drive. Diagnostic testing is available at the Erlanger North Sleep Disorders Center, which is located within the Erlanger North Campus at 632 Morrison Springs Road.  For more information and to make an appointment, call 423-778-3316.

“Rachel always goes beyond expectations in her responsibilities.  She is a genuine, conscientious, and caring nurse whose greatest honor is given to her by her patients.” states Sondra McGinnis, practice manager at Academic Internal Medicine.

Rachel goes above and beyond in providing outstanding patient care to her patients. For example, after realizing that a patient who was recently diagnosed with a terminal illness didn’t have any close family, she encouraged her fellow staff to “adopt” the patient. Rachel coordinated the fellow staff members to help provide meals and also assisted with arranging his care.

In addition, Rachel is a leader among the Academic Internal Medicine staff. She has learned creative ways to assist staff member learn Joint Commission Standards, improved workflow issues with electronic medical records, as serves as a mentor for many nursing students. She challenges her whole team to aim for excellence.

Our 2012 nominees included: Barbara Davis, Jennifer Durham, Amanda Edmundson, Rebekah Harvey, Joseph LaMaitre, Kristina Merritt, Matthew Rice, Carol White, and English Whitehead.

Know Your Numbers

Waist                                   <37″♂ , <33″ ♀

BMI                                     <25

BP                                         <120/80 mm Hg

FBSugar                             <100 mg/dl

TG                                         <150 mg/dl

TC                                         <200 mg/dl

HDL-C                                 >40 ♂, >50 ♀

LDL-C                                 <100 mg/dl

Facts about Hypertension

• Only 64 percent of patients with known hypertension have control of their blood pressure. Only about 34 percent of diabetic patients with known hypertension have adequate treatment of their hypertension and have reached their treatment goal.
• The economic burden of hypertension in the U.S. is substantial: direct and indirect costs were $73.4 billion in 2009.
• Adults in this country, 55 years of age and older, have a 90 percent risk of developing hypertension during their lifetime.
• Tennessee ranks 50/52 in the nation with stroke deaths which is directly related to hypertension treatment.

Click Here for more information about Erlanger’s  Hypertension Management Center specialists, Drs. Billy Arant and Michael Geer.

 “This is the second year in a row we have had the pleasure of announcing one of our patients will represent Tennessee for Children’s Miracle Network Hospitals,” said Betsy Taylor, President of Children’s Hospital Foundation.

Nine-year-old Andrew Ellis came to Children’s Hospital by LIFEFORCE Air Medical the night of April 27, 2011.  A tornado ripped through his grandmother’s home in Apison, Tenn., killing four of his family members and dragging him through a field where rescuers later found him.  His mother credits the bravery that was displayed by rescuers and the lifesaving skills provided by medical personnel for saving his life that night. 

“April 27^th, 2011, was a life changing event that will always be bittersweet,” said Wendy Ellis, Andrew’s mother.  “In one breath, I received the news that not only had I lost four of my closest family members, including Andrew’s brother Adam, but the lone survivor, my son Andrew, was being airlifted to Children’s Hospital at Erlanger with life threatening injuries.  Despite my emotions being in a whirlwind at the time, there was a sense of security in my heart just knowing the care he would receive once he arrived at the hospital.”

 Andrew was named a Children’s Miracle Network Hospitals Champion for his miraculous survival and his determination to live life to the fullest and will represent all pediatric patients in children’s hospitals across the state. 

“Today, as I see Andrew and his miraculous recovery he has made throughout this past year, I know this could not be possible without the services of the Children’s Miracle Network,” added Ms. Ellis.  “I want to express my sincerest thanks to all!”

In the fall, Andrew will serve as an ambassador and visit Washington, D.C.While in Washington, he, along with Champions from other states, will visit The White House and Capitol Hill. He will then take part in Children’s Miracle Network Hospitals’ annual celebration event in Orlando, Fla.

Delta Airlines, this year’s Champions program title sponsor, has been a proud supporter of CMN Hospitals since 1998.  Other 2012 partners include Ace Hardware andChico’s FAS.

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Quick action is key, act F-A-S-T:

F= FACE

Ask the person to smile. Does one side of the face droop?

A= ARMS

Ask the person to raise both arms. Does one arm drift downward?

S= SPEECH

Ask the person to repeat a simple sentence. Are the words slurred? Can the person repeat the sentence correctly?

T= TIME

If the person shows any of these symptoms, time is critical. Call 9-1-1 and go to the nearest accredited primary stroke center

Are you at risk for stroke?

If you have these risk factors, consult your physician. Education, prevention, and detection can save your life.

• High Blood Pressure
• Diabetes
• Heart Disease
• Carotid Artery Disease
• Smoking
• Family History of Stroke
• Prior Stroke or TIA (Transient Ischemic Attack)
• High Cholesterol
• Obesity
• Sleep Apnea
• Substance Abuse

Know the Warning Signs

If you or a loved one experiences any of these symptoms, seek help immediately at Erlanger, the region’s only accredited primary stroke center.

• Weakness, numbness or tingling in the face, arm, and/or leg (especially on one side of the body)
• Difficulty speaking or understanding speech
• Blurred vision (especially in one eye), loss of vision or double vision
• Dizziness, lack of coordination
• Sudden, severe or explosive headache

The Erlanger Southeast Regional Stroke Center is Southeast Tennessee’s first and only accredited Primary Stroke Center. Erlanger earned the Gold Seal of Approval from The Joint Commission for Primary Stroke Centers, recognizing that the Erlanger stroke care program follows national standards and guidelines that can significantly improve outcomes for stroke patients.

For more information about Stroke Prevention, visit:

www.erlanger.org/stroke

www.powertoendstroke.org