Synthetic Marijuana, Driveway Sealcoat and Tiny Tim – Pediacast 206

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Join Dr Mike in the PediaCast Studio as he covers News Parents Can Use. This week’s topics include the cinnamon challenge, synthetic marijuana (Blaze, Spice, K2), passive smoke exposure, successful diets for obese kids, and nitric oxide therapy for preemies. Plus, the dangers of driveway sealcoat and Tiny Tim’s medical diagnosis… It’s all right here—on PediaCast!

Topics

  • The Cinnamon Challenge
  • Synthetic Marijuana
  • Passive Smoke Exposure
  • Comparing Diets for Obese Children
  • Nitric Oxide Therapy for Preemies
  • Dangers of Driveway Sealcoat
  • Tiny Tim’s Diagnosis

Links

Transcript

Announcer 1: This is Pediacast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcasts for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio, I might add. And I'd like to welcome everyone to the program, both our regular listeners and our new listeners, alike.

If you're new to the program, welcome, sit back and take a listen. We have lots of information coming your way. This is episode 206, 2-0-6 for April 5th, 2012. Synthetic Marijuana, Driveway Sealcoat and Tiny Tim.

Now, you may be asking yourself how in the world do at least two of these topics pertain to the world of pediatric medicine. And they do relate and we'll get to exactly the hows and the whys in just a few minutes. This is a news edition of the program and we will get to the whole rundown of exactly what we're going to talk about in just a few minutes.

But before we do that, I wanted to remind you that PediaCast is on Facebook and Twitter. So if you haven't stopped by our Facebook page and liked us there, please consider doing so. We try to keep it up to-date. We let you know you what program is coming out just to remind you when a new show is available and have a description of exactly what we're going to be talking about.

And then there's other breaking pediatric news comes up, we include that. And then just some fun thoughts along the way, too. So if you are not a part of our Facebook page make sure you check us out. Facebook PediaCast, just search for PediaCast and it'll be easy to find us.

02:09

We're on Twitter, as well, and we do a few tweets a day and let you know what topics again are coming up and just some thoughts and breaking news, those kind of things. So if you don't follow us on Twitter, please make sure you do.

Also, if you want to help us create a little bit of a buzz in social media, that will be most helpful. Just use hashtag #PediaCast, that's the hashtag we use, so you may want to subscribe to that one. And if you're doing a post about us, just put a little hashtag #PediaCast and then we would appreciate it. You can help with our social media buzz.

Also on Google+ so you can check us out if that's where you are. I haven't gotten into the Pinterest thing yet. I'm not quite sure that PediaCast fits there, but who knows, if you feel strongly the other way, message me and try to convince me. And maybe we'll join the Pinterest world, as well. Although I don't see that one being as likely in the future. Maybe, who knows? I don't know, it's a little lady-like, isn't it?

03:14

OK. Speaking of buzz, you may have heard that there is new movie out, what's been out for a couple of weeks now. Hunger Games. And I wanted to weigh in on it because it is a little controversial.

When you look at just the basic description, it's that there's an arena, although it's not like a Roman gladiator arena. I mean, this is big multi-acre arena with hills and valleys and lakes and streams, so it's a whole geographic area. But still it's an arena and they basically put a bunch of teenagers in here and make them fight out to the death, so that there's only one left.

So when you say it like that, it doesn't sound like it's something that really I would want to expose my kids to. But actually, you have to kind of place that into its context. And I'm not sure that I would've really given it a chance except that few months ago, my daughter, she's a teenager and an avid reader, I might add, and she had gotten a hold of the Hunger Games books and read through it and really loved it. And just before the movie came out, she wanted to read the first one, the Hunger Games, to our family.

And we don't do this very often, I wish we did it more often and I would encourage folks with kids at home. This is really a great thing to do a book out loud as a family. You kind of gather round the living room hang out on the couches and people can take turns reading. And it's just kind of a fun thing to do together as a family.

I'm not setting on my pedestal telling you this because we don't do it very often. But we did for the Hunger Games and it kind of limit itself to it because there were fairly short chapters, so we would do one or two chapters a night; or if the action really got going, which usually did, we do three.

05:09

So when you put this whole teenagers killing each other into the context of the story, then it's not quite as bad because you understand that the society where these people are coming from, that it's actually retribution for a rebellion that had happened 70 some years ago. And there are actually a lot of learning points and talking points in the story. There's substitution, there's sacrifice, there's fear, there are things that are unfair.

It's really, when you just say sort of clinically, that it's about these teenagers all trying to kill each other, it doesn't sound so good. But for mature, older teenagers and adults, I really enjoyed it. I'm not used to doing movie reviews here, but I've been asked about it a lot, from a pediatrician and a dad's standpoint; like, hey, is it this something that kids should be seeing?

I would definitely caution you if you have younger kids from seeing this. But if you have, like I said, older, mature teenagers, especially when you look at the story in the context of where it's coming from, it's not so bad and we enjoyed it. We went out and did the midnight run, its first night out.

So, I'd encourage you to check that out if you have wondered about it and thought, ooh, that sounds a little violent. I would have thought so too but I did end up enjoying it.

06:37

All right. Before we get started, one more thing I wanted to tell you about, I'm just going to weigh in on this. I'm kind of late to the game with this one. But it's still important and I thought you'd be interested in my thoughts on this, as well, because it does concern pediatric medicine.

And that is the cinnamon challenge. Now, this is not something that's new. It's been circulating around since 2001. But it has had a recent resurgence and in fact there are 30,000 videos on YouTube that are tagged with the keywords cinnamon challenge.

Basically, what this is, if you haven't heard, if you've, I don't know, put under a log or something, folks, teenagers, adults, alike, usually younger adults, take a tablespoon of cinnamon and put it in their mouth and try to get it down in 60 seconds; and no water. They're not allowed to drink any water and they record this on video and then upload it to YouTube so that you can see the results.

And if you've seen any of these videos, you're probably thinking ahhh, these people are faking it, they're dramatic, this isn't really what happens. But as it turns out that's not the case. What this cinnamon does is it dries out the mouth because all of your spit is absorbed by the cinnamon. And if you do an entire tablespoon of it, there's too much cinnamon to absorb all of your spit. So what happens is your mouth becomes instantly dry as a bone.

08:12

And as it turns out this stimulates a severe reflexive coughing, so you just start coughing, coughing and you can't help it. It's a reflex cough, you can't stop yourself. And you'll see in these videos, it's exactly what happens. And then there's still dry cinnamon in your mouth and so that dry cinnamon as you cough comes out in a great big cloud, a big puff of cinnamon. And the person is left gasping for air and that this is supposed to be funny.

And for a lot of people the cinnamon that they do get down is irritating to the stomach and it causes vomiting and so in some of these videos they go as far as to show the person vomiting, as well. But there are some really serious risks associated with this, for one, you can choke, you can get a big wad of the wet cinnamon that can include the airway and so you can literally choke on the cinnamon. If you vomit and you're coughing and gagging, you can aspirate so that some of your stomach contents go down in the lungs and can cause an inflammation and infection.

09:21

But the most serious thing that, these are all serious things, but the one that is more likely to happen and can be a problem is that puff of cinnamon cloud, then you're coughing and so in the process of coughing you take deep breaths in and you can actually inhale the cinnamon powder down into your lungs and then that can cause wheezing, it can turn into an asthma attack, especially if you're prone to asthma, you have reactive airway disease. But even if you don't have that, it can cause airway inflammation and you can also get infection associated with that.

And there was actually a high school freshman just recently in Michigan who did this and inhaled the cinnamon powder and he ended up in an Intensive Care Unit on a ventilator with a collapsed lung and a serious infection. He survived but he was very, very sick.

Recently some celebrities and sports stars and even politicians have joined the Cinnamon Club by posting YouTube videos of themselves taking the challenge. Just as an example, Illinois Governor Pat Quinn did it. What is it with Illinois governors? NBA players, Jovial McGee and Nick Young. Great role modeling there guys.

I mean, seriously, this is dangerous and lots of kids are only doing it because they're being pressured and bullied into doing it by their peers. So, moms and dads you can and should put a stop to this. It's dangerous. Talk to your kids about it. Don't tolerate it. Look, you should know what your kids are doing, even on YouTube. It's important.

10:56

Speaking of bullying, there's a bullying movie that's coming out very soon and we'll watch. I'll make sure I take that one in and let you know my thoughts on it as well. Apparently and initially, it's sort of a docu-drama about kids being bullied and because of the real-life language that often times occurs in bullying situations, the Motion Picture Rating Association gave the film a Rated R and so the folks who really need to see this movie, the parents, along with their kids so they can generate discussions and say, hey, is this happening to you at school; how do we deal with this; let's open our eyes and see what this bullying problem really is; aren't going to go see if it's Rated R.

And so the movie company decided to take the rating to release it as an unrated film, which has gotten push back from some theaters. So there's a little bit of controversy there as well. But once it comes out, we'll talk about that one a little bit more because bullying is definitely a pediatric topic.

11:57

All right. Speaking of pediatric topics, what are we going to talk about today? We have lots coming your way. Synthetic marijuana, things like Blaze, Spice, K2, what's going on with that? They're not only common and easy to get a hold of, there are dangers associated with this as well.

Also, passive smoke exposure. Can childhood exposure lead to adult disease? So, secondhand smoke as a kid, you never smoked, but could you develop lung disease as an adult? There's a new study with some interesting information along those lines.

Also, comparing diets for obese children. Are some diet plans more effective than others and perhaps easier to follow that other? Also nitric oxide therapy for premature babies. This sounds, you know, like we're getting into a little deep into science with that one, but there are lots of parents out there who spend many days and nights in Neonatal Intensive Care Units (NICU) throughout this country. And some you, the babies, get nitric oxide and some don't, depending on where you live.

There's not really a good standardization of when and when it should not be used. So someone in the northeast may have a relative in Colorado, they had babies who were about the same, in terms of prematurity, one gets nitric oxide, the other one doesn't and they kind of compare notes and it's like, hey, should my baby have gotten that; or the other one could say, why did my baby get that.

So we're going to discuss the nitric oxide issue. I deluded to that back when Dr. McClead visited. So we are going to get to that in this particular episode.

13:34

Also, the dangers of pavement or driveway sealcoat, the type of sealcoat that you use may make a difference and it could be affecting your family's health. And then we'll wrap thing up with Tiny Tim, what was wrong with him? Well, a doctor from Le Bonheur Children's Hospital just might have an answer.

I also want to remind you if there's a topic you'd like us to talk about, you can head over to pediacast.org, click on the Contact link or you can email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

Also I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatments plans for specific individuals. So if you do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also your use of this audio program is subject to the PediaCast Terms of Use Agreement and where can find that, of course over at pediacast.org.

All right. Let's take a quick break and we will be back with the News Parents Can Use, right after this.

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15:09

Our News Parents Can Use is brought to you by in conjunction with the news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.

A growing number of adolescent children and young adults are consuming synthetic types of marijuana, commonly known as Blaze, Spice and K2. And these drugs are sending many users to emergency departments. That's according to researchers from the Children's National Medical Center in Washington, D.C. as reported in the journal Pediatrics. The author say, "Dealers make these synthetic cannabinoids in illegal laboratories and sell them to convenient stores and gas stations where teens and adults purchase them."

Like their natural counterparts, the smoke of synthetic marijuana is inhaled causing euphoric and psychoactive effects on the users. However, there are other effects associated with these drugs, some of which may be specially dangerous. Then adults and young patients, teens and adults, throughout the United States have arrived at emergency rooms with not only restlessness and agitation, but also diaphoresis, just heavy sweating, catatonia, we all know what a catatonic state is, extreme agitation and the inability to speak.

From 2010-2011, the American Association of Poison Control Centers received 4,500 telephone calls related to synthetic cannabinoid poisoning. The Author say, "The effects of intoxication are short lived, however, healthcare professionals are becoming increasingly concerned about the potential long-term effects of regular synthetic cannabinoid usage."

They also warned that synthetic marijuana does not contain what the dealers claim. According to the package, these products are "a mixture of traditional medicinal herbs". They claim the user will experience mild or relaxing effects, similar to those experienced from marijuana but from natural ingredients.

16:59

I hate to burst their bubble, but marijuana is pretty natural. Laboratory tests in several countries have found these herbal claims to be false. In fact, the labs are unable to identify any of the herbs named in the ingredient list, instead they typically find an unknown plant material sprayed with an unknown toxic chemical.

One of the chemicals has been identified as Tocoferol, which is actually a form of vitamin E, but investigators suspect other chemicals, not yet identified, are also sprayed on the plant material and these unknown chemicals are responsible for the marijuana-like euphoria and the toxic effects.

Since exact nature of the toxins are still unknown, which in drug screenings are negative, which has increased the popularity of theses substances with young users. And, since the identity of the offending chemicals has not been identified, governments are having a difficult time controlling sale and use of the products.

So this is troubling news, really. We aren't sure exactly toxic chemicals yet are sprayed on these pouches of unknown, but certainly not what stated on the label, plant material. We do know the chemicals cause a marijuana-like euphoria, but they also cause the sweating, disorientation, agitation, aggressiveness and sometimes an inability to speak.

So these are obvious signs the chemicals are having unwanted toxic effects on the brain and of course you got to wonder what's the long-term consequences of exposure to this stuff and we just don't know. So parents be on the look out, don't let your kids pass it off as incense. Don't buy that story. Blaze, Spice, K2, these are just some of the names, they aren't incense and they aren't harmless.

18:48

All right, moving on, a new study published in the journal Respirology, reveals that children who are exposed to passive smoke have almost doubled the risk of developing Chronic Obstructive Pulmonary Disease or COPD in adulthood compared with non-exposed children, that's according to researchers at Haukeland University Hospital in Bergen, Norway.

Investigators examined 433 non-smoking adult patients with COPD and 325 non-smoking and healthy adult control subjects. So these are folks who did not smoke in adulthood, their only exposure was secondhand smoke as kids. They found that regular exposure to passive smoke while growing up almost doubled the risk for COPD in adulthood. Gender differences also existed with a stronger associated noted for women. And passive smoking exposure during childhood was a much stronger factor than passive smoke exposure as adults.

Researchers say, "There were results suggest that long-term burden of COPD could be reduced if children were not exposed to cigarette smoke."

And the added factor is affecting early life development of lung function to have important long-term consequences in adult life. So moms and dads, here's another reason to keep your kids away from cigarette smoke, as if you needed another reason.

20:02

All right. A new study of three diets for obese children showed that all diets are effective in managing weight but the reduced glycemic low diet, one that accounts for how many carbs are in the food and how much each gram of carbohydrates raises blood glucose levels, may be most promising.

The Cincinnati Children's Hospital Medical Center's study of low carb reduced glycemic load and portion control diets with obese children is published online in the journal of Pediatrics. The study shows that children have more difficulty following a strict low carb diet, particularly long-term, since children adhered best to a reduced glycemic load diet, this diet may represent the most promising approach for pediatric weight management, according to Dr. Shelley Kirk, PhD, RD, LD lead author of the study.

Dr. Kirk says, "This is the first long-term randomized clinical trial that compared the effectiveness and the safety of these three diets using a family-based behavioral approach for younger obese children. All three diet groups had significant improvement in weight status, another health measures, and showed no adverse effects. Since all three diets were effective, practitioners can offer any one of these approaches for helping obese children achieve a healthier weight.

The study included 7-10-year olds who were instructed to follow their assigned diets for 12 months. During the first three months, they received weekly dietary counseling and every other week group exercise sessions. They continued their assigned diet on their own for the following nine months. Their height, weight, body fat and several other clinical measures were taken at the beginning of the study and again after three, six and 12 months. Clinical measures included cardiovascular risk factors, such as blood pressure, cholesterol, triglycerides and insulin.

Of the 102 children enrolled, 85 completed the year-long study. After three months, children on each diet showed improvements in body mass index and percent body fat and these changes were maintained at 12 months. Children in all three groups were successful in maintaining a reduced caloric intake even in the final nine months of the study, which were without the guidance or counseling from the research staff.

Dr. Kirk says, "This raises the possibility that an intensive initial intervention for any of these diets can lead to long-term successful weight management."

22:12

You know what, I've heard this kind of thing before. It's like three months is sort of a magic number for behavioral change and this is known in the counseling world as well. Really with just about anything. So if and this study kind of backs that up as well, that if you can change a behavior for three months then you're doing pretty well.

When you think about like New Year's resolutions and how long we keep those, even though we're really committed, sometimes you joke around, but when you seriously make a New Year's resolution and then fail, about a time you were really serious about it. I mean, when you started out, you really wanted to make that change and you just didn't stick with it.

But again, if you can make it out to three months then you have a really good shot at more long term success and even though that wasn't the point of this particular study and they didn't have another group where they didn't do the intervention for three months, that would have been an interesting study.

Let's do this dietary intervention that's pretty intensive and involved and do it for three months. Let's do another one where you only did that for one month and another one maybe for two months and then at 12 months see where all three groups are and just see if that three months is magic.

Yeah, I think that'd be an interesting study. OK. So you're probably wondering what are the details of the three diets that were used in this study and it will get a little monotonous if I went through all of these different diets. But I'll tell what I will do for you, in the Show Notes, we'll have a link to the full text of this particular article and we did find a site that has this article for free so you don't have to pony up any money to subscribe and get it, because a lot of them we do put links to the abstracts but you have to subscribe if you want to see the full text. But in this particular case, we do have a link for you that has the full text of the article and it has all the details about the diets right there.

So just head over to pediacast.org, click on the Show Notes for episode 2-0-6, which is this one, and you will find the link to sciencedirect.com and they do have this particular article published with the full text.

24:27

I'm also going to put a link on the Show Notes to the Parents Resource page for the Center for Healthy Weight and Nutrition here at Nationwide Children's Hospital where you'll find loads of great articles relating to, you guessed it, healthy weight and nutrition. They really do have some great stuff there, so you can head over to the Show Notes at pediacast.org, episode 2-0-6 and we'll have that link for you to the Center for Healthy Weight and Nutrition here at Nationwide Children's Hospital.

All right. Moving on, many parents including many of you listening to the show right now, have had premature babies and you spent long days and equally long nights in the Neonatal Intensive Care Unit (NICU). Here's a story that may soon affect the care of these babies, many premature infants throughout the United States continue to receive inhaled nitric oxide during their NICU stay despite the lack of evidence to support its use.

Whether or not a preemie will receive nitric oxide treatment, when and for how long, varies greatly throughout the country as its use in premature infants appears to be unstandardized. These are the findings of a Nationwide Children's Hospital study appearing in the journal Pediatrics.

Inhaled nitric oxide is a selective pulmonary laser dilator approved for use in term and near term infants with hypoxic respiratory failure. And it has been a hypothesized that nitric oxide might help prevent complications of prematurity in infants born less than 34 weeks gestation. However, the National Institutes of Health and the Agency for Healthcare Research and Quality have concluded there is no evidence to support the routine use of nitric oxide in preterm infants who require respiratory support.

"Despite years of data unable to support its off label use, nitric oxide treatment in preterm infants remains common in U.S. children's hospital NICUs," so it says Neonatologist, Dr. Michael Stinger, PhD, lead author of the study. Dr. Stinger goes on to say, "It's important to determine how nitric oxide is being used in this patient population as we may need to implement evidence-based standards of care."

To help characterized variation in recent practice, Nationwide Children's faculty and members of the Ohio Perinatal Research Network performed a retrospective study using the Child Health Corporation of America's pediatric health information database. The study population included over 22,000 premature infants born less than 34 weeks gestation who are admitted to Neonatal Intensive Care Units in 37 U.S. children's hospitals during a 3 1/2-year period.

26:49

The findings revealed that the use of inhaled nitric oxide in premature infants was variable even when controlling for demographic characteristics in disease. There was substantial variation in the age of initiation of nitric oxide treatment and the average number of days of use. Hospitals that used nitric oxide in more patients also used nitric oxide for longer durations and a higher volume NICUs used less nitric oxide and had lower mortality rates than lower volume NICUs.

Northeastern hospitals reported less use of nitric oxide and infants who received nitric oxide were less likely to survive suggesting the gases used in infants already at a high risk of death. "Overall, we found that there is a pervasive lack of standardization in nitric oxide across NICUs," said Dr. Stinger. Adherence to National Institutes of Health consensus guidelines may decrease variation in its use.

Since this study's data are observational, investigators cannot be certain whether or not premature infants benefited from nitric oxide use and Dr. Stinger says, "The findings suggest the use of nitric oxide in extremely low birth weight infants with the most severe forms of respiratory failure did not improve mortality rates." According to Dr. Stinger, "It is clear that there is a need for adherence to and further development of evidence-based protocols to standardize care in order to avoid unnecessary and costly treatment."

28:12

So again you recall a couple episodes back during our Children's on Quality Mashup, Dr. Rick McClead, Medical Director of Quality here at Nationwide Children's, and if you haven't listened to that particular show I'd encourage you to go back.

Even though we're calling it the children's on quality mashup and we did talk about each other's shows, we also sort of interviewed each other and talked a lot about we got involved in podcasting and I think you'll find that interesting. I kind of go back and talk about my days as a 10-year old working as a DJ in a skating rink, so you may want to go back and check out that show if you have not already done so.

OK. So why is this particular study important for moms and dads? And not just moms and dads with premature babies, it really just kind of affects everyone and I'll tell you why here in a minute.

Here's a deal with this particular nitric oxide thing. Nitric Oxide is a gas and it's mixed with oxygen and sometimes given to extremely premature babies who are on ventilators and why, well this gas is known to dilate or widen the openings of blood vessels in the lungs. So the thought is if you increase blood flow through the lungs you might be able to increase oxygenation and maybe these extremely premature babies would improve faster with fewer complications.

Well, the problems is nitric oxide is expensive, fine if it works we'll pay the price. But data is showing that it positively affects outcome in extremely premature babies is lacking. So I bring this up to something parents should be aware of because the underlying issue is cost versus benefit. And the concept is not unique to the newborn intensive care unit. It's happening in other sub-specialties of pediatrics, it's happening at primary care offices and it's happening in the adult medical world.

We can't keep spending and spending and spending, especially on medications, treatments and procedures that aren't effective. And if we, as medical professional don't recognize this and if we don't consider cost as well as benefit in our decision-making process, there's going to come a time when non-medical professionals will step in and make those decisions for us. It's happening in Europe, it's happening across our norther border and it's coming to the USA if we don't get our act together.

30:26

All right. Let's move out of the hospital and on to your driveway. But first, a parking lot at the edge of the University of New Hampshire campus has contributed important research on an emerging concern for the environment and human health.

The research detailed in a recent feature article in the journal Environmental Science and Technology, has found that one type of pavement sealcoat common on driveways and parking lots throughout the nation has significant health and ecosystem implications.

Dr. Alison Watts, Research Assistant Professor of Civil Engineering at UNH, is a co-author of the article, Coal-Tar-Based Pavement Sealcoat and PAHs: Implications for the Environment, Human Health and Stormwater Management.

Sealcoat is a black surface applied over asphalt pavements. It's marketed as improving appearance and enhancing pavement longevity. It's made of either an asphalt emulsion or a refined coal-tar-pitch emulsion. Although the two sealcoats are similar in appearance and cost, concentrations of PAHs or polycyclic aromatic hydrocarbons, a group of organic compounds known to be detrimental to human and ecosystem health, are about 1000 times higher in coal-tar-based sealcoats than those based in asphalt.

Conducting side-by-side studies of coal-tar-based sealcoated and non-sealcoated parking lots at UNH's west edge lot, Watts, a researcher with the UNH Stomwater Center, found the soil at the edge of the sealcoat lot contained orders of magnitude higher concentrations of PAHs compared to soil at the edge of the non-sealcoated lot. More specifically, there were several hundred parts per million PAHs from the sealcoated lot versus less than 10 parts per million from the lot without sealcoating.

What's more, soil samples taken three years after the initial application of sealcoat remained high in PAHs. The problem may be even more pronounced in New England, PAHs move into the environment as the sealcoat wears off, a process that snow piles seem to accelerate. Dr. Watts says, "We think it's likely we have a severe problem here in the Northeast because the sealcoat wears off more rapidly."

The journal article discusses the potential human health effects of coal-tar-based sealcoat, which is associated with elevated concentrations of PAHs and house dust, soil, air, water and sediment. This cites a recent study that found children living at homes adjacent to pavement with coal-tar-based sealcoats were likely exposed to about 14-fold higher doses of PAHs than those living adjacent to unsealed pavement.

32:54

Studies at the Columbia Center for Children's Health have found that PAHs at homes can contribute to delays in cognitive development, asthma and other respiratory symptoms. They are also associated with obesity, metabolic disorders and an increase in a child's cancer risk.

Unlike many complex environmental issues, however, this one has as relatively painless fix – avoid coal-tar-based sealcoats and favor asphalt-based ones or no sealcoat at all. Dr. Watts says, "Consumers generally can't tell the difference and voluntary shifts in the market are making that choice easier." She notes that retailers, Home Depot and Lowe's, no longer sell coal-tar-based sealcoat and several commercial sealcoaters use only asphalt-based products.

The corrects of this issue is in its fairly simple choice we can make that will be beneficial to the environment and the human health without significant impact to the users.

Moving beyond, the Stormwater Center's test parking lots, Watt's will next study the effect of coal-tar-based sealcoats in raising the PAHs concentrations in the sediment of New Hampshire's Great Bay. "PAHs are increasing in Great Bay's sediments and in fact in sediments across the country," she says.

While there are other sources of PAHs in the Great Bay — including old gas plants, car exhaust and woodstove smoke — she wonders if sealcoat may be the culprit.

34:11

So, I don't know about your neighborhood, but in ours a fresh coat of driveway sealcoat is a springtime ritual and that this spring we'll be sure that we use an asphalt-based product, instead of coal-tar. And it does make me wonder what we've used in the past because I really have no idea. I mean, a company drives by and says, "Hey! You want your driveway sealcoated?" And it's the same guy who did three of our neighbors', like yeah, sure you can do it; you got a good price for me?

I have no idea what he has put on my driveway. So this year we're going to ask him though, is it coal-tar-based or asphalt-based. If it's coal-tar keep moving.

All right. We're going to take a quick break. When we come back, we will diagnose Tiny Tim and we'll still wrap up the show, right after this.

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35:24

All right. We are back. So you may be wondering what exactly was wrong with Tiny Tim. Well, Le Bonheur Professor, Dr. Russell Chesney, M.D. believes he knows what ailed the young iconic character from Charles Dicken's "A Christmas Carol." Based on detailed descriptions of the boy's symptoms and the living conditions of 18th century London, Dr. Chesney hypothesizes that Tiny suffered from a combination of rickets and tuberculosis (TB). His findings were published in the Archives of Pediatrics and Adolescent Medicine.

Dr. Chesney noted during the time the novel was written, 60 percent of children in London had rickets and nearly 50 percent displayed signs of TB. He says this is due to crowded living conditions, poor diets and filth and low exposure to sunlight. Burning coal and particles from an Indonesian volcanic eruption contributed to London's blackened skies for many years.

Both rickets and TB can be improved and indeed cured through increased exposure to Vitamin D, which can be obtained through exposure to sunlight and a balanced diet.

As the Ghost of Christmas Present showed Ebenezer Scrooge, Tiny Tim’s condition would be fatal without a different course for the boy. According to Dr. Chesney’s research, Scrooge's new-found generosity to Bob Cratchit and his family could have helped Tiny Tim by ensuring an improved diet, facilitating more sunlight exposure and providing cod liver oil (a common supplement of the day known to be high in Vitamin D).

So, there you go. Modern medicine has diagnosed Tiny Tim despite the fact he was a fictional character, with the rickets and tuberculosis. And indeed, a generous Scrooge could have a been the boy's savior.

37:02

All right. So that puts a wrap on this week's show. I would like to thank everyone for listening, for taking time out of your day to make PediaCast a part of it. We know you have lots of choices where to get your healthcare information when it pertains to pediatric topics. We appreciate you stopping by PediaCast.

I want to let you know there is not going to be a show next week. We're going to skip a week because we're taking a little family trip to the rolling hills of Tennessee. Actually it's not really the rolling hills, it's more like the mountains of Tennessee. We're going to be in the Gatlinburg area, doing some hiking, doing some ziplining, kind of hang it out with the bears but not getting too close to him.

So it's just kind of a nice family vacation in the woods. We're really excited about that. So that's coming up, that'll be next week and that's why there won't be a program next week. But we'll be back in two weeks and in the meantime, get your questions in, we've actually, I've kind of dialed back the interviews a little bit this year compared to last year. Just a little, based on your guides as feedback.

So we have been getting to a more news and listener type programs. We have a research round-up also planned here in the near future. But we're getting a little bit low in the question bank. So, if you have a question, if you've had a question you've kind of put of writing or calling the voice line and you thought, well, so many people write in, they'll never get to mine; that may not be the case because we do need some questions.

Like I said, we're getting a little low in the tank. So if you have a question for us or topic idea, write and there's a good chance that we will get to it in the program. How do you get a hold of us, over at pediacast.org, just click the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

38:53

Also, I want to remind you if you email us or use the voice line, make sure you let us know your name and where you're from, because we always want to know those things. Also be sure to tell your doctor about PediaCast, probably the most important way that you can spread the word about the show. The next time you go in to see your doctor for a well child check or a sick office office, either one, just say hey, we know about this great evidence-based podcast that's aimed at parents, that answers lots of questions without giving medical advice.

And you ought to tell the other patients about it. We do have a flier to help facilitate that. You can go to the Resources tab at pediacast.org, click on the Resources tab and we do have a flier that you can download that points folks in the direction of our show.

And I'd also like to point out, yeah, OK, we're affiliated with Nationwide Children's Hospital, we are just so glad about that. It's just the excellent resource for us to be able to get to do interviews and to support the program, but don't let that discourage if you live in other parts of the country from telling people about the show, because it's about the information, it's about the community, more than it is about one particular hospital.

40:05

I mean, we're proud of it. We think it's the best pediatric hospital in the country but not everybody can live right next to it and so we're really just trying to spread the love here a little bit, around the, not just the whole country but around the world as well.

All right. Again, thanks for taking time to be a part of the show. Remember off next week, back in two weeks. And until then, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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