Austin MD Sept/Oct 2015

SEPT/OCT 2015

IT’S TAILGATING TIME! BARBECUING TIPS TO MAKE THIS YOUR BEST SEASON YET AN INNOVATIVE CANCER DETECTOR

the size of a pen

VACCINATING YOUR CHILD

should it be mandatory?

HEALTHY LUNCHBOX AND SNACK IDEAS

ANOTHER TYPE OF LOAN THAT COULD SAVE YOU

BIG DOLLARS

ON YOUR NEXT HOME

 WHY

HEALTHIER KIDS make better students

AISD WEIGHS IN

BACK TO SCHOOL HEALTH ISSUE

WITH RECIPES

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CONTENTS SE P T E M BE R/OC T OBE R 2 015

AUSTIN M DM AGAZINE S EPTEM B ER / O CT OBER 2015

18 PUBLISHER

Angela Strickland EDITOR

Nicole Carbon ART DIRECTOR

Elisa Giordano

WEB DESIGNER

Brandon Tipton

PHOTOGRAPHER

Steve Dement

CONTRIBUTING EDITORS

Jake Harding Malena Manning Samantha Schak

CONTRIBUTING WRITERS

18 COVER STORY

Jason Villaba shares his plead for vaccinations and argues against the “anti-vaxxers”

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12 KIDS AND CALCIUM

Dos Lunas shares how to incorporate this much needed nutrient into your child’s lunchbox

38 CHILDREN AND THEIR TEETH The most important task of the day goes hand in hand with the most important meal of the day, getting your child to brush their teeth before the school bell rings

62 100 PIZZITAS

Austin’s newest pizza joint is turning out something much more enticing than your average pie

08 22 38 42 44 50 58 60 62

LOCAL LIFESTYLE BACK TO SCHOOL HEALTH HEALTH MEDICAL MENTAL HEALTH HEALTH & BEAUTY SPORTS BOOKS DINING

CORRECTION: In the July/August Issue’s article titled, Men’s Health and Wellness Found at the Spa, the price for Back Treatment at Mecca Gym and Spa is $100 member/$115 non-member.

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CONTRIBUTING PHOTOGRAPHERS

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Isabel Avellan Gonzalo Veloz

Cover photo: oksun70/bigstock.com

www.AustinMDmagazine.com

For adver tising and/or editorial information, please call Angela Strickland at 512-506-1248 or email angela@AustinMDmagazine com.

Copyright © by Green Iceberg Publications LLC. All rights reserved. Reproduction without the expressed written permission of the publisher is prohibited.

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DEPARTMENTS

Giselle Suazo Arriaga Jon Black Phyllis Books Omar Dyess Megan Dywer Soriya M. Estes Miranda Hardee Sam Jackson Kyle Jerome Brad Kennington Shirat Ling Renee Hanson Malone Aaron Cato-Mata Kenneth R. Mueller Bob Pena Alina Sholar Kate Terry Haley Tidwell Gonzalo Veloz Katherine Voss

Adam Loewy Personal Injury & Wrongful Death Attorney Car Crashes Bicycle Crashes Drunk Driving Crashes Child Injuries

512.280.0800 www.LoewyLawFirm.com

FREE CASE REVIEW

Boating Accidents Motorcyle Accidents Slip and Fall Injuries Other Serious Injuries A U S T I N MD M A G A Z I N E . C O M

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PUBLISHER’S LETTER

BOARD CERTIFIED SLEEP DOCTORS:

J. Douglas Hudson, MD & Edward H. Ortiz, MD Our goal is to help patients better understand their sleep disorder and then execute the best treatment to improve the quality of their sleep and subsequently their life. We are also a full service provider for patients with Sleep Apnea.

PARTNERS WITH: The Sleep Center of Austin Accredited by the American Academy of Sleep Medicine www.thesleepcenteraustin.com 512.697.9896 ParkCrest Medical Supply For all your CPAP supplies www.parkcrestmedicalsupply.com 512.600.5897 FutureSearch Trials of Neurology Visit www.fstrials.com for current clinical trials 512.380.9925

Sleep Medicine Consultants

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5508 Parkcrest Drive, Suite 310 Austin, TX 78731 512.420.9900 www.sleepdoc.net

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SUMMER HAS COME AND GONE AND WE AT AUSTIN MD ARE WELCOMING FALL WITH OPEN ARMS AS WE CELEBRATE BACK-TO-SCHOOL SEASON WITH OUR GUIDE FULL OF TIPS ON HOW TO KEEP YOUR KIDS HEALTHY FOR THE SCHOOL YEAR. As a mother, I am always looking for ways to keep my children in good mental and physical health. So for this issue we, along with the Austin Independent School District, explore how keeping your kids active and giving them nutritious foods will help them become better students. With the help from a number of experts, we will also share how minimizing your child’s screen time and spending more quality time as a family, like having dinner together more often, positively impacts their growth. Mental health is essential for a child’s wellbeing, but often times it becomes hard to spot when something is wrong. “Look Me In The Eye” by John Elder Robison is an autobiographical piece where the author explores his struggles with Asperger’s Syndrome starting from his early years as a child and how both his parents and therapists failed to see the root of his problems.

Thank you for picking us up, we hope you enjoy this issue, and learn ways to help your kids become the healthiest version of themselves.

PUBLISHER /CEO

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Local Lifestyle

DREAMS FOR DIAMONDS Kenya Rynea is making wigs for cancer patients in Austin ANGELS WALK AMONG US here in Austin and one of them is Kenya Rynea, the founder of Dreams for Diamonds, an organization that creates bandana wigs for children fighting cancer and going through chemotherapy.

Rynea started giving back to her community while attending beauty school and it quickly became a passion of hers. In 2013 she received a call from Dell Children’s Hospital asking her to make a wig for a 16 year-old patient who had been diagnosed with cancer four years prior. The patient’s suffering was going to end soon and the hospital was giving her and her one year-old daughter a photo shoot, so the patient asked for a new wig for the occasion. The hospital decided Rynea was the one for the job.

“I was able to make her a brand new wig with beautiful highlights and luscious waves. She absolutely loved it! I was so happy to provide something so simple to me that brought someone so much joy and happiness,” said Rynea.

Being able to create such a memorable moment for a person in need inspired Rynea to create Dreams for Diamonds with the help of her girlfriend, Jazmine Johnson, who also serves as the organization’s director. What was once a hobby now became a nonprofit organization and Rynea’s bandana wigs are helping countless kids around Austin. Their first time displaying the bandana wigs to the public was at the St. Baldrick’s event hosted by Dell

Children’s Hospital. It was at this event that Rynea and Johnson met a mother looking for a wig for her daughter, after trying a few wigs on she decided on a cute curly bob. The mother turned to Rynea and mentioned that she had never seen her daughter with hair before.

“We didn’t think about that when creating these wigs. We created something for someone who had never experienced hair. Before we knew it everyone was in tears of joy and we knew we were indeed doing the right thing,” said Rynea.

Rynea and Johnson encourage anyone wanting to start a nonprofit to join in on their organization to get an idea of what it is all about. High school groups and other volunteers are welcome to attend wig-making events and donate hair. The volunteers are paired with families who have requested wigs and all the wigs made are donated to children in need.

“This gives students the opportunity to give back to the community, learn and teach, and getting them off the streets and into doing good for our community,” said Rynea.

Austinites can also support Dreams for Diamonds by donating bandanas, accessories to design and create wigs, and by liking the organization’s Facebook page to be up to date with wig-making events. Clients who donate their hair at the Kenya Rynea hair salon will receive a free haircut, this will last until December 31, 2015.

For more information visit, www.facebook.com/DreamsforDiamonds.

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PHOTOS COURTESY OF DREAMS FOR DIAMONDS

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Local Lifestyle

PROTECT YOUR FAMILY AND HOME with Dyezz Surveillance and Security

A security system to take care of your home and family when you’re not home

BY BOB PENA

whoever is home in the event the viewer sees a potentially hazardous condition about to occur or occurring. This, of course, can apply to any business as well.

Dyezz motion-detecting cameras are capable of capturing video so that evidence of an actual or attempted forced entry can be stored. Some local businesses which have experienced a break-in are sending a recording of a forced entry to local television stations as a means of asking the general public for assistance in recognizing the individuals.

Dyezz security and surveillance systems can be installed in a day or so, and are easy to set up and operate.

THESE SYSTEMS ALLOW A HOMEOWNER TO VISUALIZE THEIR HOME FROM A REMOTE LOCATION, WHILE THEY ARE AT WORK, OUT SHOPPING, IN A MEETING, ETC.

For more information visit, www.dyezz.com.

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TODAY’S SECURITY AND SURVEILLANCE SYSTEMS routinely offer many advantages to homeowners, especially to families with children. With school about to resume, a high number of children will get home while their parents or an adult is at work.

A home security and surveillance system is programmed to provide a quick, audible alarm that alerts the homeowner, enabling family members to get to a safe location either in or outside their home, in the event of a break-in by a burglar. Also, and very importantly, surveillance cameras can be positioned to enable a homeowner to see who is at the front or back door before they open it.

Home security systems also offer additional alarm protection for the homeowner – they can provide a warning about smoke and/or fire, allowing the individual inside to exit their home immediately and call their local fire department.

Also, as almost everyone knows, these systems allow a homeowner to visualize their home from a remote location, while they are at work, out shopping, in a meeting, etc., allowing the individual to contact and warn

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Local Lifestyle

How To Get More Dairy Into Your

KIDS DIET

We all know kids need calcium some tips to get them to eat more of it

BY MEGAN DYWER

Why is calcium important for kids?

Aside from the fact that calcium will help kids build stronger bones, both our cardiovascular and nervous system use calcium to maintain our ability to think and function. Blood clots can also be prevented with a healthy calcium intake. Suffering from calcium deficiency can lead to osteoporosis and make our bones more susceptible to fractures. To avoid losing calcium from our bones, kids need to absorb food properly with the help of vitamin D – found in egg yolks, fish oil, and sun exposure, and magnesium – found in leafy greens, potatoes, nuts, seeds, and whole grains, and boron – found in avocados, prune juice, peanut butter,

and nuts. Another option is cheese! We are lucky to have a great-quality source in our own backyards with Dos Lunas Cheese.

See what folks are saying about Dos Lunas Cheese “We are so happy to have a locally-sourced cheese from grass-fed cow’s milk! We consistently see our Westlake High School kids grabbing this healthy option as a snack before, during, and after school!”

It is our pleasure to be able to provide a healthy, clean, protein-rich snack. One of our biggest customers are health-conscious moms. They understand the importance of non-GMO, enzyme-rich snacks for their kiddos.

“This is such a perfectly balanced, nutrientdense snack for their lunch box. Pair with some yummy gluten-free crackers or veggies and you are good to go! Thanks for the integrity of your products, Dos Lunas!”

One of our wellness staff members, Katherine Crosswell, agrees and is often seen snacking For more information visit, www.DosLunasCheese.com.

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on these herself! Our manager says this about Katherine: “Katherine is a wellness specialist at the Westlake location and specializes in nutrition and educating teenagers on healthy eating and snacking. She suggests the kids make a minimeal out of the cheese sticks by adding a cup of fruit and some rice crackers. This is the perfect balance of nutrients to help kids stay focused during class and to maintain an even mood. No sugar drops and no sugar highs!”

OKSUN70/BIGSTOCK.COM, PHOTO BY ISABEL AVELLAN

AS WE BEGIN A NEW SCHOOL YEAR, the health and wellbeing of our children become top of mind. Packing school lunches and coming up with creative, yet healthy snacks can become challenging. With the awareness of eating locally for optimal health, you don’t have to look far beyond your own backyard for some tasty and healthy ideas. Think cheese, sourced locally, for optimal health combined with a dose of much-needed calcium for strong and healthy bones.

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Local Lifestyle LOW DOWN PAYMENT Almost all physicians’ loans offer low down payments or allow for higher, “Loan to Values (LTV),” which is the percent of how much you owe versus the value of a home. For example, some offer 100% LTV, which means that you have to put nothing down and your loan amount is equal to the purchase price of the home. A lot will offer these low down payments even into the “jumbo loan” ranges, which are loans that are greater than $417,000. The required down payment varies from lender to lender and varies depending on loan amount, size, and your FICO score. For instance, one lender will allow 100% LTV with excellent credit (greater than 720) as long as the loan amount doesn’t exceed $650,000. If the loan amount was between $650,000-$850,000, you have to put 5% down, and you have to put 10% down if your credit scores were greater than 700. To contrast this to traditional loan types, a lot of places require a minimum of 10%-20% down for jumbo loans and they require you to carry mortgage insurance, which is the next major distinguisher of the physician’s loan.

Learn the different types of loans available and which one is right for you

BY OMAR DYESS

OVER THE LAST several years, some bank and mortgage companies have started marketing and selling, “physicians’ loans,” and some even have, “professionals’ loans” that extend to other professions like attorneys.

Sometimes their advertisements are dense with mortgage jargon and it’s easy to get lost in financial terminology even for a seasoned realtor like me. Why would you choose these types of loans over traditional mortgage

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options? What are the differences from one bank to the next and should you choose a physicians’ loan to purchase your home? There are handfuls of things that distinguish these loans from traditional mortgage types and understanding how they differ will help you with deciding if it’s right for you. We’ll also discuss very general qualification requirements and give you tips on what to know and ask about when comparing.

QUALIFICATION One of the key differences between a physicians’ loan and normal financing are the requirements for qualification. First, most physicians loans allow, in various capacities, for the exclusion of student loan debt in your, “debt to income ratio,” which is the percentage of your monthly debts to your monthly income. Also, many will allow for a contract for employment

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REAL ESTATE AND DOCTOR LOANS

NO MONTHLY MORTGAGE INSURANCE Mortgage insurance is a policy that protects lenders against losses that result from defaults on home mortgages. Sometimes it’s referred to as PMI, MMI, but for the sake of this article, we’ll refer to it as MI. Historically, if you put less than 20% down, you have to pay mortgage insurance until the loan amount on your home is 78% or less than the original purchase price.

This is a monthly cost on top of your costs in your monthly payment like principle, interest, taxes, and home owners insurance. Banks will remove the MI when you believe that what you owe is less than 80% of the market value of your home, but for a lot of people, that process can be arduous and stressful. In other words, if the physicians’ loan has no MI that’s great, simply to save you the hassle later down the road.

as verification of income. Most people are required to already be in receipt of income and have pay stubs as verification, but a lot of banks allow for you to close before you’ve received your contacted income on the physicians’ loan. These programs aren’t always exclusive to MDs and reach out to optometrists, chiropractors, and dentists. Typically, the minimum FICO score seen is 680.

WHEN SHOULD I CHOOSE THIS LOAN? Physicians’ loans are great for when you’re not going to have a lot to put down on your first home and if you move from this home in a few years. Physicians’ loans have higher rates than the market rates, but when you factor in the mortgage insurance on traditional financing, the value goes to the physicians’ loan.

However, if you have more to put down and you plan on staying in this home for a long period of time, eventually, the MI will drop off and you’ll have a lower rate.

Scott Brown of Regions Mortgage adds, “100% financing mortgage loans with today’s low interest rates allows borrowers to leverage their cash and invest in other opportunities while also providing possible higher mortgage interest tax deductions. Another feature of physicians’ loans is they typically do not require mortgage insurance premiums benefiting the borrower with lower monthly payments.”

THINGS TO KNOW TO COMPARE Budget what you want your monthly payments to look like and see how much house that translates to. Knowing the price range upfront while you’re shopping will help you compare lenders.

Also, knowing your credit score will help you out tremendously as almost all physicians’ loan lenders have minimum score requirements. Lastly, having your employment details handy will allow your loan officer to overcome possible pitfalls down the road in underwriting.

For more information, visit www.DyessResidential.com.

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back to THE SCHOOL YEAR IS UPON US AND WE AT AUSTIN MD KNOW THAT KID’S HEALTH IS A TOP PRIORITY SO WE’D LIKE TO WELCOME YOU TO OUR BACK TO SCHOOL HEALTH GUIDE!

SVETAVO/BIGSTOCK.COM

We’ve surveyed multiple experts who have put together tips to help your kids become the healthiest version of themselves.

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o school One of Austin’s biggest school districts discusses how their top students are also the healthiest.

Our guide also includes a state representative’s thoughts on a dreaded school ritual.

We hope this issue helps you make 2015 the best school year yet!

Good luck!

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SHOTS FIRED

Jason Villaba and vaccines in Texas

BY SAM JACKSON PHOTOS BY STEVE DEMENT

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O

ne of the most dreaded moments of a child’s life is finding out that they’re going to the doctor because the first thing that comes to mind is that they’re getting a shot. And when they’re right, they react like hell opened up and only they can see it. It’s also a defining moment for a parent when you manage to drag your kid through that. Now, an increasingly vocal group of people is promoting the idea that vaccinating your children

is the worst thing a parent could do because it would put them at risk for autism. It’s become so well known in the mainstream that late night TV host, Jimmy Kimmel, brought on a group of doctors to fire back with choice bon mots like, “Hey, remember that time you got polio? No, you don’t, because your parents got you f***ing vaccinated.”

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What makes this really sad is that this whole movement partially stems from one dumb mistake. In 1998, influential British medical journal, The Lancet, published a study by Dr. Andrew Wakefield that found a link between the vaccine given for measles, mumps, and rubella and incidences of autism among children. It might have been one of the most damning medical findings of our generation, but investigations proved that Wakefield distorted or outright changed a dozen medical histories of the study’s subjects. Evidence uncovered by the BMJ, another reputable British journal, showed Wakefield had been paid by lawyers looking for grounds to file lawsuits against vaccine producers. The study was immediately discredited and retracted and his credentials and medical license were stripped by the British government.

That should have been the end of it, but to this day, Wakefield maintains that his research was right and that he was the victim of a coverup by the pharmaceutical industry. It didn’t take long for conspiracy theorists to welcome him into their ranks and start echoing his views, and the hellish snowball rolled on, picking up people like Jenny McCarthy, Jim Carrey, and Charlie Sheen along the way. Worse yet, parents who got wind of Wakefield’s claims stopped vaccinating their children out of fear. Now, diseases that were long since erased have started popping back up in horrifying rates, like whooping cough and the aforementioned triple threat of measles, mumps, and rubella.

It falls to people like Texas representative, Jason Villaba, to try and clean up the mess, 17 years after the fact. Earlier this year, Villaba introduced a bill in the Texas House of Representatives that would seek to remove “conscientious” objections to vaccinations (medical exemptions would not be affected by this bill), so parents could no longer refuse vaccinations because of personal reasons.

Currently, parents can sign forms expressing their objection under state law and send their kids to school without any of the required 10 vaccines, but the form does note the kids can be removed from school in the event of a public health crisis.

“I was just thinking of ways to try to prevent outbreaks from happening in the rest of Texas, to be proactive for a change,” Villaba says of the bill’s genesis. He initially was pulled into the issue by his wife bringing home a vaccination form for their children, which explained the conscientious objection option in detail. Confounded by the issue, he delved into the history and started calling doctors.

“The first person I called is a gentleman who is the head and the president of the Dallas County Medical Society by the name of Rick Snyder,” Villaba said. “We started with him, we went to the Dallas County Medical Society, we went to the Texas Medical Association, we went to the doctor’s groups, the physician’s groups, the pediatric groups, we did some research online, we did some research through epidemiologists from around the country by talking with people at MIT and at Harvard, and we read a number of white papers on this.” After all this, Villaba is thoroughly convinced there is no link between autism and vaccines.

The resulting bill is similar to a measure signed by California governor Jerry Brown, although theirs mandated vaccinations for children attending public or private schools, regardless of personal beliefs, and anyone who doesn’t comply will be home schooled or study off campus.

It goes without saying that Villaba has encountered vicious opposition in filing this,

An increasingly vocal group of people are promoting the idea that vaccinating your children is the worst thing a parent could do because it would put them at risk for autism.

especially in his own party. His social media pages have been also fielding accusatory messages not just from people in Texas, but outside of the state and around the world. As he was speaking with Texas doctors, he also made time for anti-vaxxers as well.

“Most of the anti-vaxxers we encountered were parents of children who had some debilitating disease, often mental infirmity on the spectrum of autism,” Villaba says of the conversations he had. “All of them attributed their children’s malady to vaccines, but none of them could present or produce information other than the handful of studies that had been debunked or discredited.” Half of it, Villaba says, comes from a belief that the government shouldn’t mandate what goes into their bodies. The more tragic reason tended to be that people were just trying to make sense of a bad situation and latched onto an easy boogeyman to direct their anger and sorrow at.

“They wanted to believe they understood why their child was suffering, why their family was suffering,” Villaba explains. “Their

marriages have been strained and their finances have been strained and so they feel aggrieved. And I think the idea that it was a big pharma company that did this to them, or it was vaccination that the government foisted upon them, it gives them something to hold on to, to give blame to their pain. And I think that’s what drives the people who are the loudest in the debate, those who have experienced some level of pain.”

John F. Kennedy once said when you have a child; you’re giving fate a hostage. While one can’t help but feel sympathetic to those parents, their method of therapy is not only counterproductive, it’s causing harm to other kids as well, who could slowly infect their schoolmates, then they all bring it back to their homes, and before you know it, those old diseases have become a more effective force from the grave than a billion zombies. Villaba has that in mind, because even though the vaccine bill didn’t make it out of the House, he plans to keep fighting.

“I’m a parent and I know the pain of a child is the worst pain you can possibly experience,” he adds. “My response to them is to say, ‘Look, you have a situation at home that I can’t change. I don’t know the reason for the illness that your child experiences, but I can’t change that. But what I can do is take actions and steps today to prevent other parents from experiencing pain.’ Because when measles breaks out in my community, then we’re going to see a number of parents who have children afflicted by measles. And while today measles is not generally a terminal disease, it can be a terminal disease.”

“If I can save the lives of one, two, three children in Texas and keep hundreds of Texans from having to experience the pain of measles merely by asking public school parents to vaccinate their children, I think that’s a fair trade. And science and the doctors and the PTA’s tell me that I’m right. So let’s move forward and try to protect our kids rather than trying to blame vaccines for the pain of kids who’ve been afflicted by horrible situations.”

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BACK TO SCHOOL HEALTH

WHAT IF MY CHILD GETS

HURT

AT SCHOOL?

BY KATE TERRY

1

Get there as soon as possible.

As soon as you’re notified, try to be there. Use your best judgment, of course, a Band-Aid knee scrape might not warrant skipping that 2 p.m. meeting. If the injury is serious, it is vital that you are there to comfort your child, assess the situation, and take charge of what happens next.

2

Keep calm and find out more.

Your child will react if you panic.

Keep your cool and it will be much easier to comfort them and decide how bad things are.

3

Don’t jump to conclusions.

Although you are understandably upset, try not to toss out accusations or become angry before you know the full story.

This will keep other parents and school administrators from becoming defensive and hard to work with.

4

Take photographs of everything.

This is key. Photographs can make or break a case, if it comes to that. If they are on a school bus, photograph the accident and surrounding cars. If they are at school, photograph the scene and their injuries. This can be hard to do, but it is vital.

5

Make sure there is an accurate written report.

Schools typically have a system of reporting accidents. Make sure that this happens and that the details are recorded accurately.

Gather names and phone numbers of any witnesses.

6

Get medical help immediately if they need it.

Injuries are sometimes worse than they look. When in doubt, err on the side of caution and get medical help immediately.

This is especially true for head trauma and school bus accidents, as injuries might not be immediately apparent.

7

Determine if you need a law firm’s help.

If your child was injured in a school bus accident, by another child, on school property, or while walking home from school, take a moment to discuss your case with an attorney. A good attorney will walk you through the process and let you know what can be done. This should be done quickly, as evidence is time sensitive. The most important thing to do at this time is make sure your child gets the care and treatment they need. A good law firm will be able to help you set up medical care and work with your providers to ensure you do not pay out of pocket for expenses.

Adam Loewy, founder of the Austin-based Loewy Law Firm, has dedicated 100% of his practice to helping Texans recover from catastrophic injuries or the death of loved ones. Adam Loewy and his legal team have recovered millions for injured Texans. The firm is committed to giving back to the Austin community through organizations such as the YMCA and Austin Pets Alive! and by being a caring advocate for those who need help.

For more information visit, www.LoewyLawFirm.com.

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PHOTOS COURTESY OF LOEWY LAW FIRM

S

ending children to school can bring up mixed feelings for parents. As a parent, you are proud, perhaps a bit relieved, and somewhat anxious. What if something happens while you’re not there? You might feel powerless, guilty, or unsure of what to do next.

What can you do if your child is injured while riding a school bus or while at school? We’ve asked the Loewy Law Firm, a personal injury firm that has been helping injured Texans for over 10 years. They’ve offered seven steps to take if your child is injured:

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WHAT TO EXPECT FROM A

SPORTS PHYSICAL A thorough examination can help prevent future injuries

BY DR. SHIRAT LING

A

fter performing a sports physical at an urgent care, I was told by the mother that it was the most thorough sports physical her son ever had in his life.

Although flattered, I was also surprised he hadn't received an exam of similar detail, as he had been playing sports for several years. After all, this may be the only time a child sees a physician all year and it is a great time to screen for a variety of conditions.

Why do we do sports physicals?  Determine that the athlete is in general good health.  Assess the athlete's present fitness level.  Detect conditions that predispose the athlete to new injuries.  Evaluate any existing injuries of the athlete.  Assess the size and developmental maturation of the athlete.  Detect congenital anomalies that increase the athlete's risk of injury.  Detect poor pre-participation conditioning that may put the athlete at increased risk.

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What to do before the sports physical Parents should be sure to complete all the medical history on the forms, do not rely on the athlete to provide the history. If parents share custody, communication is important, since injuries may happen in the other's absence. An athlete's medical history should focus on the detection of previous and current disease, previous and current injuries, cardiovascular abnormalities, and musculoskeletal abnormalities. If the athlete's medical history suggests the presence of any of these problems, the physician will ask for more details, and strongly consider other testing to evaluate these problems.

Have an honest discussion regarding appropriate touching by adults, and if the athlete feels more comfortable being examined by a male or female physician.

When should they be performed?

Ideally, the pre-participation sports evaluation is performed approximately six weeks before the onset of the sports season because this allows time for further evaluation of any problems that are discovered. If treatable problems are detected, rehabilitation can be done before the season starts. Unconditioned athletes may have an opportunity to improve their conditioning in this time and hopefully prevent other injuries.

How are they performed?

The private office examination is ideal from the standpoint of continuity of care and feeling at ease in the surroundings of a familiar physician. Many use the urgent care for these examinations. Some examinations are offered in a multi-station evaluation, which involves multiple providers and examination-based specialists.

Medical History Demographic data: Updated information is critical, especially in athletes who are minors. Telephone contact numbers are also essential because the authorization to treat specific conditions may be needed.

Tetanus status: With any athletic endeavor, the risk of abrasion and laceration increases as the risk of injury increases. All athletes should be current regarding tetanus immunization.

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History of excessive weight loss or gain: Changes in weight can indicate eating disorders, steroid abuse, and purging behavior. These disorders are seen not only in female athletes in gymnastics, dance, figure skating, and diving, but also in wrestlers and other athletes.

History of anaphylactic reactions: This finding is especially important if an athlete has known anaphylaxis with insect bites. Because many sports take place in an outdoor environment, insect bites are possible. If an athlete has such a history of anaphylaxis, he or she can be advised to always keep an EpiPen at hand. Furthermore, advance knowledge of an athlete’s allergy can alert coaches, trainers, and team physicians to be prepared to treat this life-threatening condition.

Recent and previous concussions: Although the mortality rate associated with head injury in sports is low, more evidence regarding the morbidity associated with repetitive

AN ATHLETE SHOULD BE MEDICALLY CLEARED FOR SPORTS PARTICIPATION ONLY AFTER THE MEDICAL HISTORY AND PHYSICAL EVALUATION ARE DEEMED UNREMARKABLE. head injuries is emerging. Because athletes, especially those in certain sports, are at risk of head trauma, the athlete’s concussion history must be assessed to identify individuals who are at risk and to determine whether they should continue playing contact or collision sports.

Dizziness or collapse with exertion: The possibility of heart disease and sudden cardiac death warrants an in-depth evaluation of symptoms, when present.

Family history of exercise-related death: This is a historical finding that puts direct relatives at higher risk for

the same condition. Therefore, in cases in which a family history of collapse with exercise is found, the athlete should be evaluated in depth.

History of asthma: Because asthma is often triggered by exercise or exertion, the severity of the previous episodes should be evaluated further. In addition, adequate instruction about treatment can help prevent dire consequences from this condition.

Loss or dysfunction in one of a pair of organs: If the remaining organ of a pair is injured, entire function can be lost. For the most part, this assessment applies to the eyes, kidneys, and testicles.

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Menstrual history: An abnormality in menstrual function can be a clue to significant underlying medical conditions, including pregnancy, osteoporosis, nutritional deficits, drug abuse, psychiatric conditions, and eating disorders.

Use of contact lenses, dental appliances, and other devices: It is important to be aware of the athlete’s use of any lenses or devices because they may become dislodged during competition, and some items should not be worn during competition. In addition, athletes may wear jewelry or have body piercings; these should be noted and assessed.

Recent or recurrent fractures, dislocations, and other injuries: A history of these types of injuries may indicate a condition that requires further treatment or surgery, or it may indicate an abnormality in the athlete’s playing mechanics, style, or equipment.

Previous heat illness: This finding is important for certain sports that have peak play seasons during hot seasons and for sports that require the use of heavy restrictive equipment. Individuals with an episode of heat illness are at high risk of recurrence.

Physical Examination The athletic pre-participation physical evaluation includes a medical examination, an orthopedic examination, and performance testing. However, if the athlete’s medical history reveals any problems, those problems should be examined thoroughly and not just for the purposes of screening.

Height and weight: These measures indicate growth and development and may reflect general fitness (e.g., obesity) and pathology (e.g., eating disorders). These measures are also valuable in evaluating an athlete’s risks for competing at certain levels. For example, these data may be useful in determining if a thin freshman should play varsity football. Some sports are classified according to the athlete’s size or weight, and these measures may affect the athlete’s class.

Blood pressure (BP): Although a BP measurement is rarely an indication for

disqualification from sports, abnormalities are often first noted during the sports physical examination setting. Athletes with BP changes can be referred for follow-up care with a primary physician. Certain sports may cause significant BP elevations, and this may be a reason to limit an athlete’s participation. The BP must be evaluated more than once, and normal BPs for the athlete’s age must be considered. Rough guidelines are a BP of 125/80 mm Hg or less for those aged 10-15 years and 130/85 mm Hg for those aged 16 years and older.

Visual acuity: Visual acuity does not need to be 20/20 for sports participation, but poor vision can affect the athlete’s performance and increase the likelihood of injury. Some recommendations advocate clearance without intervention for any person with visual acuity of 20/40 or better using both eyes.

Skin: Certain sports, such as wrestling, disqualify athletes who have infectious dermatoses, which include impetigo, herpes, and forms of tinea. Other conditions (e.g., acne, scabies, moles) can be detected, and the athlete should be counseled in such cases.

Eyes: Pupil reactivity and unequal pupils should be noted. Knowledge of preexisting abnormalities can be useful information later in case an athlete has a head injury.

Heart: The physician should listen to the heart in at least two positions (usually sitting and lying), which increase the likelihood of detecting subtle abnormalities. The most common cause of sudden cardiac death in athletes is hypertrophic cardiomyopathy, also known as hypertrophic obstructive cardiomyopathy (HOCM) and Brock’s disease.

Abdomen: The abdominal examination should assess organ size, especially an enlarged spleen, because of the risk of rupture in contact sports.

Genitalia: This examination can be used for Tanner staging in adolescents to classify athletes by maturity; therefore For more information visit, www.innatebeauty.com.

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developmental delays can be detected. The genital examination can also be used to assess males for the presence of a single testicle and to evaluate for the presence of hernias. Some sports physicians omit the genital examination unless the history indicates a single testicle or inguinal or scrotal swelling; the medical history may be adequate for finding these problems. I take this opportunity to educate the athlete and parents of how to do a proper self-testicular examination. I also describe and illustrate what a hernia is, and how I check it. One of my nurses has a collection of my anatomy illustrations on the exam table paper.

Musculoskeletal: Physician should check full range of motion of the spine and joints, strength of all the muscle groups, and deep tendon reflexes. They may also assess functional movements by having them perform a duck walk, toe and heel walk, and check for scoliosis. In performing these tests, I also check cranial nerve function.

Clearance An athlete should be medically cleared for sports participation only after the medical history and physical evaluation are deemed unremarkable. Sports with different levels of contact, static activity, and dynamic activity have different criteria for participation clearance. A single athlete may qualify to participate in one sport, but not in another. Likewise, clearance for participation in one sport may not apply to another sport or another level of the same sport.

If your child is not cleared for participation, do the appropriate intervention, such as further workup, rehabilitation, or switching to a different sport. An optimistic approach is always important when problems are detected in young and impressionable athletes. Many disqualifying conditions can be resolved or controlled with medical or surgical intervention, enabling future sports participation.

Ensuring an athlete’s safety can promote a healthy lifelong habit of physical activity in which the athlete can learn about discipline, teamwork, physical fitness, and camaraderie.

Make sure your athlete is healthy and prepared for life’s adventures.

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EDUCATE, SCREEN, AND PROTECT YOUR

and hearing in band practice

BY SORIYA M. ESTES, AUD

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eptember means back-to-school and back-to-band practice for many students in the Austin area. In the “Live Music Capital of the World,” families with children who are enrolled in musical programs are encouraged to use hearing protection during practice and may want to schedule a baseline hearing test to monitor any beginnings of noise-induced hearing loss.

The decibel level of a band or music room can be quite intense, and if it exceeds over 90-100 dB during a one to two hour practice, damage can start occurring to the hearing nerve. This damage not only affects hearing ability for music, but also leads to problems in other classroom learning settings. The result can be a drop in students’ educational performance.

The loudness of a sound is measured in decibels (abbreviated dB) and is used to measure the intensity of a particular sound. The scale ranges from 0 dB (a near-silent room) to 140 dB (a firecracker going off). To compare: normal piano practice levels can reach 60-70 dB, a violin can reach 84-103 dB, a French horn 90-110 dB, and a drum set ranges from 102-125 dB. Not only is the intensity of the sound important, but the duration of the exposure is also critical.

Hearing damage can begin around 90-95 dB with most band and orchestra classes exceeding the 90 dB level. Combined with the fact that musical classrooms are enclosed and designed to amplify sound, those dB sound pressure levels can reach even higher levels.

The damage isn’t always immediate, but can build up over time until it becomes very noticeable.

Hearing loss related to noise exposure is completely preventable if students wear proper hearing protection. There are innovative custom and non-custom filtered earplug solutions for hearing protection that will not compromise the sound quality of the music at an affordable cost. Based on the studies below, this issue has been studied for more than a decade; it is still a great concern that it is not a requirement for students to wear hearing protection in band rooms, football fields, and concert venues.

In 2000, Kris Chesky of the Texas Center for Music and Medicine at the University of North Texas in Denton, performed a survey of more than 3,200 musicians of which he found 32% of drummers, 25% of tuba players, and 18% of flute players reported hearing problems. Most of these musicians had over eight years of professional musical experience.

Phillips, Henrich, and Mace (2010) evaluated 329 student musicians. Two hundred and eighty two reported not using hearing protection. Those who used hearing protection (n=47) used it less than half the time. Forty-five percent of the students demonstrated noise induced hearing loss.

Parents and educators should check in with their students who play an instrument and take note of any ringing, discomfort or headaches that the child mentions. Any issues should be treated immediately by having a professional Audiologist conduct a hearing test to determine a baseline and if necessary the best solution for hearing protection.

For more information visit,

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www.HearLifeAgain.com.

About Estes Audiology: Estes Audiology is the premier hearing healthcare provider in Central Texas. Founded on the principle that all patients should receive superior hearing solutions, the Audiologists at Estes Audiology evaluate, manage, and treat hearing disorders in more than 7,000 patients throughout Central Texas. Estes Audiology has been the Health Alliance for Austin Musicians (HAAM) hearing healthcare provider since 2008 and provides over 300 sets of custom filtered earplugs to HAAM Members each year.

About Soriya Estes, AuD: Soriya Estes, AuD has over 15 years of experience in the field of Audiology and has three private practice offices throughout Central Texas. In 2005, Dr. Estes started her first office with the philosophy of providing superior hearing healthcare services for all patients. Estes Audiology serves as the hearing service affiliate provider for the Health Alliance for Austin Musicians (HAAM) and has been a providing partner since 2009.

Resources: Phillips SL, Henrich VC, Mace ST. (2010) Prevalence of Noise-Induced Hearing Loss in Student Musicians.

International Journal of Audiology 49(4):309-316.

Chesky, K. Preventing Music-Induced Hearing Loss Music Educators Journal January 2000 94: 36-41.

PHOTO COURTESY OF ESTES AUDIOLOGY, BELIEVEINME/BIGSTOCK.COM

BAND STUDENT Recognizing the associated risk of decibel level

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INJURY PREVENTION FOR YOUR

Identifying risk factors helps keep athletes in tiptop shape

ummer is Identification of risk coming to factors and proper suan end and pervision by coaches and the start of a new parents play an important role

BY AARON CATO-MATA, DPT school year is rapidly approachin pediatric injury prevention. ing. Parents are scrounging around Signs and symptoms should not be getting the latest back-to-school gear and ignored as “growing pains.” A gradual onsupplies. Students are eagerly awaiting the start of set of pain without a history of direct injury is a fall sports. Time for the student athletes to return from their common sign of overuse injuries. Other signs and symptoms summer vacations, getting off the couches, and return to their fainclude stiffness or aching after and during training sessions with vorite sports. This is the best time of year to work on keeping these an increase period of time for pain to resolve. Point tenderness and young athletes healthy and ready for their long and successful seavisible swelling should also be closely monitored. sons. Considering pediatric injury preventions is a great way to Training and conditioning considerations should include estabkeep these young athletes on the field and healthy. lishing a general routine that includes strengthening, endurance, Several risk factors should be considered that may predispose and flexibility. When determining and increasing training intensity, these athletes to overuse injuries. Common intrinsic factors inthe 10% rule is a great way to monitor progress. Increasing training clude muscle weakness, inflexibility, instability, and history of preintensity by 10% each week allows the body to adjust gradually. vious injury. Physical therapists and trainers play a big role screenTraining programs should also include a dynamic warm-up and ing athletes to address these risk factors. Early detection can allow emphasize stretching after practice. time for these discrepancies to be addressed through individualPediatric injury preventions are multifactorial and should be conized exercise programs. Extrinsic risk factors include consideration sidered a team effort. By considering the risk factors and monitoring of environment, poor techniques, and allowing adequate recovery training and conditioning, parents and coaches can ensure that these time. The Texas heat can affect the athletes’ ability to recover and student athletes compete safely and to their fullest potential. preform to their fullest potential. Coaches should take the time to evaluate the athletes technique and make early corrections to asValovich McLeod TC, Decoster LC, Loud KJ, Micheli LJ, Parker sist with improving performance. The extrinsic risk factors can be JT, Sandrey MA, White C. National Athletic Trainers’ Association monitored by coaches and parents and will allow for an optimal position statement: prevention of pediatric overuse injuries. J Athl and safe training environment.

Train. 2011 Mar-Apr;46(2):206-20.

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THE HIDDEN HEALTH COST OF

TEACHING Early warning signs and prevention tips to maintain a healthy bladder

BY DR. MIRANDA HARDEE

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hen Alexander the Great remarked, “I am inrealizes their need to urinate but is prohibited from using the fadebted to my father for living, but to my teacher cilities or don’t have access to a nearby toilet, leakage may occur. for living well,” he succinctly captured a widePhysically they are fine, but they are limited functionally. spread belief that teachers are an integral part Interestingly, dehydration can also become a problem if teachof our society. As a physician and lifelong learner, I owe a large ers fail to adequately hydrate during the day due to lack of time or part of my success to the many teachers who spent countless hours for fear of inducing more frequency. Dehydration is the number educating, training, and forming me into the person I am today. one cause of kidney stone formation, particularly in a hot climate Now as a urologist, I engage with teachers much differently than like Texas. In a 2012 report by Dr. Naim Maalouf on kidney stone I did as a pupil. formation, he pointed out that, “Some occupations limit the availIn reality, teachers regularly experience several urological ability of water or of toilet facilities, leading patients to reduce fluhealth conditions. Undoubtedly, the most id intake which increases nephrolithiasis common issue I see among teachers is [stone formation] risk. Examples include SOME OCCUPATIONS overactive bladder. In today’s fast-paced teachers and chauffeurs.”

LIMIT THE AVAILABILITY classroom environment, teachers are so Needless to say, maintaining good OF WATER OR OF engaged with students that bathroom bladder health is essential for teachers, TOILET FACILITIES, breaks are often overlooked or unavailas is staying properly hydrated. However, LEADING PATIENTS TO able. Often, teachers hold their bladders when urinary medical attention becomes REDUCE FLUID INTAKE which (over time) can stretch the bladder necessary, reviewing your specific health WHICH INCREASES causing frequency and urgency issues or conditions and job-related hurdles with NEPHROLITHIASIS even difficulty emptying. It’s not uncoma urologist is a good first step. Main[STONE FORMATION] RISK. mon to hear the remark that, “I used to be taining a seven-day bladder diary before able to hold it all day, but now I have to go your first visit will give your urologist a every 30 minutes!” Since overactive bladder is already common in snapshot of how often you’re urinating, how much urine you’re women, female teachers, without sufficient bathroom breaks, are producing, and if any accidents have occurred. Options such as prone to develop this condition — although it affects male teachmedications or bladder retraining, under the guidance of your ers too! urologist, may be recommended. In today’s dynamic classroom Inadequate bathroom breaks and regularly holding one’s urine environment, a teacher’s focus should remain on their students, can also increase the risk of urinary tract infections which can not on their aggravated or overworked bladder! be persistent and painful. Additionally, a non-medical form Dr. Miranda Hardee joined The Urology Team in 2013 and of functional incontinence may occur. When a teacher specializes in both General and Female Urology.

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HEALTHY EATING AS A FAMILY THIS SCHOOL YEAR

The benefits of gathering for family mealtimes are tenfold

keep it simple and incorporate basic nutrition. It’s so nice to walk into the house and sit down to ready-to-eat crock-pot meals that include meat and vegetables. Serve a whole grain roll, a fruit, and a glass of low-fat milk and all the food groups are covered.

Purchase a freshly-roasted chicken and serve with quick and nutritious sides. Vegetables can be served raw with or without low-

fat dip. Heating up frozen vegetables, or serving ready-to-go salads makes getting a meal on the table doable. Ready-made sauces can help with mealtime variety and flavor. Cooking a double batch of favorites and freezing half for later can be a big help to solve dinner dilemmas days ahead.

As for school lunches, Dr. Jennifer Helmcamp, a pediatrician at Baylor Scott & White in Round Rock, prefers children bring their own lunches to school at least three times per week. Meals prepared at home are healthier because you know exactly what ingredients are used in their preparation. They are lower in salt, preservatives, and overall calories. When packing school lunches, make sure your child has both a fruit and vegetable in their lunch bag. Grape tomatoes, baby carrots, and soy beans are great, easy-to-grab options for your child’s lunch. Take a little extra time when you get back from the grocery store to portion out baggies of grapes, strawberries, carrots, etc. If these options are easy to grab, they will be eaten and are less likely to go to waste. Having home-prepared family meals more often takes time and planning, both the nutritional and non-nutritional advantages make this a worthy and excellent goal for 2015 and beyond.

For more information, visit www.roundrock.sw.org.

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ncreasing the frequency of home-prepared meals to be eaten together as a family is a great goal that has numerous benefits for both the short and long term. Think back to those scenes in Leave it to Beaver when the family gathered at the table for dinner. Turning back the clock might seem like a near impossibility with our fast-paced lives of today, but there is ample research to support the importance of family-centered, homemade meals for wellbeing of both the body and mind.

Dinnertime is often the best time of the day for families to gather. Minimizing distractions, such as having the television on, and establishing a rule that there are no iPads, laptops, or cell phones at the table, lends itself to great family conversations.

It’s this communication that binds families and can promote positive self-esteem in children. One study showed that children were about 40 percent less likely to bully other children when their parents shared ideas and talked to their children frequently. Eating together gives parents a chance to model healthy eating behaviors for their children, so parents, make sure to get your servings of fruits and vegetables, too.

Several studies have shown a link between frequent family meals and academic achievement. Research demonstrated that children who eat meals with their families were exposed to a more diverse vocabulary, which promotes language development and later success in school. This effect even extends into older students. A study from Columbia University showed that teens who consume meals frequently with their families were more likely to get A’s and B’s in their classes.

Family mealtimes together have been shown to have positive health benefits. A study from Harvard University showed families who ate together almost every day consumed diets higher in many important nutrients and lower in fat than families who rarely ate meals together. A research review published in the journal, Pediatrics, found that children and adolescents who eat three or more meals with their families per week are 24 percent more likely to eat healthy foods and 12 percent less likely to be overweight than peers who do not eat with their families as often.

So how do we increase healthy family meals with all we have going on in our busy lives? Here a couple of ideas to help make this goal a reality this school year: When there just doesn’t seem to be enough time to prepare meals,

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AISD PREPARES STUDENTS FOR A

LIFETIME OF WELLNESS

A

ustin is a community that places great value on quality of life, including health and wellness. The Austin Independent School District (AISD) understands this and seeks to reflect community values in its policy. AISD is striving to keep its policies, faculty, and students at the cutting edge of health and wellness education with a coordinated school health approach that emphasizes the interconnectedness of health education; physical education; health services; counseling and mental health; a safe school environment; staff wellness promotion; nutrition services; and parent and community involvement.

Health in schools doesn’t mean just physical education and athletics anymore. Just as schools provide students with knowledge to help them find success in the workplace and become good citizens,

they also seek to teach lessons which will enable children to make wise choices about their health and wellness as adults. For children, families and schools, there are more immediate payoffs as well. Students in good health are more likely to attend school frequently and get better grades. Healthy students are also less likely to engage in inappropriate behavior or find themselves in in-school suspension.

Since 2001, the centerpiece of AISD’s efforts to foster student health and wellness at the K-8 level is the Coordinated Approach to Childhood Health (CATCH) platform. An integrated program focusing on all aspects of childhood health and wellness, CATCH is one of the oldest and most reputable coordinated school health programs − with more than a quarter century of data supporting its effectiveness. Currently, CATCH is utilized by more than 10,000 schools and communities nationwide, including nearly 300

For more information visit, www.austinisd.org.

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BY JON BLACK

Dr. Phyllis Books in Texas. CATCH’s goals include promoting student enjoyment of and participation in moderate to vigorous physical activity, getting students and families involved in healthy eating and physical activity, providing teachers with tools that blend health topics with core academic areas, and improving the nutritional quality of school meals by linking good food to good health According to a 2013 report, CATCH appears to be having a beneficial impact on AISD middle school students. It cited an increase in moderate to vigorous physical activity during PE as well as increased student participation in organized sports, both inside and outside of school, as well as other structured PE activities. The report highlighted the popularity of CATCH “family nights” – health fairs that promote hands-on, active learning activities such as taste-testing, active games, and messaging to promote healthy eating and physical activity. An increase in healthy dietary habits, including increased water consumption, and decreased consumption of sodas and other sugar-sweetened beverages was also noticed.

While CATCH is the centerpiece, it is only one part of AISD’s health and wellness strategy. The Fitnessgram program conducts regular physical fitness assessments of the district’s students. Elementary students are assessed at the beginning and end of every school year; middle and high school students at the beginning and end of every semester.

Elementary students are required to have 45 minutes of PE every third day. Middle school students must have four semesters of PE (or an approved substation, such as athletics dance or JROTC), including at least one semester per year. At the high school level, students must earn a 1.0 PE credit to graduate. This may come from classes such as Foundations of Personal Fitness, Aerobics and Conditioning, participating in individual or team sports, as well as a number of approved substitutions for other physically vigorous classes or activities.

AISD understands that not every child is the same and the district has a robust and proactive Adapted Physical Education program. This program serves the PE and wellness needs of students with particular physical conditions or developmental delays and their families. Currently, the district has 11 full-time adapted PE teachers, covering elementary, middle, and high schools.

School is only part of a child’s life. For healthy behaviors to take root, lessons learned in the classroom need to be reinforced by those outside of school. The district actively seeks to engage parents and other members of the community in promoting youth health and wellness. AISD makes a number of online resources available to parents, including information on topics such as health services available through AISD, nutritional information (including information and costs for AISD meals), and links to local groups and programs encouraging active, healthy lifestyles.

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I feel happier and more like myself-who I really am.”

Quinn P.B.

Call 512-331-0668 BOOKS FAMILY HEALTH CENTER www.DrPhyllisBooks.com www.Reversing Dyslexia.com A U S T I N MD M A G A Z I N E . C O M

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HEALTH

CHILDREN AND THEIR

TEETH A back-to-school primer

BY DR. KENNETH R. MUELLER

Word of Mouth

BY ROSE DENTAL

IT’S TIME to send our children back to school, whether for the next round, or for the first time ever. This brings to mind another activity that some kids would probably also like to skip – brushing their teeth.

Parents need to be mindful because children will skip brushing if given the opportunity. For starters, even if there is a rush, make sure your child has their teeth brushed in the morning before heading off to school. Sleeping late and being late for school day after day and skipping this important task doesn’t excuse them and it certainly doesn’t mean that their teeth will not fall victim to

– a sure sign it’s been used.

If your child is involved in contact sports and you want his or her mouth to be protected while playing, consider investing in a professionally-made sports mouth guard. Mouth guards are primarily used by football players, but basketball and soccer players would benefit from protecting their mouths as well. Who could handle the peer pressure if the whole team didn’t do it? Hockey players also would benefit from wearing mouth guards. Parents of children involved in contact sports should go see one of the doctors at Rose Dental Group to have a custom made mouth guard

decay, gingivitis, and other dental horrors. Skipping morning teeth brushing increases the chances of these unpleasant circumstances. If you want to be sure you son or daughter brushed and you don’t have time to physically watch them (two minutes is the general time it takes) at least check the toothbrush to make sure that it’s For more information visit, www.rosedental.net.

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for your child’s comfort and protection. Mention this article for a discount! Budding young athletes love taking to the field/court/ ice with the violent ferocity of a Mongolian horde. No one wants to see their son or daughter coming home from soccer practice looking like they insulted the Tooth Fairy’s honor.

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39

IT

’S

G

HEALTH

TA

IL G A

N I T

SEASON! Barbecuing tips and avoiding food-borne illness

IT’S JUST ABOUT kickoff time! Game day is approaching, the grill’s going and your friends and family are gathered around. You’re ready to throw that chicken and steak on the grill and you realize your cooler’s open and sitting in the hot sun. So, is the meat still safe for your guests? Scott & White Hospital – Round Rock’s Executive Chef, DyRell DiLorenzo, is here to offer tips for storing, preparing, and serving food outdoors this fall.

“The danger zone for food storage is 41 to 135 degrees (Source: Servsafe guidelines),” says DiLorenzo. “Bacteria in foods tend to survive and multiply in that danger zone of 41 to 135 degrees. Chicken,

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in particular, is more susceptible to food-borne illness. You need to keep cold foods below 41 degrees and hot foods above 135,” he advises.

What exactly is food-borne illness and what are the symptoms? It is an illness caused by the food you eat, typically caused by time and temperature control, cross-contaminations, and poor hygiene. There is an estimated 76 million cases a year, with 325,000 hospitalizations, and 5,000 deaths in the U.S. alone. Symptoms include diarrhea, nausea, and fever. Onset of these symptoms may come as soon as a half hour after eating or may not develop for several days or weeks.

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BY SCOTT AND WHITE

“It’s important for folks to keep hot food hot and cold food cold — that’s not only for uncooked items, but for cooked foods as well,” says DiLorenzo.

To keep your food safe, “Keep cold foods covered with ice and keep coolers shut tight, whether it’s a lid or a zipper, and place the coolers in the shade,” he recommends. “Also, the less frequently you open the cooler the better. The more the cold stays in, the safer it is for the food.”

Another good rule to barbecue and tailgate by, is the Two-hour Rule: Don’t leave food out for more than two hours.

If you’ve had food sitting out for two hours, throw it away. Don’t pack it up and save it. The bacteria have already had a chance to grow and you risk foodborne illness. Be safe and just tossing the food out. He also suggests avoiding mayonnaise and dairy-based foods, as they are more prone to spoiling quickly and causing food-borne illness. If you do serve potato salad or coleslaw, Keep them on ice until right before you serve them, placing the bowls in a tray of ice when serving them, and packing them

IT’S IMPORTANT FOR FOLKS TO KEEP HOT FOOD HOT AND COLD FOOD COLD – THAT’S NOT ONLY FOR UNCOOKED ITEMS, BUT FOR COOKED FOODS AS WELL. up immediately after they’ve been served.

At a tailgate party or barbecue, Chef DiLorenzo says it’s safest to bring foods that are less likely to spoil. Cold cuts for sandwiches are cured so they don’t spoil as easily, canned goods and precooked meats are good options too. If you do bring raw meat to grill, Chef DiLorenzo suggests you keep it stored tightly in a cooler on ice and take it out only when you are ready to grill it. Don’t set it out to marinate on a picnic table or on the top of a cooler. Also, always bring a meat thermometer to be certain the meat is cooked. To avoid food-borne illnesses you must be sure to cook your food properly. Chicken must be cooked to a minimum temperature of 165, whole cut beef at 145 degrees, fish 155 degrees, pork 145 degrees, sausage 165 degrees, and ground beef at 160 degrees. All must be held at this temp for a minimum of 15 seconds. Often I get

questions such as, “Why do whole cut and ground beef have different temperatures?” Ground beef has been processed more, hence has a greater chance of coming in contact with E. Coli.

The most important thing of all is to wash your hands well under warm water (as hot as you can handle without harming yourself), use soap, lather up for 20 seconds (or sing happy birthday twice), rinse your hands, and dry with disposable towels.

If you’re tailgating in a football parking lot and you don’t have access to running water, he recommends using a hand sanitizer. Rub it until it’s dry, but don’t put hand sanitizer on wet hands, because some research shows that water dilutes its efficacy. When barbecuing and tailgating remember, “keep cold foods cold and hot foods hot” and dispose of any food items that may have been compromised. A food-borne illness is not worth it!

For more information, visit www.roundrock.sw.org.

Join us for the Austin Originals Benefit Concert!

Proceeds benefit the Austin Child Guidance Center providing quality mental health care to children and families for over 64 years Presenting the 2015 Phyllis Richards Austin Icon for Children Awards to Mary Wilbur and Robin Rosell Special Thanks to our Honorary Chairs BA Snyder and Danae Falvo Emcee~Robert Hadlock of KXAN Price includes the Austin Originals Lexus of Austin Tasting Grove featuring: III Forks, Blackfinn Ameripub Cantina Laredo, Cornucopia Popcorn Bar, SC3 Catering No Va Kitchen and Bar, Snap Kitchen, Urban an American Grill & Winflo Osteria Signature Cocktail fromWhite Hat Rum Beer Garden: Texas Crafts and Goose Island Beer Reserve tickets/sponsorships at austinchildguidance.org A U S T I N MD M A G A Z I N E . C O M

41

MEDICAL

AN ADVANCED SKIN CANCER DETECTOR

BY SAM JACKSON

I

f you forgot to put on sunblock a time or two this summer and are worried about the possibility of skin cancer, a sudden advance in skin cancer detection may just be what you need to soothe your fears, thanks to two Austin doctors.

The brainchild of Seton Healthcare Family dermatologist service chief, Dr. Jason Reichenberg MD, FAAD, and James Tunnel of the University of Texas, it’s a detector the size and shape of an average pen, letting it fit perfectly into whatever pocket a doctor might want to store it in. Using it is even simpler, just wave it over the body part in question and check for a cancer almost instantaneously.

“Most devices that exist are looking at the way a spot appears to the naked eye or using different colors of regular light and then comparing that image to thousands of images that exist in a database somewhere, and then try to predict what this spot is,” Dr. Reichenberg told Austin MD in a phone interview. “This device is different because it doesn’t really care about what the spot looks like on the surface, but it’s looking at what the composition of the tissue inside is using different kinds of technology and accessing different properties of the tissue that we know are, or are not, associated with different kinds of cancer.”

The device made a marquee debut at South

by Southwest and instantly grabbed an Interactive Award for the “Sci-Fi No Longer” category, an incredible result stemming from a seven-year partnership.

“Dr. Tunnel has been at UT for several years, and had been working on an earlier version of this device before I got in touch with him,” Dr. Reichenberg remarks. “At the time I was actually working with the University of Texas Medical Branch team who were helping at Brackenridge with teaching and one of the associate deans introduced us when he heard that I had interest

in skin cancer research and I did too.”

The partnership, and their work, is pretty fairly split. “He helps to design the device and then I’m trying to figure out the way the device needs to be created, the format of the device,” Dr. Reichenberg explains. “Is it a hand piece, is it a pen, is there a foot pedal or not, things like that. And then helping with the output, what does the doctor want to see?

What would be clinically relevant information to find out from the device?”

Currently, testing for any type of skin cancer tends to

the size of a pen

involve photographing, examining, and in some cases, cutting off some afflicted skin and sending it to a lab. According to Reichenberg and Tunnel, this process is a huge waste of time and money, as well as somewhat painful to the patient, especially if the tests turned up nothing, which they found caused $6 billion in wasted costs. But it was the only definitive way to catch diseases like melanoma before they could really do harm, so that was the way every dermatologist went. Plus, Dr. Reichenberg notes that most devices were only looking to

IT’S LOOKING AT WHAT THE COMPOSITION OF THE TISSUE INSIDE IS USING DIFFERENT KINDS OF TECHNOLOGY AND ACCESSING DIFFERENT PROPERTIES OF THE TISSUE THAT WE KNOW ARE, OR ARE NOT, ASSOCIATED WITH DIFFERENT KINDS OF CANCER.

For more information visit, www.utexasphysicians.com and www.bme.utexas.edu.

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detect melanoma and missed others entirely.

With Reichenberg and Tunnel’s new invention though, all of that is set to vanish and presumably that money will sprout wings, fly back out of the garbage, and go straight into our wallets. But at the moment, Reichenberg says the device is only in its prototype form and they have planned a larger clinical trial to take place sometime this summer.

“It’s still okay to continue to have skepticism,” Reichenberg says. But from the looks of things, people better become believers quick.

PHOTO COURTESY OF UT

Two Austin doctors invent an ingenious device

A U S T I N MD M A G A Z I N E . C O M

43

MENTAL HEALTH

KIDS AND

ELECTRONICS To worry or not to worry

BY DR. PHYLLIS BOOKS

A

re your kids on electronics more than you’d like or more than you even realize? We live in a fast-paced world full of bright lights and sounds that keep our brains on alert. Electronics, smart phones, and televisions bombard with new information faster and faster. So fast, in fact, we can’t process the information quickly enough to keep up. We end up frazzled and bleary eyed as our brains are desperately trying to process all the data.

Ever feel like your kids are in a trance and don’t hear you when you call?

Similar to the way sugar is added to substances like tobacco and hot dogs to make us keep coming back for more, electrical impulses are emitted from electronic devices that keep us in a “fight or flight” state and we can’t tear ourselves away. Ever feel like your kids are in a trance and don’t hear when you call them?

They are and the trance state is induced from the very devices you bought your child.

“Screen time,” gaming addictions, and Facebook addictions are all very modern problems.

It is easy to become “addicted” to an adrenalin rush of watching the screen light up when you push the right button. Addictions don’t just happen to gamblers and alcoholics. Adults can become addicted to Facebook. Busy adults believe they are efficient by multitasking and watching several screens at once, when in fact

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they are depleting their natural reserve of dopamine and actually making more shallow business decisions than if they gave a problem their full attention. “Neural addictions” to cell phones, iPads, and gaming devices are real.

Kids are very vulnerable to “neural addictions.”

Their brains are still being formed. Scarily, the nervous system of a human being is very similar to the insides of a computer and the two can interact in ways that alter the way a child’s brain makes connections and lays wires and patterns that affect tracks of brain development.

Shannon, a 16-year-old patient of mine, confided to me that she

is worried about her 10-year-old sister who spends “way too much time on her iPad. She’s on it all the time!” A concerned father of a 21-year-old called recently, worried sick about his son whose ambition slowly deteriorated and was now at rock bottom and the son barely left his bedroom.

In both of these cases, family members were concerned and called for help. And in both

BY TURNING OFF YOUR OWN ELECTRONICS AND LOOKING INTO YOUR CHILD’S EYES, YOU ARE SENDING AN IMPORTANT MESSAGE THAT THEY ARE IMPORTANT.

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When you feel yourself going into overwhelm or you notice your kids staring into space The best solution is turn your attention away from the screens and noise for awhile. Nothing else is being processed anyway.. You’re chuck full of information, and you actually need a little time away from the screen to process all the input.

cases, as an integrative healthcare provider, I could intervene and provide a new direction.

In both of these cases, I ordered brain chemistry testing, heavy metal and mineral testing, performed neurological and structural examinations, and that implemented therapies that addressed the neurological, emotional, and chemical imbalances. The turnaround was quick and painless. The key was a family member taking charge and finding help.

The story isn’t always that good. Many times, by the time a child has become addicted to electronics, they don’t make eye contact, they mumble answers, they have lost interest in their personal hygiene, and they aren’t sleeping well.

Why do kids like to spend “screen” time so much? At what point does it become a problem? What kinds of guidelines can parents put in?

Clues that electronics are becoming a problem:  Lack of adequate physical exercise  Lack of interest in the body  Kids are in a trance, fixated or just plain don’t hear you when you call their name for dinner, etc.  They aren’t sleeping well (too excited from too much information coming in and not able to process it)...  Losing interest in personal hygiene  In teenage and young adults, loss of interest in food and meals  Lack of interest in friends or poor social skills What parents need to consider?

1/ Do you find yourself rationalizing with phrases like: “It’s not doing any harm.” “He’ll grow out of it” “He’s learning life skills,” “At least, I know where he is.”

2/ Video games are and inexpensive, reliable and convenient babysitter substitute.

3/ Video games are an instant form of discipline and reward.

4/ Video games are an easy distraction to give parents temporary quiet and breathing space.

As a parent, here’s how to model good “electronic behavior” for your kids: 1/ No cell phones allowed at the dinner table.

2/ Power down on all electronics at least an hour before bedtime.

3/ No electronics devices in the bedroom during the night.

4/ Model good balance between computer time and exercise. Set your timer for 50 minutes at the computer. Then get up and exercise for a few minutes, stretch your body, get a drink of water. Modeling is the best teacher.

5/ “Unplug” totally one day a week. Take a screen holiday one day a week. Yes, this one will make you go into withdrawal probably.

Even in the days of the bible, people rested one day a week. They unplugged from their daily activities, rested and rejuvenated. Our brains actually do their most integration while we are sleeping and resting. So to tune up your brain and your thinking, give it a rest.

6/ 10-20 minutes of face-to-face talk between parent and child daily.

That means no texting, answering calls, no playing screen games, no watching TV together. This means face-to-face, being fully present.

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Parents, listen up.

We only have one chance to raise our children. Time is precious. Children are even more precious. Please don’t let electronics seep into time you would otherwise spend with your children. By turning off your own electronics and looking into your child’s eyes, you are sending an important message that they are important. They desperately need your seeing them and noticing them. Treating them as more valuable than your own electronics, you are instilling confidence and a sense of self worth.

This is the best investment you can make in the future of your child!

About the Author

Dr. Books is an author, educator, doctor, and new thought leader. She is the founder of Books Neural Therapy™, a well-documented, systematic approach to dissolving dyslexia, ADHD, head traumas, and many chronic health issues. She is the author of Reversing Dyslexia: Improving Learning and Behavior Without Drugs. Also in 2013, Dr. Books released the world’s first online treatment class for parents,The Dyslexia Reversal System. She then added online and live classes of BNT ™ for professionals.

Her formal education includes an undergraduate degree in education and English from Michigan State University, a master’s degree in interpersonal communications from the University of North Texas, and a doctor of chiropractic from Parker University. She has taught and lectured in the U.S., Europe, and Australia. Her alma mater granted her the Outstanding International Alumni Award for her many contributions.

www.moonchildartisan.com

For more information visit, www.drphyllisbooks.com.

A U S T I N MD M A G A Z I N E . C O M

45

MENTAL HEALTH

AUSTIN ORIGINAL RISING STAR

Tameca Jones tells us why school-based mental health services are needed

BY RENEE HANSON MALONE

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R

ecently I sat down with Tameca Jones, who is headlining Austin Child Guidance Center’s Austin Originals Benefit Concert and Live Taping at the Austin Music Hall on September 26. Tameca is a local rising star and R&B vocalist in the Austin community.

She has opened up for BB King, Jill Scott, Shuggie Otis, and Smokey Robinson. Most recently she is a featured vocalist on Gary Clark Jr.’s new album. “The Story of Sonny Boy Slim.” In her lifetime, Tameca has overcome adversity, racism, loneliness, anxiety, raising twins on her own, and managing the diagnosis of narcolepsy. However, her resiliency, love for music, dedication to her children, and drive to make a difference in her community has allowed her to find joy and real purpose.

I met with Tameca and asked her a little bit about her history and what life was like for her when she grew up. She was extremely candid with her story and revealed that she had anxiety and suicidal thoughts that were wrapped up in her need for academic achievement. Although she was forthright with her story, I could tell at some points through the dialogue that some memories were still quite painful.

“I was always the straight-A student,” Tameca explains. “My mother worked a lot and I really didn’t know my father that well, so it was pretty lonely. I was the youngest child. I had this happy child façade, but I didn’t really have anyone to talk to. It was like the saying, ‘the tears of a clown.’ I looked okay and happy on the outside, but I was really struggling on the inside. I originally started school in Bastrop, where I was one of the only African American kids placed in advanced classes. I was sometimes called

PHOTO COURTESY OF AUSTIN CHILD GUIDANCE CENTER

and Children’s Mental Health Activist Speaks Out

names using the N word and other silly racially slanted names that were hurtful. It was really hard to fit in and feel accepted. Much of my identity was centered around overachieving with grades and sports. Later, I went to Bowie High School in South Austin, where the academic pressure accelerated. To top it off, I was diagnosed with narcolepsy, which makes you fall asleep at the drop of a hat. So I was taking Ritalin in order to combat the sleep disorder and stay awake to study. I had so much anxiety and stress that were tied up in achieving and getting into a good college. It got

Tameca goes on to say, “I love the fact that the Austin Child Guidance Center not only provides services at this location and that they are on the front lines in in schools. I think school-based services really helps to de-stigmatized mental health and makes it less taboo to talk about your feelings and for children to reach out and get help when they need it the most.”

We later talked about the struggles of being a single parent and a musician. “Now I am a single mother of twins and it has come full circle. I worry about them being bullied at school and want to protect them. Also, it has been hard to be a mother and have a normal nine-to-five job with narcolepsy. I have lived with my mother since the twins’ birth. My mother has always worked hard to support me and has ultimately allowed me the opportunity to follow my creative path,” says Tameca.

Tameca is now on her way and is set to perform at ACL this year. She originally started out singing some amazing renditions of cover songs like Prince’s “Purple Rain” and the Talking Heads, “Burning Down the House.”

However, she is cutting her first album of all original work. I asked her a little bit about the music she is creating now.

“I went to Baylor as an English major. I love words and writing. I have always written poems and songs. I have no institutional musical knowledge. Everything I do is based on instinct. Most recently I have been writing a lot and creating my own original works. I recently wrote a song with Casey McPherson of Alpha Rev, called ‘Head Over Heals.’ I wrote it about my kids, my twins, especially the boy. As his need for independence grew, it felt like he was falling out of love or interest with me, which is only natural. So the song is kind of a love song. Basically, it is about my son pushing away from me, but me still being head over heals in love with him,” explains Tameca.

Parental love is so strong and we all want what is best for our children.

Staying connected with our children as they get older can create real growing pains for parents, especially when our kids become adolescents and are wanting to explore their own identity.

Perhaps the timing is right. Now Tameca’s children are entering high school and finding independence as her career is really taking off. When the Austin Child Guidance Center was looking for the headlining act this year, we were thrilled to have someone like Tameca Jones accept. Not only does her unique sweet voice make the crowds sway and groove, but she really believes in the Center’s mission.

“I was really honored to be asked to sing for Austin Child Guidance Center’s annual Austin Originals Benefit Concert and Live Taping at the Austin Music Hall. I think it will allow me the opportunity to make a difference and touch people with not only my voice, but my story,” Tameca shares.

If you would like to see Tameca Jones perform live at the Austin Originals Benefit Concert and Live Taping at the Austin Music Hall on September 26 and also support the Austin Child Guidance Center, serving over 3,700 clients annually, please visit our website.

I think school-based services really helps to de-stigmatized mental health and makes it less taboo to talk about your feelings and for children to reach out and get help when they need it the most. so bad one year that I tried to commit suicide in class during the end of finals. It was during my English final. I remember taking up to 10 Ritalin pills. I was thinking about dying, I didn’t want to die, but I wanted to stop the anxiety somehow. I then waited to tell the teacher and then was rushed to the hospital where they gave me charcoal pills to pull out the toxins,” Tameca said.

Our exchange after hearing that memory lead us to converse more about how it is often the case that overachieving children are often overlooked. Much attention is typically given to kids that are struggling or getting into trouble, when the ones that play by the rules and are performing well could be struggling with some very significant issues. Moreover, the topic of race and the need to achieve for many minority African American students growing up in white schools can create feelings of extreme anxiety and pressure. Ethnicity, social identity and the need to “fit in” can be isolating for these students.

Like Tameca, these students can be the subject of racial bullying, which can have negative impacts on their emotional wellbeing. An international review of published studies has found children and young people experience poor mental health, depression, and anxiety following experiences of racism. “The review showed there are strong and consistent relationships between racial discrimination and a range of detrimental health outcomes such as low self-esteem, reduced resilience, increased behavior problems, and lower levels of wellbeing.” (Rick Nauert PhD-PsychCentral 2013). It is extremely important for schools to understand the psychological effects of bullying and racism. As time progresses, many local schools in Austin are taking extra measures in supporting the mental health of children onsite. Currently, the Austin Child Guidance Center provides behavioral healthcare in Mendez, Webb, and Decker Middle Schools, as well as KIPP and Achieve Charter Schools.

For more information visit, www.austinchildguidance.org.

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47

MENTAL HEALTH

DOES MY SON HAVE AN

EATING DISORDER? Identifying the signs and getting the help your child needs

BY BRAD KENNINGTON, LMFT, LPC

T

his is a question most parents would never think of asking themselves. After all, eating disorders are a “girl thing,” right? No, they’re not. Current research shows that 25% of those struggling with anorexia or bulimia are male, with some experts believing that number is closer to one-third. And the same research shows that 40% of those diagnosed with binge eating disorder are male.

Despite the increase in reported cases in male eating disorders, many guys continue to suffer in silence and shame because of the perception by our community — parents, coaches, teachers, physicians, therapists — that eating disorders only impact females.

So, as a concerned parent, what do you need to know so that you can intervene early if you suspect your son may have eating issues? Consider the following:

Bullying We all know how cruel some youth can be when it

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A Developing Eating Disorder: What to Look For Some early warning signs of a possible developing eating disorder in boys include:  Obvious weight gains and losses  Skipping meals, dieting, or lying about food intake  Tendency to be perfectionistic  Excessive body checking or weighing self  Complaining of being too skinny or too fat  Excessive exercising, even when injured or ill  Interest in food labels, in particular fat grams and calories  Feeling guilty about eating certain foods  Eating when feeling angry or sad  Low self-esteem and depression

CURRENT RESEARCH SHOWS THAT 25% OF THOSE STRUGGLING WITH ANOREXIA OR BULIMIA ARE MALE.

If you find your son displaying these behaviors, gently engage him and let him know you care and want him to get the help he needs and deserves. Early intervention is crucial. Do not remain quiet. Eating disorders feed on silence and isolation. Eating disorders are less about food and weight and more about self-esteem, a lack of control over one’s life, a search for identity, and a way to cope with strong negative feelings or issues. They are very normal and very treatable.

About the Author Brad Kennington, LMFT, LPC, is a therapist in private practice in West Austin. He provides therapy to individuals, couples and families, and he specializes in the treatment of eating disorders, relationship issues, anxiety and sexual orientation issues. He is also an associate faculty and clinical supervisor at the Austin Family Institute. Because of his work, Kennington has been quoted by Reuters and the Wall Street Journal, and he has been interviewed on Huff Post Live and on satellite radio. www.bradkennington.com.

For more information please visit, www.namedinc.org.

PHOTOEUPHORIA/BIGSTOCK.COM

Male Body Image Body image issues are one of the strongest factors in predicting eating disorders in both males and females.

Guys are now under the same pressure as girls to have a so-called “perfect body.” Just take a look at the cover of most men’s fitness magazines to see society’s “standard” for male bodies. I recently talked to a group of seventh and eighth grade boys about body image issues. When I asked them what the ideal look is for guys these days, most of these kids said they needed to have big arms and a set of “six-pack” abs. They are already buying into the media’s message of perfection. Is there anything wrong with wanting to be fit and in shape? Absolutely not. The problem arises, however, when the desire to be fit morphs into an obsession to be perfect.

High Risk Sports Certain sports can lead to eating issues for some kids and teenagers. Sports that are considered “weight sensitive,” including track and cross-country, rowing, gymnastics, swimming, and wrestling, can be the gateway to food and weight issues. Some athletes will engage in extreme dieting or excessive exercise to excel at their sport, going well beyond what is required to compete, turning an otherwise healthy activity into a very dangerous game of weight control.

comes to making fun of other kids. The schoolyard can feel like a verbal war-zone for some youngsters. No doubt, bullying can do a lot of damage to a young psyche. Studies show that 50% of adult men who struggle with an eating disorder were bullied when they were children or adolescents because of their weight or body shape. Parents and educators should have a zero tolerance for bullying. If you see it happening, disrupt it and address it immediately.

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49

Health & Beauty

REDUCING SIGNS OF

STRESS

on your face

Solutions to help you put your best face forward this fall

ne of my doctor friends was told by a crusty, old male stranger that she looked “haggard.” So, naturally, she came in to see me. While such brutal honesty can be refreshing, it reminds us that people make snap judgments and your skin is truly a reflection of your inner health.

So, how do we reduce the signs of stress on the face? First, get some quality sleep; women typically need more (and suffer more from inadequate) sleep than men. Drink a gallon of water daily, so your cells can function optimally and stay plump. Stop self-medicating with caffeine or alcohol, they dehydrate you, promote sunken under-eyes, and dry, deflated skin. Eat a balanced diet. Exercise regularly to get the circulation to your skin, build bone, and muscle mass (foundation for your skin), help with stress, and release endorphins. Vitamin C serums counteract

O

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the damaging rays of the sun (car windows don’t help) that cause wrinkles and brown spots. Retinoids help skin turnover and promote collagen production, so you don’t look dull and ashy. Wear sunblock with SPF 30+ and reapply every 80 minutes. Limit sodium (salt) intake to 1500 mg daily, it bloats you and contributes to hypertension...no need to look haggard and have a stroke.

Then, there’s a little help from your friend.

Here are a few medical cosmetic procedures that are great rejuvenators; some best performed in the fall/winter, when you generally have less sun exposure.

 Sunken Under Eyes • Dermal fillers (Belotero, Juvederm, Restylane) placed under the thin skin for instant gratification. I use a cannula, which is a blunt-ended fine needle that is less traumatic to this sensitive and highly vascular area.

These can last 6 – 12 months.

• CO2 fractional laser, which stimulates your body to build collagen to thicken this delicate skin and decrease the appearance of dark circles, as well as lift falling lids.

• Eye cream with retinols specially made for the delicate eye area. I recommend PCA Skin Ideal Complex Eye Cream.

 Wrinkles – Caused from concentrating, reading computers, cell phones, and fine print • Botox Cosmetic, Xeomin, or Dysport are neuromodulators that relax the muscles that create expressions. These start working a week later and can last 3-6 months.

 Jowls/Migrating Fat Pads/ Double Chin • Mesotherapy, or Kybella, are injections that disrupt fat cell membranes.

• TruSculpt utilizes radio frequency to cause fat cell death and tightens loose skin.

EVGENY ATAMANENKO/BIGSTOCK.COM

BY DR. SHIRAT LING

 Sun Spots • Photofacial with the IPL (Intense Pulsed Light) destroys the unwanted pigment, which sloughs off over the next week. These treatments are usually performed on a monthly basis until they disappear.

• Lightening creams containing hydroquinone, azelaic acid, or resorcinol help bleach them.  Acne Scars • CO2 fractional laser stimulates collagen production to fill in the scars.

Depending on the depth and nature of the scars, multiple treatments every few months may be necessary.

• Microdermabrasion and chemical peels performed monthly can reduce their appearance.  Rosacea/Broken Capillaries • Laser or IPL specifically for blood vessels can help reduce the appearance of these, along with avoiding alcohol, hot showers and saunas. These are usually performed on a monthly basis until the unwanted vessels disappear.

• Anti-redness serums can help calm down reactive blood vessels.

 Sunken Cheeks/Hollow Face • Dermal fillers (Belotero, Juvederm, Restylane, Radiesse, Sculptra, Voluma) strategically placed in temples, cheekbones, hollow cheeks, for instant gratification. These can last 6 – 25 months.

• Skin Tightening with an IPL provides instant gratification with no down time. Treatments can be performed monthly.  Dull, Lifeless Skin • Microdermabrasion uses fine crystals to exfoliate the top layer of dead cells,and whittles down fine lines and wrinkles resulting in instant gratification glow.

• Chemical peels (about a week delay; performed monthly) encourages sloughing of skin.

• Microneedling or the CO2 fractional laser to stimulate collagen production (6 months delay).

• Platelet-rich plasma can be combined with microneedling and the CO2 fractional laser, contains eight growth factors to stimulate all sorts of goodness.

• Face brush for cleansing on a daily basis helps exfoliate superficially.

 Unwanted Hairs • Laser or IPL specifically for hair removal. These are usually performed every 4-8 weeks for 6-10 treatments.

• Dermaplaning temporarily removes peach fuzz.

• Check hormone levels if you notice an increase in dark chin and mustache hairs.  Bony/Veiny Hands • Dermal fillers (Juvederm, Restylane,

VITAMIN C SERUMS COUNTERACT THE DAMAGING RAYS OF THE SUN THAT CAUSE WRINKLES AND BROWN SPOTS. Radiesse) placed under the thin skin restores the smoothness instantly. I use a cannula for this area as well.

These can last 6 – 12 months.

 Yellow Teeth • Professional teeth whitening makes a world of difference.

Schedule a consultation with your cosmetic physician friend today, because you don’t need to be told by a total stranger that you look haggard.

Dr. Shirat Ling personally performs all the medical cosmetic procedures at her South First Street office. She has performed more than 8,500 ablative laser procedures, and she has been in medical practice for 14 years, 10 of which she has spent performing medical cosmetic procedures.

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Health & Beauty

SERENITY CREEK SHARES

SKINCARE tips and treatments

How in-office visits and proper home care will allow you to put your best face foward this fall

BY HALEY TIDWELL

little line here, a sag or wrinkle there – your body may be giving away your age or even making you look older than you really are. Your eyes, neck, and hands could be revealing your secrets. We are here to tackle those trouble areas with in-office treatments and at-home care.

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EYES The eyes are one of the first features that get noticed. They are also one of the first areas of the face to show the signs of aging In Office Procedure: Botox is the only FDA-approved treatment to temporarily improve the appearance of both moderate to severe crow’s feet as well as frown lines between the brows. Receiving Botox injections in the crow’s feet area will minimize the appearance of fine lines and wrinkles, causing a more awake youthful appearance.

At Home Care: Apply an active eye cream to help smooth fine lines and hydrate this sensitive area. We recommend TNS Eye Repair from SkinMedica. It has numerous active ingredients like the TNS growth factor, Vitamins A, C, and E formulated all to help

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combat the signs of aging. It also has boron nitride, which optimizes the optical diffusion effect of light, lessening the visibility of dark circles and discoloration.

NECK Signs of aging creep up on us in the form of age spots, fine lines, wrinkles, and skin elasticity. Our necks are no different. In order for us to maintain a youthful neck, we need to remember to address that area just as often as our faces.

In Office Procedure: The SkinPen treatment helps stimulate collagen production as well as addresses fine lines & wrinkles. Botox is injected along the lower jaw line to rebalance the underlying muscles, providing a lifting effect in the neck and jaw area.

At Home Care: When applying all medical grade skincare products, be sure to bring the product down to your neck to ensure that your neck is receiving the great benefits your face is. Don’t forget to apply your sunscreen there as well!

HANDS Our hands are almost always exposed to the sun and it’s difficult to remember to apply

sunscreen throughout life’s daily routines. The skin on our hands is typically thinner than the skin on the rest of the body, so keeping hands hydrated and protected is crucial to youthful skin.

In Office Procedure: All skin thins with age, but the hands have very little fat. Without plump tissue underneath, the skin tends to look paper-thin more quickly, giving hands a sunken, hollow look. Radiesse fills in hollows throughout the hands to make them appear more youthful. IPL will address sun damage, vascular lesions, and freckles on the hands, leaving them more youthful and radiant.

At Home Care: Instead of putting product on your fingertips to apply to your face, neck, décolletage, apply to the backs of hands and use the back of your hands as your applicator for all of your skincare products. When applying sunscreen to your face and body, always remember the backs of your hands.

For more information visit, www. serenitycreek.com.

HECKMANNOLEG/BIGSTOCK.COM

INSTEAD OF PUTTING PRODUCT ON YOUR FINGERTIPS APPLY TO YOUR FACE, NECK, DÉCOLLETAGE, APPLY TO THE BACKS OF HANDS AND USE THE BACK OF YOUR HANDS AS YOUR APPLICATOR FOR ALL OF YOUR SKINCARE PRODUCTS. A U S T I N MD M A G A Z I N E . C O M

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Health & Beauty

SHEDDING

the Superwoman Cape

Being a free spirit in a practical world

BY DR. ALINA SHOLAR

o one is perfect. Give yourself a break. You CANNOT do it all. There is no Superwoman in real life. I am a self-proclaimed perfectionist and “good girl,” and this has always led to an insane amount of stress in my life. On top of that, I’ve also always felt like a free spirit waiting for her wings, but I’ve been too much of an introvert to admit it. I guess I thought the term “free spirit” implied something negative — irresponsibility, a lack of focus, or obnoxious naivety. So, herein lies my Superwoman conundrum, as many of you can identify with, I’m sure. I want to be a stressless free spirit, but how does one simply let go of stress that is unhealthy at best, deadly at worst when we want to do it all and be everything to everyone?

There’s just something about being “free-spirited” that sounds so appealing, but how do we get there? Understand what it means to be free.

Being proactive in reducing stress is number one. As an owner of a wellness spa, you would probably expect from me the usual list of massages to reduce stress, and while massage is an integral part of a stress-reducing lifestyle, there are also deeper issues at play here. Society likes to serve us up a very narrow interpretation of what and who we should be. Even the image of the stress-less “free spirit” conjures to mind the ditzy, yet deep bohemian, the starving artist, or the minimalist philosopher, but being stress-free doesn’t mean you give your life and ambitions up for a hippie lifestyle. So, what’s a type-A girl to do?

Here’s where the Superwoman concept is a fault. You cannot, in no way, do it all. You cannot “save” everyone either, so quit beating yourself up about it.

Give up the mommy guilt and wife woes. Forget it. And who is this “free spirit’ that knows no stress in her life? Isn’t it most likely that the true free spirit was the quiet girl who spent every lunch break in the library who could care less what everyone else thought of

GIVE UP PRECONCEIVED NOTIONS.

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her? Instead of falling into the trap of molding yourself to some predefined role, live your life as a free agent and don’t be afraid to contradict yourself. You can be both a tough businesswoman and a free spirit! Free spirits are inclined to explore life and enjoy new experiences that hold true to the deepest parts of themselves rather than being influenced by what the shepherded masses are doing.

Can’t you feel the stress melting away already? A free spirit does what she thinks is right, not what everyone else tells her is right.

SERGEY NIVENS/BIGSTOCK.COM

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She puts a high value on free choice. This freedom is stress-busting!

in stagnation. This purposeful living will energize you and naturally reduce stress.

Some of us are lucky enough to be able to incorporate our talents and passions into our work life. However, even if it’s not a practical thing to do, you can still pursue your passions. Living a reduced-stress life and being free-spirited means having the courage to not only follow your dreams, but also take the time to sort out what they really are. Maybe you had long decided the practical thing to do was to give up your art career. Maybe your ex-hippie parents never understood your burning desire to get an accounting degree, but you love it. Whatever it is, take the time to unearth a secret passion that maybe you didn’t even know you had. So, are you ready to take the plunge? It will absolutely ease the stress of everyday life when you have this passion to push you!

I seek to hear my GIVE UP own voice, use my EXPECTATIONS creativity, and to OF OUTCOME. follow my own integrity. Sometimes I have to go my own way, do my own thing, and maybe risk ridicule. I have to be true to me, the way God made me, so I can do what I am called to do, not what someone else thinks I’m supposed to do. That also means letting go of how things are “supposed” to be. I love the quote from Buddha’s canon, “Attachment is the root of suffering.” It is true that we experience stress when we are attached to a singular outcome. Life is a bumpy, winding road, and even the best, most straight-living person will not ever see the straight and narrow path. Going with the flow will remove stress on a whole other level!

Engage with the people, places, and things where you find a deeper connection. Free spirits are selective about who they trust to be themselves around. It is unsettling to feel like you never really belong, yet you put on the façade and “keep up with appearances.”

Living inauthentically is most likely the largest contribution to a stressful life there is, yet so many find themselves trapped in an illusion of their lives “should” look like. Finding a connection and community, whether it be at church, a close-knit group of trusted friends, or likeminded coworkers, is essential in your emotional health and wellbeing. Free spirits enjoy being around other free spirits.

FIND YOUR TRIBE.

PURSUE YOUR PASSIONS.

Just live your purpose. If your sole motive is to react against a system, whether it be political, religious, societal, parental, educational, or anything that just might rub you the wrong way, you are still allowing that system to dictate your behavior. Resistance to something simply because it is conventional is just as mindless as liking it for that same reason. On the other hand, go ahead and rebel if it is your calling and higher purpose. After all, we are born to make a better world, not to leave it

WHAT ARE YOU REBELLING AGAINST?

Alina D. Sholar, M.D., is a board-certified plastic surgeon specializing in cosmetic and reconstructive surgery in Austin, Texas. She is a diplomate of the American Board of Plastic Surgery, and she is highly trained in all aspects of plastic cosmetic and reconstructive surgery, including breast surgery, burn surgery and facial cosmetic surgery, as well all other aspects of aesthetic cosmetic surgery.

She received her B.S. in biomedical science with magna cum laude honors from Texas A&M University, and she went on to earn her M.D. from the University of Texas Medical Branch on a full-tuition merit scholarship. There, she was awarded the prestigious Janet M. Glasgow Memorial Award and Achievement Citation for Women in Medicine. Sholar then completed a full five-year residency in general surgery at the University of Louisville, where she was awarded the John W. Price Award for Excellence in Medical Student Instruction. She then continued her study of surgery by completing an additional residency in plastic and reconstructive surgery at the University of Tennessee.

Today, she is a member of the American Society of Plastic Surgeons and the American Society for Laser Medicine and Surgery, and she is a medical illustrator and an accomplished artist whose medical artwork has been published in prestigious medical journals and textbooks including the Annals of Plastic Surgery and the Plastic & Reconstructive Surgery Journal.

A Texas native who is proud to be a member of the Daughters of the Republic of Texas, Sholar loves her rescued dachshunds, and she and her husband are passionate about supporting local animal rescue organizations.

Has an old trauma kept you from making a big leap? Maybe you’re afraid of asking for help because everyone expects you to be strong all the time. Only when you’re brutally honest about the barriers in front of you can you find solutions for moving past them.

LET GO OF WHATEVER IS HOLDING YOU BACK.

Live in gratitude and always in the moment. To do this, you must realize beauty in everyday activities. It’s a conscious act that requires participation, acknowledges the beauty around us, and is not mere observation. The reward is a richer, fuller, more beautiful life.

SEE THE BEAUTY IN EVERY LITTLE THING.

Sometimes it’s okay to just say, “No.” We’ve all been in stressful situations – most people will understand and respect your boundaries. If they don’t, they are not in your tribe. Be realistic about how much you can handle. You may be taking on more responsibility than you can handle at the time. Also, don’t look too far ahead. Take one thing at a time. If you are feeling overwhelmed with even the most usual of life’s tasks, focus on one task at a time, not the whole basket. Little steps are a lot easier to take than one big leap.

KNOW YOUR LIMITS.

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“WATCH YOUR HOME OR BUSINESS FROM ANYWHERE IN THE WORLD”™



continued from page 55

Making self-care a priority is not selfish, but essential in removing stress from your busy life. Instead of getting tied up in so many obligations, intentionally schedule time free of anything except time for relaxing. Read a book, catch a movie, take a walk, do some yoga, meditate and pray, get a massage or acupuncture, take care of your skin with a facial. Do something you love and escape for a while. Find solace in solitude. We so often get caught up with trying to make a living that we forget to truly live.

TAKE TIME TO DO SOMETHING FOR YOURSELF.

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In the same way that a little wine may be good for the heart, it might also help avoid depression, a Spanish study suggests. Researchers from Harvard Medical School reported that red wine has anti-aging properties. Specifically, resveratrol was the compound found to have the beneficial effect, keeping skin more youthful and the body more fit. So while drinking too much alcohol is detrimental, wine in moderation, 1-2 glasses per day, may benefit both physical and mental health.

HAVE THAT GLASS OF WINE.

Austin • San Antonio • El Paso • Houston • Dallas SETTING THE STANDARD IN SECURITY

A FREE SPIRIT DOES WHAT SHE THINKS IS RIGHT, NOT WHAT EVERYONE ELSE TELLS HER IS RIGHT. SHE PUTS A HIGH VALUE ON FREE CHOICE. THIS FREEDOM IS STRESS-BUSTING! While there are some to whom stress-less, free-spiritedness comes easily, for most it can be difficult. It is important to reach a balance about what really needs to be done on your daily schedule, so prioritize and don’t hesitate to ask for help if you need it. Always carve out selfcare time. Live your authentic self and be willing to make adjustments when necessary. As for being Superwoman – so you leaped over a crack in the sidewalk instead of a tall building. So what? You tried your best.

Shed the cape, my dear!

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SPORTS before. Golf, however, provides the perfect outlet for kids to spend time outdoors and fill the need to be more active. What better way for your child to spend some time outdoors than at a golf course playing golf with friends after school? Not only does golf provide a physical fitness component, so desperately needed among much of our youth of today, but it also teaches them character, perseverance, honesty, problem solving, patience, and most of all, fun!

Research shows more business is done on a golf course than any other place besides a restaurant. Introducing your child to the game of golf can provide not only a fun way to spend free time outdoors but also gives them a skill that will most likely help them in the business world as adults. Corporate golf tournaments and outings are, in many cases, becoming the

Golf for kids

BY KYLE JEROME

“Back to school.” Those words can mean different things to different people. For many parents, those words could easily mean, “Time to get busy!” A full schedule of school activities, getting kids to sports practice, or juggling all of the above usually accompany this time of year. But what activities, if any, could kids be involved in where they are active, develop character traits that last a lifetime, and include spending time with friends and family? The answer is golf.

In this age of technology and ever increasing dependence on electronics, many kids are spending less and less time outside. For many parents, finding ways to talk their children into spending time outside is becoming more of a challenge than ever For more information visit, www.golfdynamics.com.

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norm for companies striving to improve team building and business contacts. Playing golf also helps improve people skills. How a person handles the ups and downs the game of golf throws at us can tell you a lot about how they’ll handle the ups and downs in the business world. Golf is also a great teacher of learning how to problem solve. Good shots provide joy and a sense of accomplishment while bad shots provide the opportunity to problem solve and find a way back to safety. What better time to learn these skills than as a child?

There are many reasons golf is a great alternative to your child spending the afternoon inside on the computer or on a phone. Spending time outdoors with friends and family in a positive environment is always a good idea. Don’t wait ... get them started now and give them a gift that will last a lifetime!

IURIISOKOLOV/BIGSTOCK.COM

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BOOKS

BOOK REVIEW:

John Elder Robison’s “Look Me In The Eye” An autobiographical look into one man’s life with Asperger’s Syndrome

BY GISELLE SUAZO ARRIAGA

For more information visit, www.johnrobison.com.

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HE WAS NATURALLY BRILLIANT AT MATH AND EXTREMELY CREATIVE; THE PRANKS HE WOULD PULL OFF AND STORIES HE WOULD MAKE UP WERE WELLTHOUGHT-OUT AND FULL OF GOOD IDEAS. like KISS and Judas Priest; he did all this without training.

Robison wanted to be normal and understood the obstacles that stood before him. He forced himself to become more socially acceptable and was able to connect his subjective world with his scholar-like tendencies and the normal world. Robison still struggles with Asperger’s everyday, but his focus and ambition to overcome the hurdles of his condition led him to achieve great successes in both his personal and professional life.

PHOTOS COURTESY OF JOHN ROBISON

“LOOK ME IN THE EYE” by John Elder Robison, a New York Times bestseller, is an autobiographical account of his life, career, and struggles growing up with Asperger’s Syndrome. It was published in 2007 and has been translated into eight different languages. Robison displayed strange behavior early on, kids would usually steer clear of him as he didn’t interact with them in a normal fashion. In one incident, Robison hit another classmate on both sides of his head after he put a red block on Robison’s neatly stacked blue blocks. Robison also had trouble communicating and his responses in casual conversation would often be inappropriate. He knew he didn’t fit in, but didn’t know why, this would cause him to display streaks of violence stemming from this frustration.

As Robison grew up and matured, he realized the tendency to not filter his comments was the root of his issues connecting with people. He also practiced adapting facial expressions that were more ‘normal’ than the blank expression he put on in every situation. One day, a friend of Robison’s mother, Betsy, was telling her about the death of a friend’s son, she noticed that 12 year-old Robison was smiling as she said this. Betsy asked Robison how he could smile at something like that, but he didn’t understand what he was doing wrong. In Robison’s mind, nothing was wrong, he didn’t know the person that died, he wasn’t dead and neither were his parents, but this event lead him to practice more adequate reactions that wouldn’t upset people.

Robison’s parents, and many others across the country during the 1960’s, didn’t know about Asperger’s syndrome and how it fell into the vast array of autistic conditions. Robison was taken to therapists as an effort to solve his issues, but most of them just determined that he was arrogant and rude and that it was an attitude problem rather than a mental one. During one of his sessions, his therapist told him he could come up with a name for his parents – he would often make up names for people as he had trouble remembering names. Robison decided to name his dad ‘stupid’ and his mother ‘slave;” they were less than thrilled about this. Robison did connect with one therapist, Dr. Finch, but he ended up doing more harm than good as Dr. Finch had mental problems of his own.

Despite his troubles, Robison noticed he had qualities that would help him out in life. He was naturally brilliant at math and extremely creative; the pranks he would pull off and stories he would make up were well-thoughtout and full of good ideas. At the age of 16, Robison dropped out of school, but did earn his GED with a 96 percent score. Robison had the traits of a savant that led him to become a successful sound engineer for bands

CHILDREN’S HEALTH AND THE ENVIRONMENT: THE PROBLEM AND THE SOLUTION Michael & Susan Dell Center for Healthy Living Invited Speaker Seminar Dr. Landrigan is the Dean for Global Health and chair of the Department of Preventive Medicine at the Icahn School of Medicine at Mount Sinai. A world-renowned pediatrician and epidemiologist, Dr. Landrigan is known for his many decades of work protecting children against environmental threats to health.

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On October 6th, Dr. Landrigan will give a talk on how the environment impacts the health of children. Come join us!

October 6, 2015 3:00 – 4:00 p.m.

Light reception to follow seminar.

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dining

100 PIZZITAS A UNIQUE AND DELICIOUS SPANISH PIZZA CONCEPT MAKES ITS WAY TO AUSTIN

BY GONZALO VELOZ / PHOTOS BY GONZALO VELOZ

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What happens when two Venezuelans bring a successful pizza franchise with an awesome, different concept from Spain to Austin? The result is 100 Pizzitas, located at 900 E 7th Street. It’s a restaurant that combines gourmet gastronomy with a fun twist, bringing a menu with 100 different small pizzas and many more options like risottos, pastas, salads, and appetizers.

The pizzitas are handmade with an immense variety of ingredients starting with basic ones like bacon and anchovies then moving through a journey of gastronomy and awesomeness with ingredients like foie gras, mahon cheese, jamon serrano, and other flavors from different influences of European cuisine.

Below is the recipe for the Specialty of the House, a pizzita made with serrano ham, brie cheese, chanterelle mushrooms, and mousse de foie.

¹ INGREDIENTS FOR PIZZA:

FOR ¹ INGREDIENTS TOMATO SAUCE:

1/2 cup of flour 1 cup of tomato sauce 1/4 cup of mozzarella cheese 1/2 pound of serrano ham 1/4 cup of chanterelle mushrooms* 1/3 pound of mousse de foie* 1/3 pound of brie cheese

FOR ¹ INGREDIENTS THE PIZZA DOUGH:

1 cup of flour (preferably double zero quality) 3/4 tsp of yeast 1/2 tsp of sugar 1/2 cup of water 1/8 cup of extra virgin olive oil PREPARATION OF PIZZA DOUGH: Divide water in half, in one bowl filled with half of the water pour in yeast and in the other bowl of water pour the sugar. Stir until dissolved. Place the flour for pizza dough in a large bowl and mix in the water previously mixed with the yeast and sugar.

Knead repeatedly until all ingredients are well mixed. Pour the extra virgin olive oil into the kneaded dough and continue kneading until olive oil is dissolved and dough takes on a homogenous aspect. Let the dough rest for 20 minutes. Cut the dough into four equal parts. With a roller and a delicate touch roll out all four pieces until they become pizza-shaped.

4 tomatoes Spanish celery Salt and pepper 2 heads of garlic 1 ounce of grated carrots

PREPARATION OF TOMATO SAUCE: In a pan, mix in the chopped heads of garlic with the grated carrots at a medium temperature and stir for a minute and half. Pour in the Spanish celery and tomatoes along with the salt and pepper. Let it sit on low heat for 5-6 minutes.

PREPARATION OF PIZZITAS: Preheat oven 450 degrees. Place pizzas on a non-stick tray and spread tomato sauce evenly on each. Drizzle the mozzarella cheese, brie cheese, and mousse de foie all on top of each other. Bake for 10 minutes. Take pizzas out of the oven and place the serrano ham on top. *The mousse de foie can be found only in Phoenicia bakery *The chanterelle mushrooms can be subbed with regular mushrooms

IT’S A RESTAURANT THAT COMBINES GOURMET GASTRONOMY WITH A FUN TWIST. For more information visit, www.cienpizzitas.com.

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to have beautiful and healthy legs.

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