Featuring Sally Ward, Head of the devision of pediatric pulmonology, medical directory of the sleep laboratory at Children's Hospital in Los Angeles.

• Sleep is just as important as a healthy diet to children
• Poor night sleep can lead to bad grades, having a harder time in class

Misdiagnosis of sleep-related disorders

(2:30)

• How to diagnose a child's sleep disorder
• Asking questions to diagnose the sleep-related issue: sleep patterns, complaints (snoring, etc.)

Non-behavoiral sleep disorders

• Destructive sleep apnea - Obesity is the largest contributor, often effects children's education. Destructive sleep apnea is treatable.

Leading causes of sleep disorders in children

• Craniofacial adnormalodies
• Down syndrome (chromosonal adnormalodies)
• Children with large tonsils, adenoids
• Asthma
• Obesity (can lead to asthma)
• Gastroesophageal reflux
• Hypoxia

Advice to families that are expecting a baby

(6:00)

• Have children initiate sleep in the correct environment.
• Review common sudden-infint-death syndrome causes.

Overweight children...

• Have more pressure on their air-ways and chest from additional fat, which can lead to sleep apnea.
• Are more likely to have asthma, which can cause coughing in the middle of their sleep.
• Sleep less due to obesity/apnea, which may lead to being less sated when eating due to sporadic leptin levels.

How sleep effects hormones and neurotransmitters

(9:00)

What impact does obesity/apnea have on a child's physiology?

(10:00)

• Effects mood at home and school
• Sleepier than peers making it hard to interact with others
• At risk for hypertension later in life
• At higher risk for Diabetes

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Featuring Dr. David Fryer Director of the Life Survivorship & Transition Program at Children's Hospital Los Angeles

Cancer does not discriminate, but there are cancer patients who do not receive the attention they should

• Adolescence and young adult patients are considered the "The Lost Generation of Cancer Patients"
• These 15-39 year old patients had a lower chance of survival as time passed. (2:00)

Reasons for the low survival rate in younger cancer patients

• Younger cancer patients tend not to take part in clinical studies. The survival rate is directly related to how much research has been dedicated to that age group.
• Younger patients may have different reactions to medication.
• Disease biology may be different in younger individuals.
• Adherence to treatment; younger individuals may take their medication less.
• Adolescence don't have access to good cancer treatment facilities
• Doctors treat younger cancer patients differently, not always on purpose (6:00)

Cancer survivorship

• Alive 5 years after diagnosis are considered long-term survivors.
• The cancer cure rate for adolescence is 80%, but these patients have long term issues (due to chemotherapy, heavy medication)
• Adolescence cancer patients need long term monitoring
• Young patients tend to leave medical surveillance after age 20. It's a busy time in their lives, so the cancer watching becomes less of a priority despite it being incredibly important.

Current research and options for "The Lost Generation"

(10:00)

• A lot of research is being done.
• Collaboration between Lance Armstrong and The National Cancer Institute called "The Livestrong Young-Adult Alliance"
• Many other alliances to help adolescence cancer patients bringing the issue in to the public's eye.

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Parkinson's Disease (PD) affects 1 million people in the United States and this number will increase with the aging population. Parkinson's Disease is a neurodegenerative disease of the central nervous system that occurs as a result of a loss of dopamine-producing cells in the brain. The cardinal features of Parkinson's Disease are Slowness of movement (bradykinesia), Rigidity annd Tremor. Non-Motor Symptoms begin 3-15 years before motor symptoms and patients usually have 50-70% loss of the cells that produce dopamine. However the accuracy of diagnosis is 70% with general neurologist and 90% with Movement Disorder Neurologists. Most neurologists have not completed formal fellowships for movement disorder specialization. We have come to find out that experience does not make up for formal training.

History of Parkinson's Disease

(1:00)

• James Parkinson wrote an essay on this disease he witnessed. Doctors later diagnosed it and established it as a disease, then named it after James Parkinson.
• 1875 — 2 year old child with Parkinson's disease, took 7 years to diagnose

The brain of Parkinson's disease patients

(4:00)

• Non-motor symptoms: decreased sense of smell, gastrointestinal issues, urinary issues, sexual disfunction, sleepiness, depression, anxiety, impaired color discrimination, contrast sensitivity, and restless leg syndrome

REM behavior sleep disorder

• Patients are able to act out their dreams when their brain is supposed to paralyze their body. These patients can move around during sleep and cause harm to others or themselves.

Patients often don't visit doctors for small signs of Parkinson's Disease (loss of smell, constipation, etc.). Patients visit their doctors after the first tremor or obvious neurological misfire five to seven years later. At this point, they have lost 50-70% of cells in the Substantia nigra (part of the brain). (8:00)

• About 1 million people in the United States have Parkinson's Disease.
• You are 1.5x more likely to get Parkinson's Disease if you are a female.

Rates of Parkinson's Disease in different cultures

• The Amish community has the highest promenence of Parkinson's Disease.
• Italy, India, and Nebraska (United States) also have a high ratio of Parkinson's Disease.
• Ethiopia and Korea have the lowest ratio.
• High agricultural areas and communities generally have higher rate of Parkinson's Disease. Studies show a link between pesticides and Parkinson's Disease. (11:00)

Pathology of Parkinson's Disease

• Starts effecting the Olfactory bulb (smell) and the brain stem that controls the GI tract (causing constipation). (12:00)
• Identifying Patients at Risk: (15:00)
• Genes
• Watching the movement of dopamine
• Smell identification test (scratch and sniff)
• Cardiac imaging

Neurologists don't have good tools to diagnose Parkinson's Disease yet (18:30).
Neurologists look through patient history, use tests, and employ their expertise to diagnose the disease.

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Stroke is the 3rd leading cause of death in the United States and the leading cause of disability. It is important to recognize the different types of stroke, the symptoms and how to reduce your risk. Your stroke risk increases with age especially if risk factors are not controlled early in ones 20's to 40's. Learn how you can prevent Stroke and help someone having a stroke in your presence.

Stroke Statistics

• Every 45 seconds, someone has a stroke in the US.
• 750,000 people per year have one
• Surveys suggest that 38% of 50+ year old individuals don't know where stokes happen in the body, 19% don't know how to prevent them.
• 3rd leading cause of death
• #1 cause of disability in adults
• 2/3 of all strokes happen to individuals over 65 years old
• Can cause $60,000+ in medical charges
• Males have a higher risk of stroke (2:00)
• African Americans also have a higher risk
• Lifestyle has a large effect on the risk of stroke

What we can't do to prevent Stroke

• Age: Changes of getting a Stroke double per decade of life
• Genetics
• Heredity: Males and African Americans have a higher risk (4:00)
• Gender: Males have a higher risk of getting a stroke, women are more likely to die of stroke
• Women taking birth control pills and smoking can get a stroke at a young age
• TIA Stroke = "mini strokes" - When someone has mini stroke, they are 10x more likely to have a major Stroke

What you can do to prevent Stroke

• Hypertension - Leading cause of Stroke. Testing your blood pressure over many years is vital to preventing Stroke.
• Smoking - Smoking can really elevate the risk of Stroke in the youth (9:00)
• Lower your Cholesterol - Someones weight and health has an effect on the likelihood of stroke. LDL Cholesterol should be less than 100.
• Keep blood sugar down - Diabetes can increase the risk of Stroke
• Eating overall healthier - Eat less saturated fat, less sodium, less carbs, and less calories. Watch out for deceptive product labels when grocery shopping. Smaller servings are generally better.
• Eating fish can be healthy, but avoid fish with high saturated fat content (12:00).
• Understand the food labels on packaged foods.
• Consume Omega-3, 4 to 6 grams daily.
• Physical activity - helps reduce plaque in the blood (17:00)
• Sleep apnea - increases risk of memory loss, heart attacks, headaches, and Stroke.
• Drugs - cocaine can induce Stroke. Don't do heavy/illegal drugs.
• Auto-immune diseases can increase Stroke risk in women
• Multiple miscarriages can increase the risk of Stroke in women.

Symptoms of an upcoming Stroke

(19:30)

• One side of the body becomes numb or week
• Sudden confusion or trouble speaking
• Hard time understanding speech or seeing clearly
• Loss of balance
• Sudden severe headache (out of nowhere)

Different types of Stroke

• TIA stroke (mini-stroke)
• Ischemic Stroke
• Hemorrhagic Stroke

How does Stroke effect the brain?

(22:00)
Right-side brain Stroke = sight loss, can lead to behavioral issues, and loss of control of left side of the body.
Left-side brain Strokes = speech and language issues, behavioral issues, and loss of control of right side of the body.
Depression - Sadness, or suicidal.
Apathy - Don't won't to do anything (productive or fun) after having a stroke

Helping a Stroke patient

• Writing journal and sticky notes are great for helpful reminders
• Call 911, do not drive potential Stroke sufferers to hospital. The hospital prepares for Stroke patients upon 911 call. Clot-busting drugs will be given in ER. Extremely useful when given within
• 3 hours of Stroke, so 911 must be called to ensure a timely delivery.
• Strokes can effect neural network and may make the sufferer think he/she is fine and doesn't need help.
• F.A.S.T = Face, Arms, Speech Test = Does a smile effect one side of the face, does one arm drift downward, do they speak in normal sentences without slurring?

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