Online betting and compulsive behavior; treating TMJ, a jaw problem; how lead injures children: Upstate Medical University's HealthLink on Air for Sunday, May 8, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a psychiatrist discusses the addictive potential of mobile sports betting:

Sunny Aslam, MD: ... About half of people with gambling use disorder have an alcohol or a tobacco addiction as well, or both ...

Host Amber Smith: A physical therapist goes over the diagnosis and treatment of temporomandibular joint dysfunction, or TMJ:

Scott Hoskins: ... To get to a diagnosis of TMJ, it's not really one specific test. It's usually we're looking more for a cluster of symptoms ...

Host Amber Smith: And a pediatrician explains why exposure to lead can be so dangerous, especially to children:

Travis Hobart, MD: ... If you get a high enough level, it can cause things as bad as seizures and what we call encephalopathy, which is brain swelling and brain problems ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, amber Smith. On this week's show, we'll hear how physical therapy can be used to treat TMJ, temporomandibular joint dysfunction. Then, a pediatrician explains what can be done to keep kids safe from lead poisoning. But first, a psychiatrist talks about mobile sports betting and the potential for fueling gambling addiction.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." During the first three months that online sports betting has been allowed in New York state, cumulative bets have totaled more than $4 billion. Mobile sports wagering, it turns out, is very popular. But is there a downside to gambling becoming such an easy recreational activity?

I'm talking about this with Dr. Sunny Aslam. He's a psychiatrist at Upstate who specializes in addiction medicine. Welcome back to "HealthLink on Air," Dr. Aslam.

Sunny Aslam, MD: Thanks for having me.

Host Amber Smith: Now sports betting is legal in 30 states and the District of Columbia, and in New York state, there are nine mobile sports betting operators, including FanDuel and DraftKings, that allow New Yorkers to place bets from their mobile phones.

Do those of you who work in addiction medicine expect to see an increase in problem gambling?

Sunny Aslam, MD: We do, of course. I think it's inevitable. The interesting thing that came up most recently for me clinically, was someone talking about cryptocurrency, someone who struggles with alcohol use and was feeling overwhelmed at their work, but didn't quite put the two together, and it seemed like the conversation focused more on cryptocurrency then than the drinking.

But it's interesting to see how things are changing rapidly, right? With the betting, with cryptocurrency and our economy as well. You can kind of think of it as a casino in some ways, the way investments work. And, this is, an area that's broad-ranging

Host Amber Smith: Is all gambling "problem" gambling?

Sunny Aslam, MD: No. One of the ways I think about gambling is analogous to alcohol, that many people can have a glass of wine or go out to a bar, and it doesn't cause them any distress at all. They do this in groups or as a couple with friends. It's a social event. They set limits around their drinking, and they do it responsibly, with no harms at all. But there are a small group of people with alcohol, just like with gambling, who will be harmed by their repeated use.

Host Amber Smith: Well, let's talk about the potential harms of gambling, aside from losing a lot of money. Right? What are the other harms?

Sunny Aslam, MD: So it can cause significant distress, in, we would say, in work and love. As, well, the way we look at life in psychiatry. Does it affect your job and does it affect your relationships, particularly to those closest to you?

And so, it's true that Fifty percent of people with gambling use disorder, have a mood disorder such as major depression, 40% can have an anxiety disorder, 32%, attempt suicide or have suicidal thinking, and half of those will actually attempt suicide. So you can see there's a a wide range of problems associated with gambling use disorder.

And about half of people with gambling use disorder have an alcohol or a tobaccoaddiction as well, or both.

Host Amber Smith: Lottery tickets and racetracks. Those are older forms of betting that have been around for years. Is there any noticeable difference in terms of the amount of time or money spent or the addictive hold between these in-person forms of gambling and the online gambling?

Sunny Aslam, MD: Our data shows that different groups of people and people with different incomes and socioeconomic status are drawn to different types of gambling. In particular, of course, our concern with online betting is that there's virtual anonymity, and the accessibility is around the clock.

There are other limits with more traditional gambling that are built in, although casinos do interesting things, like there are no clocks around, there are no windows for sunlight. They fight tooth and nail to keep smoking, inhaling tobacco, in the casinos. All of these things contribute to their profits and have been shown to be very effective in contributing to their profits.So there are many different factors that can play into this.

Host Amber Smith: You mentioned, with the in-person gambling, sort of the side benefit maybe of socializing with people, but if you're doing this mobile stuff, you're not really socializing with people, are you?

Sunny Aslam, MD: You may not be. You might be in a group, but it seems unlikely. It seems like something that people would do more likely alone, and the two different paths that we hear about from patients and that have been studied, particularly around what happens in the brain, is gambling for a rush or gambling for an escape.

And so, online can be both.It taps into both those areas.

Host Amber Smith: Can people become physically addicted to gambling the way someone might be addicted to a particular drug, or is gambling a psychological addiction, potentially?

Sunny Aslam, MD: Yeah. So this is where there's been a change in our field, to some extent.

So gambling use disorder, a gambling disorder, was moved into the category from impulsive disorders to be treated with substance use disorders, with other addictions, essentially, because there's increasing recognition of the chemistry in the brain, the wiring in the brain, is virtually identical to what happens with, for example, you inhale a cigarette, it activates seeking system in the brain, and it seems to be virtually indistinguishable for those with gambling use disorder.

Once you have become addicted to gambling, there's repeated harm. That part of the brain appears to be changed for people, and it is something that will be with them forever

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with psychiatrist Sunny Aslam about the subject of gambling addictions.

How does a person, or someone who cares about them, determine whether they're addicted to these mobile sports betting apps?

Sunny Aslam, MD: Can I come back to that point about work and love? If it's affecting your job, if it's affecting your relationship, then there probably is already. If you've noticed your partner's gone for hours, there's money missing. There are those kinds of red flags, and you bring it up, and you don't get adequate answers, that's the sign of a problem.And those are often the screening questions around gambling disorders, If you tried to repeatedly make up for losses and have you lied to loved ones about how often or how much you bet?

So when those relationships are being affected, there's a clear sign of a problem.

Host Amber Smith: Are there strategies to make sure gambling doesn't become a problem?

Sunny Aslam, MD: Yes. Unfortunately the difficulty is, the industry is built against you. The industry knows where its profit centers are, and those are in people with other addiction and mood disorders. But there are ways to an accountability partner. Don't do this alone, set a limit around how much time and how much money you'd like to spend, and then, if you notice you're going over those limits, maybe it's time to ask for help. And there's a number of ways of getting help.

And that can mean coming to the addiction medicine clinic for a consultation or going to a 12-step group; Gamblers Anonymous is very popular, and there's good evidence that 12-steps work and psychotherapy, and then the treatment of comorbid disorders can be helpful as well.

Host Amber Smith: So if someone already knows they have a problem with, let's say alcohol, are they more likely to develop a problem if they start with the mobile sports betting?

Sunny Aslam, MD: That's right. So, as I mentioned, half the people with gambling disorder have an alcohol or tobacco addiction already, so we know that those are risk factors. Being young and male is a risk factor as well for gambling disorder. If you already have a mood or anxiety disorder you're at particular risk as well, so there's a number of these risk factors that people should keep in mind before they enter into online betting or head to the casino.

Host Amber Smith: Now, someone who suspects they have a problem: If the person wants help, is the recommended strategy to quit entirely, cold turkey, so to speak, or to just cut back and try to manage?

Sunny Aslam, MD: Of course, each case is different. It's very hard to say, and we have limited amounts of research. This has not been an area that has been a focus of research during an opioid epidemic, and actually tobacco kills more people than all other addictions combined, so there's a big focus on alcohol use disorder, which kills 95,000 people a year.

Gambling's prevalence is about 1%. We just don't know as much. But what we do know, we can draw some conclusions from other areas, such as alcohol use disorder. Actually, most people who recover from alcohol problems, they do it on their own. That's interesting; you know, as a psychiatrist, I'd love to tell you that I cure all kinds of people of alcoholism. It's not true.

So we know there's certain groups of people who are able to work through their problems with gambling or alcohol, etc but we recommend, if you feel you need the help, ask for it. There tend to be barriers to treatment, but 12-step groups, for example, don't cost a thing. You can't beat the price; they're available. And we're also available, as well as other treatment centers in town, to treat people, and it doesn't hurt to come in for a one-time consultation.

I would think if someone was relatively well adjusted, it wouldn't be a problem to come in. I worry about the ones who don't come in; denial is a significant part of addiction, and often people feel like I'm just going to win big on the next one, but they can do that for hours, and it can be financially disastrous and emotionally disastrous

Host Amber Smith: Now, some people see mobile sports betting as a way purely to make money. So I wonder if there's research that shows yet whether the person who studies and pores over statistics before placing bets is any more or less likely to become addicted than the person who approaches betting like it's a game, and they're just going to bet on their team.

Sunny Aslam, MD: I certainly worry more about someone who thinks they're going to crack the code of a multibillion-dollar industry. That level of grandiosity is going to tend to lead to a large loss and a large fall. So I do worry more about those than someone who's more humble, just thinking, "I'm going to go in, I'm going to spend my 500 today, and that's it. I'm probably going to lose it." That's much healthier thinking, being humble as in most areas of life, right? If we're more humble, we tend to have a more reasonable outcome.

Host Amber Smith: Do you see similarities between mobile sports betting and online gaming?

Sunny Aslam, MD: There are similarities. Harm from repeated use is how we define addiction in our clinic. And people can get lost or dissociate off into a world where they have little face-to-face contact. And this of course was worsened through the pandemic, where there was this phenomenon where people may have only been seeing other people through online means, through Zoom meetings or their gamingso in some ways that might've been healthy, but for others, it enabled and helped them avoid the contact with other human beings that they may have already tended towards. And so for those people, that can plunge them deeper into anxiety and worsen their mood and make it harder for when they do have face-to-face contact with people, to overcome the intense feelings of anxiety, shyness or struggles with connecting with people face to face.

Host Amber Smith: There are some positive connections through these gaming communities, so how do you maintain that but also minimize the threat of getting sucked into it too far and spending too much time at it.

Sunny Aslam, MD: I see that as similar to strategies for gambling as well: setting limits, having an accountability partner, doing it with a friend or a relative, and just keeping an eye on the number of hours. A lot of the psychotherapy we do is focused around people's self-care And so when someone comes in and explains their seven eight 10 to 12 hours a day staring at a screen, they're going to tend to not have the best physical health. Maybe their jobs or their other relationships are causing them to feel anxious and they haven't put it together, but these are the kinds of connections we try to help people make in psychotherapy, is, you're feeling hopelessly, anxious, and depressed, you haven't had contact with humans much in the past few months, what's your thinking about that? And try to help people put some of those ideas together and then see what they want to do about it, if anything.

Host Amber Smith: Do the online games for kids, because a lot of them appeal to young kids, do you think it prepares them or grooms them to grow up into online sports bettors

Sunny Aslam, MD: I think, unfortunately, in a lot of for-profit businesses, they're there to make a profit. And we know this through deep study of particularly the alcohol and tobacco industry, as they, in their documents, they talk about profit centers and they know that capturing young brains gives you a profit center for life.It's not as interesting to them to focus on the elderly because then you're getting a customer for 10, 20, 30 years. If you get teenagers, you're getting a customer for 60, 70 years. And so alcohol, tobacco, those industries have learned from that.

And then you see other industries doing very similar things, cannabis and gambling. If you can make something sexy to teenagers and get their attention with bubblegum vaping flavors and sexy-looking devices, it's good for business.

And unfortunately for our patients, for people who are more vulnerable, people who already have an addiction, who already have a psychiatric disorder, they're particularly vulnerable, and they're targeted by these companies.

Host Amber Smith: Well, Dr. Aslam, you've given us some good information and lots to think about with mobile sports betting, so I appreciate you making time for this interview.

Sunny Aslam, MD: Thank you.

Host Amber Smith: My guest has been Dr. Sunny Aslam He's a psychiatrist who specializes in addiction medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- how physical therapy is used to treat temporomandibular joint dysfunction.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." If you've got tenderness in your jaw or trouble chewing, and aching pain in and around your ear, you may have wondered if you have something called TMJ: temporomandibular joint dysfunction. Physical therapists are among the health care providers who care for people with TMJ, and today I'm talking with Scott Hoskins. He's a doctor of physical therapy in Upstate's department of physical medicine and rehabilitation. Welcome to "HealthLink on Air," Dr. Hoskins.

Scott Hoskins: Thank you.

Host Amber Smith: Can you please start by describing for us what TMJ is?

Scott Hoskins: Yeah. The TMJ, the temporomandibular joint, is a joint where the mandible, or the jawbone, attaches to the skull. So there's two; there's one on either side, and it's movement is important for eating, talking, facial expressions, really any movement of your face, and if they dysfunction, it's basically an umbrella term to describe any issue with those joints or the surrounding soft tissues.

Host Amber Smith: Does it involve just the jawbone itself or also the muscles around the jawbone?

Scott Hoskins: It's actually a very complex joint, so it's bones, where the bones connect, it's all the muscles around. There's multiple muscles that open and close your jaw, there's ligaments, there's connective tissue, joint capsule, and then there is a disc in between the bones that kind of acts as a cushion or a support for the joint.

Host Amber Smith: Well, is this condition something that people are born with, or does it develop as we age?

Scott Hoskins: In certain cases, there's congenital abnormalities of the bones, things like that, but most commonly, and most of the time when people think about TMJ dysfunction, it is something that develops at some point in life, and it's not necessarily with older age. The most common is females in the age range of, say, 20 to 40; somewhere in that range is the most common time to experience this.

Host Amber Smith: Do we have any idea of what causes it?

Scott Hoskins: It depends. It's usually multiple factors that go into it. A lot of times it's related to what we call oral parafunctions, so basically bad habits of your jaw. So it's like clenching your teeth, people who grind their teeth at night, excessive gum chewing or chewing caps of pens, things like that. A lot of times those bad habits can contribute. Posture is often a big contributing factor as well.

Host Amber Smith: So grinding teeth and other bad habits, like crunching on ice, chewing gum, all of that, can contribute to causing this, then.

Scott Hoskins: Yes. And nighttime habits as well, if you tend to clench your teeth while you're asleep or grind your teeth in your sleep, that puts you at a greater risk for developing these problems.

Host Amber Smith: So would those be considered risk factors?

Scott Hoskins: Yeah, I would say so.

Host Amber Smith: And you mentioned women between like 20 and 40. So I'm wondering, is there something hormonal that has to do with this?

Scott Hoskins: That is a theory, yes. It's kind of unclear at this point, but yeah, there's definitely theories that female hormones can play a role.

Host Amber Smith: Does this condition run in families? If you have parents that have had this, is a child more likely to get it?

Scott Hoskins: Possible, yes. In some cases it does seem that way. There is some research that shows that the predisposition to things like clenching and grinding your teeth can run in families, and there's also some theories that there is a genetic component to being predisposed to chronic pain conditions. So people who have those sorts of genes, yes, you would be more predisposed to TMJ issues.

Host Amber Smith: In terms of symptoms, pain in the jaw, trouble chewing, pain around the ear, what other symptoms are common?

Scott Hoskins: There's a variety. Those ones that you mentioned, yes, are all very common. One of the major ones is clicking and popping and noises in the joint. Headaches are very common as well, pain in the neck, and one that people might not necessarily think about is a ringing in the ears, changes in the ears, feelings of pressure, fullness, hearing changes, can all be related to TMJ dysfunction.

Host Amber Smith: Taking all of those symptoms together, it makes me wonder if there are other conditions that have to be ruled out before you can diagnose TMJ?

Scott Hoskins: Yeah, I think it's definitely important to do a good differential diagnosis and rule out any other possible causes of these symptoms. You would want to rule out any sorts of infection, obviously, like an infection in the tooth or an ear infection, or any sort of autoimmune disease process, like rheumatoid arthritis, things like that. And then you'd also want to carefully screen for neck problems. Some of these things that present with these symptoms can be coming from joint dysfunction or muscle problems in the neck, and then just mimic these symptoms, so you would want to rule all those things out, for sure.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, amber Smith. I'm talking with doctor of physical therapy Scott Hoskins about temporomandibular joint dysfunction, and we're getting into how TMJ is diagnosed.

Now, I wonder, do people typically bring these complaints about these symptoms to their dentist? I mean, where would you advise people to go?

Scott Hoskins: That's one of the things that can be very frustrating for these patients, is there's no real clear consensus on where to go, like whether you go to your primary care doctor or you go to your dentist. A lot of times people aren't really sure. And that's something that we see a lot, is frustration. People have kind of been bounced around from provider to provider, but I think probably primary care is a good place to start: your family doctor, and then a referral to physical therapy is probably a good place to start.

Host Amber Smith: So can you walk us through how TMJ is diagnosed?

Scott Hoskins: Yeah. So to get to a diagnosis of TMJ, it's not really one specific test. It's usually we're looking more for a cluster of symptoms.

So it's usually some combination of a patient's subjective report, like when their pain occurs, things that aggravate their pain, the location of their pain, and usually presence of noises in the joint, like clicking and popping while you're chewing or talking, people will a lot of times hear noises.

And then there usually is a lot of tenderness around the area. So the muscles around the jaw and up into the side of the head tend to get really tender. So, that, and then looking at potentially changes in the range of motion of the jaw, so people can't open their mouth as far, and things like that. So it's usually we look for some combination of multiple symptoms, and that usually leads us to the diagnosis of TMJ dysfunction.

Host Amber Smith: Now let's talk about treatment options. What are patients typically told to do for TMJ? What do the primary care providers usually advise?

Scott Hoskins: That can be a tough question also. It varies depending on the provider that they see. The most common thing is usually heat. A lot of times, people are advised to put hot packs on their jaw, on the side of their face.

And then usually some sort of pain medication, whether it's an anti-inflammatory or muscle relaxer, something like that. It depends on who they see. And then usually as a referral to maybe a TMJ specialist dentist or a referral to physical therapy.

Host Amber Smith: So what does physical therapy usually involve?

Scott Hoskins: It'll start with an assessment, so we'll have the person describe their symptoms, things that aggravate it, things that relieve it, location. And then we'll just get an overall picture of how they move, like their posture. We'll look at their neck usually first; a lot of times, there's a close relationship between how the neck functions and how the jaw functions. So we take a close look at the neck, the range of motion, how the joints move, how the muscles work, and then we'll look at the jaw itself, how the muscles feel in the jaw. Depending on what we find, we'll get into some treatment, which is usually some combination of manual therapy, which would be like massage or stretching, things like that. And then, exercises.

Host Amber Smith: Does TMJ affect a person's ability to eat and speak?

Scott Hoskins: Yes. A lot of times that is the biggest complaint that people have, is trouble eating. Especially larger food items or harder foods, like crunchy foods, tend to be quite painful.

So a lot of times we'll have people come in and they, for example, they can't eat a full apple. They have to cut it into small pieces, or like steak, things that take a lot of chewing. That is usually people's main complaint when they to see us.

Host Amber Smith: So how long does the typical physical therapy course last?

Scott Hoskins: It's variable. I would say probably, on average, it would be maybe one to two visits a week for six to eight weeks, somewhere in that range. And usually it may be 45 minutes per session, somewhere in that range.

Host Amber Smith: And hopefully a person would see some improvement during that time?

Scott Hoskins: Yeah. Depending on the root cause of the symptoms. Sometimes it can be very quick, sometimes it can take longer, but yeah, typically in that time frame, you would see quite a bit of improvement in your symptoms. And then our goal is to give patients the tools to manage these symptoms on their own.

So ideally by the end of your course of physical therapy, you know all the stretches and all the exercises, things you need to do to be able to manage your symptoms by yourself.

Host Amber Smith: How would someone find a physical therapist with specialization in TMJ? Because this is not something that every physical therapist offers. Is that right?

Scott Hoskins: Correct. Yes. And this is another thing that can be frustrating. A lot of times it is hard for patients to find somebody who does specialize in treating TMJ, and there's no real central database of where to find it. I would just recommend when you call a physical therapy clinic, just make sure you ask before you set up your appointment, make sure if there is somebody at that clinic who can treat the TMJ.

Host Amber Smith: Is surgery ever recommended?

Scott Hoskins: In more advanced cases, yes.

Host Amber Smith: How involved does that get?

Scott Hoskins: Again, that can vary, so it can start kind of anything as basic as something that is called an arthrocentesis, where it's basically a very small incision, and then they flush the joint space with a sterile fluid. And the idea with that is you flush out any of the inflammatory cells or break up any adhesions that are messing with the way the joint moves, so that's kind of the least invasive procedure. It can be up to something like repairing the disk that's in the joint space or repositioning that disk, or sometimes even removing that disk completely just to kind of free up the movement of the joint. And then it goes all the way up to a complete replacement of the joint.

Scott Hoskins: Just the way somebody would have their knee joint replaced, you have your TMJ replaced as well.

Host Amber Smith: Can TMJ be permanently fixed, or is this a condition that may flare up from time to time for the rest of the person's life?

Scott Hoskins: Again, that kind of depends on what is the root cause of it. I would say in general it can be permanently fixed if you address the root cause. So whether it's correcting the posture, whether it's behavior modification, like changing, like we mentioned before, those bad habits that kind of lead to it. If you can permanently change those, it should permanently affect the symptoms. And then maintaining your home exercise program. Usually there is some part of your exercises that you will have to keep up with forever, just to maintain things. So, if patients are good about taking care of themselves, taking care of their symptoms, it's usually something they can manage. And then again, our goal is to provide the tools to the patients.

So if somebody does have a flare-up, they know what to do, they know what stretches they need to do, or increase frequency of, they know what exercises they need to do. They know what kind of things they have to change and avoid to take care of their symptoms by themselves.

Host Amber Smith: Well, before we wrap up, what are the things people can do to prevent the development of TMJ or at least to try to prevent the development of TMJ?

Scott Hoskins: Yeah, there's definitely things you can do.; So the easiest things are: Minimize excessive chewing. So if you're somebody who is constantly chewing gum throughout the day, chewing on pens and pencils, things like that, try and minimize that, if you can.

Being aware of your posture -- if you're always in a slouched or forward-head position, that affects the mechanics of the jaw. So being more aware of your posture, sitting up straight, keeping your shoulders back.

Stress management is a big thing. If you're somebody who's always tense and holding your shoulders up, that's going to affect all the muscles in the front of your neck and your jaw. And everything's just going to be sort of tight. So stress management is a huge thing.

As much as you can, nighttime behavior modification. So if you're somebody who clenches her teeth or grinds her teeth while you sleep, possibly geta mouth guard, which your dentist will be able to provide, can be helpful and minimize that extra stress on the jaw throughout the night.

It can be kind of a hard fix, but if you can make this your habit, it can be very beneficial. There is something that we call the resting position of the jaw. when you're not using your mouth for eating or talking or whatever, you want your habit to be, to keep your lips together, keep your teeth slightly apart and then have your tongue just gently relaxed on the roof of your mouth.

Scott Hoskins: So that is the position where there's the least stress on it -- the joint -- so the more you can make that your habit, the less stress there is on the TMJ.

Host Amber Smith: That's good to know. I appreciate you making time for this interview, Dr. Hoskins.

Scott Hoskins: Yeah, no problem. Thank you.

Host Amber Smith: My guest has been doctor of physical therapy Scott Hoskins from Upstate's department of physical medicine and rehabilitation. I'm Amber Smith for Upstate's "HealthLink on Air."

How, and why, it's important to protect kids from lead -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." One of the worst lead poisoning crises in America is here in Syracuse, where the Onondaga County Health Department reports up to one in five children in some of the lowest income neighborhoods have elevated levels of lead in their blood. Here with me to talk about this problem is a pediatrician who cares for many of the children who are lead poisoned. Dr. Travis Hobart is an assistant professor of pediatrics and of public health and preventative medicine at Upstate. And he's also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. Welcome back to "HealthLink on Air," Dr. Hobart.

Travis Hobart, MD: Thank you so much for having me. I'm glad to be here.

Host Amber Smith: I'd like to start by asking you to explain why lead is dangerous.

Travis Hobart, MD: Lead is dangerous because it has multiple effects on the body. Most importantly, it affects the brain and the nervous system, and that is particularly true for children who are more likely to be exposed and adults, for a number of reasons. And in children when they are exposed, it has permanent effects on their on their brain and development. It can lower their IQ. It can affect their behavior and attention, which gives them trouble in school as they go forward, as they grow older. And it affects their executive function. So it affects people's ability to make good decisions, which is obviously crucial to succeeding in life.

Host Amber Smith: Is it inhaled, or is it ingested?

Travis Hobart, MD: So it can be either. Most typically for kids, they are ingesting it in their mouth. And the way that that happens is usually that -- most often, anyway, the way that it happens is that -- the paint in older homes may still have lead in it, and as the paint deteriorates, dust from the paint falls onto the floor. And as we all know, children crawl around on the floor, and children often put objects in their mouth that may have that dust on them. And so they usually get it that way, by putting objects or putting their hands in their mouth that have leaded paint dust on them, and they ingest it that way. That said, it can also be inhaled into the lungs and absorbed that way. For instance, we sometimes will see that happen where somebody is doing home renovations, and they're sanding down old paint. And that sanding process, puts a lot of lead dust into the air, and people then walk through the cloud of lead dust, or children are in the room and they inhale it that way. Or adults are in the room, for that matter, and inhale it that way.

Unfortunately we sometimes see that when people are pregnant and they're renovating a room for a new child, or re painting, or something like that. And so then not only does the older child might get exposed, but also the mother, the pregnant mother can be exposed too.

Host Amber Smith: So if the pregnant mother is exposed, can she pass that onto the developing baby?

Travis Hobart, MD: She can. Yes, unfortunately, the lead does pass through the placenta into the developing baby. And usually the fetus doesn't have quite as high a level as the mother does, but it's usually 85 or 90% of what the mother's level is. So definitely. And that can have effects on the pregnancy, that can lead to miscarriage and hypertension, high blood pressure during the pregnancy. And then it also can,when the baby is born, the baby can have a high lead level then, as well.

Host Amber Smith: You talked about the long-term effects and the permanent damage that lead poisoning can do. Are there immediate effects? Are there symptoms that a parent would look for to tell whether their child has been exposed?

Travis Hobart, MD: Sometimes, but I would say most of the time, what we see most kids who have an elevated lead level don't have symptoms at the time that we see them, because if you get a high enough level, it can cause things as bad as seizures and what we call encephalopathy, which is brain swelling and brain problems, along with those seizures, and it even can cause death in some cases. But that's very rare. Most of the time, at lower levels, the most common symptoms that it can cause would be things like constipation or abdominal pain, things which, while maybe a problem, are not exclusive to lead poisoning. And many children that we see in everyday practice have abdominal pain or constipation. And so, it's really hard to pick out a child who has lead poisoning based on symptoms alone. And for that reason, and maybe I'm getting ahead of, to another question you're going to ask, but for that reason we would recommend that everybody get tested, all the kids get tested at age one and two. And that's what the state requirements are, in New York state, that all kids, age one and two, get tested, and that pediatricians are asking these questions when kids are from six months to six years old, asking the questions, "Hey, do you live in an old home? Do you have paint that's breaking down or flaking off?" and other questions that might be a warning sign for a kid that might get exposed.

Host Amber Smith: So it sounds like you generally discover this through the blood test, the routine blood tests?

Travis Hobart, MD: Yeah, that's correct. Yeah. Most of the time we don't know until we do the blood test.

Host Amber Smith: OK. Why is the lead poisoning such a problem in Syracuse?

Travis Hobart, MD: So the main reason that it's a problem in Syracuse, and I don't want it to be exclusive to Syracuse. Unfortunately it's a problem in many, many cities in the Northeast and the Midwest. And the reason for that is that our housing is very old as a whole. If you look at the housing in the city of Syracuse, about 90% of it is built before 1980. And the reason that that timeframe is important is because lead paint used to be used regularly inside homes in residential for residential use, but that was banned in 1978. So if your house was built from 1978 onwards, then it was not, lead paint was never used inside your home. But if your house was built before then, which as I said, about 90% of the houses in Syracuse were there may well have been lead paint in there. It doesn't guarantee it, but, it makes it more likely. And the older your home is, the more likely it is that lead paint was used.

Host Amber Smith: So if you live in an old home, it's probably been painted since then, probably many times, but maybe the lead paint, the original lead paint, maybe wasn't removed. So would it still potentially pose problems?

Travis Hobart, MD: So we know that a painting over the lead paint does contain it in the wall. And so fortunately, if you live in an old home and the paint on your walls is in good shape, and it's not flaking off or breaking down, then you're in good shape. But the problem is, is that we know that that's not always the case, that sometimes the paint is breaking down. And in particular, we know that when people are renting homes, they often don't have the control over the paint that the landlord does. And unfortunately there are landlords out there that aren't responsive to tenants' needs. So, if they're not painting regularly and keeping the paint in good shape, then that old paint comes through, and we end up with kids being exposed. And then another place that sometimes we see the paint breakdown, more often, I should say, is in doors and windows. And that's because they have moving parts. And so as the doors are opened and closed, as the windows are opened and closed, the paint gradually breaks down, the layers get worn away, and you get to some of that older paint. And windows in particular, if you have a very old window, it usually has a storm window, the old sort of I think -- I forget what they're called -- but the old windows that have a storm window and then a main window. And that in-between area, while people may paint the inside of the window and people made the outside of the window, they aren't always painting that in-between area. And so, that's okay as long as the window's closed. But if it's a hot summer day and you open the window, then that paint that might've deteriorated in there might come into the home.

If you're living in a home that might have old lead paint, couple of things that you can do for your family and for your children: One thing is making sure your child is getting good nutrition, because if they have enough iron and enough calcium and enough vitamin C in their system, then they will absorb less lead from their environment. So I think it's important to make sure they're getting good nutrition. If you're afraid that they're not eating well or something like that, certainly talk to their doctor, or maybe consider using a multivitamin with your doctor's advice and approval. So I think that's an important aspect of prevention.

And then the other thing that I would recommend for families to do is: if you think that there's lead paint in your home, it's important when you're cleaning to do it with a mop or a wet wipe rather than a broom, because if you sweep up the lead dust, it just kicks it up into the air, and then it resettles down on the floor. And so the important thing is to mop it up or wipe it with a wet wipe so that you're getting it out of the environment and keeping your kids from being exposed.

Host Amber Smith: And we've talked about Syracuse and cities, but is this the problem in rural or suburban areas as well, or potentially?

Travis Hobart, MD: It is. Yeah. And we do have children every year that are exposed in suburban and rural areas as well. So anywhere where there's an old house, it's true. Now typically, the suburban areas have usually a lower percentage of older housing because they've been built up in the last 50 years or 40 years, but that's not to say there's none. I live in a suburban area, and my home has even old windows that have lead in it that I know for a fact. The rural areas, in particular, when we do sometimes see kids that come that live in a farmhouse or something like that, that's been around for a hundred and 150 years, and they often will have lead paint in those places too. I think the difference is, is that, of course, in the city, more people live in the city, so we often see higher numbers there, and also more people usually rent homes in the city where, again, they have that lack of ability to make the repairs that are needed to keep the house up to date.

Host Amber Smith: What can you tell us about the lead abatement and control ordinance that the city of Syracuse passed a couple of years ago? Has it been helpful?

Travis Hobart, MD: So, yes. I'm very hopeful about that lead ordinance. I think it's on route to being helpful, let's say. What the ordinance does, is it requires that homes are inspected, I believe it's every three years, that rental homes are inspected every three years and that they're on the rental registry, so that we are sure that if there's a lead issue that comes up, that that gets identified in that three-year period, and the landlords are then responsible for fixing it. And so that's great. And that's the kind of model that has been done in other cities as well, a similar models to that of making sure that these houses, these rental homes get inspected regularly to protect the children that might live there. And why I say it's en route to becoming effective is, it was passed during the pandemic, of course. And so the city is still in the process of operationalizing it and enforcing it. And so that required that they hired more inspectors, and it required that they had money to do it. And certainly early in the pandemic, they were very low on money. And then in the last year they got some money from the federal government. So very recently I've heard that they are moving forward with getting that ordinance done and operationalized so that they can enforce it and really make it work for the families in the city.

Host Amber Smith: Is there any way, right now, for a potential tenant to know ahead of time if the apartment that they're thinking about moving into is a lead hazard?

Travis Hobart, MD: There are a couple of ways that it might come up. When you're buying a house, the previous owner is supposed to disclose if there are any lead hazards in the home. So that's at least something. It usually isn't the greatest because some people don't always know that there are lead hazards in the home, even though there are. Now if you're renting a house, you can, I believe you can ask for an inspection, but I don't know the exact rules on whether the landlord has to get the inspection done, or not, before they give it to you. I mean, now this new ordinance says that they would have had to have one within the past three years. But again, I'm not sure. It may be that they haven't because it's yet to be really enforced. But you can certainly ask for them to do an inspection and look for lead.

And then, if you live in a home where let's say you're already renting a home, if you have a child or you're pregnant, you can call the health department, and the health department can do an inspection for looking for lead, specifically. And now I should say that they will do the inspection for people that ask, but they have to prioritize the places where people have been exposed already. And for a number of reasons, including the pandemic, obviously, there's a pretty good backlog of people needing inspections, for that reason, that already have lead poisoning, and the health department has to prioritize those. So if you call out of the blue, they may not be able to come right away to do the inspection.

And then finally, what I would say is that, I wish there were an easier way to find out if your house had lead in it then than that, and we're headed in that direction. So that's encouraging. And the other thing that I would say is that you can do it yourself, to some degree. So there are lead testing kits that are available at Home Depot or Lowe's or whatever hardware stores that are little pieces, like little cylinders that have fluid in them and you pop it and then you rub it on the area that you think there might be lead, and it will turn red if there's lead. And those are pretty accurate ways of determining if there's lead in certain places.

Host Amber Smith: Well, let me ask you as a practicing pediatrician who cares for children who have been lead poisoned, what is the treatment? What are you able to offer for medical treatment?

Travis Hobart, MD: I think maybe another unfortunate thing about it is that there are not treatment options for kids at low levels of lead. The medications that we use for lead poisoning are only really effective when the level is 45 or above, and so that's obviously way higher than what is unhealthy. And any level above zero is unhealthy. But the medications just don't work unless, the medications that we have, I should say, don't work unless it's 45 or above, and unfortunately I don't know of any pharmaceutical companies making medicines that would work. So the main therapy that we would do is fixing the hazard. That's the main thing that we can do is fixing the hazard in the home, and / or removing the child from the home so that they're no longer exposed. And so that, in some cases, might mean that they move to a relative's house or for a period of time, or in some cases it might mean that the whole family gets new housingthrough housing assistance or their own other way.

The key, sort of, treatment, quote, unquote, treatment of lead poisoning is not treating the kids after they become exposed. It's treating the homes before the kids are living there to be exposed in the first place. And so I think that's why part of my job is to talk to the health department regularly and talk to the city inspectors and be a voice between the medical community and these public. Health organizations and public health agencies that are doing the work to keep kids out of these homes. That's what we call primary prevention. We'd rather keep the kid from being exposed to begin with because once we find it in the office, it's too late. They've already been exposed. Some of that damage has already been done. Now, we can prevent further damage, but we can't go back and erase the damage that's already been.

Host Amber Smith: Well, Dr. Hobart, thank you so much for making time for this interview.

Travis Hobart, MD: Yeah, no, it's my pleasure. I'm happy to do it. And thank you for inviting me.

Host Amber Smith: My guest has been Dr. Travis Hobart, a pediatrician at Upstate and also the medical director of the Central and Eastern New York Lead Poisoning Resource Center. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Robert Gregory from Upstate Medical University: How can a person recognize if someone is suicidal?

Robert Gregory, MD: A common indicator of depression is withdrawal from people and difficulty functioning at work or school. There may be a lot of expressions of pessimism and negativity. But on the other hand, many people are very good at hiding depression. So, don't beat up on yourself if you miss it. The most important take-home point is to not be afraid to ask about depression and thoughts of suicide. So many people who are struggling with suicide do not share their pain with others. It's a very isolating kind of condition, and they don't let them know that they're on the edge. And I've known so many people who wish that they had asked their loved one that question. So go ahead and ask the questions: Have you been feeling depressed lately? And then, have you been having thoughts of suicide? If the answer is anything other than a definitive no, please refer them to the many resources available to them. There are 24-hour national suicide hotlines. More locally, there's Contact, which provides 24/7 counseling by telephone as well as referral to resources. There's always the emergency room. And, thankfully in Syracuse, there's also the psychiatry high risk program.

This program was started to meet a need. We were having record numbers of suicides in young people in Central New York and around the country, but there were no programs specializing in the treatment of individuals who were at high risk for suicide. So that's what this program is all about. Our mission is very simple: to save and transform lives.

It's a comprehensive outpatient program. And we offer a full range of treatment options, including weekly individual psychotherapy, medications and family and group psychotherapy, as indicated. It's a 12-month program, since it takes a while for transformative healing to occur, enough time for individuals to change lifelong coping patterns and ways of perceiving themselves and others. So we offer up to 12 months of weekly treatment with the goal, not a complete cure by 12 months. But rather our goal is for them to be well enough so that those individuals can continue the process of healing and the recovery without needing to be in the mental health system the rest of their lives.

About half of our patients are referred by a hospital or an emergency room, and others are either self-referred -- they just call up our program -- or referred from other health care providers. So self-referral is actually very common and very easy. The person just needs to call our intake number. That's (315) 464-3117.

Host Amber Smith: You've been listening to Dr. Robert Gregory from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: We lost a stalwart member of our Muse family in 2021, poet Joyce Holmes McAllister. She was a poet who proved that aging need not dim one's perspective or facility with words. Here are the last two poems she sent us. First is "A Question":

I wonder where they went, those 80 years,

In which I claimed each breath, called life my own.

A span of time when challenge held no fear

And youthful feet could feel no aching bone.

If I had known, when young, how life would speed

And leave me here, to grope my way alone,

I would have spent more time, and learn the need

To fence youth in, and keep it for my own.

I wonder if I started now to track,

With careful count, my age to backward time.

Could I keep on until my years subtract

And I am once again, just 29?

But who would know me then, with youthful face,

or minus aging wit, long-practiced grace?

And the second poem is called "things i can't write about":

to feel what it is like

to open the desk drawer,

see the blank checks

still in their box, unused

three years after your death

to wash fresh spinach,

suddenly taste vinegar on my tongue,

remember how you sprinkled it

over young cooked greens, and how i

used only butter

to see the shape of a car,

maybe the same model, year

parked in front of our house,

know someone else will step out,

turn his back, walk away

to stare at the collection of long, slim

note pads, read your name and address

printed at the top in blue; on the bottom

thank you for your continued support of animal wildlife

my writing has always been more about

what I leave out, than what I put in

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," a look at occupational disease in New York state. If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthhinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.