Colorectal cancer's younger patients; fire safety and kids; treating back pain: Upstate Medical University's HealthLink on Air for Sunday, April 16, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," screening recommendations for colorectal cancer have dropped to age 45, and we'll hear from a surgeon about how this disease is treated.

Jeffrey Albright, MD: ... There are a number of things we think are probably the contributing factors for why people are getting colon cancer at a younger age. There's an interesting link between obesity and developing cancer at a younger age, and it is for a range of cancers, and colon cancer is just one of them. ...

Host Amber Smith: And we'll learn the fire safety education many young children missed during the pandemic.

Kara Judd: ... There is a spike in some of these burn injuries that we are seeing come in, particularly from things like candles, lighters. We always see a high incidence of scalds, which is not necessarily related to prevention, but in some cases could be mitigated with education. ...

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, a fire safety educator tells what little kids need to know about avoiding burns and reacting to fires. But first, a surgeon explains how colorectal cancer is treated and why people starting at age 45 should be screened.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Cases of colorectal cancer in people under the age of 50 have increased by more than 50% over the last couple decades, and it's one of the deadliest cancers in this age group. For help understanding why and what can be done about it, I'm talking with Dr. Jeffrey Albright. He's an associate professor of surgery at Upstate, specializing in colorectal surgery.

Welcome to "HealthLink on Air," Dr. Albright.

Jeffrey Albright, MD: Thank you for having me, Amber.

Host Amber Smith: The American Cancer Society recommends colon cancer screening to people beginning at age 45. How often do you see patients that are that young?

Jeffrey Albright, MD: With cancer specifically, we definitely have been seeing an uptick over the course of the last 10 years, and I'm seeing more and more patients who largely are not informed of the change in the screening age. And, for that reason, I sometimes will surprise them by saying, you do meet screening age, and a number of those people we will pick up having polyps or even cancers in them.

Host Amber Smith: So even people in their 20s and 30s, you sometimes have to have the conversation with?

Jeffrey Albright, MD: Yes, we do. Typically, the way that we try to approach things with people that are a bit younger, especially ones under the age of 45, is, it really depends on their overall symptoms.

And we know that somebody, if they're in their 20s, and they don't have a family history of having cancer of specifically the colon or the rectum, that the likelihood of having a little bit of bleeding on the toilet paper, something like that, is unlikely to be colon cancer. But as we start to see people as they get into their 20s or 30s, or if they start having more warning signs as far as blood or changes in their bowels or pain that we can't really explain in any other way, we will often start to recommend doing a colonoscopy or some other type of study to evaluate the colon, just to make sure that we're not dealing with a young person who does have a colon cancer.

Host Amber Smith: How are these colon cancers that you find in younger people distinguished from the colon cancers you find in older people?

Is there any difference that you've noticed?

Jeffrey Albright, MD: Well, much of that really comes down to family history, and there are some genetic syndromes, so things that people carry in their genes that put people at a much, much higher risk of developing cancer of a younger age. We think of one condition called Lynch syndrome, which we often will see colon cancer, cancer associated with the gynecologic organs, so ovaries and the lining of the uterus and a number of other cancers that all kind of cluster together. And it's related to having gene problems where people don't repair damage to the genes as effectively, and so they develop cancer at a younger age and more rapidly.

There's another one called familial adenomatous polyposis. The name doesn't matter so much, but it's just, really, these genetic syndromes probably make up less than 10% of overall colon cancers that we see. And so the majority of them are going to be more of what we call sporadic, or just kind of the random thing that pops up that develops through a typical, pathway that we see with colon cancers, and for the most part, we think that the ones that we see in younger people, people in their 30s and 40s, are mostly the same type of cancers we see in older people. It's just they're developing it at a younger age.

Host Amber Smith: So some of the reason that we're seeing more young people being diagnosed has to do with these genetic reasons.

But a lot of it is, like you said, sporadic?

Jeffrey Albright, MD: Yes, that's correct. It's really probably the sporadic ones that we are really identifying more and more. That's probably the bulk of what we're seeing. There's not an outbreak of more people with genetic problems because that's probably been there at, kind of hanging out at, its baseline level, for decades and decades.

So it's mostly just younger people, getting it through the pathways that the older people would normally get It from.

Host Amber Smith: As a colorectal surgeon, what are the symptoms you wish people would pay attention to that might signal cancer?

Jeffrey Albright, MD: So, people that experience bleeding would be one thing. Usually if somebody has a cancer or tumor that's further down, it's more likely to cause bleeding that they can see. If people have unexplained anemia. Most cancers are larger polyps that occur further up in the colon, so further away from the anal area, tend to just cause slow blood loss over the course of time. And it's maybe anemia that gets identified by their primary doctor, that needs an explanation.

Anemia for most people is not a disease, it's just a sign of something else going on, so that's something we also want to be very sensitive to.

People that have changes in their bowel function, so if they're having worsening constipation that they can't explain over the course of a few months, or if their stools are coming out narrower, or if they've got unexplained diarrhea, if they've got bowel crampiness or abdominal pain that can't be explained, those can be signs of colon cancer. They can also be signs of a number of other things, but those can be signs of colon cancer.

And then probably the other thing that we think about as well is just knowing your family history, knowing if you've got a parent who's younger who developed colon cancer, if you've got a number of different first- and second-degree relatives who have had colon or rectal cancer, then there may be some underlying issue related to your genes, even though it doesn't fit some of these specific genetic syndromes like Lynch syndrome, there could just be some type of a predisposition to developing cancers at a younger age.

Host Amber Smith: Let's talk about how colorectal cancer is diagnosed. Do primary care providers send patients to colorectal surgeons like yourself to be diagnosed? Or do they already know the patient has cancer and is going to need surgery before they come to you?

Jeffrey Albright, MD: What I'd say is there's a mix. Our primary care doctors do an excellent job of trying to get their patients to do the screening types of tests. And so colonoscopy is just one of the types of tests that we use in order to be able to identify colon cancer, as I discussed before.

People with colon cancers or bigger polyps will often have some bleeding into the intestine, into the colon. And so one of the things that we do is, we actually look for signs of blood in the stool. And there are certain tests that can be done from the stool to try to identify any blood that you may not recognize, because you just can't see it. You're losing in small enough amounts, you don't see bloody-looking stools.

There are newer tests. One that's commonly seen, people may see commercials for, is one called Cologuard, which is testing for DNA that can be spilled by cancer cells into the stool.

And so if somebody has a positive testing for that, that usually is a sign then, OK, we need to go and do the gold-standard test, which is to go in with colonoscopy and to look for what could be the cause for the blood loss or for the DNA that they're seeing in the stool.

Less commonly, we'll see people that are being sent over because they know with certainty they've got colon cancer, and colorectal surgeons, we're a relatively small group of doctors. Really, a lot of the colonoscopies are being done by gastroenterologists, or even general surgeons out in the community are doing colonoscopies in order to help, because there's too many colonoscopies to go around for it just to be done by one group or another, which is appropriate for public health, to make sure that everybody's getting the screening that they need.

Unfortunately, for people that are offered colonoscopy, it's the minority of people who actually act on it and really proceed to get the testing done.

And so that's why it's important, if screening is offered, that people go for it.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with colorectal surgeon Dr. Jeffrey Albright about rates of colon cancer that are showing up in higher numbers in younger people.

Now, treatment for colorectal cancer usually involves some sort of surgery, is that right?

Jeffrey Albright, MD: Most commonly, yes.

Host Amber Smith: And how do you remove early colon cancers or polyps?

Jeffrey Albright, MD: One of the things that differentiates the way we tell a difference between a polyp and a cancer is that a polyp is a precursor, what comes before the development of colon cancer.

And what it is, is just kind of a grouping, or cluster, of abnormal cells from the lining of the colon that starts to mound up and create kind of a growth on the inside of the colon. When we see something like that, we can go in and do a colonoscopy, and usually it's a matter of using a special thing to remove it, to pluck a piece of it off or to use kind of a little electric lasso to what we call "snare off" some of these polyps in order to take them out.

In that situation, we're removing the polyp, which prevents somebody from going on to develop a cancer from that polyp, typically, and it also gives us the ability to send that tissue off to the pathologist to confirm we're not just seeing a very early colon cancer.

Now a cancer starts to invade where it's not supposed to be, so it starts to penetrate deeper into the wall of the colon. And so if we go in, and we see something that looks like it's penetrating more deeply, we may not be able to remove it. And those are the people that tend to require an operation.

A small percentage of people can have a very, very small cancer in a polyp and have enough of what we call margin, or healthy tissue, surrounding the little tiny cancer that can just be removed with colonoscopy.

But that's definitely the minority.

Host Amber Smith: If you end up having to have a more extensive surgery, does that usually happen before or after chemotherapy or radiation? Do most colon cancer patients end up needing one or the other, or both?

Jeffrey Albright, MD: We kind of look at colon cancer and rectal cancer in a slightly different way.

The rectum is really about the last six inches of the colon, and it's down deep in the pelvis. And because of the way in which we have to do an operation for people typically for rectal cancer, if it appears that somebody's got a cancer that invades pretty deeply into the wall of the colon, or if there's evidence that there's cancer that's already spread to the lymph nodes -- and the lymph nodes are just like little filters for our body, for viruses, for cancer cells -- if we see that in our testing before the operation, that group of people may get chemotherapy and potentially radiation therapy before we do an operation, OK?

For people that have colon cancer, because of a number of differences between the way we treat them, we usually will go ahead and do the operation first. And then if there's evidence of cancer spread to lymph nodes, and the way I kind of describe this is, if your cancer's learned how to travel, it's gone from being local, in the wall of the colon, and it's figured out how to go from one place to another and start to grow and has spread to the lymph nodes, then we have to presume that it may have learned how to travel to other places further away, like the liver or the lungs, where if somebody has Stage IV, or metastatic, colon cancer, that's when people's lifespan really gets limited by colon cancer.

And so we use those as markers for people who should get chemotherapy.

And chemotherapy, I'd like to describe it as poison with a purpose. It's a poison that's intended to kill off cancer cells that may have gone elsewhere, outside of where we would normally remove a cancer when we're doing an operation. And so if you've got cancer cells that have spread to the liver, we hope by giving the chemotherapy, we can kill off those cancer cells before they have a chance to start to grow, and potentially lead to a more difficult problem to treat.

Host Amber Smith: Can surgery for colorectal cancer be curative in some cases?

Jeffrey Albright, MD: Absolutely. In order to make sure we're giving people the best type of therapy but not overtreating them, we do staging. And so when you hear about Stage I, Stage II, Stage III, Stage IV colon cancer or rectal cancer, that's the way that we as doctors kind of talk about, OK, what's somebody's risk of having cancer come back?

If somebody has a Stage I colon cancer, which is not deeply penetrating into the wall of the colon, hasn't learned how to spread to lymph nodes, that group of people, if we go and just do surgery with no chemotherapy, the likelihood that they'll be around, cancer-free, five years down the road is typically in the 90% to 95% range. And so the vast majority of people with Stage I colon cancer are going to be cured by surgery.

For people that are Stage II, so those are ones that invade more deeply, but the cancer still hasn't figured out how to spread to the lymph nodes, that's probably more in the 70% to 80% around five years, cancer-free. And so you can see as a more advanced cancer, it starts to be a much higher risk.

For Stage III, those are ones that have learned how to spread to other locations without chemotherapy. Those people are at best a coin flip as far as whether they'll be around cancer-free five years down the road.

And so for that group, that's one where we are going to be much more aggressive about treating them with chemotherapy afterwards, to try to really boost their odds of being around in the future, cancer-free.

Host Amber Smith: What can you tell us about the success of immunotherapy in colorectal cancer?

Does that ever get used alongside surgery?

Jeffrey Albright, MD: It does, it does. It's a newer therapy, and so we've got less experience with it, but there's certain types of cancers, like the one I described before, the one with Lynch syndrome, where just because of the mechanisms that lead to that type of cancer, the pathways that the things go through to get to it, that type of cancer tends not to respond to our normal chemotherapy very well. And there are even some people who can have something that looks like Lynch syndrome, that really have a similar type of problem, and those won't respond as well to standard chemotherapy. And we found that for that group of people, the immunotherapy tends to be much more effective. And so if somebody looks like they've got a reason to get chemotherapy, and we think that they're not going to do as well with the standard stuff because they fall into that grouping of type of cancer, that's when immunotherapy tends to be used, at least in the non-research world, at this point.

Host Amber Smith: How often do colorectal cancer survivors get follow-up colonoscopies, and what else is involved in their after-care?

Jeffrey Albright, MD: Once somebody's developed a colon cancer, we really worry about a couple different things. The first thing is, we already know they've got that one cancer. What's their likelihood of having, identifying down the road that, they've got a cancer coming back in their liver or their lungs?

That would be a group of people where we do all of our staging ahead of time to try to determine chance for spread. And when we do our CAT scans and stuff like that, something has to be big enough to be able to see on a CAT scan, otherwise we may not see it. So if somebody has very tiny spread to the liver or the lungs, we may not see it, initially.

And so for that group of people, we typically will follow every three months for the first couple years, and then every six months for three more years, knowing that if somebody's going to have cancer come back, most of that risk is in the first couple years. And so that's why we do more intensive surveillance, or watching, after we initially treat the patient.

And so usually what our surveillance means is getting a blood test during each of those visits, usually getting a CAT scan every year to look for any chance of spread, and then, above and beyond having their original cancer be identified in a new location, if somebody has a colon cancer, they're at a higher risk of developing a second colon cancer, so a brand new one in a different portion of the colon.

And so, those people, we typically will say, OK, we'll go back and do your first colonoscopy to check the remaining colon, usually a year down the road. And then if that one is OK and doesn't have much pre-cancerous growth, then we'll go back again three years later. And if that still is OK, we'll go back five years later.

And so then they'll be on this kind of surveillance program for getting the repeat colonoscopies, looking for new cancers, at most five years apart, but part of it also depends on what we find on each individual colonoscopy.

Host Amber Smith: Before we wrap up, I want to ask you for your advice for what people can do to reduce the risk of colorectal cancer.

And I imagine it has a lot to do with what we eat, right?

Jeffrey Albright, MD: Absolutely. There are a number of things we think are probably the contributing factors for why people are getting colon cancer at a younger age. And, there's an interesting link between obesity, so being overweight, and developing cancer at a younger age, and it is for a range of cancers, and colon cancer is just one of them.

And so maintaining healthy weight is a very important thing for people to try to do, for a number of different reasons, not just colon cancer, but overall health. We know that diabetes is associated with both developing colon cancer as well as being overweight. And so, if you're diabetic because of being overweight, that probably also contributes, and so that's kind of a double whammy.

Third thing has to do with diet. And we know that there's some things like eating lots of red meat, especially grilled or fried food, food with a lot of preservatives in it, also are damaging to the lining of the colon and can set off a cascade leading to precancerous changes or cancer. (Likewise), having a diet that's low in fiber.

People talk more and more about the microbiome. So that's the different bacteria and yeast and other things that live on our skin, in our GI (gastrointestinal, or digestive) tract, wherever, that just coexist with us. And what we eat is going to feed the bacteria in our intestine. And if we eat things that cause more inflammation in the lining of the colon, then that's going to make people more prone to developing colon cancer.

And so there's actually been some interesting studies where if you compare people that are on a high-fiber diet, which decreases the inflammation on the colon, and you switch them over to a diet where they eat more of an American type of diet, that causes a lot more inflammation and a change in the microbiome to bacteria that contribute to inflammation and can contribute to cancer.

And so, eating a diet that's high in fiber, high in fruits and vegetables, more limited on things like grilled meats, can definitely impact somebody's potential for getting colon cancer. The other thing I'd say for people, aside from diet, is, listen to your doctor. Take these things seriously.

It's a whole lot easier to go through the screening tests, even though doing a bowel prep to clean out your intestine for a colonoscopy is not fun, it's not that bad. And it sure beats living with a colostomy or not living because of advanced colon cancer.

Host Amber Smith: Now you mentioned fiber, from whole grains and green leafy vegetables and all of that.

What about fiber supplements? Do they do as good a job at protecting us as natural fiber from a diet would?

Jeffrey Albright, MD: So the short answer is yes. Really, when we talk about giving people fiber supplements, it's trying to put back into our diet what we normally should be getting. But because American diets have so much processed food, where a lot of that fiber is really taken out, it's tougher to get it just with a normal diet. And so, taking a supplement can put everything back in that we should otherwise be getting. People can start on that in their 20s and 30s and probably have that long-term benefit. There's no harm in taking it for the vast majority of people, so it can be a preventative thing, especially if you're prone to it, and it just helps to keep the colon healthy and happy.

Host Amber Smith: Now some of these symptoms we talked about earlier with the change in, dramatic change in, bowel habits and blood in the stool, those can be kind of scary, and I want to let people know, I mean, how often do you find out that that's being caused by something that's not colon cancer?

Jeffrey Albright, MD: I would say most of the time it's not colon cancer. Most of the time it can be constipation or people can have bleeding from hemorrhoids or have blood loss from other things like heavy periods and stuff like that, that people can get anemic from. Or they can have irritation in their stomach that can cause them, like ulcers or whatever, they can cause them to lose blood.

That being said, we can't really differentiate effectively between somebody with symptoms because of their colon cancer versus symptoms from something else, which is why we say, OK, if you're symptomatic, let's do further evaluation, further testing, to determine what's driving these changes.

If you're like the majority of people, where it's nothing bad, then you can have both the peace of mind that it's nothing else, and we can also try to address what the cause is. If you don't know and you don't go looking, then you're just, in a way, kind of rolling the dice and hoping you have a benign cause for it.

So it's important for us to kind of keep that in mind, that usually when people do start having symptoms, if it's because of colon cancer, it's often because it's more advanced. And so, even with people with more advanced cancer, it's better if we're picking it up at Stage III instead of Stage IV.

Host Amber Smith: I also wonder, I think a lot of people might not be aware that they have a family history of any kind of cancer or colon cancer until they're diagnosed with it and start asking.

Jeffrey Albright, MD: I agree.

Host Amber Smith: Well, thank you so much Dr. Albright, for your time. I appreciate you addressing this subject with us.

Jeffrey Albright, MD: Thank you very much.

Host Amber Smith: My guest has been Upstate colorectal surgeon Dr. Jeffrey Albright. I'm Amber Smith for Upstate's "HealthLink on Air."

What little kids need to know about fire safety -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Because the pandemic disrupted school schedules, Central New York kids between the ages of 5 and 8 missed out on fire prevention education that normally takes place at elementary schools. Today I'll be talking with a fire life safety educator and juvenile fire-setter intervention specialist from the Clark Burn Center at Upstate. Kara Judd is also a lieutenant in the Cazenovia Fire Department.

Welcome to "HealthLink on Air," Ms. Judd.

Kara Judd: Thank you so much. Thanks for having me.

Host Amber Smith: These kids who would've been in kindergarten, first, second grade during the height of the pandemic, what are fire prevention educators seeing in terms of burn injuries in this age group?

Kara Judd: Yeah, we are seeing some incidental findings. Of course, anytime you're looking at data to really have a solid picture of a change in statistics, or a shift, you have to do a longer-term study and have data from several sources, etc. But anecdotally, just based on the work that we are being asked to do and some of the injuries that we are seeing, we can correlate that, because the schools were closed down, and they did not have the traditional fire prevention education that they normally would have, there is a spike in some of these burn injuries that we are seeing come in, particularly from things like candles, lighters. We always see a high incidence of scalds, which is not necessarily related to prevention, but in some cases could be mitigated with education.

Host Amber Smith: What about fire-starting behavior?

Kara Judd: Yeah, so a part of my job as a juvenile fire-setter intervention specialist is to identify and work with children who are exhibiting fire-setting behaviors. And oftentimes this is not intentional, or there's no crime associated with it. It's really, truly, kids that are experimenting or are maybe just not understanding that fire is a tool, not a toy.

Recently I've seen more of those behaviors in this younger age group. Now, we're used to seeing it in some of the older kids because, when you get older, you have, of course, which is developmentally appropriate, less supervision, and they tend to experiment a little bit more with things.

And sometimes, again, that's very innocent behavior. But we do see that in the older kids and in the teenage population.

When we're seeing it in younger kids, ages 5 through 8, where we don't normally see those type of behaviors, it did start me wondering why we're seeing this, because it's not as common in that age group.

And so that's what led me to take a peek at what was missing. And that's where I found this kind of anecdotal link. Fire prevention education typically happens, very often, at least yearly in elementary schools, all over the place. Regardless if your fire district is covered by a career or a volunteer or a combination department, they're typically very involved.

And even if the fire department doesn't make a visit to the school during October, which is Fire Prevention Month nationally, oftentimes the teachers are talking a little bit about fire safety and fire prevention education.

So, a combination of not having traditional schooling in the last three years and some of the kids being completely on Zoom school, and also, even when the pandemic was kind of tapering off in terms of how we were isolating ourselves, schools still continued to not have outsiders come in, due to concerns for the health care crisis.

So when that happened, you really look at, OK, well, how old were those kids when they should have been starting to get this? So three years ago, that was the kindergarten class, right? And now we have those kids that are now 8 years old, who are exhibiting some fire-setting behaviors.

Host Amber Smith: So what do you advise parents or caregivers to do with this population of children who missed out on this? Can they make up for it in some way?

Kara Judd: Absolutely. One of my favorite aspects of my job when I work with young children is their overwhelming desire to learn. And they're just like little sponges. They want to learn. They want to know information. And there's a lot of ways that you can deliver the information to them so that it's useful to them but doesn't frighten them from the dangers of fire and burn injuries.

So, NFPA, that's National Fire Protection Association, they have a website for safety, nfpa.org (a kids' version is at sparky.org), where parents can go, and there's free resources including videos, printables, games, all those kinds of things that talk about fire safety, having an escape plan in your home and how to recognize what's hot and what's not. You can even print little games to play with the kids, for what's hot and what's not, so they can learn about safety and not having an increased risk of burn injuries.

Host Amber Smith: That's good to know. So getting back to the types of lessons that typically would be taught in elementary schools, is there one thing that you want children to learn or to take away with them?

Kara Judd: There's a couple things. In terms of fire-setting behaviors, the most important thing in that age group is what's a tool and what's a toy? I think that families get into a normal routine, where it's very common for them to, for example, have candles around the house that are lit. They think nothing of it.

Many families go camping. That's a really common thing that families here do. So they have bonfires and things like that, and the kids witness their parents lighting candles, moving candles around the home to different places, lighting bonfires, all those kinds of things.

And the kids don't realize that it's an adult job to do those things, right? Those are adult things. They see matches and lighters around the home; they don't recognize that those are just for adults. And a lot of times it's just such a normal daily routine for the families that they don't think about stopping to teach the kids that they're not to touch those things.

I think that also for parents, you need to really look carefully if you're seeing something that's kind of odd and you don't have an explanation for it. For example, we have seen cases where we've gone to do an intervention after a larger fire incident has happened in the home. And what we found out through the investigation is that, maybe a month ago, several weeks ago, the parents started to find what they thought were little black marks on the carpet, for example. And those were scorch marks, but the parents were not thinking about fire-setting behaviors. It was just not on their radar. And you might have a child that's just making a little campfire for the Barbie, and that goes completely unnoticed because they keep a Dixie cup of water from the bathroom in their bedroom and put it out.

And, you know, the parents are none the wiser, but they might see these little black marks and not know how did that happen? So, thinking about fire safety and fire prevention in your home and putting it in the forefront of your mind is really the first step because parents, I think, and many adults just do not think that a fire emergency is ever going to happen in their home.

So, that's extremely important. Look for those signs. Think about the toys that you have in your house and the tools that you have in your house, and make sure that you understand that the children have a distinction between the two.

Really sending the message that lighters and matches are for adult handling only is very important to do.

And, of course, we always, always, always want to make sure that families have working smoke alarms in their homes and that they're tested regularly and that the family has a fire escape plan.

Host Amber Smith: Is there a good age for fire safety education? I imagine the younger kids are fascinated, but maybe by the time they're teenagers, they've sort of lost interest.

Kara Judd: One of the projects that I started here when I took this position is called Rural Teen Outreach. So we're finding that teenagers, especially, are getting flash burns from things like brush fires and fires where they're adding an accelerant, like gasoline or kerosene.

So, you're 100% correct, right? The kids, when we roll up with that big red truck at the elementary school, oh boy, you feel like a million bucks because you're the celebrity for the day, right?

And then a lot of schools don't ever have us come back in the older grades. And what we are finding is now the end result of that is we've got our highest injury for adults is 30- to 40-year-old males who are getting injured by gasoline fires.

Why is that? Because they didn't learn that. They learned "stop, drop and roll" and "hot and not," and the basic little-kid things, and then nobody ever gave them any other fire education.

So I started Rural Teen Outreach, where I go out and I talk about when you're starting to mow the lawn, and you're starting to do yard chores, and you're handling gasoline, what are gasoline's properties?

How does it burn? How can it hurt you? We started talking about it.

So this is the age group that's talking about.

We need to talk to them about cooking safety. They're alone, they're babysitting, they're alone with other kids. They need to know how to get out and what to do in an emergency.

And then I talk to them about juvenile fire-setting behavior, and I actually have a slide where a 14-year-old was killed because him and his buddy were just lighting pieces of paper off in a factory, an abandoned factory, and they got trapped. So, just innocent play that they didn't think was going to come to any harm, one kid died and the other kid was prosecuted, and it ruined his whole life. So, those kids actually are captivated by the material because it directly applies to them in their lives.

Host Amber Smith: So you get into gasoline safety and space heaters, things like that?

Kara Judd: Yep. Because these are the kids that are starting to use those kind of things, especially in our rural communities, you see that a lot more. And kids that work on farms, and they don't think anything of it; you know, it's their daily life, but nobody's taught them that gasoline has a 12-foot vapor trail.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more information about fire safety from Kara Judd, from the Clark Burn Center at Upstate.

Welcome back to Upstate's "HealthLink on Air." This is your host, Amber Smith. My guest is Kara Judd. She's a fire safety educator at the Clark Burn Center at Upstate and also a fire lieutenant with the Cazenovia Fire Department. We've been talking about the young children who missed out on fire safety education during the pandemic, when they were not attending schools. And she's been explaining some of the lessons parents can instill to help prevent burns and teach their kids how to react to fires in the safest way possible.

Let's talk about what's important and age appropriate for young elementary schoolers. Why is it important to explain that fire is hot?

Kara Judd: Kids are naturally curious and, again, they like to emulate what they see their parents doing, right? That's why toys for that age group are like trucks and kitchen sets and imaginary play. They like to do what they see adults doing. So it's extremely important for parents to have those teachable moments about not touching candles, because they get very hot, and your skin is very sensitive to it.

We do see children that come in with typical burn injuries. We call those contact burns, so where kids are touching a hot surface. Another great example for teachable moments for those kids is if you have them helping you in the kitchen, make sure that you have a kind of area that's taped off, away from hot surfaces. So if the kids are joining you in the kitchen during cooking time, they are back away from the things that can burn them, and explain why. Explain why they have to stay away from the stove when it's hot, and that hot things can hurt their skin and burn them.

Hot water when you're making soup or boiling water on the stove: That's a really common risk for burn injury for young children, is they see the parents doing the cooking activity, and they reach up, not realizing that the pan is hot. So that can cause spills, that can create very devastating scald injuries for kids as well. So, really just teaching them what's hot and showing them an example, you know, the iron versus an ice cube. This is something that's cold to touch. This is something that's hot to touch.

Host Amber Smith: How do you teach kids about how fast fire can spread?

Kara Judd: So, that's a really tricky topic. I know that some families are very uncomfortable talking about fire because they don't want to scare the kids, but what we have really found is that kids that are informed and know what to do. Even in really young kids, we see with technology these days, 3-year-olds can operate an iPhone better than some adults, so teaching them at a young age how to call 911 for help, when they need help in an emergency, is a skill that even young children can learn. And it helps actually make them feel empowered to do something, instead of feeling scared about it.

One of the things that we really want people to understand is that fire doubles in growth every 30 seconds. Kids really don't understand that fire is only a tool and should not be played with because of that. It's not something that can be easily controlled by a young child. It's not something that can be easily controlled by an adult, either, but definitely not by a kid.

So, we really want kids to understand that. Even simple terms: Fire gets bigger; fire doesn't get smaller. We need to not play with fire because we don't want the fire to get bigger. Fire is something that only adults should take care of.

Host Amber Smith: What do kids need to know about how to react if they're in a fire? I know you already mentioned they need to be taught to call 911 in an emergency, but if they recognize that they wake up, and the house is on fire, what's the first thing you tell them to do?

Kara Judd: We teach the kids if they hear that smoke alarm go off that they need to act, and that's a really important thing. There's so much ambient noise in our homes these days. Dishwashers beep, washers and dryers beep, video games beep. They need to recognize first and foremost what the sound of the smoke alarm means. So, the smoke alarm sounds different than anything else in the house.

If it's going off during cooking or accidentally or because somebody overcooked the toast, a lot of times, unfortunately, parents just hush it and don't give the family an opportunity to react when it's a non-emergency. So I always say, learn what the beep means. You want to start to get up and move when you hear the beep.

So, we want the kids to have an escape plan. We teach them to find two ways out of every room that they're in and to have a family meeting place away from the house. It can be a big tree, it can be a big rock, it can be the mailbox. If it's away from the house, it can be the neighbor's porch, anything like that.

We want to give them a plan. Other things, depending on the age, for kids probably 5 and up, if they're in their bedroom when they hear the smoke alarm go off, we want them to go to the door and feel it with the back of their hand first, before they open it. And again, this is where that hot and not training comes in. If the door is hot, we do not want to open it. We want to stay where we are and wait for help. If it's not hot, then you can stay low and go. These are other little terms that we use. That keeps the kids low on their belly, under the smoke, where they'll have the best chance of breathable air, and they can crawl to where their escape plan is.

Now, a lot of times parents are like, "I don't want to do a fire drill in my house because I don't want my kids to be scared." Kids do fire drills in school all the time and think nothing of it, right? I am, well, well, well past my school years, but if I go back to my school right now where I went to elementary school and that fire alarm rang, I would've known exactly where to go and what to do because we did it so much, it becomes muscle memory.

We hear that fire alarm go off in school, we stand up, we line up, we go to the flagpole. They only know that because they do it over and over and over again. If they're doing it at home, when there is an emergency, they're going to be able to have that muscle memory and have the best chance of an early escape.

Host Amber Smith: I've heard that some kids have a natural impulse to hide when they're scared. And so I wonder, do you address that, or is there a way to disrupt that sort of impulse that they may have?

Kara Judd: That's a great question, and yes, that's a very common problem that we see with children. So as firefighters, when we do have the opportunities to go in the school, one of the things that we like to do is make sure that we start out in our regular, basic uniform and then slowly put on our turnout gear and our mask and our air packs, so the kids can see what a firefighter responding to an emergency, a fire emergency at their home, would look like and sound like.

We also tell them that when they hear us calling out for them, because as firefighters, when you go in for search, you're yelling, "Fire department! Fire department!" you want the people to know where you are.

We teach the kids that that's what we will be doing, and they need to come towards the sound of our voice or yell out to us, but not hide. We always tell them, stay low. If you cannot come out of your door, just get low, and yell out to us so that we can hear you and get to you. But yes, we do want to make sure that kids are not afraid of the firefighters who are coming to help them, because our turnout gear and our masks can be intimidating.

Host Amber Smith: Is the stop, drop and roll still taught as a way to deal if you yourself have been put on fire? Are you still training kids to stop, drop and roll to put the fire out?

Kara Judd: We do still touch on that, absolutely. There is a little bit of a shift to trying to keep kids away from open flame, so you try to teach them not to even expose themselves to get to that point in the first place.

Some fire departments have a hard time teaching stop, drop and roll because again, they don't want to frighten the kids, but you can really taper it the way that you use your language, right? So instead of saying, "When your clothes catch on fire, stop, drop and roll," because I don't know about you, but as a child, I thought my clothes catching on fire and quicksand were going to be huge concerns in my life. And, until I was a firefighter, I never was on fire. So, hopefully it's a very rare event, but you want to kind of soften your language while you're educating in this age group and say, "If you got too close to the fire, and you noticed that your clothes had some fire on them, then what you want to do is immediately stop, drop and roll away from the fire. This will make the fire go out."

So, you just have to explain it very calmly and really choose your phrasing carefully, and the tone in the way that you deliver. And again, really heavily focus on, "That's something that probably won't happen if you stay back away from the campfire and don't get too close. And if you stay away from the stove and don't get close."

Host Amber Smith: In terms of prevention, how much can kids under 10 do to prevent fires? Are there any messages you're trying to get across?

Kara Judd: Absolutely. We want to, again, make sure that the kids are giving matches or lighters that they find, out in the house, that they have easy access to, hand them right to the parent or tell a parent, there's a lighter on the table, or I found matches in the driveway, whichever, so that adults can handle them.

Additionally, again, we want to make sure that the kids themselves are not handling, lighting or moving candles around the home.

And we want to make sure that we're creating that safe space in kitchen areas and fire areas where the kids are back away from open flame. Those are really common things that young kids can do. Of course, additionally, we want to make sure that kids at that age learn about what 911 is and how to access it.

Host Amber Smith: Before we wrap up, can you tell us about the common types of burn- or fire-related injuries that you typically see in young children? I'm interested in what's involved in the treatment once they're at the Clark Burn Center.

Kara Judd: The most common pediatric burn injury that we see is scald injuries, so kids that are injured in hot water, so this can be a bath that's been run too hot. We want everybody's hot water heaters to be at 120 degrees or below. Always, always, always test the bath water before you let a child get into it or before you place a baby into the water, test it every single time. Your water temperature can have surges. You just never know. You can run a bath 800 times, and on the 801st time, the water's going to be too hot. .So make sure you test every single time.

We have kids, again, very commonly, pulling pans of hot soup or hot water or hot tea down on themselves. Or if someone is carrying a baby and is drinking a hot cup of tea or coffee, for example, the baby can knock that cup, so we always tell families, don't carry children when you're carrying hot liquids. If you have hot liquids around children, keep it in a travel cup to minimize spillage and injury that way.

When kids are injured from a burn or scald injury, it is a very intensive, and we call it a lifelong, injury.

Obviously children are still growing into their skin, their skin is still growing with them, so they are likely, will have a lot of surgeries ahead of them for grafting as they grow. They will have to wear compression garments to protect their new skin as they're continuing to heal. The kids that we treat get a lot of occupational and physical therapy to help reduce any kind of contracture over joints so that they can continue to move and grow and develop normally.

Obviously, there's a huge psychological component to these types of traumatic burn injuries, so we have a wonderful team of child life specialists here who help, work with the children and the families to learn both about their medical procedures that they're going to have related to their burn care and how to cope with the trauma of the injury itself.

So we have an amazing team that works with the kids, but all of us collectively will 100% say at all times that we would rather not have to treat the burn injury. That's why I'm here. I'm trying to put us all out of work, right? We, ideally, don't want to have anyone come in to see us injured. We're really trying to do a lot of focus on community risk reduction so that we can push these numbers downward, so that families and kids do not have to suffer with these long-term burn injuries.

Host Amber Smith: Well, Kara Judd, I hope this helps, and I appreciate you making time for this interview.

Kara Judd: Thank you so much. We appreciate you helping us get the word out, and we're happy to answer any questions from anybody. We can be reachable in Instagram, Facebook or via our website (https://www.upstate.edu/burncenter/index.php). Just reach out and message us. And we offer outreach programs for schools, fire departments, and we're happy to answer questions from families as well.

Host Amber Smith: My guest has been Cazenovia Fire Lt. and Fire Life Safety Educator and Juvenile Fire-Setter Intervention Specialist Kara Judd from the Clark Burn Center at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Vandana Sharma, from Upstate Medical University. How might chronic back pain be treated?

Vandana Sharma, MD: So chronic back pain, the treatment of this condition involves treatment of the cause. That's what I tell my patients when it comes to that. If I do not know where the pain is coming from, it will be very hard to treat the pain. So, first, it involves finding out what is causing the pain, and that involves doing some studies such as doing bone scans, or EMG (electromyography) studies or nerve conduction studies, and then an MRI of your affected area of pain, mostly chronic back or neck pain. An MRI gives us a very clear picture of what could be the source of your pain. Once we know the source of the pain, then we treat it with a three-pronged approach. One of them is, depending upon the medications, which is the simple and the basic way to start -- using over-the-counter analgesics like anti-inflammatory medications and Tylenol, using some more complicated medications such as anti-convulsants and antidepressant medications. And then thirdly, when the pain is not treated by just these medications, and we move on to use opioids as our last resort, which we like to keep only for chronic pain that is extremely debilitating, and when no other way can be offered to treat pain, or for cancer-related back pain. These are the conditions for medication management of pain.

Something that goes hand in hand with medication management is physical therapy and use of all other therapies that could help with treating the biomechanics of the spine, such as chiropractor management, using transcutaneous electrical leads, like TENS (transcutaneous electrical nerve stimulation) unit, and using acupuncture when your insurance covers. Unfortunately, insurance doesn't cover a lot of acupuncture modalities, even though they are very helpful in treating some particular causes of back pain.

And then, thirdly, is the spinal injections that can be done by a pain physician using X-ray guidance or sometimes, in some complicated cases, using CT guidance for placing those injections. When all these three modalities fail -- when we have used medications, you continue to do physical therapy, weight management, and along with that we do the spinal injections -- when all these things have failed, then we do a comprehensive evaluation by a surgeon as well, which could be an orthopedic spine surgeon or a neurosurgeon, who can again, go over the cause of the pain, whether it can be modified by the injections alone, or do they need a surgery at that point, which could be minimally invasive to something that's extensive, and that all goes into that arena at that point.

Host Amber Smith: You've been listening to pain medicine specialist Dr. Vandana Sharma from Upstate Medical University.

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

Deirdre Neilen, PhD: Some of our most visual and poignant poems are those describing family members. Sibling love. Here are two from our latest issue.

First is Jeremy Gadd from Australia, who offers us a portrait of opposites when young, but now finding common ground.

Here is "We Were":

We were orange and apple,

yin and yang, chalk and cheese

as children; quiet to your loud,

near to your far, circle to your square,

sharing only unruly hair and shelter

from the storm of parental repression

and mutual amusement at our

teenage indiscretions but, now,

more bonded in dying than

in life by a genetic disease,

we share more laughter than depression,

more love than any previous sibling aggression.

Zoe FitzGerald-Beckett is from Maine, and she takes us back and forth in time to pay tribute to sisters' love. Here is "Sleeping with My Sister":

We were sleeping together again, rain drumming

on the roof. Rain and tears in torrents, and the salt

and sweat of love's labor to save her. To vanquish

all fears, and the monster growing in her brain.

Our childish fears often drove us both out of bed

in the past. Her fear of everything. My fear our parents

might disappear. We'd meet in the dark and cling together,

crying and comforting, in whatever bed would have us.

Our grown-up fears were in bed with us that night, silencing

the hard questions. What is her brain tumor doing? Is there

nothing left we can do? Truth banished to the darkest

corner. No answers but the drumbeat of rain on the roof.

She was the beauty of the family; the baby sister who followed

me everywhere, sure I knew everything. She always asked, Where

are you going? Can I come too? I'd say, Yes. Sometimes. Or, No.

Leave me alone. That night I prayed, Don't ever leave me.

The rain was slowing. Her voice a drifting mist. She said, Listen,

it sounds like music. What does it mean? Knowing nothing, I

could only ask, What? She said, The back and forth, the back

and forth. And I could only whisper -- O, Pioneer. O, Dear Heart.

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," do you have sinusitis, or is it a cold?

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 healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broekel.

This is your host, Amber Smith, thanking you for listening.