Caring for your tattoo; prescribing books to kids: Upstate Medical University's HealthLink on Air for Sunday, Nov. 24, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a dermatologist explains how to care for your tattoo.

Ramsay Farah, MD: ... The sharpness of the lines and of the artistic work, that potentially can change quite a bit over the years. ...

Host Amber Smith: A pediatrician tells why she sometimes writes prescriptions for books.

Jaclyn Sisskind, MD: ... One is called "Different Kinds of Fruit," and that's by Kyle Lukoff. One is called "The Poet X," by Elizabeth Acevedo. And the other is "Starfish," by Lisa Fipps. These are three books that I've been recommending a lot recently because they deal with issues that my patients have been coming to me with recently. ...

Host Amber Smith: And a geriatrician explains what we can do to reduce our risk of dementia.

Sharon Brangman, MD: ... There's a lot of studies that show that exercise is very, very important for our overall health, but especially important for brain health. ...

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 pediatrician sometimes finds herself writing prescriptions for particular books. Then, some advice about reducing our risk of dementia. But first, now that you have a tattoo, how do you take care of it?

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

A tattoo is art that some people use to assert their personal style, but it's also a bit of a medical procedure. The tattoo artist inserts ink beneath the skin using a needle.

Today, I'll talk with a doctor who specializes in skin care about what's important to consider about tattoos. Dr. Ramsay Farah is chief of dermatology at Upstate.

Welcome back to "HealthLink on Air," Dr. Farah.

Ramsay Farah, MD: Thank you. It's nice to be here.

Host Amber Smith: For the person who's thinking about getting a tattoo, let's talk about some of the things they need to decide beforehand. Are there areas of the skin on the body that ought to be avoided, either for medical or practical reasons?

Ramsay Farah, MD: I wouldn't say that physiologically there's a particular area of skin that needs to be avoided. I think all areas of skin can probably take receiving the tattoo ink. it's just that in terms of removal, if that ever becomes an issue in the future, there are certain areas that are more tricky to remove, or, I should say, certain areas that are less responsive to removal of tattoos.

And basically, the farther away you go from the heart and the less drainage there is of blood supply and lymphatic supply, the harder it is to get the tattoo to go away, even with laser therapy.

So, in particular, I would say around the feet or the ankles. I should say I've never really removed tattoos from the palms and soles, but I imagine, as I'm discussing with respect to the ankles, it would be difficult to remove it from that area.

Host Amber Smith: Are there pros and cons of getting a tattoo in a fleshy area versus a spot where the skin is thinner?

Ramsay Farah, MD: Again, I'm not a tattoo artist, so I can't comment on the pros and cons of inserting the tattoo pigment in those areas.

Off the top of my head, I would say it doesn't really matter much. What I will say is if there is an area that's kind of more over bone than over a fatty area, I think it would probably hurt more to get the tattoo in those areas, just like it would hurt more to remove the tattoos in those areas.

Host Amber Smith: I definitely want to talk to you more about tattoo removal, but before we get to that, in terms of getting a tattoo, people have to choose between black ink or colored ink. Does that make a difference in how hard it might be to remove later on?

Ramsay Farah, MD: It does. So the red ink is very hard to remove.

Paradoxically, the black ink, even though it's the darkest ink, is actually the easiest to remove. So I would say red ink is among the most difficult, and then, other shades of color become also more difficult to remove than black. So for example, blue and yellow and so forth. Those are harder to remove than the black, but probably easier to remove than the red.

The other issue with the red is that the chemicals that make up the red color tend to make for more allergies for people. So sometimes, if you get a lot of red ink and you're allergic to it, you can wind up getting an allergy in the areas of the red ink, even without removing the tattoo. So just generally speaking, allergic reactions, whether it's the red ink or other inks, is something to consider.

Host Amber Smith: Now, will the shape or the size of the tattoo change as a person's body changes over time?

Ramsay Farah, MD: I would say yes. And to the degree that there are changes in the skin surface area, either by weight gain or weight loss, or even sun damage and loss of elasticity, all of those will, of course, affect the way that the tattoo looks like.

So, I mean, if you imagine that the skin is like a parchment, and when you get the tattoo, the skin is young and the parchment is nice and tight and clean and all of that stuff, the tattoo is going to look far different than if the parchment has been aged for 30 years per se.

And so the outlines of the tattoo may become less distinct. The vibrancy of the colors may become less distinct. If you wind up getting sun damage and pigmentation from the sun and all of those changes associated with sun exposure, that overlay on top of the tattoo, again, that can change the way the tattoo looks. I would say that it's mostly about the vibrancy, and it's mostly about the sort of the division between tattooed skin and non-tattooed skin, the sharpness of the lines and of the artistic work. That potentially can change quite a bit over the years.

Host Amber Smith: Is it safe for people with rosacea or acne or eczema to get tattoos?

Ramsay Farah, MD: They can. I mean, if you're talking about them getting a tattoo on the face, I think their face would almost certainly be more reactive, but people with rosacea, I don't think it's going to matter much if they get a tattoo on their arms.

So if we're talking about the face, then yes, I think there would be quite a bit more reaction and potentially more problems in that area, but not if it's at distant sites from the activity of the rosacea.

Host Amber Smith: You talked a little about the allergic reaction possibility. Are there other risks associated with tattoos, and how often do you hear about people that have bad outcomes?

Ramsay Farah, MD: So I would say that the worst outcome, so to speak, it tends to be related to people not liking the tattoo once it's on their skin, for various reasons. Maybe it wasn't quite what they expected, or they didn't review in detail with the artist exactly what was going to be part of the artistic tattoo, the endeavor.

And so they're kind of surprised because they say, "Oh, that's not really what I had in mind." That's far more common, I would say, in all honesty, than some of the physiologic problems I see. I would say that I see allergies, I wouldn't say commonly, but I see them, and that manifests kind of as bumps within the area of the tattoo.

You know, whenever you do anything on the skin that's somewhat invasive, and I would say the application of tattoo ink through a needle would constitute an invasive procedure, there's always the risk of hypertrophic scarring, or forming a scar, as a result of that trauma. I wouldn't say that I see that often, but potentially that can occur.

And then, of course, you have to consider that you're inserting something into the skin. So you want to make sure that the place where you're getting this procedure follows sterile or near-sterile technique, that there's no contamination of the instruments, there's as little chance of possible of getting a bloodborne disease like hepatitis through cross-contamination of equipment and things like that.

So I would say there's the allergy issue, there's the scar issue, and there's the infectious disease issue as the things to consider physiologically. And then just make sure you review with the tattoo artist exactly what's going on your skin and where, so you're not taken by surprise when it happens.

Host Amber Smith: Tattoo artists send people home with a dressing covering a new tattoo. What's the purpose of covering that?

Ramsay Farah, MD: It's probably because they would consider the area that is just recently tattooed to sort of be a fresh wound, right? Because the skin has been compromised through the needle to get the tattoo ink. There's a lot of physiology going on with wound healing and inflammation and so forth. And when the skin is kind of in that fragile healing state, you need to consider it a wound and treat it like a wound, which for the skin would mean covering it up, keeping it moist, et cetera, until that inflammatory phase of the healing is over, and the skin is less fragile, and then therefore can be exposed to the environment, without any risk of infection or harm.

Host Amber Smith: So the skin may be sort of reddish or feel warm or itchy afterward, and that might be normal?

Ramsay Farah, MD: Yeah, sure. It could be, again, from the trauma of the needle insertion and then all of the inflammation that ensues afterwards. It can cause it to be a little tender, a little bit red, possibly a little bit warm. Sure, all of that's possible.

Host Amber Smith: Are there any ointments to use or anything to avoid with a new tattoo?

Ramsay Farah, MD: I would probably use very bland ointments, things that have very little chance of making people allergic. So Vaseline or Aquaphor, these are kind of moisturizing ointments. I would probably stay away from things like oils, and especially like nut-based oils or even aloe vera, because all of those materials, while they can in certain settings be soothing, that's true, but many people can also be allergic and sensitive to them. So I would use something that's less likely to cause that, just plain old Vaseline, Aquaphor, something very bland, but something that can moisturize.

Host Amber Smith: Now, once a tattoo is no longer new, what kinds of care do people need to follow, going forward?

Is there anything they can do to keep their tattoo from fading or drying out?

Ramsay Farah, MD: I would say, and this is not necessarily from a specific source that I'm getting, I'm just kind of speaking off the top of my head, the more you take care of your skin in that area, and the more you keep your skin physiologically normal, so using sunscreens, using moisturizers, not letting your skin get too dry, those kinds of general measures that you would follow for general skin health, I think would probably contribute to keeping your tattoo as vibrant as possible for as long as possible.

I must say, people, when they come to me for their tattoos, they kind of want them off, so I'm usually not engaged in a discussion about how you can lengthen the longevity of your tattoo.

On the contrary, they come to me and say, "I want this off. What can I do?" So that's more my area of expertise. But I think it's probably correct to say that the more you keep your skin healthy, with all of what that entails, the more likely that your tattoo is going to remain kind of as young looking as possible.

Host Amber Smith: So what's involved? If someone regrets their tattoo, and they want it removed, how can that be done?

Ramsay Farah, MD: One could probably find various methods that have been described on the internet, but I would kind of stay away from all of them. I think the laser tattoo removal is probably the safest method and the method that has the most scientific study behind it.

I've seen lots of scarring and some pretty bad aftereffects of some very bizarre kind of home remedies that have been recommended. So I would definitely stick with the laser tattoo removal as the preferred method of treatment. And what I would say to people is, you should find a physician who does this, who's familiar with lasers and has done laser tattoo removal and get a consult, because probably the reality, process, of getting your tattoo taken off is different than what people think. They may think, "Oh, I'll just go in a couple of times, get the tattoos zapped, and it'll be gone, and my skin will be completely normal after that."

And unfortunately, that's not the case.

I mean, there's a lot to consider, and it's a pretty long process, to be honest. It's not one or two treatments.

Host Amber Smith: Does it matter if it's a recent tattoo or if it's a tattoo from decades ago? Are they equally challenging to remove?

Ramsay Farah, MD: So that's a good question, and I'm not sure we have a great answer for that.

The thinking used to be that if the tattoo is very old, that means over the years the body has tried to kind of degrade the tattoo and sort of break up the tattoo, and therefore the tattoo would be easier to remove with lasers. More recently, there's been a suggestion that actually if it's a very fresh tattoo, and the ink hasn't sort of gotten a chance to settle in as much into the skin, that that might be easier.

So I don't know exactly what the right answer is. I guess what I would say from my experience that they're equally challenging. they will both take a large number of treatments, over many, many months. So I don't know what the answer is, but I think they're both hard on a practical level.

Host Amber Smith: Does it cost more to remove a tattoo than it probably did to get it in the first place?

Ramsay Farah, MD: I would say, as a general rule, yes. To be honest with you, I don't know what the going rates are for getting a tattoo. And the going rates for removal of a tattoo can also vary from practice to practice, the type of laser that is offered in the practice. So, I can't give you a definite answer. I can just kind of give you a general gestalt (overview).

I think it's going to cost more to remove the tattoo than to get it, if, for nothing else, the number of treatments that are required to remove the tattoo, whereas getting a tattoo is basically one and done.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but we'll be back shortly with more about tattoo care from Dr. Ramsay Farah.

Welcome back to "HealthLink on Air." This is your host, Amber Smith, talking with Upstate's chief of dermatology, Dr. Ramsay Farah, about tattoo care.

So once it's removed, and I understand it may be more than one visit to get it removed, will there be any sort of, like, a ghostly image of it left on the body, or will it be invisible?

Ramsay Farah, MD: That depends a lot on the tattoo, the colors, the location, and to a certain extent, the technique used. And so the answer is there are really, I would say, three possibilities of what can happen when you start the process of tattoo removal.

The first possibility is that the best you can do is just fade the tattoo, such that people will look at it, it will look very faded, but they can still make out that a tattoo was there. I don't think that happens very often to be honest with you, but it is possible. So that's one possibility.

The other possibility is that the tattoo can be almost completely gone, but some tattoo pigment remains in the skin, maybe it's even sort of caught in a little microscopic scar that could develop as the process continues. And so, what that means is that the tattoo, the area of the tattoo, might look, like, a little smudgy or even a little dirty. People might look at that area and say, "Hmm, what is that? Is that like a birthmark? I can't tell what that is, but there's something on the skin." So that's another possibility.

And then the third possibility is that the tattoo is completely removed and the skin looks completely normal, and that's obviously the home run, and that's what we aim to get.

And then there is a fourth possibility. The fourth possibility is that the tattoo is completely removed, but in the process of removing it and all of that physiology that takes effect after the tattoo is zapped with the laser and the healing and the number of treatments that are done, you can leave microscopic scarring in the skin, which you can't see with the naked eye, other than it looks a little white. And that is called ghosting. So basically you remove the tattoo, but you leave a whitish outline of the tattoo, and that is also a possibility.

Now, that tends to be more common in darker-skinned individuals, so someone like from a Mediterranean or Southern European background, it's more likely to occur in that setting than someone who's of Northern European descent and has very, very white skin. Now, if that happens, that ghosting happens, there are some lasers you can use to try and blend that in somewhat, although it may not be perfect.

So you can have a fading, you can have a smudging, you can have a ghosting, or you can have it gone completely with no residual whatsoever.

Host Amber Smith: Well, if it goes as planned, and the skin returns to normal, does the hair grow back? Does it return to like what it used to be before the tattoo?

Ramsay Farah, MD: Yes. I mean, if all goes well, then it would go back to what it was before the tattoo. The hair should grow back again because the depths of the penetration and so forth of the laser may not quite be where the hair follicle is to get rid of the hair. There's always a little bit of a chance of that, by the way. But generally, alopecia, or hair loss, is not much of an issue, and most people don't necessarily have tattoos in hair-bearing areas, unless women choose to tattoo their eyebrows. But even in that setting, even though the hair growth may be slowed, the hair generally does come back. So it's not really a hair-removal procedure.

Host Amber Smith: Well, if you remove a tattoo from someone's body, and then they decide they want to get a new one, would they be recommended to get it in the same place, or would you tell them to avoid that area?

Ramsay Farah, MD: Generally, I tell them to avoid the area. So even though visually it looks like it's perfectly normal, right, if all goes well in that fourth scenario, I think if you biopsy the skin and look at it under the microscope, you're going to see some changes in the structure of the skin. There's just too much energy kind of zapped into the skin and too much inflammation over and over and over again to remove a tattoo, in my opinion, to make the skin there completely normal.

So, as a general rule, I would tell them to maybe avoid that area.

But I do sometimes have people come and say, "You know, remove this part of the tattoo. Don't remove the whole thing, just this part that I don't like. And then I'm going to have another tattoo kind of done over it." So they come and ask me to remove it as much as possible, so then they can camouflage the area they didn't like with yet another tattoo.

And people do that, and I haven't heard from them that. something terrible has happened with that strategy, but it's just that the more you traumatize the skin, the less the skin is likely to remain completely normal.

Host Amber Smith: I guess some people put a tattoo to kind of camouflage a mole. Does the mole change colors; does it accept the ink? Or does it stay as a mole?

Ramsay Farah, MD: It kind of depends what the tattoo artist does. If they ink around the mole, then the mole won't necessarily change color.

If they put ink over the mole and deposit the ink even above some of the mole cells, then potentially it could change color, and could kind of look weird and be sort of a diagnostic challenge for the physician looking at it. What is that? That's an unusual morphology (form), an unusual color. So it makes ambiguity enter into an arena that is already ambiguous enough.

I mean, mole checks are hard enough on their own, without having to add these other factors to complicate it.

Host Amber Smith: Well, as tattoos seem to be getting more popular with people and some people have many, many tattoos covering a lot of their body, if they had a tattoo over a mole or other skin blemishes, how would you be able to, or would you be able to, do a skin cancer screening if they're covered?

Ramsay Farah, MD: Yeah, so that's a very good question. And actually there have been some studies that have shown that moles in the area of tattoos can be sufficiently camouflaged that sometimes if they turn malignant, it's more difficult to recognize them.

So that is true, and what I do when someone comes in for a skin exam and they've got a tattoo, a large one, I turn my light on, I turn my magnifiers on, and I look very, very carefully within the tattoo to see if I can identify a mole. And then if I can, I use my dermatoscope, which is a device that can make me see even more.

So I'm very careful when examining skin that has been tattooed, for that reason. Now, the other question I think that you asked is: Can you remove a tattoo if there's a mole there? And the answer is yes, but do we know exactly what all of that energy does to the mole that's there?

I mean, I don't know that anyone knows for sure. I haven't really seen any studies that would suggest that the lasers will make a mole turn into cancer. and I don't think that that's probably true. The question is whether there was a mole there that would have turned to cancer anyway happens to be in an area of a tattoo. That's a more difficult question and a more difficult mole to identify.

The other thing I'll comment is, if people come in with a -- I'll call it like a bathing trunk tattoo, something really large, like over their chest or their entire arm, I wouldn't be able to remove that in one sitting because, again, there's a lot of biology that's activated with these treatments. There's a lot of inflammation, and people can actually wind up feeling sick if I do way too much of a surface area.

So for someone with a very large tattoo, I kind of do it piecemeal. I do a certain section at one sitting and another section at another sitting. But I wouldn't do the whole thing because they can actually get systemic effects of feeling joint pains and muscle aches, and almost like they have a flu or a virus.

Host Amber Smith: That's very interesting to know. Dr. Farah, I thank you so much for making time for this interview.

Ramsay Farah, MD: My pleasure. Thanks for asking me to speak.

Host Amber Smith: My guest has been Dr. Ramsay Farah. He's the chief of dermatology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air.

Certain books make excellent prescriptions -- next on Upstate's "HealthLink on Air."

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

Dr. Jaclyn Sisskind is an assistant professor of pediatrics at Upstate who believes in the power of books, so much so that she sometimes prescribes specific books to her patients. She recently wrote about her practice in the School Library Journal, and she's here to tell us about that.

Welcome back to "HealthLink on Air," Dr. Sisskind.

Jaclyn Sisskind, MD: Thank you so much for having me again.

Host Amber Smith: Now, I know you ask each of your patients what they're reading. So I'd like to ask you, what are you reading?

Jaclyn Sisskind, MD: So, last night I just finished "The Last Mapmaker." This is a book by Christina Soontornvat, and it is a fantastic book for middle-grade students about a girl who is trying to get out of where she lives and find a better life for herself. So that's the book I finished last night, but then, as far as grown-up books go, I'm reading "Tomorrow and Tomorrow and Tomorrow," which was a big book last year, and I didn't get a chance to read it.

Host Amber Smith: So you read some of the books that you may end up recommending to your patients, too, it sounds like.

Jaclyn Sisskind, MD: Absolutely. I never recommend a book to my patients that I haven't read first, and this time of year is really exciting for me, reading-wise and recommending-wise, because the American Library Association Youth Media Awards came out just at the end of January. that includes the Newbery (for children's literature) and the Caldecott (for children's picture book), and then a lot of others that people are not as familiar with.

And so for me, February and March is really just reading through that list and getting excited about all of the great books that came out last year.

Host Amber Smith: What's your impression of "Tomorrow and Tomorrow and Tomorrow" so far?

Jaclyn Sisskind, MD: I'm just at the beginning of it. I mean, I truly started the first two chapters last night because I finished "The Last Mapmaker" and wasn't quite ready for bed. It's really grabbed my attention, but I'm not that deep into it yet.

Host Amber Smith: Well, it's a controversial subject, but I know you feel strongly about the rise in book bans across the country and the impacts some of these books have had on your patients. You wrote in your essay about patients who've told you how certain books have allowed them to feel valid and worthy and not alone for the first time.

What are some of the book titles that you've seen be helpful to your patients?

Jaclyn Sisskind, MD: There are so many different books that I've recommended to my patients, and I know that you and I have spoken about that in past interviews, and I've written about them in some articles recently. I think the three books that I'm probably talking about the most with my patients right now: one is called "Different Kinds of Fruit," and that's by Kyle Lukoff, one is called "The Poet X," by Elizabeth Acevedo, and the other is "Starfish," by Lisa Fipps. These are three books that I've been recommending a lot recently because they deal with issues that my patients have been coming to me with recently.

"Starfish" is about body image and bullying. "Different Kinds of Fruit" is about a student who is struggling with their own sexual identity and learning about how they fit in with their group of friends, one of whom happens to come out as nonbinary. And "The Poet X" is a novel in verse that has won every possible award a children's book can win, and it is about a girl who's in a difficult relationship with her mom and is trying to find her way. And the way she finds herself is through poetry and spoken word.

I tend to recommend those a lot, and what really warms my heart is recently, as I've been talking about some of those books, my patients have said, "Oh, I heard about that one already, either through school or through a friend, and so it's really exciting to me that these titles are getting the traction that they deserve.

I hate to call out one particular book over another because there's so many I recommend, and I don't want anyone to be left out. But I think those are the three that I'm recommending the most recently, and it's worth noting that "Different Kinds of Fruit" and "The Poet X" are on the list of some of the most challenged titles in school districts right now, and not just in school districts, but also public libraries. And so, as much as it warms my heart that when I recommend them, people have heard about it, it really makes me sad to know that the access to these books is being limited across the country.

Host Amber Smith: What is objectionable in them? I mean, your description makes them sound like lovely books. What is objectionable?

Jaclyn Sisskind, MD: They are lovely books. They're lovely, important books, and I think what is objectional about them is that they feature characters who have not traditionally been featured in the literature that came before. So there are characters that are not white, characters that are queer, characters that have traditionally been bullied.

It's not often that an overweight child is the main protagonist in a book. Often they're the sidekick, or they're treated as someone who's not intelligent, or they're the butt of the joke. And so, to put those characters that have often been marginalized in the spotlight and say, "This is my story, this is what's happening to me," I think that's the problem that people have with a lot of these books.

Host Amber Smith: What has it accomplished by making those books unavailable? If a person goes to the library to get them, they're banned, they're not there, to the school and they can't get them, what does that accomplish?

Jaclyn Sisskind, MD: I think, honestly, it's othering, is what it's doing. I think that it is working to silence the voices of the people whose voices most need to be heard. And I think it's a problem that has two prongs.

The first is that it denies kids the chance, and I'm just talking about children's literature right now, certainly adults can find themselves in these books, too, right? But it takes kids that might see themselves in that book, and it decreases their opportunity for them to see themselves on the page, to see their experience represented. And that could make them feel ashamed for who they are, especially if they're being told that book is not available because it is, quote, inappropriate, right? That's telling the child: "You are inappropriate." It's also going to make the child feel erased. It may make them feel less apt to speak up about an experience that they've had because they think that it's not acceptable to others So that's a big problem.

And I think that the second problem is that it denies any child the opportunity to see the experience of others through a book, right?

So there are some people who perhaps are white, perhaps are cisgendered, perhaps consider themselves to be straight, but could certainly benefit from reading about the experience of someone else their age, who is not those things. And, in a very idealistic way, I think that could make us a more accepting, peaceful society if we all listened to each other's experiences more.

And what better opportunity to do that than in childhood, in adolescence, when your brain is so open to learning and being accepting to other people's experiences.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Jaclyn Sisskind.

She's the "readiatrician," you might say. She's a pediatrician who really respects books and uses them in her practice.

So is there any middle ground? Are there any sorts of reasonable limitations on who can read what that would make everybody happy?

Jaclyn Sisskind, MD: Of course there is. I think there are resources that we have that we could be using better.

So school librarians, English teachers, elementary and middle school teachers have been specifically trained to know what is out there in the world of children's literature and to help connect kids to the book that is right for them. And so when it comes to middle ground, I think the middle ground is: Keep the book, keep all of the books in the library and in the classrooms, and trust that the people who are trained to help connect kids to the right book are doing their job and helping kids, find the right book for them or being able to gently say to them, knowing what I know about you and your current reading level, I think this book is a little bit of a stretch for you. Let's find something similar that might meet your interest but be more approachable for you. And parents can also always have a voice in what their children are reading.

But when it comes to book banning in schools and in public libraries, parents are not just making a decision for their own child. They're making a decision for every child, and I think it's very important for people to have access to these books. So if there's a particular book that a parent has a problem with, they can talk to their child or their child's educator or their child's librarian about why this particular book makes me feel uncomfortable.

It might be a great opportunity for discussion and for the parent to hear both sides of why that book is there, but to limit access to all children by taking the books out entirely is a really dangerous thing.

Host Amber Smith: Now, you being a parent yourself of readers, I'm sure you're raising your children as readers, if one of your children chose a title that you thought was a little bit of a grasp for them at that level, but they really wanted to read it, what would you do?

Jaclyn Sisskind, MD: I would let them read it. And that's happened before in our house. I think there's two kinds of reaching.

One is, this book is really too hard for you, right? Like you are in second grade, and this is a book that's intended for a 10th-grader, let's say. And I just don't think you have the stamina to get through this book, or you're going to have to be looking up all the vocabulary. But if you want to try it, try it. And that's happened.

And my son said, "I think this book's too hard for me."

And I said, I agree. And he put it down.

And then the other kind of reaching is, this book is at your level, grade-wise, but perhaps the concepts in it are going to be challenging for you. And when that has happened, I've had a conversation with my son to say, I think this book is going to talk about things that you might find scary. The book in question that he brought home was a book about the Holocaust. And so I said, you know, I think there may be things in this book that you find scary, but the things in this book really happened and sometimes scary things happened

So if you want, we can read this book together. This is a book I've already read, so if you want, I can give you a summary, and then you can see how you feel about experiencing it yourself.

Or, if you want, you can wait until you're a little older or the summertime, when it's not dark so early, and it won't feel scary at night, and we can read this book at a different time.

And he ended up wanting to read the book, and he did, and he said that he was glad we had had the talk beforehand because he was prepared for it.

And he knew that he could talk to me throughout the book if anything was upsetting or confusing or scary, as it was. And I think that type of template of conversation could be applied to any book: a book about gender, a book about racial inequality, a book about violence, a book about the death of a parent.

Life is full of uncomfortable things, and sometimes a book is a safe way to explore those topics because you can close it and put it down. You can talk about it with somebody. You can take your time with it. Unlike watching a TV show or a movie where it's just sort of coming at you. Of course, you can hit "pause," but it's a different type of thing. I think books are the best way to explore those uncomfortable situations.

Host Amber Smith: Now, I know with your individual patients you give personalized recommendations, but can you give us some reading recommendations for kids who are, let's say, dealing with issues of body image? I know you already mentioned "Starfish," was it?

Jaclyn Sisskind, MD: Yeah, so "Starfish" is a novel in verse by Lisa Fipps. It is such a fantastic book. I think anyone who has talked to me since probably the middle of 2020 until now has heard me talk about "Starfish."

I have a book club that I run now for pediatricians at Upstate. It's called Pedia Lit, and we read one book a month, and Starfish was our first book because I think it's so important for adults, for health care providers, anyone who was a kid or works with kids should read this book, so I recommend "Starfish" often.

Also there's a book called "Taking Up Space," by Alyson Gerber, that I think is very good.

So "Starfish" talks about a girl who is overweight and dealing with bullies.

"Taking Up Space" talks about a girl who thinks she is overweight, but she's actually working through an eating disorder. And so it's the opposite side of things. It's an excellent book and a book that shows therapy and the positive impact that teachers and guidance counselors can have, in a really approachable light. So, I love that book.

Another one that I think is just a fun one is called "Fat Chance, Charlie Vega." This is by Crystal Maldonado, and it's a book for high school students about a girl who is overweight but very proud of who she is and is dealing with the people in her life who are telling her that she should be a different size.

Host Amber Smith: What about books for dealing with the loss of a parent?

Jaclyn Sisskind, MD: "Red, White, and Whole" is a great book that deals with a girl who's losing her mother to leukemia, and it's set in the 1980s, so I liked it a lot just because the soundtrack and the styles were very much my youth. But the kids that I've recommended it to said that "Wow, this hurt my soul a little bit," but they said they liked that it was a vintage book, which made me sad because it was set in the '80s, and I'm not vintage yet. But that book is by Rajani LaRocca, and it's just a wonderful story. It was a Newbery Honor book last year.

Also, there's a new picture book that just came out called "Sitting Shiva." It's by Erin Silver, and it's illustrated by Michelle Theodore. This is a book that talks about a girl whose mother just died, and they're working through the Jewish tradition of sitting shiva, which is a seven-day mourning period right after death. And the purpose of it is that the family is not alone, and the girl does not want all these people in the house.

And then she starts to understand how that community afterwards can help you work through the emotions of sadness. And I think that this book really applies, even though it's about a Jewish tradition. It's a lovely picture book for anybody who's going through loss.

Host Amber Smith: What about some books for someone who's feeling surrounded by bad news?

Jaclyn Sisskind, MD: "Everywhere Blue," by Joanne Fritz, is a book about a girl whose family is struggling. Her parents aren't communicating well, her older brother has run away from college, and she's just trying to deal with all of that. Plus the regular stresses and drama of being a middle school girl. And I think it's a book a lot of people can identify with.

But also, sometimes when you're feeling like you're surrounded by bad news, you just want to read a book that makes you feel happy and hear about a person who was in a bad situation and came out OK. And so for me, that book is "Donuts and Other Proclamations of Love," by Jared Reck. Written for high school students, it's funny, and it's sweet, and it's got some sad, deep parts to it, but in the end it just has the ending that you want it to.

Host Amber Smith: And what about for kids who are struggling with loneliness?

Jaclyn Sisskind, MD: There are two books by the same author that I just love for this sort of thing. Both of the books are by Erin Entrada Kelly.

One is called "We Dream of Space." The other is "Hello, Universe."

"We Dream of Space" is about a girl -- it's also set in the '80s -- it's a girl who feels lonely in her family. Her parents are on the brink of divorce. She and her brothers aren't connecting very well, and she really hooks into the astronauts that are going up in the (space shuttle) Challenger and wants to be an astronaut and really connects with them. And the story brings you through leading up to and then after the disaster and how she finds friends and solace in her family.

And "Hello, Universe," also by the same author, is about a boy who's just a loner and finds his group of friends in a very unconventional way.

Host Amber Smith: In general, when you walk into a library with no idea about what you want to read, how do you go about choosing a book?

Jaclyn Sisskind, MD: This is going to sound like a really annoying answer. I very rarely walk into the library with no idea what I'm going for.

But I often have a list, but I usually just kind of browse around. I tend to find an author that I've already enjoyed and look to see if there's anything else by them. I also am somewhat of a dork when I am reading. I read the acknowledgments at the end of the book, and often authors will thank their agent, their publishing house or other authors that read their book that have similar styles.

And so then I'll look up those authors and see if it's something I would like.

Plus, libraries always have great displays, depending on themes of the month.

So that's a great way to find information, too.

Host Amber Smith: Well, Dr. Sisskind, thank you so much for making time to talk with me.

Jaclyn Sisskind, MD: Thank you so much for having me. And Amber, I just wanted to say at the end, if people are interested, and want to know what they can do about book banning in their community, there are a couple very small things that make a big difference. One is just to speak up, talking about the books that you love and why you love them.

If you are on social media, putting out a tweet or an Instagram post, this was a great book and here's why, it makes a big difference, especially if you tag the author in it. Speaking up at school board meetings and supporting your teachers and librarians, especially if you see that something like this is happening in your community.

The first thing to do is reach out to teachers and librarians and say, how can I help? When's the next meeting? Writing letters of support. Those are always to get voices out there fighting for the books and for everyone to have access to them.

Host Amber Smith: My guest has been Dr. Jaclyn Sisskind, a pediatrician from Upstate Medical University who's enthusiastic about reading.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Sharon Brangman, who directs the center of excellence for Alzheimer's disease at Upstate Medical University.

What can we do to reduce our dementia risk?

Sharon Brangman, MD: There's a lot that's within our control that we can do to help reduce that risk. And one of those is exercise. There's a lot of studies that show that exercise is very, very important for our overall health, but especially important for brain health. We know that the brain requires a good circulation, a good blood flow, and when you exercise, that increases blood flow to the brain.

The other thing that happens is that there's these chemicals that help stabilize and grow nerve cells that move from our peripheral or external circulation into the brain and help stabilize the brain. And I tell people, you don't have to go run a marathon. It's as simple as taking a walk every day. And if you can build up to taking a walk about 30 minutes a day, that is excellent. The bare minimum is 150 minutes a week.

And the other piece I say is take a walk with a friend, because socializing and talking to people is very, very good for our brains. And we learned during the pandemic when people were isolated they actually had a decline in their brain power and had an increased risk of developing Alzheimer's disease.

So socialization, meeting people in groups, in person as much as possible is the best for our brains. The screens are not as good. They're probably better than nothing, but it's really that in-person interaction that our brains do the best in.

So you want to eat a healthy diet, which means not that much red meat, mostly fish and lean meats, lots of vegetables -- the more color in your vegetables, the better -- fruits. Stay away from things that are highly concentrated in sugar, such as sodas and fruit juices, and of course all the things we love like chocolate and dessert. I'm not saying you should eliminate all of them. And people get all nervous because they don't want to do radical changes in their diet. So I say just start small with one thing. So maybe stop drinking soda, and don't even drink diet soda because artificial sugars aren't very good for you either. Try doing water or maybe a seltzer or something like that.

Skip the orange juice in the morning because that's usually too much sugar first thing in the morning. And maybe reduce your takeout food, or your fast food, and do more food preparation in your own home. And I know everyone's busy, and it gets hard to make those meals, but those are the things that may help to make the difference.

A healthy diet means eating foods that look as natural and normal as possible. The more they are processed, the worse they are for our bodies. So we want foods that look like what they're supposed to, and in general, those foods that are convenient that you heat up quickly, that you get by taking out, are generally processed to the point where a lot of extra ingredients are added, such as salt and sugar and excess fats, and maybe certain chemicals to make them maintain color or last longer. Those are all bad for our body.

And then the other thing that most people don't want to hear is that alcohol isn't really good for our brains. And there's more and more research that shows there's no safe amount of alcohol in general for our bodies, but we know that alcohol is toxic to nerve cells, and we've seen this in people who have had problems with alcohol use who get a form of dementia from too much alcohol. So I try to encourage people to maybe save alcohol for very special occasions. Try to pass it up. Certainly don't drink it every day. And that's another way of making sure that you have good brain health.

I'm a geriatrician, so I'm always helping people to understand what we need to do to age well or age successfully. And that doesn't necessarily mean that you age without getting certain diseases, but you try to control the things that you can control. And the things that we can control are eating well, sleeping well, maintaining social contacts, exercising, keeping close eye on the amount of alcohol you're taking. Of course, if you smoke -- don't smoke. I can't think of any disease where smoking is helpful. If you have diabetes or high blood pressure, see your doctor and get those under control. If you have high cholesterol, get that under control.

These are all things that cause wear and tear on our bodies -- whether it's your brain, your heart, or your kidneys -- and can get in the way of you aging well.

Host Amber Smith: You've been listening to Dr. Sharon Brangman, director of the center of excellence for Alzheimer's disease at 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: Jennifer Campbell is a poet and English professor in Buffalo, New York, where she co-edits the journal Earth's Daughters. Her poem reflects the sense of helplessness we feel when a friend receives terrible news. Here is:

"For You, I Would Wish"

a sensory deprivation tank

the numbed pulse of sound

tepid limbs floating

above the black surface

separating here and gone

There would be no trooper

knocking on your door

at daybreak, waking the dog

on a cold Sunday.

No spears of light

jamming your eyes

with information

No bristle of his beard

to miss as you look

into the doll faces

of his daughters

who clung to his shirt

the night before

In the silent chamber

all will be mint, eggshell, slate

no windows to the world

saying you are alive

but now he is not

the son you brought the world

in your teenage fierceness

and lost far too soon

to ever want to feel

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," recharging during times of stress.

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 Broeckel.

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