What Your Teen Should Know About Ovarian Cysts

By Angela Chu, pediatric resident at CHOC Children’s

When girls hear the words ovarian cyst, they think of pain and worry about needing surgery. However, there are many different types of cysts, and some are actually part of the normal monthly cycle.

What are ovarian cysts?

A cyst is sac filled with fluid. Ovarian cysts are relatively common in adolescents and are often found incidentally. They can be either simple or complex cysts and are most frequently “physiologic,” meaning they happen normally, because of the way the body functions. In menstruating females, the ovary goes through a cycle every month to prepare an egg to be released into the uterus. During the first part of the monthly cycle, the egg is enclosed in a follicle which grows for two weeks, and then ruptures to release the prepared egg (i.e. ovulation). The follicle then evolves into something called a corpus luteum which shrinks and then disappears within two weeks, in time for a new follicle to develop. Cysts can develop when the follicle fails to rupture to release the egg or if the corpus luteum fails to shrink.

If the cyst develops separate pockets of fluid, it’s a complex cyst. Some cysts contain material other than fluid, such as skin cells or blood.

ovarian cysts
Image courtesy of Encyclopedia Britannica

Symptoms of ovarian cysts

Cysts are often found incidentally and don’t cause any symptoms. Some women may feel a sudden sharp pain in the lower abdominal region during the middle of their cycle. This corresponds to when the follicular cyst ruptures to release the egg, and is called “mittleschmerz.” The pain usually resolves fairly quickly. Larger cysts can cause pain simply due to their size, or when they rupture. In these cases, women might experience irregular periods, pelvic (lower abdominal) pain, bloating and a sense of fullness in the lower abdominal region. If the cyst is large enough, it can push on surrounding organs and cause increased urinary frequency, constipation, indigestion, or pelvic heaviness. If your daughter experiences any of these symptoms, speak to your primary care provider. Most common concerns can be managed by your primary care provider or an adolescent medicine specialist, who will determine if studies such as an ultrasound are necessary. If there is concern that a cyst may need to be removed, your provider will refer you to a gynecologist.

Complications of ovarian cysts

If the cyst becomes large and ruptures, it can lead to abdominal pain and bleeding, which can be minor or severe. There are times when the cyst can cause the ovary to twist on itself, leading to something called ovarian torsion. This can cause intermittent severe pain, nausea, vomiting, pallor and inflammation.  Ovarian torsion should be evaluated immediately.

Treatment for ovarian cysts

Cysts can be visualized and monitored with an ultrasound. Cysts that are smaller than 6 cm are usually asymptomatic and will likely only be monitored and not require intervention. Most cysts resolve on their own without treatment. Depending on the size, your doctor may recommend a repeat ultrasound in 4-6 weeks to make sure the cyst has resolved on its own. Oral contraceptive pills, also known as birth control pills, can be given to prevent new cysts from forming; however, they do not make existing cysts go away. Follicular cysts that become symptomatic or keep coming back may require surgery for removal and are an indication to start a hormone pill. Rarely, some forms of cysts identified by ultrasound will need to be surgically removed.

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Is Your Teen a Safe Driver?

By Kambria Nguyen, pediatric resident at CHOC Children’s

Motor vehicle accidents are the number one cause of unintentional injuries in adolescents age 15-19. These accidents account for 36 percent of all deaths in this age group ― Six teens die every day due to motor vehicle accidents. Summer months have the highest rates of teen fatalities throughout the year, but it’s not just teen drivers who are at risk; teen passengers are also at increased risk.

There are many factors unique to teens that put them at increased risk of having an accident:

  • Teens are inexperienced drivers and may not be able to recognize dangerous situations.
  • Teens are also more likely to engage in risky behaviors such as speeding and leaving little room between themselves and the car in front of them (known as headway).
  • Teens have the lowest rates of seat belt use.
  • 40 percent of teens report texting while driving.
  • The risk of being in an accident increases with the number of teen passengers.

According to the Centers for Disease Control (CDC), nearly one-third of traffic-related deaths occurred due to an alcohol-impaired driving crash. However, drugged driving is on the rise. A recent study found that the number of people killed in crashes where drugs were present surpassed the number killed in crashes where only alcohol was detected.

In 2014, the most recent data available, 209 child passengers ages 14 and younger died in alcohol-impaired driving crashes. More than half were riding in the vehicle with the alcohol-impaired driver.

Safe Driving Tips for Teens

  • Always wear your seatbelts.
  • Follow the rules of the road.
  • Never drink and drive. Never get into a car with someone who had a drink. Make sure you have a designated driver or someone you can call if you are stuck.
  • Whether it be alcohol, marijuana or recreational drugs, impaired driving of any kind can be deadly.
  • Remember that your texts can wait. Distracted driving is dangerous.

How can you help your teen be a safe driver? Keep in mind the following tips to support your teen and their safe driving habits:

  • Before teens drive alone, supervise them driving during different times of the day and in different weather conditions.
  • Lead by example. Wear your seatbelt and do not text and drive.
  • Stress the importance of a good night’s rest as drowsy driving leads to accidents.
  • Prohibit teen passengers for the first year your teen is licensed. In California, you cannot drive between 11 p.m. and 5 a.m. or transport passengers under 20 years old, unless accompanied by a California-licensed, parent or guardian, driver 25 years or older, or a driving instructor.
  • Talk to your teen about drugs and alcohol. Discuss the dangers of impaired driving and distracted driving.
  • Sign a parent-teen driving agreement. The CDC has a template, or you can make your own.

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Mindfulness Tips for Teens

Teens’ mental health is as important as their physical health. It’s not always obvious when a teen is struggling emotionally, but recognizing the symptoms and seeking early and effective mental health services are important to prevent more serious mental health issues.

Parents should talk to their teens and foster a relationship based on open communication. Seek to understand how your child is feeling, without judgment, before you try to fix the problem.

As a pediatric psychologist at CHOC Children’s Hospital, Dr. Mery Taylor helps teens and their families who are facing a variety of mental health challenges. Typical concerns or issues teens seek treatment for include:

  • Anxiety
  • Depression
  • Difficulty coping with stressors such as: chronic illness, a life or family change, a social or school concern, and grief and loss
  • Disruptive behavior disorders, including attention deficit/hyperactivity disorder (ADHD) and oppositional defiance disorder (ODD)
  • Eating disorders

“Throughout my ten years at CHOC, a majority of teens I have worked with have come to me for pain issues, anxiety, depression, eating disorders and difficulty coping with stress,” says Taylor. “I have also seen an increase number of transgender youth and parents seeking services.”

mindfulness
Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

What is mindfulness?

Practicing mindfulness, or relaxation techniques can help teens build coping skills to address issues, such as anxiety disorders. It’s very easy to get wrapped up in our emotions and not see our way out of them, says Dr. Taylor.

“The more we attend to the fear, the more power it gets and we can become paralyzed about what to do, or avoid aspects of our life in attempt to manage the anxiety. We can get stuck on a cycle of trying to avoid our anxiety and forget to live life. At times, we allow our negative thoughts and emotions to dictate our actions without stopping to assess if they are valid and irrespective of the consequences. For example, we might avoid going to school because we don’t feel we have studied enough for a test and then end up missing out on important instruction for another class. Mindfulness makes us stop for a minute and check in with ourselves,” says Dr. Taylor. “Mindfulness asks us to be curious of our thoughts and feelings without judgment or action—to just be in the moment. Developing acceptance and compassion for the painful parts of our inner emotional life can weaken the power of the anxiety. Once weakened, we can better manage our fears.”

Tips for practicing mindfulness:

  • When something is bothering you, shift that attention to yourself, rather than what you’re reacting to.
  • Stop for a moment to center yourself, by addressing and labeling those sensations (fear, worry, anger). Validate these feelings to ourselves can help to lessen our fight or flight reaction.
  • Now turn to your attention to your body. Identify the sensations going on in your body. All emotions are experienced as sensations in our body.
  • If you find yourself attending to the thoughts or feeling again, gently bring your focus to your body sensation (e.g., muscle tension, heartbeat, etc.).
  • Practice relaxation techniques to calm the nervous system, to stop the nervous reaction and respond more cognitively. For example:
    • Autogenic relaxation. Autogenic means something that comes from within you. Visualize a peaceful setting. You can repeat a phrase such as, “I am relaxed” to invoke muscle tension release. Focus also on breathing slowly and evenly.
    • Progressive muscle relaxation. In this relaxation technique, you focus on slowly tensing and then relaxing different muscle groups in your body. You can start with clenching your hands into a fist and then relaxing them. Focusing on the difference between muscle tension and relaxation, will help you become more aware of physical sensations.
    • Form a mental image of a place that find to be peaceful and calming. To relax imagine yourself exploring this place. Try to incorporate as many senses as you can, including smell, sight, sound and touch on your journey. If you imagine relaxing at the beach and feel the cool sand on your felt, and sound of the crashing waves
    • You probably already know other things that calm you (e.g., listening to music, taking a shower, walking your dog, etc.). You can do those things too.

Parents can help facilitate mindfulness.

“Being non-judgmental is a big part of mindfulness,” says Taylor. “It’s important to accept that we do what we can, and that we have limitations. It’s important to acknowledge everything you have going on in your life that’s happening at once, and to give yourself a break.”

“A parent might acknowledge and normalize the anxiety associated with college applications as a way to show compassion and thereby minimizing the urgency that the teen feels. Once more calm, the teen can focus on the college application, instead of attending to the distressing thoughts and feelings.”

Parents hoping to teach mindfulness practices to their teens are also encouraged to model the behavior themselves, says Taylor. Remind teens that practicing mindfulness can also improve concentration at school and improve performance.

CHOC believes mental health treatment should be fully integrated with physical health treatment. Our psychology team works closely with patients’ medical teams to attend to emotional, behavioral and developmental needs through inpatient and outpatient therapy. Our goal is to foster the whole well-being of the teen and family.

CHOC psychologists have recorded a library of guided imagery audio tracks to help children and teens relax, manage pain, ease fears and anxiety, fall asleep easier and more:

Experience guided imagery as a healing tool

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Stimulants Abuse in Teens

By Sandy Merino and Jennifer Yen, clinical pharmacists at CHOC Children’s

With final exams right around the corner, teens will be tempted to turn to stimulants as they hope to cram in some last-minute late-night studying. Kids seem to be under more pressure now than ever before. Get to know the dangers of stimulant abuse to help your kids make smart decisions and stay healthy while performing under pressure.

These days, stimulants are only prescribed to treat a few health conditions, including attention deficit hyperactivity disorder (ADHD), narcolepsy, and rare cases of depression that have not responded to other treatments. Any time these drugs are taken in a way that is not intended, it is considered abuse.. This includes taking someone else’s prescription, taking the medication in ways other than prescribed, and taking the stimulant to get high. A basic understanding of stimulant abuse can help you as a parent protect your family and friends against it.

The Science Behind Stimulants

As the name suggests, prescription stimulants increase biochemical activity in the brain that can help boost alertness, attention and energy. The most common prescription stimulants are Adderall, Ritalin and Concerta. ADHD is one of the most commonly diagnosed conditions in children and adolescents. According to the Centers for Disease Control (CDC) and National Institutes of Health (NIH), approximately ten percent of children between ages 4 and 17 years are diagnosed with ADHD, and about 60 percent of them take medication. When they are taken as prescribed they are generally safe and effective. Doctors prescribe these medications starting at low doses and then gradually increase them, monitoring for effectiveness and side effects. The lowest effective dose is then continued, and the child is monitored on a regular basis. When taken as prescribed, many of these children will experience a reduction in ADHD symptoms and an improvement their academic performance, behavior, social relationships, and self-esteem.

Unfortunately, stimulants can be abused, and often by friends and family. Did you know that almost ten percent of high school seniors admit to abusing ADHD medications in the past year, according to the National Institute on Drug Abuse? This number is as high as 35 percent among college students.

Pressure to perform tempts teens to turn to stimulants

Teens and young adults who abuse stimulants often do so for a better ability to concentrate, increased energy and more confidence. Academic pressures are the main trigger for teens and young adults to abuse stimulants, such as pulling all-nighters to study. What they might not realize, though, is that these drugs can be habit-forming when abused and can be dangerous when taken in high doses. Stimulants can speed up heart rate and blood pressure, and cause insomnia and anxiety. Although students expect stimulants to help their academic performance, studies have found that stimulants do not increase learning or thinking ability when taken by people who are not diagnosed with ADHD. Students who abuse prescription stimulants actually had lower GPAs in high school and college than those who didn’t abuse prescription stimulants, according to the NIH.  Although a late-night study session and some Adderall might seem like a good way to cram for exams, it actually doesn’t work, may hurt them in the short-term, and definitely won’t help them with their long-term goals.

While some teens turn to caffeine pills or Adderall medication believing it will help them focus and cram for school exams, others turn to energy drinks. Many teens aren’t aware of exactly how much caffeine they’re consuming in each energy drink. Although experts consider 200-300 mg of caffeine a day to be a moderate amount for adults, teens should limit their consumption to much less, about 100 mg per day. Meanwhile, many caffeinated drinks easily contain 80-160 mg of caffeine in one serving. Some popular energy drinks contain up to 240 mg per can. Teens consume caffeine in more places than they realize: hot chocolate, iced tea and non-cola soda all contain caffeine. Too much of it can lead to anxiety, dizziness and headaches.

Abusing stimulants to get high

While some teens abuse stimulants for academic performance, others may use them to get high. When stimulant medications are taken suddenly and in ways not prescribed, they can rapidly increase dopamine activity in the brain, causing a sense of euphoria, which can increase the risk of addiction. This effect on the body and brain is similar to the effect of illicit drugs. Prescription stimulants are normally meant to be taken by mouth in a pill form, but other ways of abusing them include crushing the tablets to snort or inject them. This can cause additional problems because inactive ingredients in the tablets can block small blood vessels, leading to severe damage to the heart, brain and other organs, not to mention the risks associated with intravenous drug abuse, such as hepatitis and HIV/AIDS. Another form of prescription stimulants is a prescription patch, which contains an entire day’s worth of medication that is meant to release slowly over time through the skin. Some people abuse the patch by extracting the medication and consuming it all at once or by chewing on the patch. This is an extremely unsafe method of prescription drug abuse due to the more rapid method of exposure.

Be aware of the most commonly abused stimulants and their side effects:

Drug Street Name Medical Use Reason for abuse Adverse Effects
Amphetamines (Eg: Adderall and Dexedrine)

Methylphenidate (Eg: Ritalin and Concerta)

Skippy

The Smart Drug

Vitamin R

Bennies

Black Beauties

Roses

Hearts

Speed

Uppers

Lightening

Amped

Black/Blue Mollies

ADHD

Narcolepsy

Depression

Academic performance enhancement

To stay alert

Lose weight

Get high

 Decreased sleep

Decreased appetite

Sense of anger

Paranoia

Increase in blood pressure

Dangerously high body temperatures

Irregular heartbeat

Risk for seizures and stroke at high doses

If you or your family has ADHD medication at home, be aware that it may be of interest to friends and family. Keep a close eye on your supply, especially if you have other teens and young adults in the house. Always keep medication out of reach of children. Keep open lines of communication with your kids about the pressures they experience and healthy perspectives on drug abuse. If you notice any red flags like a rapidly dwindling medication supply or sudden increases in cash flow, talk to them about it.

If you notice some changes in your teen and suspect drug abuse, look out for red flags such as: insomnia, excessive weight loss, twitching, disinterest in their hobbies, memory problems, neglect of personal appearance, sudden disinterest in work, school, or family responsibilities, or change in spending habits (for example, money missing or sudden requests for money without a reasonable explanation). If you notice or suspect signs of a drug problem in your teen, take action right away. Consult their primary care physician or school guidance counselor.

If you or someone you know is in a crisis and need to speak with someone immediately, call the National Suicide Prevention Lifeline: 1-800-273-TALK. This is a crisis helpline that can help with a variety of issues.

If you need information on treatment and available resources, speak to your child’s primary care doctor, or visit the Substance Abuse Treatment Facility Locator, or the National Institute on Drug Abuse for Teens.

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What to Expect from Polycystic Ovary Syndrome in Teens

By Dr. Alexandra Roche, pediatrician specializing in adolescent medicine, and Dr. Marc Dadios, pediatric resident at CHOC Children’s

It’s normal for adolescents to go through physical and behavioral changes during puberty, but it can be difficult for parents to know when something may be cause for concern. Teen girls who experience irregular or missed periods may be suffering from Polycystic Ovary Syndrome (PCOS), a condition where a woman’s hormones become out of balance.

With PCOS, ovaries produce higher than normal amounts of hormones causing small cysts to form on the ovaries. These are generally not cancerous and don’t need to be surgically removed. Side effects include hair overgrowth and acne outbreaks.  This condition frequently manifests during adolescence and can be associated with obesity. Women with PCOS may have an increased risk of developing type 2 diabetes, metabolic syndromes, cardiovascular disease and endometrial carcinoma. It is the most common cause of infertility in women.

What to expect during your doctor’s visit

If your doctor is concerned about your child developing PCOS, your doctor will order blood work to be checked before your next visit. Some of the blood work that your doctor will check are testosterone levels, estrogen levels, hormone precursors called DHEA levels, glucose levels, lipid levels, and cholesterol levels. Your child will also be asked to provide a urine sample as pregnancy, like PCOs, can be the cause of irregular or absent periods.

PCOS Treatment

A treatment plan for PCOS includes management of the underlying metabolic abnormalities as well as reducing the risk factors for type 2 diabetes and cardiovascular disease. Diet and exercise changes for weight reduction will be recommended in cases associated with obesity, to prevent diabetes and help control hormonal imbalances in your child’s body. Hormonal therapy can help control hormonal imbalances caused by PCOS. Hormonal therapy is also known as oral contraceptives or birth control pills but those names can be misleading for the purpose of using these pills. The importance of using hormonal therapy is to normalize your child’s periods to prevent the development of endometrial cancer. Women who do not have periods for a long period of time are at increased risk of developing endometrial cancer.

What to expect next

If your child’s blood work shows evidence of hormonal imbalances concerning for PCOS your doctor will recommend diet, exercise, hormonal therapy, and close follow up. While PCOS can be a scary diagnosis to face, this condition can be effectively managed with a team effort between yourself and your doctor. Your pediatrician may refer your child to a pediatric endocrinologist for further specialty care.

Learn more about adolescent medicine at CHOC.

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