001all right good morning everyone thank you for attending the annual freshman forum virtually from danbury high school i want to quickly thank everyone for the time they put in in organizing this and without further ado because we don't have a ton of time i want to introduce elky from mcca thank you principal davidson good morning d'ambree high school students and staff my name is elky kaleroswini i'm the director of prevention services at mcca i would like to thank caitlyn lewis jennifer ondeck principal chris davidson and the danbury high school staff for organizing the freshman forum presented by dr santucci i would like to wish our danbury students staff and community a very safe and healthy holiday season dr santucci is an assistant professor at yale new haven children's hospital and she's been with yale hospital
002for the past 21 years she is a professor of pediatrics and the emergency medicine at yale university school of medicine dr santucci has been actively involved in medical student education she is regularly out in the community interacting with and teaching school nurses and meeting with community emergency medicine and family medicine providers dr santucci is board certified in pediatrics and pediatric emergency medicine and is a fellow of the american academy of pediatrics otherwise known as aap she has authored numerous research papers book chapters and review articles and has received invitations to speak nationally on topics such as clinical forensic medicine trauma and risk management she is a recipient of the michael shannon humanitarian award i could say more amazing things about dr santucci's work however we have limited time so i would like to introduce to
003our danbury staff students and community dr karen santucci good morning everyone and and elky thank you so much for that lovely introduction you did a great job that was fantastic um and i so very much appreciate the invitation to speak with all of you this morning i wish i could see you i was just saying it's so important to be able to sort of pick up on your audience and to get a sense of whether or not there's a question i'm gonna do the very best that i can and i really need for you to know um that this is just about the most important half an hour that i can spend during my year um and that is very much because of who i am what i do where i work um working in
004an emergency department seeing what i see and my colleagues seeing what they see this is top of mind for us to try to get information out there um knowledge is very much power and i'm so hoping to share some knowledge with you in just a brief time period about 15 maybe maximally 20 minutes and then hopefully having an opportunity for some questions so we'll dive right in but thank you so much for allowing me to speak with you what we're going to talk about over the next few moments is a little bit about the science of the adolescent brain so basically your brain and what makes your brain different from an old brain like mine the impact of things like underage nicotine use and that can be related to either cigarette use or vaping marijuana
005and alcohol use the effects of those types of substances basically toxins on a healthy developing brain some of the consequences of underage drinking and we're actually going to present a case scenario related to that an actual patient that i hope to take care of in the emergency department at yale new haven children's hospital that's a pediatric emergency department where we see about 38 to 40 000 children a year so a busy emergency department and then as a pediatrician as an emergency medicine physician and also as a mom i am privileged enough to have two children but what happens when there is an untoward and unfortunate event that occurs related to something like alcohol and someone's not okay a patient is not okay and what that feels like to either make a phone call or go
006out into our waiting room in the emergency department to share information with a family information that you would never want to give to anyone so to start off the adolescent brain this is sick sick in a good way and that the adolescent brain is absolutely amazing and you're going to hear a little bit about why but i wanted to have you think about something what age group first of all do we care for in pediatrics some folks might think you know dr santucci probably from birth because we know about neonatologists and you start right when someone's born and maybe up until about 18 years of age or so so when most people are graduating from high school most people are going off to college the really interesting answer to that to sort of set the
007stage for what we're going to talk about today is the adolescent brain a developing brain a brain that is being pruned a brain that's evolving a brain that's getting better all the time a brain that's developing and expanding its capability that goes on according to neuroscientists until about 25 to 27 years of age and in particular a part of our brains called the frontal lobe um and that's in the front part of your head there's something called the frontal lobe and the prefrontal cortex right where your forehead is that's the area that we're very much dependent on for its full development at 25 to 27 years of age for what most people would categorize as executive function and we're going to talk about that in just a moment so what's special about your brain the
008adolescent brain absolutely everything is special about your brain you can learn things much more quickly than i can you can remember things so much better than i can your plasticity your capacity the ability of your brain is absolutely immense and you may have heard from people and some of you may be taking language classes like spanish or italian or french you can pick up a new language so much more quickly than someone who's a little bit older and it's not just that we're older but it's truly related to the fact that an older person's brain is very different from a younger person's brain and that the capacity is that much greater and why is it that much greater because what you're doing with your brain really really matters and almost like a muscle like your
009biceps muscle or your gastroc for those of you who are athletes the more you use those muscles the better they get the stronger they get the bigger they get for your brain as a developing brain this is the neuroscience of cognition and your brain the more you use your brain in a healthy way reading thinking studying on eating healthy listening to music learning a new language um you may have heard about people doing crossword puzzles just thinking a little bit outside the box the more you use your brain in a healthy way very much like using your muscles in a healthy way you're developing your brain and allowing your brain to be that much better but the converse of that is that you're if you're doing something that could potentially hurt your brain like introducing
010your brain to something like a toxin and a toxin is something that can hurt you and oftentimes we don't think about things like cigarettes or alcohol or marijuana or e-cigarettes or vaping as introducing a toxin to our brains but i'm here today to tell you that that's exactly what's happening and those toxins affect our adolescents our teenagers brains differently than they affect the brain of an adult and why is that it's because a teenager's brain is different it's evolving it's sensitive it's growing and because it's literally growing that growth can arrest it can stop and there can actually even be this is crazy but shrinkage of the size of someone's brain it can get smaller there can be fewer nerve cells based on the introduction of some of these toxins and then the other thing
011is because an adolescent brain is different than an adult brain it's more sensitive to different chemicals and the way we respond to different chemicals as an adolescent is very different there's higher sensitivity the feedback loop that we have with our neurons and our nerve cells and our neural transmitters things like dopamine and norepinephrine and things like that serotonin the way that our brains respond when there's an introduction of a toxin is very very different in adolescence than it is in adults and very much related to that some people may be surprised to hear that when there's an introduction of something like alcohol at an earlier age so the legal age of drinking is 21 right and there's a reason for that it should probably be 25 in reality as a pediatrician i would say that
012but the legal age that we have in connecticut is 21 when someone starts drinking alcohol and it may start off very innocently tasting something having some wine drinking beer something that starts early on the earlier someone actually starts to drink alcohol or smoke cigarettes or use marijuana because the adolescent brain is different than the adult brain the actual likelihood of developing a dependency or an addiction is much much greater and so there have been very good studies that have been published in medicine in neuroscience that if someone's older when they start to drink 21 22 23 even if they might have a genetic predisposition towards dependency or alcoholism and that does exist in certain families even if there might be a genetic propensity towards that folks if they start drinking later are much less likely
013to develop a dependency or an addiction and this information this knowledge is incredibly powerful and so if you were to ask me dr santucci so does that mean you know as a parent if i could keep my child from drinking until they're older from experimenting with having alcohol or even um some people say you know i have let my child have a glass of wine or a beer you know they're 16 17 years old they're in my house it's controlled here's the issue that actually is dangerous to do something like that because you're introducing something to a brain that doesn't exactly know how to handle it and is much more vulnerable than an adult brain so there are hazards associated associated with that okay to recap the adolescent brain keeps growing and developing and evolving
014until about 25 to 27 years of age this younger brain has a tremendous capacity to learn things very very quickly languages math dance steps amazingly quickly the connections between different sections of our brain as an adolescent are not fully developed yet and the adolescent brain the developing brain is constantly going through alterations really good alterations pruning and rewiring of these nerve cells of these neurons making it better when given the opportunity when not being exposed to a toxin the amygdala a little almond sized and almond shaped area of the brain in teenagers is being hyper stimulated hyper triggered by hormones there's a lot going on in adolescence there's a lot going on in middle school and in high school related to the brain related to hormones there are so many changes some children will grow
015six eight inches in one year it's an amazing time period for transformation and the brain is no different there's a lot going on there and the fact that the amygdala which helps us temper things like our responses to external stimuli if someone gives us feedback is very very sensitive and so we're sensitive to others and this area is also very very sensitive to the chemicals associated with things like cigarette smoking alcohol marijuana additionally that prefrontal cortex that we spoke about a little while ago right where your forehead is this is the last area to fully develop and make its connections and i had mentioned that this area is responsible for executive function that's stuff like making the right decision exercising really good judgment and so if we have an adolescent brain and if that area
016isn't fully developed yet we may not make the best decisions baseline but then imagine if we're not making the best decisions baseline because we truly aren't capable when we're 13 14 15 years of age but then what if you superimpose on top of that something like a toxin something like a chemical that's going to impede that even farther and for any adults who are listening right now the fact that the prefrontal cortex the frontal cortex isn't fully developed yet um if you've ever been in a situation where your child your son your daughter your niece your nephew has done something and you're like what the heck were they thinking the fact of the matter is when you're thinking oh my gosh what a knucklehead the fact of the matter is yes that's what's happening their
017prefrontal cortex the frontal cortex isn't fully developed yet so for most of the time a good part of the time they're struggling with really trying to make the very best decision because that prefrontal cortex isn't fully developed yet so they don't really have the capability to make the very best decisions and that's why having really good relationships with adults with mentors with coaches with colleagues with the folks who've organized this session is so critically important because that mentoring as their brain is developing is allowing them to make the right decisions okay so a couple of cartoons that allow you to see the structure of the brain i don't know if you can see my cursor or not but they're labeled and so there's a side view on the left the front of the brain the
018frontal cortex we were talking about the back of the brain is the cerebellum and this is a cross-sectional view you can see the little brown almond shaped um object there the amygdala and right below that the green object is called the hippocampus that structure hippocampus is actually affected by things like alcohol as well and that the hippocampus along with partially the amygdala also um allows us to lay down memory and so you'll hear when someone has had a fair amount of alcohol they may not actually remember an event you may see that on tv you may have heard stories about that but that's why that happens because the effects of alcohol on the hippocampus that green structure that you see um there's one on each side the left and the right um hemispheres so some
019of the effects of alcohol we know now based on what we just discussed that teenagers are more vulnerable to the effects of alcohol than adults are for a whole host of reasons but predominantly because a teenager's brain is still evolving growing being pruned setting down networks there is good data now in medicine from functional mris magnetic resonance imaging that folks who drink alcohol start drinking alcohol early and with some degree of consistency will actually have smaller brains less capable brains than folks who avoid alcohol during high school and the early parts of college and the right side of the slide you'll see the alcoholic brain and the dark that you're seeing these are ventricles within the center of these images of the brain and that's cerebral spinal fluid so that's fluid the bright white that
020you see in these images is brain white and gray matter now if you go down to the lower panel on the right hand side that's a normal brain there's far less of that central black the central black is fluid what that means is that's a lack of brain structure that's a lack of neurons that's that's there a diminished amount so we have data that we didn't have 20 30 40 years ago to support on all of this information that i'm providing unto you today so some of the consequences of underage drinking you may have heard about folks who had a little bit too much to drink they will get nauseated and will have vomiting in reality what that is that's the body saying oh my god oh my god oh my god my body just
021took in too much alcohol if i don't make my body throw up and vomit that alcohol can actually kill me that's really what's happening when someone drinks too much alcohol there can be depression of the respiratory center and with depression of the respiratory center someone can actually slow down their respirations their breathing rate to the point where they stop breathing and die and so as a pediatric emergency medicine physician when someone calls 9-1-1 because a friend or a colleague has had too much to drink and they're afraid they're afraid to call someone for help but they're like oh my god i'm scared i say to them thank you you did the right thing because if you leave someone alone after drinking too much alcohol and they have depression of that respiratory center they can actually
022stop breathing and can die and i would like to say that that's never happened and i've never experienced that in my emergency department but that does happen and we never want something like that to happen again before getting to that point where there's something that severe someone may have an unsteady gait may not be able to really walk in a straight line they may start to talk a little bit more than they normally would and feel kind of disinhibited and many people are like oh my god they're so funny when they drink that's this inhibition that's happening and the other thing related to the adolescent brain teenagers are less likely to get kind of sleepy after alcohol they get a little bit more revved up and think they can do almost anything whereas adults when
023they drink will get a little bit more tired and then kind of sort of stop drinking and probably watch a movie at home and go to sleep or something like that but if you're disinhibited and you're not realizing exactly what's happening as a teenager you're much more likely to have risk-taking behavior things like saying you know what i just got my license i'm 17 years old i can drive there's nothing wrong but you're not recognizing that there really is a major problem and that your decision-making processes are impaired and you may not have the best judgment so if someone says i'm taking your keys you want to let them take your keys especially if they're that designated driver okay i have promised folks i would just touch for a moment on vaping people think that
024vaping is safe it's not there's nicotine and what's the point here aside from the nicotine and a whole host of other toxins the potential for addiction and much more potential for addiction and dependency with the adolescent brain rather than an adult brain and the other thing is with essen cigarettes and vaping devices these products are being marketed towards children folks are making a gazillion dollars off of middle school students high school students college students with developing brains developing different types of flavors for these devices these are being marketed towards children and people are spending money on this and becoming addicted to it and it's very very dangerous important to be aware of that i just wanted to throw a few pictures up about what some of these devices look like some of them may look
025like a car charger for your phone some of them may look like a flash drive and if i have you focus your eyes to the lower left of this slide you'll see that vaping is dangerous and can affect your brain can affect your lungs can affect your organs and people have died from the effects of vaping okay let's talk about a case this is related to alcohol someone that i saw in the emergency department his name is jeremy this was towards june he came in was brought into the emergency department and i'll tell you why in just a moment jeremy was a great student he got a full scholarship to college he was also an athlete he had the entire rest of his life ahead of him jeremy had graduation at school got a bunch
026of gift cards from his family grandma grandpa they could not have been more proud his future could not be more bright after having a little bit of a barbecue with the family he asked if it was okay to hang out with his buddies on towards the evening and his parents said you know what you earn that absolutely go out and have a good time so he went out unbeknownst to his family and actually even unbeknownst to jeremy um he and his buddies um his friends had brought along some marijuana as well as some alcohol they went to an area in connecticut climbed some rocks and sat up on a ledge and they were feeling great they just graduated they were a little bit disinhibited they were laughing they were talking they were smiling it was
027like the best day ever until jeremy stood up was a bit disinhibited probably shouldn't have he was on top of a ledge he lost his balance he fell back and he landed on a boulder about mid-back his buddies called 9-1-1 he was transported to our emergency department and this is a picture of our trauma room and you can see there's a lot of equipment there there are overhead monitors overhead lights there's a stretcher in the center there's actually um a breathing machine a ventilator in the back um and jeremy jeremy was brought in awake and alert but he could not move his legs he could not move his lower extremities this is considered to be a full trauma we had surgeons anesthesiologists orthopedists anesthesia respiratory therapy we had everybody in the room including pediatric emergency
028medicine everything was done right for jeremy in the hospital and how is it possible that with everything being done correctly things could be so very wrong the damage was done already because of one mistake the rest of his life his entire trajectory was altered jeremy was paralyzed from the weight that the waist down and jeremy was admitted to the hospital and left our hospital in a wheelchair without a hope of ever being able to walk again we knew that the dye had been cast already had to walk out into the waiting room to give this news to his mom and his aunt to share with them what had transpired not only jeremy's life but their lives were changed forever i've seen jeremy multiple times since then he's come into the emergency department with depression with
029urinary tract infections with hopelessness and we can't go back we can only try to go forward this was devastating for jeremy as well as for his family sometimes in healthcare we can't make a difference but sometimes in the world we can and that's why i'm so grateful to be here today because sometimes we can give someone a second chance if you are walking and talking and getting ready for your gym class and going into your cafeteria for lunch and tomorrow morning when you wake up in the morning actually it's saturday you might get up a little bit later when you place your feet on the floor when you get up from bed and you stand up and you're like i can walk that's a gift and you're healthy so we can actually make a difference
030armed with this information that we have so a day like today a partnership with the community like your school has parents like you have who care about you and really smart kids like yourself we can really make a difference you only have one body please take care of it we only have one life please take care of yours and you only have one brain and it's a very very special brain it's evolving it's growing it has tremendous capacity please develop it and use it wisely and i thank you so very much never underestimate the power of one and just how powerful you are we might have like three minutes for questions and i thank you all so very much thank you dr santucci this is not extremely questions in from our students you know so
031i'm just checking refreshing everything nothing yet but we were um i was just wondering um if you have seen an increase in er cases since civilization so so yes jen unfortunately especially with the pandemic where folks are so very stressed we've seen an uptick of utilization of things like marijuana as well as alcohol um you know and i'll just share one very brief um study with you some of you may be familiar with it called the rat park where there was a study related to rats now rats are not humans but there are some similarities where um rats being offered either water or alcohol um in terms of where they are and being fed um when they're alone they will prefer to go towards alcohol you have rats in a rat park where they're with
032other rats they are stimulated they are we think happy it's hard to tell if a rat is happy but they're interacting and they're socializing when water is available to them and alcohol is available to them the rats will drink the water and avoid the alcohol now i only bring this up because it's really really really important to have relationships to socialize we're so fortunate that at least even if we can't get out and about we can actually facetime our friends even if say someone today finds out they're coded positive and they have to be quarantined at home you might be like oh my gosh i can't even see my friends i can't talk to anyone we can still use our phones we can call each other we can facetime that in and of itself is
033an intervention to keep us healthy and to keep our brains healthy and to do the right thing shorter answer is we have seen an uptick yes thank you i do have a couple questions um the first one does weight affect tolerance level oh like someone's body weight does that affect tolerance level so um adipose tissue which is which is um fat probably not so so much but weight in and of itself like if there's a six foot two sophomore compared with a 4 foot 11 sophomore um liver being smaller in the 4 foot 11 person smaller body mass lean body mass overall um the smaller person may not be able to tolerate quote-unquote as much as a larger person now that being said i would be remiss if i didn't say that each individual is
034just that an individual and the way someone metabolizes alcohol can be very different the enzymatic levels of people things like alcohol dehydrogenase can be very different in certain populations there may be folks of asian descent who cannot metabolize alcohol and can become incredibly ill based on that and people who may be much more sensitive to alcohol so as a general rule of thumb with a disparity like that four foot eleven six foot one or two yes overall you could say that but then you've got the individualization of each person to consider as well um and so just very very important to know thank you that was a great question thank you um one last question what happens to your brain if you only smoke marijuana one time so another wonderful question i would say if
035someone has only smoked marijuana once i would say and if this were my daughter my son and they were like oh my god mom i can't believe i did that i'm gonna die i would say you know what first of all thank you so much for telling me that was so important and for parents just being able to listen to hear you know to talk about this someone smokes marijuana once your brain is going to be absolutely fine the problem that we have is because people are genetically different we call that genetic loading and there may be histories and genetic loading where there is dependency and addiction and that's a genetic predisposition within a family if someone smokes marijuana once and they're like oh and then they have a situation where they might be able
036to have it again and then it's a very slippery slope we call marijuana a gateway drug where it can lead to more more severe addictions dependency and utilization of other things like crack cocaine heroin things like that um we've got to be super careful about that because it can be a gateway drug and be a slippery slope but for someone who might have had it once your brain is okay you're not going to have brain damage the worry something is having it once and then your brain not being able to manage it and then developing a dependency and utilizing it and developing that feedback loop where it's a really slippery slope and leads to other problems i hope that helped that was a really good question yeah that did for sure thank you so much
037so welcome thank you all right dr santucci thank you so much for your time today as always very informative and very valuable thanks again for for coming on thank you very much dr santucci thank you elky and everyone happy happy holidays make sure you wear your mask be safe okay be safe and god bless you all take good care thank you thank you happy holidays everyone thank you