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Daily Dose

2016 Goals

1:15 to read

Just finished cleaning up after the Christmas holidays and I resolved that I was going to “de-construct” the decorations before the next holiday…and not have to face the New Year with that task looming.  Now I can move on to some different resolutions!

The more and more that I realize how much time we all spend “hunched” over a screen of some sort, the more I think that this year should be about finding time to disconnect.  It used to be that you could just turn off your phone when you wanted to be “unavailable”.  That seemed so easy…people would just have to call back later, right?  But now we try text, email, g-chat, face time….all sorts of ways to try to connect.  It is much harder to be on the DL or unavailable. 

I continue to read new data on the need for personal communication via oral language, rather than a text or email. But the immediacy of communication these days makes it seem that we don’t talk any more, we just type!!  This is even becoming an issue for younger and younger children as they focus on their “baby”computers and screens that are given to them to watch…rather than on their parents and caregivers faces and interactive language.  There is already data to show that the interaction with a screen is not the same as that with a human….and that language may even be delayed.

So the point of this is that my resolution is to take time everyday to just disconnect from a screen and enjoy a bit of old fashioned solitude and quiet time.  I am going to get up each day and not rush to the computer to check any “late breaking” emails from overnight.  I am also  going to turn off the I-phone which as they taught me early on at the Apple store, is not really a phone but rather a hand held computer!  I hope that there may be an hour every morning and another in the evening when I am totally disconnected….I’ll let you know how I do. Don’t worry if you can’t “find” me….I am just off the grid.

What are your resolutions?

Daily Dose

Red Cheeks In Winter

1:15 to read

Why do children get red cheeks in winter?

It is the time of year for cold temperatures, low humidity and dry skin. It is funny, every year as the temperatures drop, I we start seeing these cute little babies and toddlers who have those bright red cheeks. I always say that they “look like British babies”.

Dry skin is just one of the many issues we see with colder temperatures, and babies red cheeks are one of the most evident. During the winter months we all experience dry skin and using moisturizer becomes very important.

I have written previous blogs about eczema, and while chapped skin is not synonymous with eczema, there are some similarities. The most important thing to prevent dry skin while the weather is cold is to use a moisturizer, and applying moisturizer is best on damp skin. After bathing your baby or child, pat them dry until they are just “a tad bit moist” and then take a moisturizer and apply it to the almost dry skin. The thicker the moisturizer the better, so a cream is preferable to a lotion. It will take a little more time to rub the cream in when the skin is a bit moist, but it will help the moisturizer penetrate the skin. The same thing goes for the face.

I always found that the best time for me to moisturize those rosy cheeks was really after the child had gone to sleep. When my children were younger I found that if I put the cream on when they were awake, that they either rubbed their faces more, or if they were verbal, complained about lotion on their faces. So…I decided that it worked best to have their bedtime routine, with baths, books, and prayers, and then once they were asleep I would slip in and lather up their faces and also even used Chap Stick on their dry little lips. Now, there is no science in this routine, but it seemed to work, and they were much more tolerant of lubricants when asleep than awake.

We are definitely in the low humidity season and the heat is on in the house (I am typing this as I sit by the fire with a blanket over my feet), so you can expect several months of dry skin and chapped cheeks. If moisturizers like Vanicream, Cerave, Aquaphor and Eucerin go on sale, stock up!!  April is a long way away.

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Daily Dose

Spring Allergies

1:30 to read

I just came in from walking my dog and found myself sneezing and rubbing my nose….funny I didn’t think I had allergies!!  But, all of the pollen blowing around right now not only coats your car and yard, but is coating your nasal passages, eyes and being inhaled into your upper respiratory tract as well causing all sorts of issues with seasonal allergies.

This year is proving to be a big allergy season as most of the U.S. had a mild wet winter which is a perfect “storm” for spring allergies. Tree pollen is the biggest culprit right now, and depending where you live it may be oak, elm, mulberry, maple, pecan, aspen….. but all are producing pollen that are blowing in the spring wind.

At this time of the year many people think they have a cold rather than allergies, but there are several distinguishing features.  With a cold, which is due to a virus,  not only do you have a runny nose and cough, you often feel achey and may have a low grade fever and sore throat and the symptoms usually last for 7-10 days and then improve. With allergies you may have itchy or watery eyes, and a clear runny nose which may sometimes trigger a cough, especially in children who have underlying asthma. You may also find that your child has 2 bad days, then several good days rather than continuous symptoms like a cold. Even though seasonal allergies are often called “hayfever” there is no fever associated with allergies. Many a parent with a 2 year old comes into the office with their child complaining of a fever of 102, runny nose and cough, and they think their child may have allergies and can go to school…..not so.

Seasonal allergies in children typically present between the ages of 2  - 6 years and occur in up to 10 - 15% of children. Parents may start to notice that their child always has red rimmed eyes and runny nose in March, April as tree pollens emerge, or are worse in June as grass pollen becomes an issue…. all pointing towards allergies. 

Fortunately, many of the best products to help prevent and control seasonal allergies are available over the counter.  Anti-histamines are the mainstay for allergies for those who have occasional problems. There are both older sedating anti-histamines like diphenhydramine (Benadryl) and newer non-sedating medications such as loratadine (Claritin), cetirizine  (Zyrtec), fexofenadine (Allegra).  All come in both liquid and pill form and some have orally disintegrating tablets which are wonderful for a young child who cannot yet swallow a pill but balks at liquid medications.  (Good time to also discuss how to swallow a pill!).  

For children who have known seasonal allergies or ongoing issues I encourage daily steroid nasal spray use - which is a preventative measure to help block the allergic cascade from occurring. You can now buy fluticasone ( Flonase), Mometasone (Nasonex), budesonide (Rhinocort) and triamcinolone (Nascort) all over the counter. Even a young child over the age of 4 years  (they are often used in even younger children when prescribed by your pediatrician) may use a steroid nasal spray daily during allergy seaon.   Using these nose sprays for extended periods of time has been associated with a slight decrease in growth velocity while being used, so discuss this with your pediatrician. 

I typically also recommend a nasal saline solution like Little Remedies to irrigate the nose before using the steroid spray. Not only does this help to wash out any pollen that has adhered inside the nostril, it clears the airway so that the steroid nasal spray may be more effective. Teaching your child to blow their nose after irrigating it is a huge milestone as well, and helps prevent ear infections and sinus infections….keep practicing blowing.

Playing outside at this time of year is always encouraged, but if your child seems to be developing allergies make sure to bathe them and wash their hair (and eyelashes)  when they come in at the end of the day. Irrigate their nose, use a daily OTC steroid nasal spray, add  OTC antihistamines and see how they do. If they have continued problems time for a visit to your pediatrician to look at other options.

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Daily Dose

School Lunches & Obesity

1.30 to read

Since we have been talking about healthier school lunches, I thought I would share with you an interesting article in last month’s Pediatrics which related to regulations on school snacks.  

While the nutrition standards for school meals changed for the 2012-2013 school year, the new guidelines do not effect foods in vending machines, snack bars or other venues within the school that are not a part of the regular school meal programs. These foods (typically snacks and drinks) are termed “competitive foods” as they compete with school breakfasts and lunches. 

This study looked at weight changes for 6,300 students between 2004-2007 and followed the students from fifth to eighth grade.  They found that adolescents in states with strict laws regulating the sale of “competitive foods” gained less weight over this 3 year period than those living in states without laws. 

As the childhood obesity epidemic continues (the CDC now estimates that 1/5 of American children are obese), public health officials continue to look at ways to improve a child’s eating habits during the school day.  The laws surrounding snack foods at school differ by state. There are no laws in some states, weak laws (where recommendations were made but there were no specific guidelines), and strong laws (where detailed nutritional standards were issued). 

The study did not conclude that strong laws were directly responsible for the differences in a student’s weight gain, but it did conclude that these outcomes tended to happen in states with strong laws.  That would seem to make sense to me as most children including my own, if given the opportunity, would at times choose vending machine snacks over a healthy school lunch. 

I also think that this is more common as the children become teens and seem to “snack” for lunch while multi-tasking rather than sitting down to eat a well balanced lunch. I continually hear this comment from adolescent patients of mine when I ask them about their lunch habits, and many of whom eat “off campus” if allowed, and choose fast foods over a healthy school cafeteria lunch.  Off school lunches seem to be another issue as well. 

One of the lead authors on the study stated, “competitive-food laws can have an effect on obesity rates if the laws are specific, required and consistent”. It seems like this might be a good cause to discuss with your own state representative.

Daily Dose

Monitoring Moles In Children

Everybody gets moles, even people who use sunscreen routinely. Moles can occur on any area of the body from the scalp, to the face, chest, arms, legs, groin and even between fingers and toes and the bottom of the feet.

So, not all moles are related to sun exposure. Many people inherit the tendency to have moles and may have a family history of melanoma (cancer), so it is important to know your family history. People with certain skins types, especially fair skin, as well as those people who spend a great deal of time outside whether for work or pleasure may be more likely to develop dangerous moles. Children may be born with a mole (congenital) or often develop a mole in early childhood. It is common for children to continue to get moles throughout their childhood and adolescence and even into adulthood. The most important issue surrounding moles is to be observant for changes in the shape, color, or size of your mole. Look especially at moles that have irregular shapes, jagged borders, uneven color within the same mole, and redness in a mole. I begin checking children’s moles at their early check ups and look for any moles that I want parents to continue to be watching and to be aware of. I note all moles on my chart so I know each year which ones I want to pay attention to, especially moles in the scalp, on fingers and toes and in areas that are not routinely examined. A parent may even check their child’s moles every several months too and pay particular attention to any of the more unusual moles. Be aware that a malignant mole may often be flat, rather than the raised larger mole. Freckles are also common in children and are usually found on the face and nose, the chest, upper back and arms. Freckles tend to be lighter than moles, and cluster. If you are not sure ask your doctor. Sun exposure plays a role in the development of melanoma and skin cancer, so it is imperative that your child is sun smart. That includes wearing a hat and sunscreen, as well as the newer protective clothing that is available at many stores. I would also have your child avoid the midday sun and wear a hat. Early awareness of sun protection will hopefully establish good habits and continue throughout your child’s life. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Rotarix Vaccine Temporarily Suspended

The FDA suspends Glaxo Rotarix vaccine I received the CDC Health Alert yesterday afternoon notifying physicians to “temporarily suspend the usage of GlaxoSmithKline (GSK) Rotarix (rotavirus) vaccine. Rotarix was licensed for use in 2008 to prevent rotavirus disease, which typically causes fever, vomiting and diarrhea in infants and young children.

Prior to this Merck’s vaccine RotaTeq had been licensed for us in 2006. Both of these vaccines are given orally. Both RotaTeq and Rotarix were found to prevent serious rotavirus illness and hospitalizations for dehydration. The GSK product, Rotarix, which is a “live attenuated” vaccine, has been found to contain DNA from porcine circovirus type 1 (PCV 1). PCV 1 virus is not known to multiply in human cells or to cause illness.  According to the FDA, “all available evidence indicates that there had been no increased risk to patients who have received this vaccine”.  The GSK vaccine, Rotarix, is made in a different manner than the Merck vaccine RotaTeq.  Preliminary studies by the FDA on RotaTeq vaccine have not shown the presence of PCV 1 DNA. Preliminary data reported to the FDA  by GSK related to PCV 1 being in the vaccine seems to suggest that it has been present since the early stages of the vaccine’s development.  Studies on Rotarix, both before and after the approval of the vaccine, have shown it to be extremely safe and no unusual adverse events have been reported.  At the same time, the vaccines that have been given are presumed to be effective. In the interim, while futher studies are being completed, it is recommended that children continue to receive RotaTeq vaccine.  The FDA plans to convene an advisory committee to look into how the DNA components came to be present in this vaccine. They are also going to look into the use of new techniques for identifying viruses in vaccines.  After this meeting, the FDA will make further recommendations about the use of rotavirus vaccines in the United States. This recall was limited to the United States, and children in other areas or the world are continuing to receive Rotarix, as the available evidence suggests that the benefits of the vaccine outweigh the risks, especially in areas where rotavirus disease causes severe disease and even deaths. I would not be alarmed if my baby had received this vaccine as it does not cause disease in animals or humans.  I would also complete my child’s vaccine series with the Merck product which is available.  We will all have to stay tuned for further details,  but this should also make parents aware that the safety of vaccines continues to be monitored, even after they have been approved. That's your daily dose for today.  We'll chat again tomorrow! Send Dr. Sue your question now!

Daily Dose

Latest Flu News

Dr. SUe discusses the latest news about seasonal flu and H1N1It seems like a while since I have discussed one of the favorite topics this fall, swine flu (novel H1N1).  Now that there is less swine flu in the U.S., actually less than 14 states are reporting widespread flu (the latest update will be released today), there is less hysteria and at the same time less concern for prevention.  

Influenza, and particularly swine flu, is always difficult to predict when and where it will occur, but one thing that seems certain, there will be more flu in the U.S. in the New Year, as flu typically lasts in some parts of the country until May.  Many infectious disease experts worry that swine flu (novel H1N1) will peak again as it has in some parts of the southern hemisphere.  If this turns out to be the case, there are many more people who will become ill. If the current statistics are correct, and 1 out of 6 Americans has already had swine flu, that still leaves MILLIONS more who are at risk of becoming ill. Unfortunately, with illness we will also see deaths, and the swine flu seems to be infecting a younger population and therefore there are more pediatric deaths being reported. All of this is important, as the only way to try and prevent disease is through vaccination.  When novel H1N1 vaccine was first shipped to my pediatric office in October, we could not keep up with the phone calls or provide enough vaccine for those that wanted it.  Remember it is recommended for all children from 6 months – 24 years of age.  That is really my entire practice. It is also recommended for parents and caregivers who have infants under 6 months of age, as these young babies cannot be vaccinated against flu.  But, what I have seen happening, is that now that novel H1N1 is not rampant in our area, the desire for vaccine is also waning.  Human nature is quite interesting, we want what we cannot have, and once the “Frenzy” passes, the desire also wanes. I know this right now from my own Christmas shopping,  as I am desperate to find a “marshmallow gun”.  I am sure that once the “game” of locating one is over, or Christmas arrives, I too will not feel like I “need” a marshmallow gun. There will be something else to replace the gun. This should not be the case with flu vaccines. Do not be complacent and forget to get your swine flu vaccine (or your seasonal flu for that matter).  The swine flu vaccine is safe, and post marketing surveillance continues and has not shown any problems with the vaccine in terms of safety. The latest recall was not due to safety, but rather to concern that the lots of vaccine that were recalled may provide less immunity than expected. In other words, it wont’ hurt you, but it may not provide as much protection as a good vaccine should. Those lots have already been pulled and those infants will be getting a second dose of swine flu vaccine any way, and that should boost their antibody level. Give your children a Christmas present and get their flu vaccines. We may not know which flu is coming, but just like Santa comes each year, we know that flu will too. Who wants to be home sick for a week, hospitalized, or even worse, have someone in your own family become a statistic.   Just because you have been lucky enough never to have had the flu before, does not mean that you are immune.  Don’t test it, get the vaccine and remember children under 10 years need to get a second dose of vaccine to provide optimum immunity and protection. That's your daily dose.  Heave a wonderful weekend!

Daily Dose

Lice is Tough to Treat

1:15 to read

What are kids bringing home from school besides their homework? Lice! The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

Daily Dose

College Students & Drugs

1:30 to read

It is the end of the school year and therefore there seems to be a great deal of stress among students of all ages. I am especially seeing this in some of my college students…..who seem to be making some rather dangerous choices in order to “help them cram for finals” and “stay awake”.

In the past few weeks I have had several students who have purchased or somehow procured a variety of drugs that were “purported” to aid in their studying for finals.  While there has been a great deal in the news about opiod addiction in young adult males, some of my patients have preferred other drugs that are seemingly available and acquiring them illegally.  

The on line drug scene, as well as the drug dealing among students, seems to be a growing problem among some college students.  While I have known that there was a great deal of alcohol and weed being used and abused, I suddenly feel as if I am getting more calls about patients, typically male, being taken to the ER after trying a combination of drugs, which were purportedly being taken to help them study, stay awake, curb anxiety and “succeed in school”.

So, what to do when you realize you have a test in a few days, or a paper that is due and you are “freaking out” as you are not prepared?!?!  Your roommate, or friend in the dorm, or even a complete stranger on line offers you an option - why not take a “stimulant”,  the preferred drug seems to be Adderall  (which was not prescribed for you) and chase it with an anti-anxiety drug   (Xanax, Valium or Ativan) then add in some alcohol when you need to chill or get some sleep. Some have even bought an unknown drug that is also supposed to curb anxiety and relax you (on line fake quaaludes)? This same scenario may occur over a few days or even weeks. While these patients thought they were “fine” and ready for class the next morning they were not!  In several cases these “crazy, stupid boys” suffered a grand mal seizure..never making it to class. Truly they are lucky to be alive the way they combined all of these medications.

Neither of my patients had ever had a history of seizures and were otherwise healthy.  Thankfully, they both recovered without problems.  But, they both admitted to me that they were just one of many who were doing the same thing.  Why they asked, did they have “adverse effects” from this lifestyle, when lots of their friends seemed to be fine….really??? I don’t even have words to try and answer this.

When I probed about how they “acquired” these drugs they said they are for sale in the dorms or on line and basically all over their campuses…..and these students attended what would be called “good” colleges. I have asked several kids who were already home from school about this and they too had heard some similar stories….and were aware of drugs being readily available, but had not partaken.

So, when your college student gets home you might take the opportunity to ask some questions about their college experience and if they are aware of these drugs …and remind them of the fact that taking ANY drug which is not prescribed for them is dangerous.  I have discussed binge drinking before and warn all of my student/patients that drinking excessive alcohol to “get drunk and pass out” can kill you from alcohol poisoning. But after hearing these stories and dealing with my own patients and their visits to the ER I am adding more information to my check ups with college students.  Mixing alcohol  and drugs has always been risky….but now the availability of these drugs is nothing but scary…..BE WARNED.  

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