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Daily Dose

Measles Outbreak

1:30 to read

Entering Disneyland where the sign reads, “The Happiest Place on Earth”, it does not also say, “Beware of Infectious Diseases!”.  But, if you think about it...what better place to contract any infectious disease than Disneyland where many of the visitors are under the age of 12 years....and I know from my own experiences as a parent taking children to Disney...even if not feeling well nothing stops a child at Disney. That means not even a fever.  (Other parents have reported the same thing to me when they went;  fever/tylenol and then off to theme park). 

So, now reports of at least 70 cases (and counting) of measles which children have contracted while visiting Disneyland in December. Not all of the confirmed cases have even been in California with cases are now in Utah, Washington, Colorado and Mexico.  With continued new cases, and our mobile population, unintentional exposures will occur, so unfortunately there are expected to be more cases.

Measles is a VACCINE PREVENTABLE DISEASE!!!  I repeat, you can prevent measles but that means your child needs to receive an MMR at 1 year and again between 4-5 years of age.  About 3/4 of the current new measles cases were unvaccinated, by choice.  Several of the children were too young to receive the vaccine and so they were unprotected for that reason.  Orange County (home of Disneyland) has one of the highest rates of vaccine refusers, and Dr. Bob Sears practices there as well where he admits that “many/most” of his patients refuse some vaccines.  In my humble opinion he has had a big impact with families who are making vaccine choices. Dr. Sears' books are “wishy washy” on this subject and he has proposed an “alternative vaccine schedule” which has not been scientifically proven to work. Dr. Paul Offit a pre-eminent scientist, doctor and vaccine proponent has some good articles discussing his feelings about alternative vaccine schedules. Feel free to check them out. 

Enough of the soap box...but this should be yet another wake up call that many of the diseases younger parents think are “not around” are indeed showing a resurgence.  Measles cases are the highest they have been for over 20 years in the U.S. Pertussis (whooping cough) rates are still on the rise here as well.  Polio continues to be a problem in other parts of the world despite huge efforts in vaccinating and trying to eradicate this disease.

Fortunately, there have been no deaths in the latest measles outbreak but there have been hospitalizations.  Only hoping people go get their children vaccinated as there is no other way to stop this.  It makes so much sense and seems simple. There are so many places to get a vaccine!! 

Daily Dose

Peanut Allergies

1:30 to read

Did you see the New England Journal of Medicine article which was recently published regarding peanut allergy? Interestingly, the study out of the UK seemed to confirm what some of us “old school pediatricians” had thought... the previous recommendation that babies and toddlers avoid peanut products in the first year of life may actually lead to more peanut allergies in children who are already at risk for developing food allergies.

In the late 1990’s allergists were concerned about the rise in peanut allergies and recommendations were made to delay introduction of peanuts (as well as some other foods).  At the time it did seem strange seeing that children born prior to this were raised on peanut butter...but like many things, nothing stays the same, right?

But over the years, the increase in peanut allergies continued, despite the fact that mothers were not eating peanut products during their pregnancy or while breast feeding and parents were delaying the introduction of peanut products until their child was 2 years of age. When the data from this period was analyzed, instead of seeing a decrease in children with peanut allergies... the incidence of peanut allergies continued to increase.

So, in 2008 the AAP changed their recommendations and again encouraged parents to let their children eat peanut products in the first year of life just NO peanuts due to the choking hazard.  But many parents continued to be wary...in fact some, who had no history suggesting allergies ( eczema, wheezing, family history of food allergies), would actually bring peanut butter to my office for a trial. One mother came for a quick “house call” one day and I handed her child (who was 20 months at the time) a peanut butter cracker I was eating and her mother “freaked out”.  Fortunately, the child loved the cracker and no issues with peanut butter either. She was thrilled when she left with another cracker in hand 

This article was just the first of many studies being undertaken to “help solve the puzzle of food allergies”. There is so much about this topic on the horizon but in the meantime, if your child does not have a  history to suggest allergies I would try introducing peanut butter, almond butter, as well as eggs and dairy to your child. If you have a family history of food allergies, or concerns talk to your doctor about beginning these foods earlier than later even if that is in a controlled situation in the pediatrician’s or allergist’s office.

I can’t wait to give baby granddaughter some of these foods as well (she just started to get some veggies) and peanut butter is not far behind.  I did “sneak” her a morsel of pancake the other morning...you should have seen that smile.

Daily Dose

Eeek...Ticks!

1:30 to read

It is the time of year many families are spending time outdoors including camping and hiking. I often get phone calls from worried parents about finding a tick on their children and concerns about what to do.  Ticks are most active in the warmer months (April - Sept), while we are also enjoying vacations.  Many parents are concerned about tick borne illnesses,  as well as just being “grossed” out with the idea of finding a tick on their child. 

The number one thing to remember is to try to prevent a tick bite, which means using insecticide before you plan on hiking etc. It is important to use a product that contains enough DEET, so if you are going to an area with an increased incidence of ticks ( especially that carry disease)  use a product that contains 20-30% DEET, which will provide several hours of protection.  Make sure to avoid your child’s hands, eyes and mouth.   You can also spray your clothes with a permethrin product prior to exposure.  Interestingly, the clothes that have been sprayed with a 0.5% permethrin product remain protective through several washings.  

Now that you have protection before you go out you want to bathe or shower after you return from an outdoor activity, and the sooner the better.  This is the best time to check your child for ticks. Check their head and hair as well as in the ears, belly button, groin, between their legs and under their arms. 

If you find a tick use fine tipped tweezers to grasp the head of the tick as close to the skin as possible. Resist the urge to “yank” the tick, but rather apply slow steady upward pressure to release the tick from the skin. Once the tick is removed wash the area with alcohol or soap and water.  It is a myth that you can remove the tick by painting it with fingernail polish.  

While not all ticks transmit disease, in certain areas of the country the black-legged deer tick may cause Lyme disease.   In most cases a tick must be attached for 36-48 hours before the bacteria (Borrelia burgdorferi) is transmitted. So, back to the bath and look for ticks after you are home for the day. 

Once the tick is removed and the area is cleaned you are generally good to go. You do not need to “save” the tick to show to the doctor. But, if you live in an area known for Lyme disease ( the Northeastern U.S. in particular), watch for a red bull’s eye rash that spreads over several days. This typically occurs within a week after the tick bite. A small red bump left after the tick bite is not the same thing and will resolve in a day or two, rather than “grow”. Lyme disease also causes fever, chills, headache, joint pains and swollen lymph nodes. 

Lyme disease is best treated early with a course of antibiotics….so if concerned seek treatment in the early stages of infection.

Daily Dose

Waiting for the Doctor

1:30 to read

I just read a really good article from The Huffington Post that was written by a young woman from the UK.  She was discussing the issue of waiting for a doctor. She herself had been waiting for her doctor when she noticed another patient who was being very loud and quite verbal about waiting. He engaged her in conversation and said, “I bet that doctor is back there having a cup of tea”. He must have been stunned when she replied, “well, I certainly hope so”.  She knew that the doctors had recently seen her as an emergency when she began bleeding during her pregnancy. She knew that they had dropped everything to attend to her and her unborn baby and for that she was eternally grateful.  

I also “hate to wait” when I am seeing my own doctor, but I do know that he or she is not “back there eating bon-bons".  I also know that many patients have waited for me, sometimes for up to an hour.  I promise you that I know that I am running late and it makes me very anxious. But at the same time, I am doing the best that I can to treat each and every patient as if they were my own child or family member.  Sometimes a patient comes in with a more complicated or urgent problem and the time taken with that patient is much longer than was expected. Or, a child arrives wheezing and in respiratory distress without even having an appointment….they to will be “worked on” in front of everyone else…as they need a doctor immediately. 

The article continued to re-count how many times during her pregnancy that she had needed to be seen as she continued to have issues with bleeding, and each and every time, the doctors were there, no wait and no questions….they just did their job.

It is difficult to explain why doctors run late and I understand how patients are frustrated when they wait. But at the same time, how do you schedule the appropriate amount of time for a patient who calls for an appointment because their child is sick with a fever and a sore throat. But, while you are seeing their child they break down in your exam room and tell you that they have found out that their husband is “cheating on them” and that “he wants a divorce”.  As their pediatrician, do you tell them that you don’t “have the time” to listen to their problems. Do you just deal with their child’s sore throat and ignore the mother’s anguish. In my case, I choose to spend time with the mother, to empathize with her, and hope to help her.  I know that this reaction will make me late….but it is what I need and want to do for my patients and families.

Whenever I am talking to prospective patients I am perfectly honest when they ask me, “will I ever have to wait?”.  My response has changed over the years as I have come to realize that there will be times when they do wait….but it is not because I ever want to “run late” or make my patients wait. It is because, I have decided that my practice has just as many flaws as my parenting, not perfect. But similar to my children, at times one will need me more than another, and when they do I will spend more time with the one that needs me the most.  It may not seem “fair”, but how do you make it always be “fair”?  I hope that at the end of the 23-25 years I spend with these families they come to realize…it all evens out in the end…there are times that I spent too much time with them and then there are times that they waited.  But, just like parenting, you do the best that you can.  I will continue to practice that way as well. I promise, if you are waiting I am not having tea and bon-bons!!!   

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DR SUE'S DAILY DOSE

New moms have enough pressure and breast feeding is one of them.

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