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Daily Dose

Hand-Foot-Mouth Disease

1:30 to read

I am back on my soap box about what is a newsworthy announcement…..especially as it pertains to viral infections. While I know that day care centers and pre-schools are “keen” on posting notices or sending emails to parents about the latest virus to be found at school, I am still baffled as to the necessity to do this and alarm parents. Aren’t there HIPPA violations or something?  Knowing that a child in school has been diagnosed with  “hand-foot-mouth" disease (HFMD) does not seem to be anything out of the ordinary. Pediatricians are used to seeing HFMD, sometimes daily, and yes it does seem that these viral illnesses cluster at different times of the year. But, with that being said, does it really do any one any good, and does it maybe actually “worry” already anxious parents about possible exposure. Are we forgetting that children are exposed to these pesky viral infections all of the time…and that in most cases they are fairly minor, inconvenient and cause several days of fever and generally not feeling well.  End of story.

But now HFMD has made the national news….as there have been 22 cases of HFMD diagnosed at Florida State University…..which has an enrollment of over 41,000 students!!!  Statistically speaking, that is not a significant “attack” rate….and this news is being reported on all of the networks.  While I realize that adolescents and young adults are less likely to acquire HFMD and they may feel worse than a toddler who in most cases seems to “power through”  with fever reducing medication, popsicles and ice cream, is this really a national news story?  

HFMD is caused by an enterovirus (Coxsackie A16) and typically causes several days of fever and not feeing well followed by small ulcers and blisters that may occur in the throat (painful) as well as on the hands and feet. (younger children seem to often get a rash on their buttocks too).  HFMD may be spread in a variety of ways including direct contact with saliva or fluid from the blisters that may occur on the hands and feet, from fecal contamination, and also when a person coughs or sneezes in close proximity. The virus may also live on surfaces that we touch and then touch our eyes, nose or mouth and cause infection.  As I always say, “good hand washing” and keeping yourself home when sick is the best way to prevent the spread of a virus. While I believe in good sanitation and clean public spaces is it really necessary to “wipe down” classrooms, dorms, cafeterias and even toys in school due to several cases of HFMD. Do you have to do this all day long?  HFMD is not a bacterial disease like meningitis and does not have life threatening consequences.  There will be another viral infection  (or 2 or 3 or 4)  soon to follow and one of these will be influenza.

So, rather than talking about HFMD and mass “cleaning efforts” I think we should focus on another way to prevent illness. VACCINATIONS!  We do know that vaccines work to prevent disease and despite the science behind that, there are still those that “opt out” of vaccines, and this includes getting a flu vaccine.  I wonder if there are students at FSU who have opted out of vaccines and if so how many….maybe more than 22/41,000?  At the same time, how many of those students will opt “in” and get a flu vaccine? That is the bigger story ….get vaccinated for flu now…so we don’t have another even bigger “outbreak”.   I know there will be more than 22 students who get the flu at FSU and will that make the news?  It is the same thing for schools everywhere…lets put up signs about flu vaccines and keep those numbers down.I hope the news reports this.


Daily Dose

Let's Talk Flu

1:30 to read

Summer is not even officially over, but it is time to discuss flu vaccines.  This years flu vaccine is now being shipped and our office has already started giving the vaccine.  If you somehow missed the biggest news you need to know that there is not an intranasal flu vaccine (Flumist) available this year…in other words, everyone gets a shot!

The flu vaccine is recommended for everyone over the age of 6 months. Because circulating flu strains change, the flu vaccine is “new” every other words, the flu shot you may have received last year is not the same shot that will be given this year.  I have had several adults  (friends) already say to me, “  got my flu vaccine in January….so I don’t need one now, right?” WRONG..that was “last years vaccine”…put your arm out for the new one.

While many children had gotten used to “sniffing” their flu vaccine and were thrilled not to have a shot, recent studies found that the intranasal flu vaccine was not as effective as the injectable flu vaccine.  In fact, for the 2015-2016 flu season the intranasal vaccine effectiveness among children 2 through 17 years was 3 percent as compared with 63 percent for the injected vaccine (quite a significant difference).

Actually, the fact that studies are done to look at flu vaccine effectiveness each year should be reassuring. By having the data available adjustments and new recommendations can be made, providing children with the best possible protection from getting the flu, and this year that means a shot.

The flu vaccines available this year may be either a trivalent vaccine ( containing 2 influenza A strains and 1 B )  or a quadrivalent vaccine (2 influenza A strains and 2 B).  I would ask my doctor which vaccine they are offering and if given a choice I would pick the quadrivalent…but most importantly just get your vaccine, sooner rather than later.

While I am already seeing sad little faces when they hear they will have a “shot rather than a mist”,  the good news that should bring smiles to their faces (and their parents) is that they will have better protection against the flu.  

Even though temperatures may still be on the warm side without any hint of flu “in the air”, it is time to get your vaccine…and yes, the protection will last throughout the flu season. It is best to be vaccinated and protected ahead of flu season.


Daily Dose

Travel Healthy During The Holidays

1:30 to read

With all of the viruses and illnesses popping up, I am getting a lot of questions about travel plans. Many parents are asking "should I travel with a sick child?"

In my opinion, we all must continue our lives, even in the face of flu fear, and a trip for a toddler to see his/her grandparents is important for everyone. We should all make our plans for trips to the visit family. While traveling, everyone needs to practice good hand washing and cough hygiene and be prepared to change plans if a family member is ill. Traveling while being acutely ill and running a fever is only exposing everyone else to you or your child’s illness and seems somewhat selfish.

None of us should be traveling within 24 hours of having a fever (that means without the benefit of fever reducing medications), and isolating a child or parent for several days will be better for everyone, than traveling while sick. Think of the greater good! With that being said, I am not a proponent of a newborn under the age of 2 months traveling, unless out of necessity.  I have always been fairly conservative about exposing a baby to crowds and closed in spaces (malls, movies, restaurants) and airplanes certainly fit that description.  With the uncertainty of this year’s flu season it seems like a really good year to stay put. A newborn’s immune system is still fragile, and the more often a newborn is exposed to large groups of people,  the better chance they have of getting sick in the first 6 – 12 weeks of life. This must have been what was called “confinement” in the olden days.

Staying home and enjoying the simplicity of life, with the excuse, “I have a newborn baby” gets you out of so many invitations and situations.  This is probably the only time that you can get away with that line, as after several months the realities of work, family commitments, and day to day living return and often that means with baby in tow. We all do what we have to do, but if you don’t have to take your newborn baby on a flight this holiday season, I would not. I also know that not everyone will abide by the “Do Not Travel While Sick” mantra, and exposure to illness is not uncommon during airline travel. There is not a way to sit 3 – 6 feet from another person on a plane! This is probably the time to have family come to you, and to make sure that they have all had their seasonal flu vaccines, and when available, the swine flu vaccine.

I don’t have a crystal ball to see how this winter season is going to unfold, but I do know that a sick infant has a better chance of ending up in the hospital if they develop a flu like illness.  The holidays will be a happier for all, if infants stay close to home and leave the travel to those with older children.

That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Colds & Suctioning Your Child's Nose

1:30 to read

I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Do Not Travel When Kids Are Sick

1.30 to read

While I have been busy working during the holiday season, I have not been the most popular doctor around town.  With that being said I need to explain. 

As everyone knows the Christmas holidays fall right at the beginning of the winter SICK SEASON. The pediatrician’s office never really stops and if anything it gets busier as families are trying to get out of town, or are trying to get well in time for holiday activities which may include big family plans which may include out of town guests.  This is a perfect storm to spread germs as well as families fly around the country and gather together.

While working over the holidays, I have found myself having to be the “bad guy” by recommending that families cancel their airline flights and trips to see the grandparents or for others to cancel their vacations to far away destinations. All of these cancelled plans were due to children in the family who were too sick to travel. The majority of these patients have one of the numerous viral upper respiratory infections that are currently TNTC (too numerous to count). 

I am seeing children with rhinovirus, respiratory syncytial virus (RSV), meta -pneumovirus and the first few influenza cases of the season. These viruses may sometimes cause children to wheeze and some of the sicker children may even be hospitalized.

In most of these cases, children may be treated at home with rest, lots of fluids and some children may need nebulizer treatments to help their breathing. For those in the hospital the treatment is the same although the hospitalized children typically need oxygen.  The rest of the treatment is really about letting the virus run its course, and that is really frustrating, as there is not a doctor around who can tell you what a virus is going to do.

Since you can never tell “when and if” a child’s breathing will deteriorate, I had to recommend that several families cancel their trips.  What if you are in the middle of a plane flight at 30,000 feet and your child who has already been coughing and wheezing suddenly turns blue?  It is just too risky.

At the same time I had to put a child in the hospital who had travelled from out of town to visit family, and once here they worsened and required hospitalization.  They are now in the hospital far away from home and the dreams of a big family reunion were squelched, unless you can fit everyone into a tiny hospital room and let them all be wearing a mask in the family picture. (Not the best picture for the holiday card).

With all of this being said, I know that all of these children will ultimately be fine and their plans will get re-booked or re scheduled, but disappointment is never fun, especially during holidays.

So if your child is sick and your doctor recommends that you stay home or change your plans just remember that they feel as badly as you do, it is never fun to be the “scrooge” during the holidays.   

That’s your daily dose for today.  We’ll chat again tomorrow. 

Daily Dose

Do Essential Oils Boost Immune System?

1:30 to read

Although it is still hot and officially summer, soon everyone will be heading back to school  and coughs and colds (and eventually flu, another topic) will be just around the corner. I had a patient ask me about the use of essential oils. Her 2 1/2 year old daughter is heading to preschool for the first time and she “had heard from her friends that essential oils help a child’s immunity during cold season”.

Unfortunately, there is very little data at all to confirm that statement. I only wish that rubbing a bit of lavender oil on would help prevent the common cold. While it may smell great and be relaxing....there is no data that I can find to show that there is any reproducible science to the claims that essential oils boost the immune system.  

While I was researching I found many sites stating that “eucalyptus oil is an anti-viral” and “peppermint oil is an anti-pyretic (fever reducer)”.  Tea tree oil is touted as being “both anti -bacterial and anti-fungal” (I don’t know of other drugs that can claim both!).  But, I just don’t see any data to support all of this. 

The word essential refers to the essence of the plant the oil is derived from, rather than being “essential” to your health. While in most cases essential oils (which are highly concentrated) used as aromatherapy are not harmful for adults, it may be a different story in children, especially those under the age of 6. While labels may say  “natural” it may not always mean safe.  Many oils are poisonous if ingested and there have been reports of accidental overdoses in children with several different oils. In one report tea tree oil and lavender oil applied topically have been shown to cause breast enlargement in boys.  Oil of eucalyptus and peppermint are high in menthol and cineole.  These substances may cause children to become drowsy have decreased respirations.  While there are articles stating that the use of menthol (Vicks) on a child’s feet may be helpful during a cold for reducing a cough, do not use this if child is young enough to put their feet in their mouths. 

I must say that I sometime use a few drops of eucalyptus oil in the shower when I have a cold as I think it smells great and seems to help “open up” my head. Whether this is in “my mind” or a response from my olfactory centers which sends calming messages to respiratory center is not clear. But, I am not ingesting it or using it topically. 


Daily Dose

Flu Cases Rising

1:30 to read

Flu season is definitely upon us and unfortunately it is hitting just in time for the holidays!  I have been on call for the last 2 weekends and I can assure you, flu is everywhere. You name the place and you are probably being exposed somewhere.  That includes the mall (where people are shopping whether sick or well), grocery stores, churches, synagogues, restaurants, day care, schools, airports...the list is endless.   I am saying this because patients continue to ask, “where do you think I got this?”.  

To compound the problem families are gathering for the holidays, so it makes it an even better time for the respiratory viruses to spread.  Those viruses just love this time of year.

Fortunately, despite the flu vaccine not being a “good match” for the Influenza A (H3N2) that is widely circulating, the children I am seeing with the flu (and yes, I myself have already seen 100’s) are not terribly sick.  They do have the typical fever, cough, sore throat, headache and body aches that typically comes with flu, but they are typically only running fever for 1-3 days and when the fever is down they are playing video games, watching TV and baking cookies. I have not seen anyone that has had a serious complication....I am hopeful that this continues.  

Many patients are wondering about using Tamiflu (which is advertising heavily right now). I am using Tamiflu for children who are high risk (under 2 years, have underlying illnesses, are immunocompromised, have significant asthma etc).  For most children the flu can be handled at home with the usual symptomatic treatment, fever control, fluids, rest and parental TLC (tender loving care).  I would always watch for any respiratory distress and make sure your child stays hydrated. In most cases I bet the fever is gone in a day or two and they are left with a nasty cough (same goes for the parents).  I always warn parents to watch for any re-occurence of fever later in the illness, which makes me worry about a secondary infection which would require a visit to the doctor.

Best prevention right now is to continue to get a flu vaccine....some protection is always better than none. Wash your hands, eat healthy, get plenty of sleep and if you are sick- please stay home!!  We’ve got several more months of flu....winter is just really starting.




Daily Dose

Dog Flu Is Going Around

1:15 to read

Funny time of year for me to be blogging about flu?  Well, now it is “dog flu” that has been spreading across the United States.  Dog flu is caused by an influenza virus and is a contagious respiratory disease in dogs. There have not been any reported human infections with either of the viruses that cause dog flu.  The viruses are also of the Influenza A variety and cause symptoms similar to those seen in humans including cough, runny nose, fever, lethargy and at times severe respiratory symptoms including pneumonia. Sadly, there have been dog deaths reported due to this infection. 

Because dog flu is a fairly new virus now being seen in the United States, most dogs have never been exposed to this virus.  Due to this, just like new influenza types in humans, most dogs that are exposed (about 80%) may develop dog flu but remember most will have mild symptoms and just require supportive care including extra fluids and rest.

If you are concerned that your dog may be showing signs of dog flu there is a test that your vet may administer ( just like we do flu tests for kids!). Extremely ill dogs, especially young puppies or pregnant dogs may have a harder time handing the virus ( again, does this sound familiar?).

But, the main thing to know is that this flu is not being seen in humans.  There is a vaccine for one of the types of dog flu and the veterinary community it working on other vaccines.

So, no need to worry about the kids and their pet dog!!  Just like your children make sure your dog is up to date on their vaccines, gets a healthy diet, exercises daily, has enough sleep and enjoys lots of family time too. But,  this is a good time to remember that human flu vaccine will begin to be available by the end of the summer. But don’t worry, I will remind you! 

Daily Dose

Flu Frenzy Across The Country

1.30 to read

“Flu Frenzy” is rampant in Dallas and across the country.  It is a very busy flu season and it did start earlier than usual in the southern part of the country. Texas has been hit especially hard.  I started seeing flu cases in my office at the end of October.  

But, with that being said, if you look at flu statistics over the past few years, January and February are typically the peaks of the flu season.  I know that these are usually the busiest months in the office and it  seems like there is not a child who doesn’t have a cough or cold and many have a fever lasting a few days.  Don’t panic! 

We have been lucky for several years to have had a light flu season, so this year’s flu season does seem worse. Fortunately, the majority of children we are seeing with flu symptoms are handling the virus very well (like many childhood viruses) and actually do not appear to be too sick. 

The children I am seeing are running 2-4 days of fever, many as high as 102 or 103 degrees, which is not unusual with the flu.  They have coughs, congestion and scratchy throats and the older kids are complaining of feeling “achy” as well. But they are also still drinking fluids, appear well hydrated, and when their temps come down with the help of acetaminophen or ibuprofen, they play, watch a movie, or even run around our waiting room. With a practice of 13 pediatricians we have literally seen hundreds of kids with the flu (both types A and B) but we have not had to hospitalize anyone! 

Parents always want to watch their children for respiratory distress or for prolonged fever, but most of the children may be treated symptomatically. Remember fever is your friend, and higher temps do not necessarily mean a sicker child. 

While there have been 29 pediatric deaths to date reported secondary to complications from the flu (1 death is too many), the majority of people who are having complications from the flu are the elderly.  The CDC confirms that this year is “is shaping up to be a worse than average season and is especially bad for the elderly”. 

The best way to prevent the flu is to make sure that any child over the age of 6 months of age gets a flu vaccine. With the early start of flu season and many people now heading to get vaccinated, the flu vaccine that is given to children between the ages of 6 months and 2 years is hard to find. The live flumist vaccine which is given to healthy children over 2 years of age seems to be more readily available. Call to check if your doctor still has availability. 

Historically we still have 6-8 weeks of flu season to go, so if your child is not yet vaccinated, call your doctor and get that vaccine! While it is not guaranteed to prevent the flu, it is definitely the best protection there is. 

That's your daily dose for today. We'll chat again tomorrow.


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Coxsackie outbreak on college campus.

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