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Daily Dose

Plants That Cause Summer Rashes

1:15 to read

Now that summer is upon us and everyone is enjoying being outside I am seeing patients with contact dermatitis (rashes) after coming into contact with poisonous plants.  While allergies are slowing down a bit with the hotter weather, plants like poison ivy, oak and sumac (depending where you live) are full of leaves.  About 50% of people who come into contact with the leaves of these plants will have a reaction.

The adage “leaves of three, let them be” continues to be the best way to prevent getting a rash. That also means wearing long sleeves, and pants...and gloves. But what child goes off to play in the yard, or by the creek dressed like that for summer?  Sunscreen yes, gloves, probably not. 

If you realize you have been exposed to the plant leaves and therefore the urushiol (oil on leaf) , wash all areas of exposed skin as soon as possible with some products that are available like Tecru, Sanfel and Goop Hand Cleaner....if you don’t have those use dish washing soap.  

It may take up to 4 days after exposure to develop the rash and lesions may also appear at different times depending on the location and length of exposure to the urushiol.  The rash is usually really itchy and is often is linear clusters or little vesicles or blisters.  The rash does not spread by scratching or from the fluid inside the blisters, that is a myth. You cannot give anyone else poison ivy if you have washed off the urushiol.  

The best treatments relieve the itching and irritation.  Keeps nails short and hands clean so that scratching will not cause a secondary bacterial infection.  You can use oatmeal baths (Aveeno) or cool compresses (Dommeboro) to help control itching. An over the counter steroid cream is a good place to start to help the inflammation, but it may be a stronger prescription steroid cream will be needed. 

I also try calamine lotion or astringent to soothe the irritation. Sarna is another good lotion for itching....Oral antihistamines like diphenhydramine (Benadryl) really don’t help with the itching as it is not due to histamines, but may cause a bit of sedation so a child can sleep.

If the rash is getting worse, spreading to the face and around the eyes or begins to look infected it is time for a visit to the pediatrician. For severe cases oral steroids may be necessary.

It sometimes takes 10-14 days for the rash to go away.  Oh, and getting overheated only makes you itch more.

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Daily Dose

How to Treat Swimmer's Ear

1:30 to read

The entire country seems to be experiencing the “dog days of summer”.  That huge high pressure system has covered most of the weather map, so the only thing to do for the next month is to head to any water you can find…swimming pool, lake, ocean, river or fountain!  But, with swimming comes swimmer’s ear or otitis externa.

I rarely see a child with an otitis externa except during the hot summer months.  Swimmer’s ear is a frequent problem for children who “live in the water” all day long. They are just like a fish. They head to to the pool first thing in the morning and don’t come in until they are water logged…and their ears stay wet all day long and into the night….then back to the water again.  When the ear canal cannot dry out it becomes the perfect dark, damp breeding ground for bacteria to take root.

The most common complaint with swimmer’s ear is pain!! I have seen big stoic teenage athletes in tears from the pain when you just touch their ear.  The pain is due to the inflammation and infection of the ear canal..not the ear drum (an inner ear infection).  So, if you tug on the ear lobe or push the area in front of the ear at the jawline, this causes pain.  Rolling over in bed and laying on that ear will cause pain.  Many people also feel a fullness and complain that they don’t hear as well as the ear canal is so swollen.

The treatment for a swimmer’s ear is not an oral antibiotic, it is rather for ear drops that contain an antibiotic to treat the infection topically at the source. Many of the ear drops used to treat otitis externa also contain a steroid that will help with the inflammation (and swelling) of the ear canal.  Pain control is also important with a combination of acetaminophen and/or ibuprofen.   Keeping the ear canal dry is imperative in order that the ear drops stay in the canal and are not “washed out” right after you put them in the ear. I try to keep the patient’s ear canal dry for several days and have them pain free before getting their ear wet again.

BUT, the best treatment for swimmer’s ear is actually prevention.  Little children who are just learning to swim really do not spend enough time under water or during a bath to have their ear canals become infected.  It is typically seen in children over the ages of 5 or 6 who are now great swimmers and spend a great deal of time in the pool, lake or any body of water.  For these children I recommend putting in “home made” ear drops made with half alcohol and half white vinegar. It is easy to make a bottle and buy a dropper and leave it by the back door to the pool or by the dock…..in this way as the kids come in at the end of the day, everyone tilts their head and gets several drops instilled into both ears before heading inside for the night.  You can also buy “Swim Ear” over the counter if you aren’t “into” making the frugal ear drops.

On occasion, for an extremely swollen ear canal you may need to see an ENT to have the ear canal cleaned and treated…..but if treated early this is uncommon. 

Stay cool, hydrated and avoid swimmer’s ear by using those ear drops routinely!! I learned my lesson the hard way one year….prevention is the key to avoiding a painful otitis externa.

Daily Dose

West Nile Virus

1.50 to read

The temperatures are warming up around the country and “summer” iis only a few weeks away.  But the bugs are already coming out in full force and that includes those pesky mosquitos.  In Texas with warmer temperatures than other areas, I am already seeing lots of mosquito bites, which is already causing some anxiety due to the risk of West Nile Virus.

West Nile Virus (WNV) was first detected in the United States in 1999 and 2012 was the second worst outbreak of WNV disease (the worst was in 2003). WNV disease is a seasonal illness which typically is seen during summer and early fall, when mosquitos are at their peak.  

In 2012 there were a total of 5,674 cases of WNV in the U.S. reported to CDC and there were 286 deaths.  WNV has been reported in all 48 contiguous states as well as DC and Puerto Rico ( we can all head to Hawaii??). 75% of human WNV cases were reported from just 10 states, with Texas having the highest number. (1,868 cases and 89 deaths)

So....what do you need to know.  Number 1: WNV as the name states is a VIRUS, which means there is not an antibiotic used to treat the infection!! 

Secondly, about 80% of people (or 4/5) who are infected with WNV will NEVER show any symptoms of illness. Up to 20% of people who are infected will show symptoms of fever, headache, body aches , nausea or vomiting and some may also have swollen lymph nodes and a rash. These symptoms mimic many other viral illnesses so trying to decide if your child who has a fever and “the feel bads” has WNV or an enterovirus (like coxsackie) or and adenoviral infection is really not important.  

What do you do for all of these viral infections but treat the symptoms, right?  Give it a few days to see how your child is doing, treat the fever, keep them comfortable and hydrated and in a few days the illness will typically resolve and will be another unnamed nuisance viral illness.

About 1/150 people infected with WNV will develop severe illness with neurological problems including seizures, meningitis, and encephalitis. Those are the people who are at greatest risk of requiring medical care, which includes hospitalization and life support, which is most often seen in older people and in people who have other medical problems.

The best thing to do is to keep yourself protected from mosquito bites by using bug spray, closing windows and doors, draining standing water and avoiding peak exposure during the early morning and evening hours.  When you can wear long sleeves and long pants and socks to cover up from bites. For infants I would head out now to get some mosquito netting to cover strollers when a baby is outside (buy it now while available).

Lastly, don’t panic!!!  Some parents are already telling me they aren’t letting their children go outside!?  We have a long summer ahead and everyone needs fresh air and exercise.  Start shopping for bug spray....i am looking for buy one get one free deals! 

More on WNV as we get into the thick of the season although my zipcode in TX is already reporting WNV positive mosquitos.....maybe Hawaii? 

Daily Dose

Hot Car Deaths

1:30 to read

Did you know that heat stroke is the second leading cause of non-traffic fatalities among children, with the first being backover deaths.  As the summer temperatures are rising these tragic accidents become all too frequent.  

My home state of Texas leads the country in child vehicular heat stroke deaths, followed by Florida and California.  But children who are trapped in vehicles have died in milder climates as well. The temperatures outside may be as low as 60 degrees, but the inside of a car heats up quickly, with 80% of the increase in temperature happening in the first 10 minutes. The reason for this is due to physics.....the sun’s short-wave radiation is absorbed by dark dashboards and seats...the heated objects including child seats then emit long wave radiation which heats a vehicle’s interior air.  All of this leads to tragedy.

A child’s thermoregulatory system is not the same as an adult’s, and their body temperatures will warm 3 -5 times faster.  When a child’s body temperature rises to about 107 degrees or greater, their internal organs begin to shut down.This scenario can then lead to death. If you see a child who has been left in a hot car call 911...every minute matters.

The greatest percentage of these tragic deaths are totally unintentional.  These parents are not “bad parents” or “child abusers”, they are loving, good parents who simply forgot that their child was in the car. On average there have been around 37 deaths per year due to vehicular heat stroke and in most cases this is not due to reckless behavior but simply to forgetfulness.  Parents and caregivers both admit to “just forgetting” a child was in the car.  It truly can happen to anyone.

So, how can you remember that your precious, quiet, sleeping child is in back seat. Make it a routine to always look in the back seat before you lock and leave the car.  Try putting your purse, briefcase, or cell phone in the back seat as a reminder to look for your child. Lastly, if your child is in childcare, have a plan that the childcare provider will call you if you have not notified them that your child will not be coming to school,  and they don’t show up.

Daily Dose

Swim Lessons Can Reduce Risk of Drowning

1:15 to read

Now that hot weather is with all of us, the issue of childhood drowning is an ever-present concern. The American Academy of Pediatrics recommends that after the age of five years, all children be taught to swim. The AAP does not recommend for or against swimming lessons as a measure to prevent drowning in children younger than five years. Between 2000 and 2005, 6,900 children died from non-boating accidental drowning. The rate of drowning was almost four times higher for children one to two years of age, and twice as high for those younger than five.

An article in Archives of Pediatric and Adolescent Medicine looked at the association between swimming lessons and risk of drowning specifically in the one to four year old age groups. Previous concerns had been raised about the potential for swimming lessons to increase the risk for drowning in younger children. This study provided good news that kids aged one to four who have taken formal swimming lessons have an 88% less risk of drowning. Researchers found that only three percent of the children who had drowned had taken swimming lessons. So with this news, it might be prudent to start swimming lessons at a younger age than previously thought.

But swimming lessons alone will not prevent drowning and even in this study, many of the older children who drowned were noted to have been proficient swimmers. It is still important to have other drowning prevention strategies in place including pool fencing (some parents with pools feel like their child will not be able to unlock a door and head to the pool and do not have a fence in place, and I totally disagree with that argument), constant and age appropriate adult supervision and training in CPR. Children are amazing at finding ways to unlock doors, and windows that lead outside and no parent can know where their child is for every minute of the day. If you have a pool and a child is missing always check the pool first, as a child can quietly slip into the water and lose consciousness in as little as two minutes and drown in five minutes.

That's your daily dose, we'll chat again tomorrow.

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