Inception - The Power of an Idea

With a new year coming many of us will want to help encourage change in ourselves, our spouse, or our friend's behavior.

First we can ask what we want to change. 

Then follow with four simple questions:

Desire - Do you want to change?
Ability - How can you change? What do you need to do?
Reasons - What are some reasons to change?
Need - How important is this to you?

By merely thinking about changing for the better we plant a seed that might sprout and change who we are and change who we will become.

Do you have itchy dry skin?

Check out www.nationaleczema.org 


Eczema equals dry damaged skin.  This is a chronic condition that improves with daily skin care.


Following are a few non-soap cleanser suggestions:

• Aquaphor® Gentle Wash
• AVEENO® Advanced Care Wash
• Basis® Sensitive Skin Bar
• CeraVe™ Hydrating Cleanser
• Cetaphil® Gentle Cleansing Bar
• Dove® Sensitive Skin Unscented Beauty Bar
• Mustela® Stelatopia Cream Cleanser
• Oilatum® Cleansing Bar

What moisturizer should I use?

Following are a few suggestions:

• Aquaphor® Healing Ointment
• AVEENO® Advanced Care Cream
• Crisco Regular Shortening
• CeraVe™ Moisturizing Cream
• Cetaphil® Moisturizing Cream
• Eucerin® Original Creme
• Moisturel® Therapeutic Cream
• Mustela® Stelatopia Moisturizing Cream
• Vanicream™ Moisturizing Skin Cream
• Vaseline® Petroleum Jelly

Homeopathic Teething Tablets May Pose Risk for Children, FDA Warns

From Journal Watch:

"Hyland's Teething Tablets, which are sold over-the-counter and used for relieving symptoms of teething, are being recalled because they contain inconsistent amounts of belladonna, which can be harmful to children in large doses.
According to the FDA, which has been conducting an ongoing inspection of the product's manufacturer, Standard Homeopathic Company, there have also been reports of children consuming too many of the tablets because the caps on the bottles are not childproof.
Symptoms of belladonna toxicity in children can include skin flushing, dry skin and mouth, increased body temperature, dilated pupils, difficulty breathing, excessive sleepiness, disorientation, and seizures. The agency urges consumers to stop giving the tablets to their children; unused portions should be discarded or returned."

Congenital Adrenal Hyperplasia CAH: My body isn't making the right steroid.

Steroids are produced naturally in our bodies.   Steroids help us cope with stress, keep the right balance of salts in our body, and help us mature into boys (testosterone) and girls (estrogen). Sometimes children inherit problems with the enzymes that make these steroids.

Where are the steroids made? Some of the steroids are made in the adrenal glands which sit on top of the kidneys.  The adrenal glands look a little bit like scoops of ice cream on the kidneys. The outside of the adrenal glands make steroids.

Think of steroid production like irrigation. If one row is blocked, water will flow to other rows.  If one of the  ways to make specific steroids are blocked, the ingredients get pushed down different rows and make different steroids. 

The most common problem in CAH is one enzyme doesn't work and so too much "boy" steroid is made.  This can lead to little girls' genitals that look male.  This also leads to not enough specific steroid to help that child's body balance salt and stress which can make them very sick.

The way to treat this is to give the child steroids that replace what the body needs and can't make.  This allows the body to get back in balance with managing salt, stress, and "boy" steroids (yes girls have a little bit of boy "steroids" or hormones too).

Note, when children are born in many states the hospitals and doctor's offices screen for these and many other problems.

If you want more info check out CAH at the Mayo Clinic or google CAH and emedicine.

Three Missed Menstrual Cycles = Time for a check up.

Regular cycles mean that the ovaries are working normally. Ovaries produce estrogen. The main estrogen that our bodies produce is Estradiol. Yes, even for men.

When to get a check up?
1. Menses absent for 90 days.
2. Menses not started by 15.
3. No sign of puberty by 13.
4. Menses not started within 3 years of breast development.

So I missed three periods what can that mean? The fancy name is secondary amenorrhea. That means that your periods have stopped. Most stop for 4 reasons: High levels of prolactin, low thyroid, low estrogen because of the ovary, and Polycystic Ovarian Syndrome or PCOS.

High prolactin, low thyroid, and ovary problems lead to low estradiol. The average normal level of estradiol is 100 pg/mL.

Compression-Only CPR by Bystanders Raises Rates of Survival

This is an update from Journal Watch

"Compression-only CPR by lay rescuers modestly increases survival over conventional resuscitation, a JAMA study finds.

Researchers prospectively studied rates of survival to hospital discharge in some 4400 adult victims of out-of-hospital cardiac arrest not witnessed by emergency medical personnel. All episodes occurred over a 5-year period in Arizona during a public campaign to encourage bystander intervention with compression-only CPR.

Among the principal findings:

* The overall annual rate of bystander CPR increased during the 5-year period, from 28% to 40%.
* Compression-only CPR increased from 20% to 76%.
* Overall survival increased from 4% to 10%; survival was 13% in the compression-only group.
* Good neurological status at discharge, however, did not differ significantly between those getting compression-only versus conventional CPR."

Pregnant Women Should Get Flu Shots

The American College of Obstetricians and Gynecologists recommends that all women who are pregnant during flu season receive inactivated influenza vaccinations.

Morning Only prep for Afternoon Colonoscopies

Morning-Only Bowel Preparation for Afternoon Colonoscopies

October 1, 2010 | Douglas K. Rex, MD

Compared with split dosing, morning-only preparation offered equivalent cleansing and better tolerability.

Reviewing: Matro R et al. Am J Gastroenterol 2010 Sep 105:1954

Dogs might help protect children from eczema.

Study: Dogs might help protect children from eczema
A study found that children who lived with a dog at age 1 had significantly reduced rates of eczema at age 4 compared with those without a dog, while children who lived with a cat had significantly higher rates of eczema. The researchers also found that living with a dog protected children against becoming allergic to cats.

Autism Resources - Online

About 1 in 100 children will be diagnosed with autism. About 1 in 70 boys will be affected. Children with Autism struggle with social and personal skills. Here are resources online that can help.

Autism Resources:

Autism Speaks - www.autismspeaks.org

National Center on Birth Defects - www.cdc.gov/ncbddd/autism

Organization for Autism Research - www.researchautism.org

Autism Society of America - www.autism-society.org

Future Horizons - www.fhautism.com

Wrightslaw - www.wrightslaw.com

The National Academies Press - www.nap.edu

Colic - Fussy Baby

Infants communicate by crying.  They have a different cry for pain, hunger, and attention.  Most infants cry in the evening.  This seems to peak at about 6 weeks.  If the baby calms after about 2 hours and seems happy during the rest of the day their is no reason to worry.

If your infant cries longer than 3 hours a day you should look at other reasons for the fussiness.

Gas
 
One common reason is gas.  Sometimes mom's diet can affect the child if she is breast feeding.  If nursing, you might try to eliminate caffeine, dairy, cabbage, cauliflower, broccoli, beans, spicy foods, citrus, and chocolate one at a time.  Try to discover if one food makes your baby gassy.  Some moms like to try gripe water.

Reflux
 
If your baby spits a lot your baby may have heartburn.  The most important thing is to elevate your baby about 30 degrees.  This includes sleeping position (elevate the head of the mattress) and after feeding make sure the baby is elevated.  If this does not help, talk with your doctor about trying "heartburn" or reflux medicine like Zantac or Prevacid.

Probiotics

Some research suggests that probiotics may help colic.  Our NICU uses probiotics like culturelle or Align.

Milk Intolerance

Some babies actually cannot tolerate mothers breast milk or regular formula.  These infants need to try a special formula like Nutramigen or Alimentum.

See Your Doctor

If your baby has a rectal temperature of 100, refuses to eat, has a lot of pain, or if you have other concerns you should see your doctor.


Calming

Car rides, swings, rocking, pacifiers, back rubs, and swaddling can calm a baby.

Let someone else take over for a time.

It's hard listening to your baby cry for long periods, so give yourself a break.  There are plenty of people that would love to hold a baby.

How do I know if I have Strep Throat?

With school back in full swing kids will start to come home with a sore throat.  When should I be worried about strep?

Strep throat usually looks red with white patches on the tonsils.  There can also be small red/brown spots on the upper soft palate.  Most children have sore throat, stomach ache, headache, and fever.  Some children have fine bumps on their torso ("gooseflesh").  Strep is not usually associated with cough and runny nose.

How accurate is the Rapid Strep test?  The rapid test picks up about 95% of the cases.  If you really feel that it might be strep ask that they send the swab for "culture".  Call the office in about 48 hours for culture results.  If it is positive the office can call in an antibiotic for you.  Common antibiotics that are used are: Amoxicillin (the pink stuff for 10 days), Keflex (Cephalosporin antibiotic for 10 days), or Zithromax (if you are allergic to penicillin and cephalosporin and it is only 5 days).  You can also do one shot of Bicillin but most children are not excited about it.

Summary:
Sore throat with headache, stomach ache, fever, and rash = probably strep
Sore throat with runny nose, cough or sneezing = probably virus or allergies

Can you store Breast Milk?

Yes you can.

Mom's Milk storage guide from www.ameda.com

Storage Time for Human Milk*	Deep Freeze (0°F/ -18°C)	Refrigerator Freezer (variable 0°F/-18°C)	Refrigerator (39°F/4°C)	Cooler with Ice Packs Frozen (59°F/15°C)	Room Temperature
						(72°F-79°F) (22°C-26°C)
Fresh	Up to 12 Months	3-4 Months	8 Days	24 Hours		4 Hours
Frozen, Thawed in Fridge	Do Not Refreeze	Do Not Refreeze	24 Hours	Do Not Store		4 Hours
Thawed, Warmed, Not Fed	Do Not Refreeze	Do Not Refreeze	4 Hours	Do Not Store		Until Feeding Ends
Warmed, Fed	Discard	Discard	Discard	Discard		Until Feeding Ends

The NICU stores the milk until needed and then measures out enough for one feeding.  Any left over in the bottle is discarded.

How many flu shots this year?

This year's "flu" vaccine has three antigen groups in one vaccine:

H1N1
H3N2
Influenza B

Children 6 months to 8 years old who have received in the past:
1 dose of H1N1 + 2 doses of seasonal flu = 1 dose this year

       All other children 6 months to 8 yr should get 2 doses of the 2010-2011 flu vaccine.

All children 9 years and older get 1 dose.

A Guide to Caring for your Newborn

A guide to caring for your Newborn

Newborn Care links from IHC

Is a Fever of 103 bad?

Any infant 2 months or younger with a fever (>100.3) needs to see a doctor immediately.  

For the rest of our children, fever is a normal response to infection.  In children it is usually caused by viruses.  "Colds" typically last about 7-14 days.  Most of these can be watched at home.

When should I see the doctor?

As a parent there are four important questions:

1. Has the fever lasted longer than 4 days?
2. Is my child drinking enough to stay hydrated?
3. Is my child breathing well?
4. Does my child look really bad?

If the fever lasts longer than 4 full days you should probably take your child in for evaluation.  Most fevers will be gone by then.

If you are concerned about your child's breathing, drinking, or appearance you should always have them seen.  Usually I like to give the child Motrin.  If the child perks up and improves dramatically with a little motrin it is probably a viral infection.

Ok, to answer the very first question, "Is a fever of 103 bad?".  If a child has a persistent fever of 102.2 or greater and no symptoms you should see a doctor.  Persistent temperatures over 102.2 may represent a bacterial infection.  Girls can have bladder infections.  Sometimes a little cough can actually be pneumonia.

Summary: I use four full days as my rule of thumb.  Push fluids and Motrin as needed.  But always trust your mother's intuition.  If you feel something is really wrong, keep bugging physicians until you find someone who will listen to you and answer your questions.

7 important questions to ask your 5 - 6 year old

With school beginning it is time to review with our kids important safety tips.

1. "Do you know Mom's phone number?"
Make sure to put your number in their backpack if they cannot remember it.

2. "What do you do if a stranger wants you to get in the car."
With my kids we roll play "robber".  I go sit in the car and role play with them.  You really start to recognize what kids do in these situations.  I hate talking about it, but it is necessary.

3."What do you do if there is a fire?"
Practice climbing out of the bedroom windows.  My children have a lot of fun with this.

4. "Who do you call if mommy needs an ambulance?"
Five year old children need to know who to call if there is a true emergency.

5. "What do you do if you find a gun at your friends house?"
Some families love to hunt or target shoot so it is wise to cover this topic.

6. "What do you do if someone wants you to smoke or do drugs?"
A firm brief answer and then a quick retreat is a good policy.

7. "What do you do if an adult or child that you know wants you to do something you know is wrong?"
This is the same as stranger safety.  Focus on quick retreat and telling your mom.

I've found role playing is a fun way to teach our kids to be safe.  If you have any other safety situations that you have found to be helpful please let me know.

5 tips for keeping those headaches away and keeping your brain happy.

A common complaint during the school year is after school headaches.

Migraines are the most common headache syndrome in children.  Headaches may be accompanied by nausea, tummy ache, eyes sensitive to light, or children sensitive to sound.   They may describe headaches as pounding.

An ounce of prevention is worth a pound of cure.

5 tips for keeping those headaches away and keeping  your brain happy.

1. Getting to bed on time.  Early bedtimes are most helpful for children and adults.  (A recent article highlighted the need for sleep to keep our waists slim as well.  Lack of sleep may increase obesity).  We all know that we are more alert and able to handle more stress when we are well rested.

2. Drink!  Did you know that your brain is mostly water?  It is about 75 - 80 % water.  Many children and adults don't drink enough water throughout the day.  This may be a big contributor to afternoon headaches.
An easy way to check is make sure your urine is a light yellow.  If it is dark reach for another glass of water.
If your child has frequent headaches check with your school about carrying bottled water.

3. Avoid caffeine.  Caffeine is notorious for dehydrating you and triggering headaches.  Chocolate (has a caffeine like chemical theobromine) can also trigger headaches.  "But I need caffeine to function!"  If you feel like you need caffeine, it is a good time to reevaluate your lifestyle.  You may need to simplify and cut out activities so you can get to bed on time.

4. Exercise and play outside.  Brains benefit from increased blood flow.  Dr Amen in a Magnificant Mind challenges us to think about brain health as well as heart health.  Exercise decreases stress, reduces stress hormones, which leads to decreased fat, salt, and sugar cravings.  Increased endorphins help us feel better and increased adrenaline helps us remember what we are studying.  This leads to better work and school performance and less overall stress.

5. Boost your cuisine with fruits, veggies, whole grains, fish, legumes and nuts.  Eating foods high in nutrients and antioxidants help our bodies and our minds deal with stress.

Treatment

If you need to treat a child with a headache:
1. Ibuprofen with a glass of water (the water might actually help the most).
2. Light healthy snack (yogurt, cheese, fruit, nuts, etc)
3. For the older kids you can use Aleve.
4. Rest (children with migraines like to sleep it off)
5. See a health care provider if you are concerned about the headache.

Does your baby look at you? Early Autism Screening.

Check out this article in the L.A. Times Early Autism Screening

What is autism? Autistic children have impairments in three major domains: reciprocal socialization, communication, and behavior.

What are early warning signs of Autism?

• No babbling by 9 months
• No pointing or gestures by 12 months
• Lack of orientation to name by 12 months of age
• No single words by 16 months
• Lack of pretend or symbolic play by 18 months
• No spontaneous, meaningful (not repetitive or echolalic) two-word phrases by 24 months
• Any loss of any language or social skills at any age

Gaze
Lack of appropriate gaze
Lack of warm, joyful expressions with gaze
Receptive language
Lack of recognition of mother's, father's, or consistent caregiver's voice
Lack of response to name
Increased awareness of environmental sounds
Lack of interest in or response to comments made by others
Expressive language
Lack of to-and-fro pattern of vocalization that typically occurs by about 6 months of age
Delayed onset of babbling (after 9 months of age)
Lack of expressions such as "oh-oh" or "huh"
Pre-speech gestures
Decreased or absent use of pre-speech gestures, such as waving, pointing, showing

If you notice any of these warning signs you should seek a specialist in autism spectrum disorders for evaluation.


Data from: Johnson, CP, Myers, SM. Identification and evaluation of children with autism spectrum disorders. Pediatrics 2007; 120:1183.

California Outbreak of Whooping Cough (Pertussis)

From the California Department of Health we learn the following:

To date (8/31/2010), there have been 3,600 confirmed, probable and suspect cases of pertussis reported.  This is the most cases reported in 52 years since there were 3,837 cases reported in 1958 according to the California Department of Health.  106 (60%) of hospitalized cases were infants <3 months of age and 132 (75%) were infants <6 months of age.  8 deaths have been reported, 7 were in infants <2 months of age at time of disease onset and had not received any doses of pertussis-containing vaccine.

What is pertussis?  Bordetella Pertussis is a bacteria usually spread by coughing or sneezing.  In China it is known as the hundred day cough.  It starts out like a regular head cold but then changes into coughing fits that end with a huge breath (whoop).




How do I protect myself and my kids? The Tdap vaccine should be given to all close contacts of infants and newborns.

http://www.cdc.gov/pertussis/

The Gardasil vaccine: do my girls need it?

First a little background.  The Gardasil vaccine was made to reduce cervical cancer.   It was approved by the FDA in June 8, 2006 for use in girls and women through 26 years of age (probably because it was tested in this age group).  There is another competing vaccine called Cervarix.

How common is cervical cancer in America?  The CDC says that about 12,000 women a year will be diagnosed with cervical cancer.  The American Cancer Society estimated that 4,070 women would die from cervical cancer in the United States in 2009.

How do you get it?  Most cervical cancer is caused by a virus. The virus is the Human Papilloma Virus or HPV.  Three types 16, 18, 31 can cause cervical cancer.  HPV is spread skin to skin mainly from sexual contact and is the number one sexually transmitted infection.

How do  you know if  you have it?  "Pap tests" done during annual exams look at cells from the cervix.  That is the reason for the Pap test.

So back to the question.  Is the vaccine safe? Yes.  Do my girls need it?  I usually respond by saying if they had a vaccine for prostate cancer I would be first in line.  Most girls will be sexually active sometime in their life.  You may think, "But, my daughter will only have one partner".  That may be true, but what if they remarry?  Life never turns out the way you expect.

What would I recommend?  Get informed, read the information, and then decide.  The protection only comes before sexual activity.  If you want, you can wait until the girls are older and then let them decide.

CDC - HPV

CDC - Gardasil Safety

Time to get your flu shot.

Influenza (the flu) is a respiratory illness that happens every year usually from late Fall to early Spring.  It is caused by a group of influenza viruses.  It typically causes high fever, respiratory symptoms, and body aches.  At highest risk are the very young, the very old, pregnant and those with lung or heart problems.  The best way to prevent the flu is by getting vaccinated.

The "flu shot" contains killed virus that is injected in the arm or leg. The flu shot is approved for use in people older than 6 months. The CDC directs that "children less than nine years of age being vaccinated for the first time should receive two doses of influenza vaccine, spaced at least 4 weeks apart in the initial year."  The following year they should receive only one dose.

The "flu mist" is a weakened virus that is given in a nasal - spray.  My children call it "sniff up".  The weakened virus grows only in the cold and may cause a small amount of nasal congestion for about 2 days.  The vaccine is approved for healthy individuals ages 2-49 years.  Women who are pregnant or people with asthma or other lung or heart problems should not get the "flu mist".

Who does the CDC say should not get vaccinated?

• People who have a severe allergy to chicken eggs (it is made in eggs).
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
• Children less than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

 I think I have the flu,  what should I do now?  If you or your child have symptoms of high fever, runny nose, cough, and body aches you may want to see your doctor.  Your doctor may prescribe Tamiflu (Oseltamivir) or another antiviral medicine to help shorten the illness.  What should you watch for?  If  your child is not drinking well or is having trouble breathing you should seek medical care immediately.

Do not give aspirin containing products to children with the flu. It can result in Reye's syndrome which is a potentially fatal liver disease.

The best treatment is prevention.  A small poke can save you weeks of frustration and may prevent serious illness.

For more information online goto www.cdc.gov/flu .

This article is for information only and is not a substitute for medical advice.  Please speak with  your physician if you have questions about your specific situation.