Ok, ok, so it's been a while. The in-laws were in town. Cold season is in full swing. The muse just wasn't quite hitting me. Excuses, excuses. Time to get back to work. Hopefully, I'll be back in full swing here now.
So my wife had me working out in the yard yesterday. While I love working out, running, lifting, biking, swimming, I don't actually like working very much and yesterday was work. However, I was enjoying the sun, listening to frogs do their chirping and listening to the birds. Here and there, there were splotches of green showing in the undergrowth in our landscape. So, I guess it was all good.
It reminded me, however, that more of my patients will be spending more time outside here soon. School is out in about 6 weeks. Daylight savings time has started, so evenings are spent outside. It's time for me to start considering problems that occur outdoors compared to indoors.
The most obvious is injuries. While many injuries are unavoidable (hence the word, "accident"), many can be minimized or avoided all together. Bike helmets are critical, especially in neighborhoods where drivers may not be constantly alert. Trampolines should be limited to one user at a time. Children should be supervised anytime they are outside running around. I still remember a camping trip we took with a group. During evening fireside time, several parents were enjoying themselves instead of watching their children dance around the fire. By the time I went to bed, I was a nervous wreck keeping everyone elses children out of the fire pit. Water time should always be supervised and the dangers of river swimming constantly appreciated, even while on a "lazy" float trip. Hiking trips often take hikers close to significant falls and children are very curious what is on the other side of that drop.
Insects and arachnids become a nuisance or worse over the next few weeks. Mosquitos carry West Nile virus. Ticks carry Rocky Mountain Spotted fever, Erlichia and Lyme disease. The occasional brown recluse spider is seen and carries a wicked bite. Chiggers are a constant problem in many grassy or woodland areas. DEET containing products are fairly effective at hiding our presence from many of these critters. Higher concentrations last longer and are probably more effective. Deep Woods Off may be the best. "Natural" insect repellants have not been shown to be effective in discouraging ticks, mosquitos or chiggers.
Sunburns are a constant threat during this time of year, as I found out yesterday, again... High levels of SPF are required as well as frequent reapplication of product. Mixed sunscreen/insect repellant products have not been shown to repell bugs. Sweat and swimming both dramatically decrease the useful life of the applied product. Reapplication as often as every 1/2 to 1 hour may be necessary.
Natural sources of water, while very entertaining, are not really good to be drinking, whether accidental or not. While e. coli tends to be the primary concern of most county health departments in neighborhood lakes such as Lake St. Loius, giardia tends to be a much larger problem. Giardia is a smal protozoa found in many lakes and streams in many parts of the country. It tends to cause loose stools several times a day, often for weeks before anyone discovers that it is the problem.
So, while being outdoors is important for the health of our children, it does pose many risks as well that are very different than their risks indoors over the winter. Until next time, enjoy the beautiful weather we've been having.
Wednesday, March 31, 2010
Wednesday, March 10, 2010
My "pee pee" hurts!
What do you do when this complaint comes out? I here it from all ages and both from boys and girls.
Pain in the genitalia comes from a large number of sources. The most common is the basic urinary tract infection. Both boys and girls can get these, though they are far more common in girls due to the proximity of urethra and rectum. Some experts maintain that wiping from front to back prevents contamination of the urethra, but I have my doubts. The ordinary urinary tract infection is caused by bacteria entering into the urethra and bladder and setting up camp there. Increasing fluids, altering the pH of the urine (drinking cranberry juice) and a simple antibiotic usually suffice.
Pyelonephritis is a basic urinary tract infection that has gone up past the bladder and entered the kidneys. Fever, back pain, vomiting, abdominal pain and pain when one urinates are the common symptoms. Depending on how ill the patient is, treatment can be as simple as an oral antibiotic as above, but if one becomes quite ill, IV fluids and IV antibiotics may be necessary.
Neither of these infections is considered "normal" the way ear infections and colds are. Especially in boys, there is sometimes an underlying reason the infection occured in the first place. The most common is urinary reflux. Instead of flowing out of the bladder when one urinates, some of the urine "refluxes" back up toward the kidney. This irritates the ureters, the tubes that go from kidney to bladder, and allows bacteria to persist. Also, abnormalities in the shape and structure of the kidneys can allow bacteria to cause trouble. Doctors often recommend studies to rule out these abnormalities when children develop urinary tract infections.
Other causes of dysuria, pain with urination, include yeast infections, skin infections and irritation of the urethra. Irritation often is caused by some chemical, hence the ubiquitous claim that bubble baths cause bladder infections. This is technically not true, but they CAN cause urethral irritation. Treatment for this is as simple as pushing fluids and avoiding the irritation. Physical manipulation (masturbation) can also cause urethritis in sensitive individuals. Obviously, trauma can also cause pain, and is sometimes the only indication that an individual is being abused.
So the causes of urethral pain are many and can be difficult to sort through. In anybody, if the pain seems to be persistant, give your doctor a call.
Pain in the genitalia comes from a large number of sources. The most common is the basic urinary tract infection. Both boys and girls can get these, though they are far more common in girls due to the proximity of urethra and rectum. Some experts maintain that wiping from front to back prevents contamination of the urethra, but I have my doubts. The ordinary urinary tract infection is caused by bacteria entering into the urethra and bladder and setting up camp there. Increasing fluids, altering the pH of the urine (drinking cranberry juice) and a simple antibiotic usually suffice.
Pyelonephritis is a basic urinary tract infection that has gone up past the bladder and entered the kidneys. Fever, back pain, vomiting, abdominal pain and pain when one urinates are the common symptoms. Depending on how ill the patient is, treatment can be as simple as an oral antibiotic as above, but if one becomes quite ill, IV fluids and IV antibiotics may be necessary.
Neither of these infections is considered "normal" the way ear infections and colds are. Especially in boys, there is sometimes an underlying reason the infection occured in the first place. The most common is urinary reflux. Instead of flowing out of the bladder when one urinates, some of the urine "refluxes" back up toward the kidney. This irritates the ureters, the tubes that go from kidney to bladder, and allows bacteria to persist. Also, abnormalities in the shape and structure of the kidneys can allow bacteria to cause trouble. Doctors often recommend studies to rule out these abnormalities when children develop urinary tract infections.
Other causes of dysuria, pain with urination, include yeast infections, skin infections and irritation of the urethra. Irritation often is caused by some chemical, hence the ubiquitous claim that bubble baths cause bladder infections. This is technically not true, but they CAN cause urethral irritation. Treatment for this is as simple as pushing fluids and avoiding the irritation. Physical manipulation (masturbation) can also cause urethritis in sensitive individuals. Obviously, trauma can also cause pain, and is sometimes the only indication that an individual is being abused.
So the causes of urethral pain are many and can be difficult to sort through. In anybody, if the pain seems to be persistant, give your doctor a call.
Monday, March 1, 2010
What to do with the sniffles and snuffles.
We're, hopefully, coming to the end of cold season. Part of the reason for my delayed posting is because cold season is very busy in the office and I'm just not always the most motivated writer. My apologies if you faithfully read my posts... Cold season is VERY frustrating to parents and causes pediatricians to often rethink how they approach their practices.
The fancy name for a cold is "upper respiratory infection." This unfortanate naming causes all sorts of trouble for pediatricians. This term encompasses ear infections, sinus infections, sore throats and infections of the airway below the nose, but outside the lungs, such as croup. Colds are triggers for all these problems, but don't necessarily include all these problems.
By definition, a cold is caused by a virus. There is a list of several dozen viruses that cause colds, each of which comes in a variety of sub-types. It is this large number of sub-types that causes people to catch cold after cold after cold instead of becoming immune to the common cold. This same variation in sub-types makes it impossible, for now, to create a working vaccine.
The symptoms of the common cold are well known to most people. Cough, congestion, sore throat and fever are the most common symptoms. Headaches, muscle aches, ear aches and chest pain are not uncommon other symptoms. Usually the fevers are low grade, 101 or less, and last no more than 72 hours. The congestion and nasal drainage usually starts out clear, but often will turn yellow or green within 72 hours and stay that way for several days. Our mothers always taught us that green means we need an antibiotic, but it's pretty clear now that this is not true. Your average cold will last 10-14 days, regardless of age. Some fortunate individuals seem to fight off their colds in a much shorter time frame.
Treatment of the common cold is symptomatic. Nasal saline or nasal saline washes (Netti pots) can help relieve congestion. A spoonful of honey as needed, for individuals older than 12 months, can be used to help supress cough. Cough drops may also be helpful. Running a humidifier keeps nasal congestion loose and easier to breath through. Elevating the head of the bed may help the drainage and cough to be more tolerable. Tylenol or Motrin (for those over 6 months old) helps with the muscle aches and fevers.
Cold medications available by prescription or over-the-counter have not been shown to make a difference in symptoms. Available studies suggest that they are merely sedating, which may help with sleep, but not with symptoms.
Colds that have fevers higher than 103, fever lasting longer than 72 hours, cough and congestion longer than 14 days or colds with unusual or severe symptoms need to be evaluated. A common question is "what is more severe?" The most concerning is a headache with neck stiffness as a symptom of meningitis. Shortness of breath and "windedness" may suggest pneumonia. Significant facial or tooth pain may indicate a sinus infection. As always, if you have concerns, discuss your symptoms with your regular physician.
The fancy name for a cold is "upper respiratory infection." This unfortanate naming causes all sorts of trouble for pediatricians. This term encompasses ear infections, sinus infections, sore throats and infections of the airway below the nose, but outside the lungs, such as croup. Colds are triggers for all these problems, but don't necessarily include all these problems.
By definition, a cold is caused by a virus. There is a list of several dozen viruses that cause colds, each of which comes in a variety of sub-types. It is this large number of sub-types that causes people to catch cold after cold after cold instead of becoming immune to the common cold. This same variation in sub-types makes it impossible, for now, to create a working vaccine.
The symptoms of the common cold are well known to most people. Cough, congestion, sore throat and fever are the most common symptoms. Headaches, muscle aches, ear aches and chest pain are not uncommon other symptoms. Usually the fevers are low grade, 101 or less, and last no more than 72 hours. The congestion and nasal drainage usually starts out clear, but often will turn yellow or green within 72 hours and stay that way for several days. Our mothers always taught us that green means we need an antibiotic, but it's pretty clear now that this is not true. Your average cold will last 10-14 days, regardless of age. Some fortunate individuals seem to fight off their colds in a much shorter time frame.
Treatment of the common cold is symptomatic. Nasal saline or nasal saline washes (Netti pots) can help relieve congestion. A spoonful of honey as needed, for individuals older than 12 months, can be used to help supress cough. Cough drops may also be helpful. Running a humidifier keeps nasal congestion loose and easier to breath through. Elevating the head of the bed may help the drainage and cough to be more tolerable. Tylenol or Motrin (for those over 6 months old) helps with the muscle aches and fevers.
Cold medications available by prescription or over-the-counter have not been shown to make a difference in symptoms. Available studies suggest that they are merely sedating, which may help with sleep, but not with symptoms.
Colds that have fevers higher than 103, fever lasting longer than 72 hours, cough and congestion longer than 14 days or colds with unusual or severe symptoms need to be evaluated. A common question is "what is more severe?" The most concerning is a headache with neck stiffness as a symptom of meningitis. Shortness of breath and "windedness" may suggest pneumonia. Significant facial or tooth pain may indicate a sinus infection. As always, if you have concerns, discuss your symptoms with your regular physician.
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