It's time to return to a staple of my trade... ear infections. Ear infections remain one of the most common reasons that parents turn to their child's pediatrician. Often it's due to the middle of the night crying with ear pain. Sometimes it's due to the week long complaining that their child can't hear. Ear infections clearly come in several colors.
Usually, ear infections start off as a "cold" with cough and congestion, often for several days, before the classic sign of ear pain begins. Sometimes, but not always, there is fever. Often, the fever doesn't start until the children have had cold symptoms for a few days. Other times, the children will come in for a regular check up with no symptoms at all and, during their exam, we'll find an ear infection. Parents are always curious how that could possibly be true, but it is.
Probably most frustrating are the kids who complain of ear pain, have cold symptoms, come in to the office and I see no evidence of an ear infection on exam. This is probably due to eustacian tube dysfunction. Basically, the "relief valve" of the middle ear is so swollen and clogged with mucous that the children develop pain, much like the discomfort one has when ascending and descending in an airplane.
For decades, the treatment of choice for ear infections has been a round of antibiotics. That dogma is beginning to change. There have been a number of good studies demonstrating that 90-95% of ear infections resolve without antibiotic therapy. Fifty percent of them are viral infections and won't respond to an antibiotic anyways. There are also more recent studies that suggest that even if the infection is bacterial, antibiotics might not speed recovery or hasten the resolution of pain. The most recent American Academy of Pediatrics guidelines suggest that in children older than two, the pediatrician consider providing pain relief and not antibiotics for the infection. For pain relief, parents can use Motrin or Tylenol. A warm moist washcloth placed over the ear that hurts can also provide relief of pain. Some physicians recommend narcotics (codeine) though I find that these medications provide no more relief than Motrin. Finally, there are prescription ear drops that have a topical anesthetic in them that can temporarily provide relief.
However you choose to treat the ear infection, it is important that someone trained to evaluate ears look at the childs ears to confirm the presence of an ear infection as there are a large number of ears that hurt that are not infected.
As always, consult your child's pediatrician if you have specific questions.
Thursday, February 11, 2010
Thursday, January 28, 2010
It's RSV season again
I know I've touched this topic before, but since the season has started again and we're in a different format, I'll touch it again. There may even be new information in here. RSV stands for Respiratory Syncytial Virus. The key word here is "virus." It predominantly infects infants and toddlers, but can cause illness at any age. In older children and adolescents, the illness shows up primarily as a cold with cough and congestion lasting one to two weeks. In infants and toddlers, however, there is frequently a severe cough and likely some wheeze. In very small infants, an infection with RSV can actually cause the children to stop breathing all together (called apnea) for short periods.
It's this wheezing and apnea that causes so much trouble with RSV. The wheeze comes because the airways have become inflamed and swollen. These swollen airways have a much smaller air passage than normal and causes the infants to have difficulty breathing (imagine breathing through a straw). This combination causes the respiratory rate to go up and causes the children to have to work much harder than normal to catch their breath. Eventually, some infants tire to the point that they quit working so hard. This is when the trouble begins and their little bodies need help with extra oxygen and maybe even breathing support.
The apnea appears to be unassociated with the swollen airways and can occur without warning in very small infants and is potentially life-threatening.
The biggest trouble is that there are no proven therapies for this infection. Much like the common cold, nothing specifically treats RSV. There is an immunization, Synagis, that can provide some protection for those that are most likely to suffer a severe infection (premies and infants with chronic lung conditions). It is very expensive and does not offer long term protection. Therapies for asthma like breathing treatments and steroids only prove to be helpful in a limited number of patients. There is some suggestion that those who do respond may actually have underlying asthma. Antibiotics don't help at all since it is a viral infection. That leaves physicians with very little to do except watch very carefully for the infants at risk of tiring out and needing extra help. We do that with supplemental oxygen and in severe cases, actually breathing for the infant with a ventilator.
Much like the cold, the best management is to try to prevent this infection. Good handwashing is the cornerstone of prevention. If you know your child has RSV, they are contagious with the start of the runny nose and for several days after that. If your child is wheezing, and especially if he or she seems to be short of breath, then he or she needs to be seen. Give your doctor a call!
It's this wheezing and apnea that causes so much trouble with RSV. The wheeze comes because the airways have become inflamed and swollen. These swollen airways have a much smaller air passage than normal and causes the infants to have difficulty breathing (imagine breathing through a straw). This combination causes the respiratory rate to go up and causes the children to have to work much harder than normal to catch their breath. Eventually, some infants tire to the point that they quit working so hard. This is when the trouble begins and their little bodies need help with extra oxygen and maybe even breathing support.
The apnea appears to be unassociated with the swollen airways and can occur without warning in very small infants and is potentially life-threatening.
The biggest trouble is that there are no proven therapies for this infection. Much like the common cold, nothing specifically treats RSV. There is an immunization, Synagis, that can provide some protection for those that are most likely to suffer a severe infection (premies and infants with chronic lung conditions). It is very expensive and does not offer long term protection. Therapies for asthma like breathing treatments and steroids only prove to be helpful in a limited number of patients. There is some suggestion that those who do respond may actually have underlying asthma. Antibiotics don't help at all since it is a viral infection. That leaves physicians with very little to do except watch very carefully for the infants at risk of tiring out and needing extra help. We do that with supplemental oxygen and in severe cases, actually breathing for the infant with a ventilator.
Much like the cold, the best management is to try to prevent this infection. Good handwashing is the cornerstone of prevention. If you know your child has RSV, they are contagious with the start of the runny nose and for several days after that. If your child is wheezing, and especially if he or she seems to be short of breath, then he or she needs to be seen. Give your doctor a call!
Tuesday, January 19, 2010
The "skin"ny on "Staph"
I'm sure you've all heard about the Staph bug by now. It seems to have made all the news networks at one point or another. Having said that, what do you really need to know? What do you really need to do about it?
At any given point, all of us have millions of bacteria living on our skin. There is absolutely no way to completely eliminate them all, nor is there evidence that eliminating them all is a good idea. One of those "free loaders" is inevitably Staphylococcus Aureus (Staph). Most of the time, humans and staph bacteria coexist happily, but on occasion, this coexistance becomes strained and the staph gets a little out of hand.
Staph infections have a wide variety of common names indicating the wide variety of skin illnesses they cause. Impetigo is a yellow, crusty, weepy sore that is generally found around the nose, but can be found anywhere on the body. It is relatively contagious, but usually can be treated with topical creams. Pustular impetigo is a staph infection that causes small blisters that are filled with pus that can be found anywhere on the body. Cellulitis is an infection in which the staph has actually gotten into the layers of the skin rather than on top of the skin. It shows up as gradually enlarging, painful, swollen red areas on the skin. Usually, it is only located as an isolated lesion unlike impetigo which is usually many lesions. Folliculitis is a skin infection in which the hair follicles or pores have become clogged and the staph multiply in the follicle leading to a small red irritation of each involved follicle. Usually many follicles at a time are involved. Both cellulitis and folliculitis can lead to abcess formation, a large accumulation of pus under the sking that generally increases in size, redness and pain before either spontaneously emptying or being actively drained. Each of these infections are potentially serious and worthy of being discussed and/or treated by your physician.
MRSA has become a hot topic in medicine these days. This stands for methicillin resistant staphylococcal aureus. These staph have adapted to the antibiotics that are usually used for skin infections. In so doing, they've made themselves resistant so these antibiotics no longer work against them. Unfortunately, they have become so common that many physicians, myself included, no longer even use the usual antibiotics. The problem, of course, is as resistance patterns continue to change, we are quickly arriving at a point where we do not have the antibiotics to treat some of these infections.
For most, a skin infection here and there is not a cause for concern. Physicians are seeing an increasing number of individuals and families that tend to have recurring problems with serious skin infections from staph, however. Physicians are unclear on why this is occuring, but it doesn't seem to be particularly dependant on hygeine, but rather genetic and other environmental factors. There is a great deal of discussion, but no clear guidelines or good studies on what to do to help these families avoid future infections. Some have advised bleach baths twice a week, others have recommended the use of antibacterial soaps with bathing, while others suggest that none of these methods work and that these families should just get treated anytime they get the infection.
Needless to say, these infections can be quite serious. Any evidence of a skin infection is a cause for concern and should be brought to the attention of your physician. Sometimes, a simple cream is all you need. Other times, IV antibiotics and or surgical treatment are required. As usual, don't hesitate to call your physician if you're concerned.
At any given point, all of us have millions of bacteria living on our skin. There is absolutely no way to completely eliminate them all, nor is there evidence that eliminating them all is a good idea. One of those "free loaders" is inevitably Staphylococcus Aureus (Staph). Most of the time, humans and staph bacteria coexist happily, but on occasion, this coexistance becomes strained and the staph gets a little out of hand.
Staph infections have a wide variety of common names indicating the wide variety of skin illnesses they cause. Impetigo is a yellow, crusty, weepy sore that is generally found around the nose, but can be found anywhere on the body. It is relatively contagious, but usually can be treated with topical creams. Pustular impetigo is a staph infection that causes small blisters that are filled with pus that can be found anywhere on the body. Cellulitis is an infection in which the staph has actually gotten into the layers of the skin rather than on top of the skin. It shows up as gradually enlarging, painful, swollen red areas on the skin. Usually, it is only located as an isolated lesion unlike impetigo which is usually many lesions. Folliculitis is a skin infection in which the hair follicles or pores have become clogged and the staph multiply in the follicle leading to a small red irritation of each involved follicle. Usually many follicles at a time are involved. Both cellulitis and folliculitis can lead to abcess formation, a large accumulation of pus under the sking that generally increases in size, redness and pain before either spontaneously emptying or being actively drained. Each of these infections are potentially serious and worthy of being discussed and/or treated by your physician.
MRSA has become a hot topic in medicine these days. This stands for methicillin resistant staphylococcal aureus. These staph have adapted to the antibiotics that are usually used for skin infections. In so doing, they've made themselves resistant so these antibiotics no longer work against them. Unfortunately, they have become so common that many physicians, myself included, no longer even use the usual antibiotics. The problem, of course, is as resistance patterns continue to change, we are quickly arriving at a point where we do not have the antibiotics to treat some of these infections.
For most, a skin infection here and there is not a cause for concern. Physicians are seeing an increasing number of individuals and families that tend to have recurring problems with serious skin infections from staph, however. Physicians are unclear on why this is occuring, but it doesn't seem to be particularly dependant on hygeine, but rather genetic and other environmental factors. There is a great deal of discussion, but no clear guidelines or good studies on what to do to help these families avoid future infections. Some have advised bleach baths twice a week, others have recommended the use of antibacterial soaps with bathing, while others suggest that none of these methods work and that these families should just get treated anytime they get the infection.
Needless to say, these infections can be quite serious. Any evidence of a skin infection is a cause for concern and should be brought to the attention of your physician. Sometimes, a simple cream is all you need. Other times, IV antibiotics and or surgical treatment are required. As usual, don't hesitate to call your physician if you're concerned.
Monday, January 11, 2010
It's "stomach flu" season...
Yes, it's that time of year again. I'm hearing about it every day in the office. Not so fun to talk about and certainly no fun when it's your child's turn. Vomiting and diarrhea... two of the least fun things that kids do. What triggers it? Why does my kid have it? Can it be prevented? What do I do now that my children have it?
Gastroenteritis (fancy word for "stomach flu") has multiple causes, both bacterial and viral. Every rare once in a while, it's caused by something other than an infection and we can talk about that in a future post. Children always "catch it" from another individual whether it's viral or bacterial. Typical symptoms are vomiting for about 8 to 12 hours and diarrhea off and on for a week or two. The largest concern with gastroenteritis is dehydration. Most often, children become dehydrated only if the vomiting doesn't resolve within about 12 hours and they are unable to keep down any fluids. Symptoms of dehydration include lethargy, unwillingness to drink despite a known need, glassy eyes, dry mouth and decreased number of trips to the bathroom to urinate. These kinds of symptoms should prompt a parent to take their child to the emergency room.
Once your child begins to vomit, as a parent, you walk a bit of a tight rope between resting the stomach and providing enough fluids to prevent dehydration. Any fluids that you can get your child to drink is ok to use, but often the fluids that go down easiest are Pedialyte, Gatorade, juices and chicken broth. The extra salts in these fluids can be more helpful than straight water. Milk and formula are also perfectly acceptable, but for some children, they will cause more vomiting. Always think small volumes frequently. A half spoonful every 5-10 minutes that is not thrown up is more useful than 2 ounces every half hour that does get thrown up. Often, you need to wait a half hour or a full hour after a child throws up in order to give them more fluids. Ice chips can be helpful in older children if they want to "wet their whistle."
With diarrhea, yogurt is really the only thing that has been shown to consistantly help some with slowing down the frequency and volume. Any yogurt that has active culture can be helpful. There have been studies that suggest that zinc can likewise help, but the studies were done mostly in developing countries. Also, there are no products available in US pharmacies that provide zinc in the dosages suggested.
Blood or slimy mucous in diarrheal stools is a cause for a higher level of concern as they may indicate bacterial infections such as salmonella, shigella or e. coli. Often these infections don't need antibiotics, but they do warrant closer attention.
The best defense against gastroenteritis is the usual stand-by... good hygeine. Always washing hands well before eating, before cooking and after using the restroom or changing a diaper are very important. Likewise, cooking food completely can help prevent salmonella, shigella and e. coli. As with many illnesses, prevention is the best medicine.
Gastroenteritis (fancy word for "stomach flu") has multiple causes, both bacterial and viral. Every rare once in a while, it's caused by something other than an infection and we can talk about that in a future post. Children always "catch it" from another individual whether it's viral or bacterial. Typical symptoms are vomiting for about 8 to 12 hours and diarrhea off and on for a week or two. The largest concern with gastroenteritis is dehydration. Most often, children become dehydrated only if the vomiting doesn't resolve within about 12 hours and they are unable to keep down any fluids. Symptoms of dehydration include lethargy, unwillingness to drink despite a known need, glassy eyes, dry mouth and decreased number of trips to the bathroom to urinate. These kinds of symptoms should prompt a parent to take their child to the emergency room.
Once your child begins to vomit, as a parent, you walk a bit of a tight rope between resting the stomach and providing enough fluids to prevent dehydration. Any fluids that you can get your child to drink is ok to use, but often the fluids that go down easiest are Pedialyte, Gatorade, juices and chicken broth. The extra salts in these fluids can be more helpful than straight water. Milk and formula are also perfectly acceptable, but for some children, they will cause more vomiting. Always think small volumes frequently. A half spoonful every 5-10 minutes that is not thrown up is more useful than 2 ounces every half hour that does get thrown up. Often, you need to wait a half hour or a full hour after a child throws up in order to give them more fluids. Ice chips can be helpful in older children if they want to "wet their whistle."
With diarrhea, yogurt is really the only thing that has been shown to consistantly help some with slowing down the frequency and volume. Any yogurt that has active culture can be helpful. There have been studies that suggest that zinc can likewise help, but the studies were done mostly in developing countries. Also, there are no products available in US pharmacies that provide zinc in the dosages suggested.
Blood or slimy mucous in diarrheal stools is a cause for a higher level of concern as they may indicate bacterial infections such as salmonella, shigella or e. coli. Often these infections don't need antibiotics, but they do warrant closer attention.
The best defense against gastroenteritis is the usual stand-by... good hygeine. Always washing hands well before eating, before cooking and after using the restroom or changing a diaper are very important. Likewise, cooking food completely can help prevent salmonella, shigella and e. coli. As with many illnesses, prevention is the best medicine.
Wednesday, January 6, 2010
New Year's Resolutions
Good Morning,
I thought it would be a good idea to clarify a comment I made in my previous blog concerning the impact of exercise. I actually commented that exercise is both over-rated and under-rated.
Now, those of you who know me, know that I enjoy exercise. I am somewhat limited by torn cartilage in my left shoulder and deteriorating cartilage in my left knee, but that hasn't stopped me from enjoying good exercise. It just limits my choices somewhat. Having said all that, why would I say exercise is over-rated?
I think a good way to see what I'm saying is for me to say that exercise can not reveal what diet has covered up, but diet CAN reveal what exercise has done. Exercise is absolutely critical for cardiovascular health. It improves blood flow. It improves muscle elasticity. It improves strength. It improves basal metabolic rates. It enhances concentration. It enhances insulin sensitivity. All these things are not only good for you, but, in general, if not over-done, make you feel good.
However, the truth of the matter is that it is nearly impossible to out exercise your diet! I work out about 6 hours a week, sometimes a little more, sometimes less. However, that adds up to only about 3000-3500 calories a WEEK (or about 1 lb of exercise/week). I am more than capable of eating 3000+ calories each DAY!!! Needless to say, it would take a huge volume of exercise to lose weight if I didn't control my diet.
On the other hand, cutting 500 calories a day from my usual diet (the equivlent of 3 sodas daily) amounts to 3500 calories each week. That is the pound a week that most experts say is appropriate. Not only that, but cutting 500 calories is not NEARLY so exhausting as 6-7 hours of exercise!!
So, as you make your new year plans, plan appropriately. If your goal is to lose some weight, cutting calories by making smart food choices is critical. Exercise will make you look good, but only if your diet doesn't cover up all your good looks!
I thought it would be a good idea to clarify a comment I made in my previous blog concerning the impact of exercise. I actually commented that exercise is both over-rated and under-rated.
Now, those of you who know me, know that I enjoy exercise. I am somewhat limited by torn cartilage in my left shoulder and deteriorating cartilage in my left knee, but that hasn't stopped me from enjoying good exercise. It just limits my choices somewhat. Having said all that, why would I say exercise is over-rated?
I think a good way to see what I'm saying is for me to say that exercise can not reveal what diet has covered up, but diet CAN reveal what exercise has done. Exercise is absolutely critical for cardiovascular health. It improves blood flow. It improves muscle elasticity. It improves strength. It improves basal metabolic rates. It enhances concentration. It enhances insulin sensitivity. All these things are not only good for you, but, in general, if not over-done, make you feel good.
However, the truth of the matter is that it is nearly impossible to out exercise your diet! I work out about 6 hours a week, sometimes a little more, sometimes less. However, that adds up to only about 3000-3500 calories a WEEK (or about 1 lb of exercise/week). I am more than capable of eating 3000+ calories each DAY!!! Needless to say, it would take a huge volume of exercise to lose weight if I didn't control my diet.
On the other hand, cutting 500 calories a day from my usual diet (the equivlent of 3 sodas daily) amounts to 3500 calories each week. That is the pound a week that most experts say is appropriate. Not only that, but cutting 500 calories is not NEARLY so exhausting as 6-7 hours of exercise!!
So, as you make your new year plans, plan appropriately. If your goal is to lose some weight, cutting calories by making smart food choices is critical. Exercise will make you look good, but only if your diet doesn't cover up all your good looks!
Wednesday, December 30, 2009
Bringing in the New Year
Welcome,
Some of you are coming here from my old 'blog over at SSM Health Care. If you are, I thank you for following me here. I'll make this post very short. I hope to basically continue the same themes that were present on the last 'blog.
For those of you who are new, I'm a pediatrician in Lake St. Louis, just outside of St. Louis, Missouri. I've been in practice for almost 15 years. My practice is in general pediatrics covering everything from basic well care to ADD and everything in between. You'll get to hear my opinion on many things pediatric. I also tend to be very health oriented, so you'll hear my opinions on general health and preventive health.
Since I will no longer be attached to an SSM Health Care web-site, you may hear me say some things that I might not say on one of their websites. Nothing bad... You just might hear references to sports teams, bullet points and other taboos that I wouldn't use there.
I also hope to be a little more free with my personal thoughts and musings on life in general than I was on the old site.
Thank you for visiting.
Feel free to comment or question anything you read here. Add your own insights. Ask questions that might prompt the next column. In short, let's make this a shared 'blog where we all learn a little more about staying healthy in today's challenging times.
Some of you are coming here from my old 'blog over at SSM Health Care. If you are, I thank you for following me here. I'll make this post very short. I hope to basically continue the same themes that were present on the last 'blog.
For those of you who are new, I'm a pediatrician in Lake St. Louis, just outside of St. Louis, Missouri. I've been in practice for almost 15 years. My practice is in general pediatrics covering everything from basic well care to ADD and everything in between. You'll get to hear my opinion on many things pediatric. I also tend to be very health oriented, so you'll hear my opinions on general health and preventive health.
Since I will no longer be attached to an SSM Health Care web-site, you may hear me say some things that I might not say on one of their websites. Nothing bad... You just might hear references to sports teams, bullet points and other taboos that I wouldn't use there.
I also hope to be a little more free with my personal thoughts and musings on life in general than I was on the old site.
Thank you for visiting.
Feel free to comment or question anything you read here. Add your own insights. Ask questions that might prompt the next column. In short, let's make this a shared 'blog where we all learn a little more about staying healthy in today's challenging times.
Subscribe to:
Posts (Atom)