Food Allergies in Children by Colleen Kraft, M.D.

How do you know if your child has a food allergy? A food allergy happens when the body reacts against harmless proteins found in foods. The reaction usually happens shortly after a food is eaten. Food allergy reactions can vary from mild to severe.

Because many symptoms and illnesses could be wrongly blamed on "food allergies," it is important for parents to know the usual symptoms. The following is information from the American Academy of Pediatrics (AAP) about food allergies and how to recognize and treat the symptoms.

Symptoms of a food allergy When the body's immune system overreacts to certain foods, the following symptoms may occur:

  • Skin problems Hives (red spots that look like mosquito bites) Itchy skin rashes (eczema, also called atopic dermatitis)

  • Swelling

  • Breathing problems

  • Sneezing

  • Wheezing

  • Throat tightness

  • Stomach symptoms

    • Nausea

    • Vomiting

    • Diarrhea



  • Pale skin

  • Light-headedness

  • Loss of consciousness


 

If several areas of the body are affected, the reaction may be severe or even life-threatening. This type of allergic reaction is called anaphylaxis and requires immediate medical attention.

  • Food can cause many illnesses that are sometimes confused with food allergies. The following are not food allergies:

  • Food poisoning—Can cause diarrhea or vomiting, but is usually caused by bacteria in spoiled food or undercooked food.

  • Drug effects—Certain ingredients, such as caffeine in soda or candy, can make your child shaky or restless.

  • Skin irritation—Can often be caused by acids found in such foods as orange juice or tomato products.

  • Diarrhea—Can occur in small children from too much sugar, such as from fruit juices.


Any food could cause a food allergy, but most food allergies are caused by the following:

  • Cow’s milk

  • Eggs

  • Peanuts

  • Soy

  • Wheat

  • Nuts from trees (such as walnuts, pistachios, pecans, cashews)

  • Fish (such as tuna, salmon, cod) Shellfish (such as shrimp, lobster)


Peanuts, nuts, and seafood are the most common causes of severe reactions. Allergies can also occur to other foods such as meats, fruits, vegetables, grains, and seeds such as sesame.

The good news is that food allergies are often outgrown during early childhood. It is estimated that 80% to 90% of egg, milk, wheat, and soy allergies go away by age 5 years. Some allergies are more persistent. For example, 1 in 5 young children will outgrow a peanut allergy and fewer will outgrow allergies to nuts or seafood.

Your doctor can perform tests to track your child's food allergies and watch to see if they are going away. They can also advise you with regard to an allergy action plan, that you can keep in your child’s school or child care center, to manage an acute exposure to their food allergen. Often your doctor will prescribe an epinephrine injector in case you child has a severe reaction.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

Water Fluoridation by Nima Alipour D.O.

Water Fluoridation:

A Brief Review Leading to Recent Changes in Public Health Measures and Recommendations by Nima Alipour  D.O., MBA
Occupational, Environmental, and Preventive Medicine
Director of Occupational Health and Workplace Wellness

Fluorine is an abundant element, found widely in the environment, from soil to rocks, water, and even air.  It makes up approximately 0.1% of the earth’s crust.  It is also an industrial byproduct of aluminum, iron ore, and fertilizer.  The impact of fluoride was initially noted in 1909 when high levels were associated with deleterious effects, specifically, mottled enamel.  However, by 1945, researchers at the NIH found that fluoride had protective effects and prevented dental carries.

In January of 1945, the city of Grand Rapids became the first of many to have their water supply artificially fluorinated to the level of 1ppm followed this discovery.   However, while advocates will refer to this as one of the most practical, cost effective, and safe measures that communities can take to improve oral health, water fluorination remains a controversial public health topic.  Experts opposing the fluorination of water cite studies highlighting th



at what gains are seen in oral health, can be significantly offset by adverse systemic toxic effects.

Pollutant, or Medical Nutrient?

If one were to review the July 2015 issue of the public health reports under the ‘Surgeon Generals Perspectives” section, they would see the article titled “Community Water Fluorination, One of the CDC’s “10 Greatest Public Health Achievements of the 20th Century.”  In fact, 2015 marked the 70th anniversary of water fluorination that began in Grand Rapids Michigan as one of the first of many landmark studies that demonstrated that the addition of low amounts of Fluorine to the community water system resulted in fewer dental carries than communities with naturally occurring, or negligible amounts of fluoride in the water system.



In 1962, the U.S. Public Health Service published recommendations that community water systems add fluorine to water systems.  These recommendations continue to this day, with approximately 75 percent of the population – about 210 million people – are served by these such water systems.

While the main positive impact of fluoride on human health is its contribution to prevention of dental carries, this benefit was found to be topical, and in turn, the notion of adequate daily intake appears to be flawed.  Furthermore, fluoride is still classified as a pollutant, and not a medical nutrient, and thus, it becomes a starting point for conversations about adverse effects.   At a total fluoride intake of 14 mg/day, there is evidence of skeletal fluorosis and an increased risk of bone fractures; at levels above about 6 mg fluoride/day the evidence is suggestive of an increased risk of effects on bone.  There are now more sources of fluoride than in the past, which warrants a re-evaluation of the previously published recommendation of maintaining concentrations between 0.7 and 1.2ppm in public water systems.  In a study by the CDC, it was found that total fluoride intake for adults was between 1.58 and 6.6mg/day and between 0.9 and 3.6mg per day.   Without a way to regulate an individual dose of ingested fluoride, it is difficult to stay within certain permissible limits or to identify an ‘optimal dose.’  In short, the recommendations and the permissible exposure that is artificially created warrants reevaluation.

A General Public Health View

From a public health perspective, any large-action action that is low cost (or cost-effective), equitable, safe, and seemingly practical, is an action that is highly sought after if there are clear findings of benefit for the public to whom the action serves. While this concept is well-known and simple on the surface, as anecdotal observations and poorly designed studies are peeled away to reveal evidence-based scientific findings, the depth and complicated nature of these actions are revealed.  Artificial fluorination of community water systems to prevent or minimize tooth decay is one such example.

In July of 2015, public health reports, published an article by Surgeon General Vivek H. Murthy, where he celebrated the –then- 70th anniversary of the start of community water fluorination.  In the article, Dr, Murthy proposes his thoughts that water fluorination ‘is the best method for delivering fluoride to all members of the community, regardless of age, education, income level, or access to routine dental care.’  He then cites two articles stating, “each generation born since the implementation of water fluoridation has enjoyed better dental health than the preceding generation.”

Mixed Messages

The first comment is without supportive evidence and poses the obvious question: is fluorination of water is in fact the ‘best way’ to deliver fluoride to all members of the community?   Furthermore, there is a seemingly endless list of confounding factors to call into question the stated fact that ‘each generation born since the implementation of water fluoridation has enjoyed better dental health than the preceding generation.’   Improvements in dental care and hygiene, including improved education, floss and toothbrush technology, access to more readily available and affordable dental care, are a few of these confounders.



In his article, the surgeon general admits to an increase in dental fluorosis, a condition arising from over exposure to fluoride resulting in staining and pitting of the tooth surface (fig 1).  What is left out however is the neurotoxicant effect of increased systemic exposure to fluoride.

In 2011, Environmental Health Perspectives published a study by Choi et. Al. from the Harvard School of Public Health which highlighted the neurotoxicity of fluoride in children, and specifically their neurodevelopment.   Findings from a meta-analysis of 27 studies published over a 22-year period suggested an inverse association between high fluoride exposure, and children I.Q.   Their analysis revealed that exposed groups had access to drinking water with fluoride concentrations up to 11.5 mg/L; thus, in many cases concentrations were above the levels recommended by the department of health and human services (0.7–1.2 mg/L) or allowed in public drinking water (4.0 mg/L; U.S. EPA) in the United States.   Their findings concluded that the standardized weighted mean difference in IQ score between exposed and reference populations was –0.45 (95% confidence interval: –0.56, –0.35)3.

In a review by Ekambaram et al, it was found that dental fluorosis is the first visible sign of chronic toxic effect of Fluoride in experimental animals.  This is then followed by skeletal fluorosis, revealing that a moderate increase in Fluoride concentration is sufficient to produce harmful effects to teeth and bones.  With continued exposure, there is a resultant impairment in neurological activities such as locomotor activities.

Analysis of the effects of fluoride would be incomplete without a brief outline of the mechanisms of action.  As an enzyme disruptor, Fluoride gains its anti-cavity benefits from its ability to derange the enzymes of bacteria causing dental carries.  Fluoride (having the highest electronegativity of all elements) can interfere by attaching itself to metal ions on the enzymes active site or by forming competing hydrogen bonds.

There are 66 known enzymes which are affected by fluoride ingestion; not all these enzymes are exclusive to dental tissue. Thus, it was further shown that Fluoride can interact with a wide range of enzyme-mediated cellular processes and genes modulated by fluoride, including those related to the stress response, metabolic enzymes, the cell cycle, cell-cell communications, and signal transduction.  This impact on both adult and child neurological processes has been well documented.

Conclusions

Considering some of this research, in 2015 the surgeon general issued a change in the 1965 HHS recommendations.  Based on the assessment that there are other sources of fluoride, the new recommendations have changed from a target fluoride concentration of 0.7-1.2mg/L to a single universal concentration of 0.7mg/L.

Despite the change in the recommended target concentration for community water supply fluorination, this activity remains a controversial public health measure.  Clearly, there is evidence supporting the development of dental fluorosis, however, the neurotoxicity from the development of learning disorders such as ADHD, to decreased IQ of children due to interference with neurodevelopment, and many in vitro and animal studies, are also seemingly unintended consequences of a cost-effective prevention of tooth decay.

As the available evidence suggests the fluoride has the potential to cause major adverse health effects, with perhaps,  more limited dental care prevention effect than initially thought.

While no conclusive studies have shown definitively what actions need to be taken on a public/societal scale, the practice of artificial water fluoridation should be considered on a global scale.  Additionally, as water fluoridation is not the only source or exposure of the public to fluoride, industrial safety measures need to be taken as well to limit the discharge of industrial fluoride compounds and byproducts into the environment.

REFERENCES

  1. Department of Health and Human Services (US), Office of the Surgeon General. Oral health in America: a report of the Surgeon General. Rockville (MD): HHS, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000.

  2. Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries. MWR Morb Mortal Wkly Rep 1999;48(41):933-40.

  3. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis; Anna L. Choi, Guifan Sun,Ying Zhang, Philippe Grandjean
    4. Environ Health Perspect 120:1362–1368 (2012) Ekambaram Perumal∗, Vanaja Paul, Vimal Govindarajan,Lakshmikanthan Panneerselvam ; Toxicology Letters 223 (2013) 236–251

  4. Ekambaram, P., Paul, V., 2003. Effect of vitamin D on chronic behavioral and dental toxicities of sodium fluoride in rats. Fluoride 36, 189–197.

  5. I.R.Hamilton, “Biochemical effects of fluoride on oral bacteria,” Journal of Dental Research, vol. 69, pp. 660–667, 1990.

  6. O.Barbier,L.Arreola-Mendoza,and, L.M.DelRazo,“Molecular mechanisms of Fluoride toxicity,” ; Chemico-Biological Interactions, vol. 188, no. 2, pp. 319–333, 2010.

  7. R.Yolken, P.Konecny, and P.McCarthy,“Acute Fluoride Poisoning,” Pediatrics, vol. 58, no. 1, pp. 90–93, 1976.


9..R.T.Hainmanot,“Neurological complications of endemic skeletal  fluorosis, with special emphasis on radiculomyelopathy,” Paraplegia, vol. 28, no. 4, pp. 244–251, 1990.

  1. Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association

  2. Ashley J Malin* and Christine Till., Malin and Till Environmental Health (2015) 14:17


The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

Foods and Inflammation by Your Marque Team

Chronic inflammation has been subject of many debates. Recent research reveals that chronic inflammation occurs when our immune system gets stuck and attacks our own cells; the result could be extra weight gain, quick aging, autoimmune diseases, cancer, arthritis and heart disease (among other health concerns).  Not only can your lifestyle add to inflammation, but what you choose to eat – or not eat directly impacts inflammation. It has been suggested that the best way to reduce chronic inflammation is through diet.  When you supply your body with the nutrients it needs, it heals faster and can serve as a protective barrier against inflammation and infection.

 

Anti-Inflammatory Diet


An anti-inflammatory diet consists of foods such as high quality proteins, green leafy vegetables, fish such as salmon, healthy fats (extra virgin olive oil, avocados), and nuts. This is the natural diet we're genetically programmed to need and it helps to reduce inflammation.  Healing chronic inflammation isn't just about adding anti-inflammatory foods, it's also about getting rid of pro-inflammatory foods.  The obvious culprits of inflammation are sugar and white flour, but there are also many other food-triggers to avoid:

Whole Wheat Grain 


The sugar in whole wheat bread can raise blood glucose, causing body to produce higher levels of pro-inflammatory cytokines. Sugar also elevates levels of advanced glycation end products, which are destructive molecules that feed inflammation.  The advice is to go grain-free or at least avoid gluten which is inflammatory.



Seed Oils 


Seed oils like corn, soybean, sunflower, canola oil are heavily processed and have an unhealthy ratio of omega-6 to omega -3 fatty acids. They're high in omega-6s which are pro-inflammatory and low in anti-inflammatory omega-3s.  Substituting the aforementioned oils with healthy fats like coconut, olive, avocado oils is recommended.



Alcohol


Alcohol is naturally irritating to our insides, but shouldn’t necessarily cause lasting problems unless you overdo it. However, with too many drinks, bacteria can easily pass through the intestinal lining leading to increased inflammation. Though a small amount of alcohol has been linked to lowering heart disease and Alzheimer’s, too much can stop you from reaping the positive effects.



Soy Burgers


Soy extract suppresses iodine uptake and can stimulate the production of autoimmunogens that could put us at risk for autoimmune thyroid disease.



Diet Soda


Research points to artificial sweeteners as culprits for glucose intolerance which packs on belly fat; belly fat produces inflammatory chemicals. There is also speculation that artificial sweeteners play a role in inflammatory bowel disease.



Nonfat Fruit Yogurt


It has been observed that most people don't tolerate dairy foods well. Symptoms like headaches, skin breakouts, boating, and stuffy nose clear up faster when avoiding dairy products which suggests that they cause inflammation inside our body. Also non-fat fruit yogurts are often loaded with pro-inflammatory sugar or artificial sweeteners and only contain a small amount of fruit. It’s recommended to switch to cultured coconut milk which gives the same probiotics as dairy yogurt.  Regarding dairy in general, its suggested to go without it for 21 days and see if you feel much better.


To recap, it’s suggested we give our cells what they crave, which is natural, unprocessed foods that reduce inflammation. Also recommended is the supplementation with high grade/potency probiotics that play a role in digestion, regularity, immunity, nutrient production/absorption and production of short-chain fatty acids that promote a healthy colon.

 

 

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

Bicycle Safety: Myths and Facts by Colleen Kraft, M.D.

Learning to ride a bike is a developmental milestone in the life of a child. The bicycle, a child's first vehicle, is a source of pride and a symbol of independence and freedom. Yet all too often children are seriously injured, or even killed, when they fail to follow basic bicycle safety rules. The following is a list of common bicycle safety myths, coupled with the correct information you need to teach your children about safe bike riding. These facts will help you and your children make every bike ride safe.

Myth: My child doesn't need to wear a helmet on short rides around the neighborhood.

Fact: Your child needs to wear a helmet on every bike ride, no matter how short or how close to home. Many accidents happen in driveways, on sidewalks, and on bike paths, not just on streets. In fact, the majority of bike crashes happen near home. A helmet protects your child from serious injury, and should always be worn. And remember, wearing a helmet at all times helps children develop the helmet habit.

Myth: A football helmet will work just as well as a bicycle helmet.

Fact: Only a bicycle helmet is made specifically to protect the head from any fall that may occur while biking. Other helmets or hard hats are made to protect the head from other types of injury. Never allow your child to wear another type of helmet when riding a bike.

Myth: I need to buy a bicycle for my child to grow into.

Fact: Oversized bikes are especially dangerous. Your child does not have the skills and coordination needed to handle a bigger bike and may lose control. Your child should be able to sit on the seat, with hands on the handlebars, and place the balls of both feet on the ground. Your child's first bike should also be equipped with foot brakes, since your children's hand muscles and coordination are not mature enough to control hand brakes.

Myth: It's safer for my child to ride facing traffic.

Fact: Your child should always ride on the right, with traffic. Riding against traffic confuses or surprises drivers. Almost one fourth of bicycle-car collisions result from bicyclists riding against traffic.

Myth: Bike reflectors and a reflective vest will make it safe for my child to ride at night.

Fact: It's never safe for your child to ride a bike at night. Night riding requires special skills and special equipment. Few youngsters are equipped with either. Never allow your child to ride at dusk or after dark.

Myth: I don't need to teach my child all of this bicycle safety stuff. I was never injured as a child. Biking is just meant to be fun.

Fact: Riding a bike is fun – if it's done safely. Unfortunately, most people don't realize hundreds of thousands of children are seriously injured each year in bicycle falls. Worse still, more than 600 children die from them each year. While you may have been lucky enough to survive childhood without a serious bicycle-related injury, you shouldn't count on luck to protect your child.

Source: HealthyChildren.org

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

Sepsis – An Opinion (Part 1) by J. Paul Curry, M.D.

In lay terms, bacterial infections usually show up in different parts of our bodies like the lungs (pneumonia), kidney (pyelonephritis), sinuses, etc. where they make us quite ill until we take the proper antibiotic that kills the causing bacteria off. But once the bacteria settles into our bodies, we are always at risk that the infection may spread into our blood stream. Once in the blood, it can both multiply freely and exponentially- meaning that it can redouble its size and numbers rapidly sending the infection throughout the entire body with grave consequences such as shock that deprives our cells of oxygen and metabolic acidosis that shuts down our ability to keep our organs functioning. This all occurs very quickly and once it becomes obvious it’s generally too late to save the patient or critical organs like kidneys, liver, heart and lungs. To completely understand how it works mechanistically you would have to understand how first the different bacteria that cause sepsis go about making an individual patient septic, and then understand the different ways patients who become septic react to the sepsis. These differences in both us and the bacteria are called phenotypes, just like people with blue eyes and people with brown eyes. When you have differences in any group of things we say it’s heterogeneous, as opposed to homogeneous where everything is identical. So, like cancer that in the 1960s was believed to be homogeneous until thirty years later when all that was disproved, the experts in sepsis believed even today that you can understand sepsis by just looking at a bunch of different peoples’ reaction to sepsis discounting entirely that this is a heterogeneous group all different in how they react, and ignoring entirely the bacteria types that cause the infection to begin with. Also, history has taught us that using thresholds and expert opinion to define things rarely works out well. Early in the war on sepsis a large clinical trial was done that got people excited about how to cure it, but it didn’t seem to be working well and a second large clinical trial costing millions was done that disproved everything the first trial had come up with. We are no closer today than 25 years ago. This is what happens when we deviate from rigorous clinical research depending on guesswork to define  anything scientific.

Part 1       Sepsis struck more than a million Americans in 2011, killing between twenty-eight to fifty percent of its victims while costing more than $20 billion dollars.  Both victims and cost have been increasing for decades and continue to rise today, emphasizing just how serious a problem this is.  Yet our consensus sepsis experts in 1992 had openly declared war on this “disease,” promising treatment advances supported by large clinical trials and bold technologic breakthroughs.  None of these promises have been delivered.  Today, like the five decades preceding, the only sure way to save septic patients is still to recognize the symptoms and signs early, treating it immediately with proper antibiotics.  So, the question before us is why had this costly war failed so completely?

A broad understanding of medicine’s history reveals the answer. Two new decision-making theories had gained influence in the 1980s, their processes arising largely from a foreseen need to better manage the exponential growth of medical knowledge compiling throughout preceding decades and continuing to accelerate at a blistering pace.  These theories, namely threshold decision-making and expert consensus decision-making, were adaptations meant to both simplify and speed up our ability to know all diseases well, while simultaneously preserving the fundamental truth found in traditional, although much more tedious and slow-to-develop scientific discovery.  Their processes would hopefully encourage development of better, faster, and much easier ways to secure accurate, earlier diagnoses, especially when pertaining to rapidly evolving clinical change as seen in sepsis where time to treatment makes the difference between life and death.

Threshold decision-making borrowed reductionist (simplification based) principles rooted in the concept that human disease could best be defined by using one or more thresholds, often derived from laboratory or vital sign observations.  Threshold decision-making holds that the clinician can either mathematically or mentally combine pretest probabilities of a condition with the sensitivity and specificity of one or more breached thresholds (e.g. white blood cell counts going above 12,000 or below 4,000, or respiratory rates above 20/min) to determine the overall probability of the presence of an acute disease.  This process is simple enough to learn easily, copy accurately, and disseminate widely.   Merging it with consensus decision-making contending that reliable, valid scientific judgments could now be rendered through a somewhat formal process of capturing expert opinion derived from a heterogeneous population of experts rather than insisting on much more rigorous clinical trials, proved enormously seductive as well.  The latter had been popularized by the Delphi method, where several rounds of questionnaires are sent out to experts and anonymous responses are then aggregated and shared with the group after each round until consensus is reached.  This would offer the quickest solution to creating a “legitimized” definition for sepsis and getting its war launched.

Our experts jumped at the opportunity.  Expecting to be extolled for the transparency and standardization that their definition would bring to all sepsis related clinical care, as would their anticipated clinical trial successes, they toiled through two decades searching for just the right blend of threshold reductionism capable of revealing a fast track to taming sepsis, the number one cause of hospital deaths.  Instead, those years proved all these foregone conclusions wrong, including the expert consensus definition derived for sepsis itself.  In fairness, formal threshold decision making was only ten years old in 1992, and its weaknesses not yet appreciated.  The merging of threshold theory with consensus theory seemed quite reasonable during those early years.  Unfortunately, their well-meant choice to use a hybridization of these two new theories of decision processing was the beginning of just another colossal failure involving a high profile, but poorly understood, compendium of illnesses mistaken for one.

We who ignore the broad history of medicine surrounding us are doomed to repeat its disasters.  Because medical specialty work, both good and bad, tends to remain cloistered to all except those with vested interests, it’s common for physicians to be clueless while disastrous consequences unravel in disciplines unrelated to their own.  In this regard, another colossal failure had played out three decades earlier in an extended attempt to conquer another horrific, poorly understood illness, costing us dearly in flawed research design, wasted resources and loss in life.  Arguably, the most important contribution to both failures has been the remarkable similarities seen in the truculent attitudes and opinions of our experts leading the charge.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

Responding to Children’s Emotional Needs During Times of Crisis by Colleen Kraft, M.D.

Fires. School Shootings. Hurricanes. There are some scary events happening in our world, and the images our kids see on television and the internet can be overwhelming. Here are some tips on how adults can be supportive of our children during times of crisis.

  • Take care of yourself first. Children depend on the adults around them to be and feel safe and secure.

  • Watch for unusual behavior that may suggest your child is having difficulty dealing with disturbing events. Stress-related symptoms to be aware of include:

    • depressed or irritable moods

    • sleep disturbances, including increased sleeping, difficulty falling asleep, nightmares or nighttime waking

    • changes in appetite, either increased or decreased

    • social withdrawal

    • obsessive play, such as repetitively acting out the traumatic event, which interferes with normal activities

    • hyperactivity that was not previously present.



  • Talk about the event with your child. Start by asking what your child has already heard about the events and what understanding he or she has reached. As your child explains, listen for misinformation, misconceptions, and underlying fears or concerns.

  • Explain—as simply and directly as possible—the events that occurred. The amount of information that will be helpful to a child depends on his or her age. Because every child is different, take cues from your own child as to how much information to provide.

  • Limit television viewing of terrorist events or other disasters, especially for younger children. When older children watch television, try to watch with them and use the opportunity to discuss what is being seen and how it makes you and your child feel.

  • Encourage your child to ask questions and answer those questions directly. Like adults, children are better able to cope with a crisis if they feel they understand it. Question-and-answer exchanges help to ensure ongoing support as your child begins to understand the crisis and the response to it.

  • Reassure children of the steps that are being taken to keep them safe.

  • Consider sharing your feelings about the event or crisis with your child. This is an opportunity for you to role model how to cope and how to plan for the future. Be sure that you are able to express a positive or hopeful plan.


If you have concerns about your child’s behavior, contact your child’s doctor or a qualified mental health care specialist for assistance.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

UTIs by David G. Porzio, M.D., FACC

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One of the most common complaints from women seen in an urgent care setting is dysuria or, as I like to say…”it hurts to make water.”  Dysuria or painful urination is a hallmark sign of a lower urinary tract infection or UTI.

Here are some of the other common symptoms:

  • Urgency or the feeling you need to use the restroom right away

  • Frequency or the need to go seemingly right after you have voided

  • Pain in the lower abdomen or pelvis

  • Blood in the urine


I am going to educate you regarding urinary tract infections as well as the non-infectious form of cystitis known as “interstitial cystitis”.

The urinary tract can be divided into two broad anatomical sections: lower and upper. The lower urinary tract consists of the urethra (tube from the bladder to the outside world) and the bladder (essentially a bag that holds urine). The upper urinary tract consists of the ureters (tubes that carry urine from, the kidneys to the bladder) and the kidneys, which make the urine itself. Both segments can become infected with bacteria and be called a urinary tract infection although they are not necessarily the same.

Both lower and upper urinary tract infections involve the urinary tract, but they have marked differences in their clinical severity and treatment. When the lower urinary tract becomes infected, it is typically a more benign illness and is called cystitis. The symptoms are typically dysuria, urgency and frequency. Sometimes there is a dull, non-specific low back or side (flank) pain or visible blood in the urine (tea colored urine). Rarely, the patient will have a fever or other more serious symptoms. When the patient is either older ( > 75) or younger ( < 5) the symptoms may be quite subtle. An upper urinary tract infection, also called acute pyelonephritis or “kidney” infection, can be a much more serious condition. It usually starts with symptoms of a lower UTI, but progresses to involve the upper urinary tract. When this happens, the symptoms include fever (100 F and above), chills, nausea, vomiting, and back tenderness just below the rib cage. Treatment of a lower UTI usually requires just an oral antibiotic for 3-7 days and culture of the urine to identify the causative agent. Acute pyelonephritis is a systemic illness and almost always requires either IM (intra-muscular) or IV (intravenous) antibiotics for several days before switching over to oral antibiotics to finish a treatment course of at least 7 days.

UTIs are one of the most common conditions seen in the urgent care setting and are far more frequent in women than men. UTIs account for approximately 8 million patient visits per year to a health care facility. Women have a 50% chance of developing a UTI in adulthood over their lifetime. Women are more prone to UTIs because the urethra is anatomically shorter than in men and is close to bacteria that can migrate form the anus to the urethra. The diagnosis of a UTI is based on the clinical symptoms described above and the presence of leukocytes (white blood cells that fight infection) in the urine. Microscopic blood (hematuria) or nitrite (bacteria produce it) can also be present in the urine sample. If symptoms and urine sample analysis are consistent with the a UTI diagnosis, then most providers will initiate treatment with an appropriate antibiotic and have the urine sent for culture. This latter step is important to identify the presence of pathogenic bacteria in the urine in a quantity sufficient to cause an infection. The lab will also check the sensitivity of the bacteria to a variety of antibiotics to determine if there is resistance. In this manner, the choice of antibiotic can be changed if the sensitivity shows the bacteria to be resistant to the initial antibiotic. In some cases, the urine culture fails to grow any bacteria at all, which indicates an infection is not the cause of the symptoms.

Patients who have chronic symptoms of bladder pain, urgency and frequency but have negative urine cultures may actually have “interstitial cystitis/bladder pain syndrome (IC/BPS). The diagnosis of IC/BPS is made on a clinical basis. There are no specific tests or diagnostic imaging that establish the diagnosis. The simplest diagnostic criteria are from the American Urological Society:

An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks’ duration, in the absence of infection or other identifiable causes.

Typically, these patients who come repeatedly to the urgent care setting or their PCP with recurring symptoms of cystitis, get started on an antibiotic only to have the urine culture come back with no growth. That is why obtaining a urine culture is so important when evaluating patient with urinary tract complaints. Whenever I encounter a patient with recurrent UTI symptoms and consistently negative urine cultures, then I consider IC/BPC as more likely diagnosis. I educate them regarding the difference between a true, culture positive UTI and IC/BPS and provide a referral to a urogynecologist, who are the best specialist to see to establish the diagnosis, eliminate other possible causes like a genital tract cancer, bladder stone or pelvic mass and to provide treatment recommendations.

Dysuria, urgency and frequency are common symptoms of “cystitis”. The most common reason people and especially females develop these symptoms is a urinary tract infection. If these symptomatic patients have the presence of leukocytes, nitrites or hematuria in the urine, then they are usually placed on an appropriate antibiotic and the urine sample cultured. If the patient continues to have recurrent symptoms of a UTI without a positive urine culture, then the diagnosis of interstitial cystitis/bladder pain syndrome should be considered and the patient referred to either a gynecologist or urogynecologist for an appropriate diagnostic evaluation and development of a comprehensive treatment plan.

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The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

 

 

Is it My Heart? by Mark Wade, M.D.

dr-wade-lo-resHeart problems can present with a large variety of symptoms, and it's important that we are aware of the wide range of ways in which acute and chronic heart conditions can appear.  As patients, we should not expect to be able to make the diagnosis by ourselves and, if there is any question in our minds that we may be having cardiac symptoms, we must promptly seek the attention of a physician. The way we seek that attention may depend upon the circumstances and the nature of the symptoms.

If we have any suspicion that we might be suffering an acute cardiac event, including, but not limited to an acute myocardial infarction (“heart attack”), it's essential that we call 911 immediately so that trainedstethoscope_heart-pulse EMT personnel will be at our side within a very few minutes to assist in a preliminary diagnosis, deliver immediate potentially-lifesaving critical care treatment, and provide immediate transportation to an emergency facility where we will be placed at the front of the line and treated immediately.  We should never be embarrassed to use the emergency medical system.  If it turns out that our concerns were a false alarm and the problem was not as serious as we had feared, nobody (especially medical personnel) is going to be critical of us for seeking urgent help.  On the contrary, in more than three decades of medical practice I can think of many times when in subsequent conversations with patients, and relatives of deceased patients, it became clear that they should have sought immediate help but did not, sometimes with tragic consequences.

Here is a brief summary of how I broadly classify potential heart symptoms and some ideas about how to interpret them.  I think in terms of four major categories of symptoms:

  • Chest Pain

  • Shortness of Breath

  • Palpitations

  • Other


 

CHEST PAIN  

Cardiologists sometimes use this term because it's quick and easy to say, but I prefer to use the term “chest discomfort” which is a much broader and more accurate one.  Chest discomfort can be caused in a variety of ways which may be, but are sometimes not, related to the heart.  Cardiac chest discomfort (usually caused by deficient oxygen delivery to heart muscle resulting usually, but not always, from blockage of a coronary artery) is classically described as a pressure or heaviness in the mid chest. This can be of gradual onset (predictably occurring as the result of some form of exertion), of a more progressive nature (sometimes occurring at rest or in a worsening or prolonged manner if coronary blockages are in the process of worsening), or sudden and prolonged (in the case of acute closure of a coronary artery.)  We must remember that cardiac chest discomfort can radiate into the neck, jaw, either arm or hand (more commonly the left side), the back, or the abdomen, and sometimes can be felt only in these other regions without being perceived in the chest at all.  Another less common, but deadly, cause of cardiovascular chest discomfort is the sudden tearing chest and back pain caused by a dissection (tear) of the aorta.  However, cardiovascular chest discomfort can also be felt in other ways.   It can feel exactly like “indigestion” (in fact I have personally known patients who died from acute myocardial infarction after insisting that they were only experiencing acid reflux and therefore refusing cardiac evaluation, to their own detriment).  Heart symptoms can also feel like chest wall (muscle, rib, or sternal) pain.  If the discomfort is relieved promptly and completely by antacids, or clearly caused by musculoskeletal movement or palpation, those mitigating factors would point toward alternative causes of discomfort.   The aforementioned are among the questions that a physician is going to ask.  You can never be too safe, and one must always consider the possibility of a cardiac cause of any chest discomfort.

SHORTNESS OF BREATH

This is often the result of a lung condition.  Of course, shortness of breath can accompany a respiratory infection (bronchitis or pneumonia), or can result from acute or chronic airway spasm (asthma or Chronic Obstructive Pulmonary Disease).  However, it can also result from fluid congestion in the lungs (Congestive Heart Failure) due to a chronic or acute decrease in the heart’s ability to pump blood forward. Congestive Heart Failure (CHF) is often worse when lying down, and may be (but is often not) associated with swelling in the legs or abdomen.  While wheezing may usually point toward asthma or COPD, it can also be present in acute fluid congestion from CHF. So, it's important to consider the heart if we are experiencing shortness of breath.

PALPITATIONS

This term means the perception of an abnormal heart beat.  It may be normal to briefly feel our heart pounding in our chest after sudden physical exertion or a sudden fright.  However, we generally don’t feel our heart beating in our chest in the absence of such provocation.  Palpitations may be in the form of a perceived rapid heartbeat or a perceived irregular heart rhythm.  Rapid heartbeat at rest may be due to some metabolic conditions (such as hyperthyroidism or anemia) but can be due to a primarily abnormal heart rhythm.  Irregular heart rhythms may or may not be perceived by a given person, and may or may not be life-threatening or health-threatening.   Also we must remember that sometimes a rapid or irregular heartbeat may be the heart’s distressed response to the fact that it is at times beating abnormally slowly. The evaluation and treatment of palpitations can sometimes be complex and is always deserving of evaluation by a physician.  Whether that evaluation can be in an outpatient setting or warrants calling for emergency help depends upon the severity, context, and presence of accompanying symptoms such as chest discomfort, shortness of breath, loss of consciousness, or lightheadedness.  If there is any question in our mind, we should call 911.

OTHER

This category is comprised of several other types of symptoms, including lightheadedness, loss of consciousness, nausea, and even simple fatigue.  All of these symptoms can have many other causes too, but the heart, even in the absence of any other more specific cardiac symptoms, is on the list of possibilities.   Depending on the context, a cardiac cause must be considered.

As we can see, acute and chronic heart disease can manifest itself by a wide range of symptoms which can sometimes be difficult to sort out.  The stakes are too high to ignore suspicious symptoms.  We should always seek medical attention for any symptoms we are concerned about, and we should never hesitate to activate the emergency medical system if our symptoms are severe, occur suddenly, or are rapidly progressive.

The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.

 

 

Caring for Your Child’s Cold or Flu by Colleen Kraft, M.D.

The goal for caring for your child’s cold or flu is to make your child comfortable.  Antibiotics may be used to combat bacterial infections, but they have no effect on viruses.  Make sure your child gets extra rest and drinks lots of fluids. Your doctor may want to see your child or ask you to watch him or her closely and report back if there is not daily improvement or a full recovery after one week.

To Relieve a Stuffy Nose:

Nose drops or spray

  • Use saltwater (saline) nose drops (1 to 2 drops in each nostril) or spray (1 to 2 sprays in each nostril). For infants, use a rubber suction bulb to suck out the extra drops or spray. When using the suction bulb, remember to squeeze the bulb part of the syringe first, gently stick the rubber tip into one nostril, and then slowly release the bulb. This slight amount of suction will draw the clogged mucus out of the nose and should allow her to breathe and suck at the same time once again. You'll find that this technique works best when your baby is under 6 months of age. As your baby gets older, he or she will fight the bulb, making it difficult to suction the mucus, but the saline drops will still be effective.


Humidifier

  • Place a cool-mist humidifier (vaporizer) in your child's room to help keep nasal secretions more liquid and make your child more comfortable. Set it close to your child (but safely beyond reach) so that he or she gets the full benefit of the additional moisture. Be sure to clean and dry the humidifier thoroughly each day to prevent bacterial or mold contamination. Hot-water vaporizers are not recommended since they can cause serious scalds or burns.


To Relieve a Cough:

Honey

  • Do not give honey to babies under one year—it is not safe. 

  • For children ages 1 to 5 years: Try half a teaspoon of honey.

  • For children ages 6 to 11: Try one teaspoon of honey.

  • For children 12 or older: Try two teaspoons of honey.

  • If honey is given at bedtime, make sure your child's teeth are brushed afterward.


Cough drops or lozenges

  • Consider cough drops or lozenges for children 4 and older. Do not give cough drops or lozenges to a child younger than 4 years because he could choke on them. Also do not give your child more cough drops than directed on the package.


To Relieve a Fever:

Acetaminophen or Ibuprofen

  • ​​If your child has a fever and is very uncomfortable, give her single ingredient acetaminophen or ibuprofen. Call your doctor before giving medicine to a child under 2 years of age, and call right away if your child is under three months of age and has a fever.

  • Ibuprofen is approved for use in children 6 months of age and older; however, it should never be given to children who are dehydrated or who are vomiting repeatedly.

  • Do not give your child aspirin, which has been linked with Reye syn​drome, a rare but very serious illness that affects the liver and the brain.

  • Always measure each dose using a device (syringe, dosing cup, or distinctly marked measuring spoon) that is marked in milliliters.


Prevention & Treatment:

Flu vaccine

  • Children 6 months or older should get a flu vaccine each year. Children who are older than 6 months but younger than 2 years should get a flu shot.

  • Children younger than 6 months are too young to get a flu vaccines. In order to protect them, make sure the people around them get a flu vaccine.


Over-the-counter cough & cold medicines

  • Over-the-counter (OTC) cough and cold medicines should not be given to infants and children under 4 years of age because of the risk of life-threatening side effects. Several studies show that cold and cough products don't work in children younger than 6 years and can have potentially serious side effects.

  • Many cold medicines already have acetaminophen (Tylenol or generic) in them. If you give one of these medicines along with acetaminophen or (Tylenol or generic), your child will get a double dose.

  • Children should NOT take cough medicine with codeine.


If antibiotics are prescribed

  • Make sure children take them exactly as directed, even if they feel better. If antibiotic treatment stops too soon, the infection may get worse or spread in the body. Call the doctor if your child is not getting better with treatment.


The information provided is for general interest only and should not be misconstrued as a diagnosis, prognosis or treatment recommendation. This information does not in any way constitute the practice of medicine, or any other health care profession. Readers are directed to consult their health care provider regarding their specific health situation. Marque Medical is not liable for any action taken by a reader based upon this information.