Tuesday, July 18, 2017

Meningitis Vaccine for 7th and 12th graders on back order.

     The Menveo meningitis vaccine is recommended by the CDC and AAP for prevention of bacterial meningitis. It is required for Ohio schools to be received before starting 7th and 12th grades. We have consistently given to 11 year olds and 16-17 year olds in our office.
     We were recently informed that the vaccine was on back order by the manufacturer. Soon afterwards, we ran out of our supply of the vaccine. As of this morning, we do not have any further doses of the vaccine. Many pre-teens and teens have appointments with us in the weeks before school who will be due for the vaccine. What to do?
     When this happens, we typically are not informed when we will receive further doses of the vaccine. This is true now. We anticipate receiving more vaccine before school starts. Since we ran out of the vaccine, we are keeping track of those who needed the vaccine at a visit but did not receive it. We plan to contact those families when the vaccine arrives. In addition, we will post on Dr. Tim's Hilliard Pediatric page on Facebook when the vaccine is available. When it arrives, those patients will be able to be promptly scheduled for a nurse-only vaccine visit.
     In the unlikely event that the vaccine is still unavailable to us when the school year begins, we can provide a note to the school detailing the situation.
     We will keep you informed!

Tuesday, April 18, 2017

Testing for Food Allergies -- a great article by Dr. Stukus

     Food allergies and the testing for them can be befuddling for many families (and their doctors). We very often use the expertise of an allergist in these cases. Testing for food allergies can be a challenge (yes, that is a pun). Dr. David Stukus, M.D., pediatric allergist at Nationwide Children's Hospital here in Columbus, Ohio has an excellent discussion of testing for food allergies. Here is the article.

Wednesday, April 5, 2017

Testing for Strep Throat in Our Office

     I have been practicing pediatrics since 1994. When I started in practice, a rapid strep test was done in the office and an culture test was done on the negative (no strep found) rapid tests to confirm whether strep was there or not. This culture took 1-2 days to get the results. A few years ago, we and most practices in Central Ohio switched to doing the over-night tests at Nationwide Children's Hospital that was completed by the next morning, so we would know for sure if the child has strep by the start of the next office day. One of the on-going issues with the Nationwide Children's test has been the expense.
     As of April 4th, 2017 we are now doing an in-office DNA probe test for strep. It takes a few extra minutes, we swab the throat in the same way (although the swabs may be a little different), and it eliminates the need to do an overnight test. We believe the insurance coverage will be good, and in fact it will be cheaper if the previous overnight test would be needed. We like that the results are available right away, where for years we have called families the next day to tell them the overnight test was positive for strep. This delayed getting back to school (and parents back to work). Now we will know a definitive "Is it strep or not?" in about 8 minutes.

Tuesday, April 4, 2017

New Once-Daily Amoxicillin Dosing for Strep Throat

     For many years, the standard way to treat strep throat has been to use twice-daily dosing for amoxicillin. A recent study confirmed that once-daily dosing for amoxicillin was effective in treating strep throat. For children who are not allergic to amoxicillin or penicillin, this will be more and more common to treat strep in this way.
     The once daily dosing may seem as if the dose is a little higher than before. We commonly use the 400 milligram/5 milliliter suspension and have the children 45 pounds and above take 2 1/2 teaspoons (10.5 milliliters) once a day for 10 days. Smaller children with strep throat will take a small dose.
     One nice change: if the first dose is given before 5 p.m., your child is not contagious the next morning. The higher dosing works so quickly that the usual recommendation to wait 24 hours before your child is not contagious does not apply. We recommend that the first dose of the amoxicillin be given right away once it has been prescribed. Note that the twice daily dosing would still mean that the child was not contagious until they have been on the antibiotics for 24 hours.
     So do not be surprised if your child is given once-daily amoxicillin if they are diagnosed with strep throat. We think treating this way has some real benefits.

Tuesday, February 14, 2017

The American Academy of Pediatrics has a newly released Allergy and Anaphylaxis Emergency Plan form.

     I like most pediatricians am a member of a national organization of pediatricians called the American Academy of Pediatrics. They are the experts on many topics about infants and children. I was interested this week when they released an Allergy and Anaphylaxis Emergency Plan to assist families, caregivers, and school personnel in the event of an allergic reaction. Other action plans exist for this purpose. The FARE (Food Allergy Research & Education) Food Allergy & Anaphylaxis Emergency Care Plan has been commonly used in Central Ohio by pediatricians.
     I like things about both forms. The AAP form is easy to read and follow the instructions. The FARE form has simple diagrams that make it easy to quickly read through the instructions that match the symptoms. Both talk about when to use antihistamines and epinephrine. Both talk about a plan for what to do after these are given. One difference is that the FARE form specifies something that is very important: it says that after giving epinephrine, "Transport patient to ER, even if symptoms resolve. Patient should remain in ER for at least 4 hours because symptoms may return." This is very important advice!
     The FARE form is here. The AAP form is available here. The American Academy of Allergy Asthma and Immunology has a similar (though simpler) form and it is here.
     Although I think both the AAP and FARE forms are very good, I suspect some schools may show a preference to one or the other. The important thing is to have a plan in place should an emergency occur with a food allergy reaction.

Wednesday, February 1, 2017

Is there a safe short-cut to getting bigger, faster, stronger for sports?

     As a pediatrician who sees many pre-teens and teenagers, I am frequently asked "My child wants to take ______ (sports supplement). Is it safe?" I explain that the current supplements available have not proven to be safe and effective. It is possible to have sports performance worsen because of supplements. In addition, the short and long term safety of these are in doubt, with side effects including kidney damage, growth issues, stomach issues, heart issues and high blood pressure all under investigation.
     Here is a link about safely improving sports performance. Here is a link to a different article about the sale of these products to under-age teens. It is good to remember the store is trying to make a sale, not look after your safety. Be very skeptical about claims these sports supplements.
     The safest way to gain strength and muscle is to add lean protein in your diet. If you Google search this, millions of articles come up. Some of these, sadly, will lead you to purchase their supplements (which I hope our patients will avoid)! Here is an article with good information about good sources of protein.

Monday, January 16, 2017

CVS Is Offering a Cheaper Alternative Epinephrine Injector

     As previously discussed in this blog, epinephrine injectors are often very expensive. They also can be life-saving in the case of a dangerous life threatening allergic reaction.
     As is being publicized, CVS is offering a less expensive alternative. It is a generic equivalent of a prescription epinephrine injector called Adrenaclick. They are going to be offered at $109 for a twin pack. Here is a webpage from CVS about these. Note that the doctor's office will need to write something specific ("epinephrine auto-injector") to qualify for this. When your child who needs an epinephrine injector needs a refill or is getting a new prescription, ask your doctor about this less expensive alternative.