Tuesday, February 25, 2014

February 2014 update on the HPV (cervical cancer) vaccine.

     I am excited that there is very encouraging information about how safe and effective the human papilloma virus (HPV) vaccine is for pre-teens and teens. Although I know this article has some "technical" words and information that might be confusing, but the data is very encouraging. The safety remains very good. The numbers of pre-teens and teens receiving the vaccine in this country is still less than 50%, but hopefully the number increases over time. This will allow everyone to be better protected.
     I still strongly support the vaccine. I have had my own three sons vaccinated. They tolerated the vaccine well (except for one of them with some arm soreness afterwards for a day or two with the first shot). I have posted before about the HPV vaccine -- here is a link to the most complete of the posts on the vaccine.

Monday, February 24, 2014

Underarms, sweating, odor, and hyperhidrosis.

     Not a very glamorous topic, but one that bothers quite a few of our patients and about which I get lots of questions.
     First, I get a lot of questions about when to start deodorant with kids. There are many 7 and 8 year old girls and 8 to 10 year old boys that (years before puberty starts) will need deodorant because they develop underarm body odor. If your child is grumbling around about using deodorant remind them that every one gets to a point where, as they grow up, they need to use it. It is fine to use any deodorant at a young age (it does not have to be a "teen deodorant"). As with any deodorant, if it causes irritation, try a different brand (see below). The average child starts using deodorant when they are a little older than the ages above, but if your child needs it at a younger age, encourage them to do so.
     When to start an antiperspirant, you ask? If it is an odor issue and not an issue with excess sweating, it is fine to use just the deodorant. If your child sweats through shirts (even a little bit), make sure it is a product with both a deodorant and antiperspirant.
     Some teens and adults are so sensitive to different antiperspirants and deodorants, that they need a fragrance-free deodorant and antiperspirant designed for sensitive skin. Common ingredients that cause reactions include the fragrance, propylene glycol, essential oils, parabens, vitamin E, and lanolin. Dr. Matthew Zirwas, M.D., a dermatologist at the Ohio State University, did a study on antiperspirant and deodorant allergy. He reported that the leading products with low likelihood of causing local allergic reactions include the following:
Almay Hypo-Allergenic Fragrance Free Roll On (antiperspirant and deodorant)
Certain Dri (antiperspirant)
Crystal Roll-On Body Deodorant for Sensitive Skin (deodorant)
Crystal Stick Body Deodorant for Sensitive Skin (deodorant)
Mitchum Roll-On Deodorant (antiperspirant and deodorant)
Secret Soft Solid Platinum Deodorant Unscented (deodorant)
If your child is having an issue with rashes, irritation, or itching with antiperspirant and deodorant use, consider one of these products. They are available in stores and on-line. If the itching is an issue or a rash is forming, it is fine to use over the counter 0.5 or 1% hydrocortisone cream once or twice a day for a few days to calm the itching and rash down.
     What is hyperhidrosis? It means excessive sweating. Some folks sweat excessively compared to others. Sometimes, it is multiple areas. Other times it is just it one place or two, such as hands, feet, head, or underarms. Although there are some medications (stimulants for ADHD) and conditions (hyperthyroidism) that can cause increased sweating, the vast majority of kids and adults with hyperhidrosis do not have a specific medical reason for the issue. I remind teens that caffeine can cause excessive sweating. If someone has excessive sweating and drinks caffeine, they should try cutting back or stopping their caffeine intake to see if that helps reduce the sweating. Genetics can play a part -- many times this runs in families (not something you would wish to pass on, however).
     If your child struggles with excessive sweating at their feet, try doing more breathable socks and shoes (less leather shoes and more athletic shoes or sandals; Drymax or CoolMax socks). For sweaty feet that need something more, consider using an underarm antiperspirant on the feet every morning.
If usual antiperspirants do not work, consider a "Clinical Strength" antiperspirant such as Gillette (for guys) and Secret (for girls). If that does not help decrease the sweating, try the over the counter Certain Dri Antierspirant Roll-On on the feet at bedtime. Then use the Clinical Strength antiperspirant on the feet in the morning. One more step would be to continue the Certain Dri Antiperspirant Roll-On at bedtime and do Certain Dri A.M. in the morning.
     If your child struggles with excessive sweating at the underarms, start with a "Clinical Strength" antiperspirant. If that is not helping, add the Certain Dri AntiPerspirant Roll-On at bedtime. One more step would be to try the Certain Dri A.M. in the morning. If those are not helping, we can discuss at a check-up or appointment other options, including trying prescription medications including Xerac AC or DrySol. If we are not having good success with these options, the next step is to see the dermatologist -- they are the hyperhidrosis specialist.
     What to do for sweaty hands? Try the Certain Dri AntiPerspirant Roll-On each evening, applying to the palms of your hands. If that helps, continue the Certain Dri. If that does not help, we can discuss at a check-up or other appointment other options. These include the Xerac AC and DrySol. See below.

Use of prescription Xerac AC or DrySol solution:
These medications are used to reduce the sweating from an area. They are applied to the area before bedtime and allowed to stay over night. They can cause irritation or redness at the site. Ironically, it can help to reduce the sweating if it has caused some irritation. If the irritation or redness is too much, wipe it off early with a warm, wet washcloth. For irritation afterwards, apply some Aquaphor Healing Ointment or over-the-counter 1% hydrocortisone cream. It may take 1-2 weeks of using it every night to notice a difference with how much that area sweats. If it is helping, we recommend using it for 2-3 weeks total then see if simply continuing the morning antiperspirant is working. Even if you have a good 3-6 weeks of less sweating even after stopping the medication, the sweating will likely return. At that point, you may need to do it just 3-7 nights in a row to reduce the sweating for a number of weeks. If working, continue in this way. If not helping, let our office know during a visit or call during routine office hours.

Tuesday, February 4, 2014

What to do when you think your child may have ADHD.

     I realize that I have written long handouts about ADHD and its treatment, but it might not be quite clear what to do if you suspect your child has ADHD. First, look at this list of the symptoms that fit for ADHD. If a child is 6 years old or above and the symptoms on the form are interfering with home, school, and other activities and it has been going on for more than 6 months, we should look into the possibility of ADHD. That does not mean that all of those children have ADHD or need medication. In fact, over the years many families where this question of whether or not their child has ADHD comes up, most of the times the child does not.
     If they are showing symptoms of ADHD and do not have ADHD, what could it be? Whole books have been written about this topic. A short list: hearing loss, learning disability, vision problems, absence seizures, medications, and thyroid disease. I have had patients who have had classic ADHD symptoms (but something seemed different about the story) where we found they had profound hearing loss, hyperthyroidism, or a medication side effect causing the symptoms. In addition, there are children with some of the ADHD symptoms who do not quite fit the diagnosis of ADHD that in the "gray zone" between "no ADHD" and "ADHD". Many of these children will be watched to see how they do over the coming months and years. We can re-evaluate things depending on how they do in school and at home.
     For children who have symptoms that we want to further check into, we have you the family and the school fill out the Vanderbilt form for Teachers and the Vanderbilt form for Parents. It is very helpful to have each teacher complete the form. At home, having each parent complete the form is helpful. For teens, they can complete one also. When those forms are returned to us by you, the doctor will review the forms and we will get back with you shortly (usually within a couple days and sometimes sooner). At this point, if the scores on the Vanderbilt forms show that we should have a discussion about the diagnosis of ADHD and possible treatment for it, we set-up a saved time appointment (these can take 30--45 minutes) sometime soon to discuss it in the office. Is it helpful to have your child there at this appointment? It depends. For many young kids, they may feel that so many people have gotten frustrated with their symptoms, that hearing their parent(s) and pediatrician discuss it may be stressful and not productive. For older kids, it can helpful to be part of the discussion. Based on the scores on the Vanderbilt forms, the history of the problems, and our discussion in the office, the diagnosis can be made of ADHD. We can discuss medication treatment for ADHD, which I can tell you has about a 80-90% chance of making a big impact on the symptoms. Why is it the doctors talk about stimulant medications? Because they work. Although special diets, cognitive-behavioral therapy, and specialized computer training has all been tested, there is less than a 20% chance of these helping by themselves. Please see my blog post on ADHD and diet here.

Monday, February 3, 2014

Formula changing their calorie count.

     For many years, infant standard formulas have had 20 calories per ounce. This was based on the fact that breast milk averaged 20 calories per ounce. However, many formulas (including formulas such as Similac and Isomil) are changing to 19 calories per ounce. The ongoing research shows that although the average mom's breast milk contains 19 calories per ounce in the US, the range is from 11 to 35 calories per ounce. To try to be as close to breast milk as possible, the formulas are changing. Research has showed that although there are 5% less calories per ounce, the infants fed about the same amount each day AND grew just fine. My take on this is that it makes sense to try to match the calories of breast milk and the infants should do fine. If you have questions, ask at your child's appointment time or call us during routine office hours.