Thursday, April 23, 2015
Keeping your family safe from botulism.
You are likely aware of the botulism outbreak in Lancaster, Ohio. It appears tied to contaminated food from a potluck dinner at a Lancaster church. Botulism can be deadly, as we have seen during this outbreak. The bacteria that causes botulism, called Clostridium botulinum, is most often transmitted from fruit, vegetables, seafood, and honey. The Dispatch has an excellent article about protecting your family from botulism and it can be found here. If you have difficulty accessing that article, the Centers for Disease Control (CDC) has an excellent page dedicated to information about botulism and its prevention. That page can be found here. Stay healthy!
Wednesday, April 22, 2015
Spring 2015 Allergies
As Spring is in full bloom in Central Ohio, allergy season is in full bloom also. Here in the middle of April, the trees are pollenating, the grass is pollenating (a little early this year), and the mold counts are quite high. The molds are a tricky one. There are molds that prefer dry conditions and molds that prefer wet conditions. During the Spring, when it rains for a few days then warms up and is sunny and windy (something that has happened frequently this last 4 weeks), the mold counts are high.
There is an excellent website that gives frequent updates about allergy counts. It is the AAAAI site, a national professional allergy group. The closest reporting station is in Dayton, Ohio and here is the link. If you are wondering "What is out there today, allergy wise?", this is an excellent resource.
Although years ago everything was by prescription only, now the vast majority of allergy medicines are over the counter: the big three antihistamines (Claritin, Zyrtec, and Allegra), two of the top nasal sprays (Nasacort and Flonase), and the allergy eye drops Zaditor and Patanol. The doses are on the package or check our website.
If you are having problems keeping the symptoms under control, contact us to discuss what further needs to be done to help.
There is an excellent website that gives frequent updates about allergy counts. It is the AAAAI site, a national professional allergy group. The closest reporting station is in Dayton, Ohio and here is the link. If you are wondering "What is out there today, allergy wise?", this is an excellent resource.
Although years ago everything was by prescription only, now the vast majority of allergy medicines are over the counter: the big three antihistamines (Claritin, Zyrtec, and Allegra), two of the top nasal sprays (Nasacort and Flonase), and the allergy eye drops Zaditor and Patanol. The doses are on the package or check our website.
If you are having problems keeping the symptoms under control, contact us to discuss what further needs to be done to help.
Measles Update
As you have heard in the news, there has been an increase in the number of cases of measles in the United States this past year. Nearly 75% of them are linked to an outbreak at Disneyland in California. Sadly, this outbreak, along with the recent increases in the cases of whooping cough and mumps, is related to fewer persons being immunized. This lowers the immunity of a group of people and leads to outbreaks such as what is being seen. None of the doctors at Hilliard Pediatrics has seen a case of the measles. We hope it stays that way!
People who have received two doses of the vaccine of the measles, mumps, rubella vaccine are very well protected. The majority of the people that have been infected in the recent outbreak have not received both doses. Of the more than 100 California residents infected, only 6% had received both doses!
Like many other illnesses, the signs and symptoms of measles are common ones. It is the exact symptoms that help us decide when a patient has measles. Eight to 14 days after exposure a fever, cough, cold, and spots in the inside cheeks of the mouth (Koplik spots) occur. A rash begins on the face and head and spreads downward, becoming widespread and obvious on the legs and buttocks on the third day of the illness. Common serious complications are encephalitis and pneumonia.
It appears this recent outbreak is winding down. As always, we recommend you have your children vaccinated at 1 year of age and 5 years of age. This two-shot series safely provides excellent protection against measles, mumps, and rubella.
People who have received two doses of the vaccine of the measles, mumps, rubella vaccine are very well protected. The majority of the people that have been infected in the recent outbreak have not received both doses. Of the more than 100 California residents infected, only 6% had received both doses!
Like many other illnesses, the signs and symptoms of measles are common ones. It is the exact symptoms that help us decide when a patient has measles. Eight to 14 days after exposure a fever, cough, cold, and spots in the inside cheeks of the mouth (Koplik spots) occur. A rash begins on the face and head and spreads downward, becoming widespread and obvious on the legs and buttocks on the third day of the illness. Common serious complications are encephalitis and pneumonia.
It appears this recent outbreak is winding down. As always, we recommend you have your children vaccinated at 1 year of age and 5 years of age. This two-shot series safely provides excellent protection against measles, mumps, and rubella.
Monday, January 12, 2015
January 2015 Illnesses in Central Ohio
We at Hilliard Pediatrics had a historically busy Decembers in 2014. Although Influenza virus gets a lot of press, we are seeing quite a variety of viral illnesses right now.
Influenza with fever (often 102-106 degrees), cough, cold, sore throat, headache, nausea, and achiness. The illness often lasts 4-6 days. Because of "antigen drift" (the viral strain evolving), even those that got the flu vaccine this season are becoming ill with the "flu". Remember what gets people hospitalized with influenza are dehydration or pneumonia. The pneumonia usually presents just as the initial few days of fever has broken, the cough improves, and then the cough worsens and the fever is elevated again.
RSV causes cold and cough symptoms in older children and bronchiolitis in infants and toddlers. These young children wheeze with the virus. See the Bronchiolitis handout for more information.
Rhinovirus is a respiratory virus that causes cough, congestion, runny nose, and sometimes a fever. The illness can cause a lingering upper respiratory illness for 2 weeks. Check our handout about coughs, colds, and other respiratory symptoms for more information about treatment.
Croup is a viral respiratory illness with a barky cough (like a barking seal), sometimes a fever for a couple days, sometimes nasal congestion, and a hoarse voice. When it becomes more worrisome, there will be noisy, raspy breathing in between the coughs, especially when taking in a deep breath. This is called stridor. Please check our croup handout for more information.
There seem to be two major "stomach flus" or viral gastro-enteritis illnesses going through town. One causes frequent, intense vomiting for 6-12 hours, less vomiting for another 12 hours or so, then usually loose stools for another couple days. Another virus causes vomiting for 2-3 days then diarrhea for 4-7 days afterwards. Check our website here and here for more information on treatment of vomiting and diarrhea.
We are also seeing viral sore throats, Strep throat, bacterial pink eye, a lot of viral pink eye, and a number of other illnesses. I hope this is helpful! We hope you and your family stays well!
Influenza with fever (often 102-106 degrees), cough, cold, sore throat, headache, nausea, and achiness. The illness often lasts 4-6 days. Because of "antigen drift" (the viral strain evolving), even those that got the flu vaccine this season are becoming ill with the "flu". Remember what gets people hospitalized with influenza are dehydration or pneumonia. The pneumonia usually presents just as the initial few days of fever has broken, the cough improves, and then the cough worsens and the fever is elevated again.
RSV causes cold and cough symptoms in older children and bronchiolitis in infants and toddlers. These young children wheeze with the virus. See the Bronchiolitis handout for more information.
Rhinovirus is a respiratory virus that causes cough, congestion, runny nose, and sometimes a fever. The illness can cause a lingering upper respiratory illness for 2 weeks. Check our handout about coughs, colds, and other respiratory symptoms for more information about treatment.
Croup is a viral respiratory illness with a barky cough (like a barking seal), sometimes a fever for a couple days, sometimes nasal congestion, and a hoarse voice. When it becomes more worrisome, there will be noisy, raspy breathing in between the coughs, especially when taking in a deep breath. This is called stridor. Please check our croup handout for more information.
There seem to be two major "stomach flus" or viral gastro-enteritis illnesses going through town. One causes frequent, intense vomiting for 6-12 hours, less vomiting for another 12 hours or so, then usually loose stools for another couple days. Another virus causes vomiting for 2-3 days then diarrhea for 4-7 days afterwards. Check our website here and here for more information on treatment of vomiting and diarrhea.
We are also seeing viral sore throats, Strep throat, bacterial pink eye, a lot of viral pink eye, and a number of other illnesses. I hope this is helpful! We hope you and your family stays well!
Thursday, January 8, 2015
Miralax for children with constipation and questions about it's safety.
Miralax is an over the counter powder used to treat constipation. It previously was a prescription product and has been prescribed or recommended by pediatricians since the late 1990s. The active ingredient is polyethylene glycol 3350 ("PEG 3350"), which works by pulling water into the intestines. This softens the bowel movements and makes them more likely to happen regularly. Over the years, many of our toddlers, children, and teens have used Miralax to help with constipation. It is the most frequently recommended laxative for children by both pediatricians and pediatric gastroenterologists. One of my own sons took the medication regularly (essentially daily) for many years. He found it so helpful and was a normal part of his routine that he referred to it as his "Magical Pooping Powder".
Despite the years of use and how often doctors recommend it for persistent (daily) use, it is not technically FDA approved for that use. Is that a problem? I would tell you probably not. We have an odd way of approving medications for use in this country. Many medications used for years in this country that have a good, safe "track record" have not been FDA approved for a certain use. A good example is amoxicillin use for sinus infections. It is used all the time, is recommended by the specialists, and has been safely and effectively used for years. It is not approved by the FDA for this use. Does that mean it has not been safe? No. The companies manufacturing the amoxicillin would need to spend hundreds of thousands of dollars to do the research to submit to the FDA to have this approval happen. Why don't they do that? It is so expensive and it would be unlikely to change how it is used by the doctors, so there is very little motivation to spend the time and money.
In fact, at one point it was estimated that nearly 80% of the medications commonly used by pediatricians were not used "just" according to FDA approval. They may be used at different ages (clotrimazole states not to use on a diaper rash without it being recommended by a physician -- we do so all the time), for different diagnoses (approved for ear infections but used for sinus infections), for longer amounts of time (over the counter antacids are approved for use up to 14 days but are taken all the time for daily use), and other variations. The truth is pediatricians have so much good experience with these medications that we fill very comfortable recommending and prescribing them.
There was an article in the New York Times in 2012 about this issue and Miralax. A link to it is here. My worry is that a safe, effective medication will no longer be used when the other options become more frequently used after concerns are raised. And despite 15 years of its use, no good studies have raised any worrisome concerns. I am always skeptical of individuals or groups blaming side effects on a medication or treatment and then it getting over-blown. Also, it is always important to remember that if a symptom or health issue starts while using a medication or undergoing a treatment, it does not mean the medication or treatment caused it.
So further study into the safety of Miralax and PEG 3350 is going to occur. Here is another recent New York Times article about it. In the meantime, based on 15 years of experience and my reading, I will continue to recommend Miralax as I have found it safe and effective for my patients and family members who need it. If you are concerned about using Miralax at this time, there are other options listed on my "Constipation" protocol on the Hilliard Pediatrics website, available here.
Despite the years of use and how often doctors recommend it for persistent (daily) use, it is not technically FDA approved for that use. Is that a problem? I would tell you probably not. We have an odd way of approving medications for use in this country. Many medications used for years in this country that have a good, safe "track record" have not been FDA approved for a certain use. A good example is amoxicillin use for sinus infections. It is used all the time, is recommended by the specialists, and has been safely and effectively used for years. It is not approved by the FDA for this use. Does that mean it has not been safe? No. The companies manufacturing the amoxicillin would need to spend hundreds of thousands of dollars to do the research to submit to the FDA to have this approval happen. Why don't they do that? It is so expensive and it would be unlikely to change how it is used by the doctors, so there is very little motivation to spend the time and money.
In fact, at one point it was estimated that nearly 80% of the medications commonly used by pediatricians were not used "just" according to FDA approval. They may be used at different ages (clotrimazole states not to use on a diaper rash without it being recommended by a physician -- we do so all the time), for different diagnoses (approved for ear infections but used for sinus infections), for longer amounts of time (over the counter antacids are approved for use up to 14 days but are taken all the time for daily use), and other variations. The truth is pediatricians have so much good experience with these medications that we fill very comfortable recommending and prescribing them.
There was an article in the New York Times in 2012 about this issue and Miralax. A link to it is here. My worry is that a safe, effective medication will no longer be used when the other options become more frequently used after concerns are raised. And despite 15 years of its use, no good studies have raised any worrisome concerns. I am always skeptical of individuals or groups blaming side effects on a medication or treatment and then it getting over-blown. Also, it is always important to remember that if a symptom or health issue starts while using a medication or undergoing a treatment, it does not mean the medication or treatment caused it.
So further study into the safety of Miralax and PEG 3350 is going to occur. Here is another recent New York Times article about it. In the meantime, based on 15 years of experience and my reading, I will continue to recommend Miralax as I have found it safe and effective for my patients and family members who need it. If you are concerned about using Miralax at this time, there are other options listed on my "Constipation" protocol on the Hilliard Pediatrics website, available here.
Tuesday, December 2, 2014
Start Talking! program to reduce medication abuse.
Start Talking! is a program from the State of Ohio to prevent over the counter and prescription medication abuse by children. It is aimed at reducing the misuse or abuse of these medications by informing the public and taking steps to ensure that parents and families are advised about these potential issues before filling a prescription. The website is here at Start Talking! Ohio.
I think this program is terrific and it has a very real impact on our practice. When a prescription for an opioid is written for a child (often a prescription strength cough medication for pre-teens and teenagers), a form needs to be signed by the prescribing doctor and the parent. This form then is brought to the pharmacy where the prescription will be filled. We are required to do this step with the opioids now -- the doctor could lose their prescribing privileges for controlled medications if these steps are not followed.
This above scenario most often applies to one of the hydrocodone-containing cough medications that are prescription-only, including Histussin, Hycodan, and generics (hydrocodone-homotropine). We used to be allowed to call the medication into the pharmacy. We cannot call this medication into the pharmacy any longer. If we do write the prescription in the office, it needs to be hand delivered by the parent to the pharmacy, along side the signed Start Talking! form stating that we have discussed the safe use of these medications as they can be misused and abused, and therefore are potentially dangerous. The forms are to be signed by the doctor and the parent dropping off the prescription.
Although there are pain medications that contain the opioid hydrocodone (along with acetaminophen), such as Vicodin, it is very rare for pediatricians to prescribe these medications -- I can recall only prescribing them a handful of times in 21 years of being a pediatrician.
I realize this is burden to families who "follow the rules" and the medications do not become misused or abused. However, the reality is we will need to follow these guidelines for the foreseeable future.
I think this program is terrific and it has a very real impact on our practice. When a prescription for an opioid is written for a child (often a prescription strength cough medication for pre-teens and teenagers), a form needs to be signed by the prescribing doctor and the parent. This form then is brought to the pharmacy where the prescription will be filled. We are required to do this step with the opioids now -- the doctor could lose their prescribing privileges for controlled medications if these steps are not followed.
This above scenario most often applies to one of the hydrocodone-containing cough medications that are prescription-only, including Histussin, Hycodan, and generics (hydrocodone-homotropine). We used to be allowed to call the medication into the pharmacy. We cannot call this medication into the pharmacy any longer. If we do write the prescription in the office, it needs to be hand delivered by the parent to the pharmacy, along side the signed Start Talking! form stating that we have discussed the safe use of these medications as they can be misused and abused, and therefore are potentially dangerous. The forms are to be signed by the doctor and the parent dropping off the prescription.
Although there are pain medications that contain the opioid hydrocodone (along with acetaminophen), such as Vicodin, it is very rare for pediatricians to prescribe these medications -- I can recall only prescribing them a handful of times in 21 years of being a pediatrician.
I realize this is burden to families who "follow the rules" and the medications do not become misused or abused. However, the reality is we will need to follow these guidelines for the foreseeable future.
New Bacterial Meningitis Vaccine for Pre-Teens and Teens
One of the scariest bacterial infections in children, adolescents, and young adults is bacterial meningitis. It can come on suddenly. It can quickly progress to a deadly infection. Our Menveo vaccine for bacterial meningitis helps prevent cases of Neisseria meningitis due to strains A, C, W, and Y. Approximately 30% of all Neisseria meningitis cases in the U.S. were due to strain B, which is not in the Menveo vaccine.
The FDA has now approved a vaccine called Trumenba that helps prevent cases of meningitis due to this B strain. It is currently approved for 10-25 year olds. It is a three shot series given at a doctor's visit then 2 months and 6 months after the first. The side effects are similar to other vaccines given to adolescents: soreness of the arm, tiredness, and headache. Generally, the vaccine has been well tolerated. The Advisory Committee on Immunization Practices, the national committee of vaccine specialists that make the recommendations we follow, is going to make a further recommendation on the Trumenba's routine use in February of 2015.
I anticipate that in 2015, we will start to routinely recommend the vaccine series. I will keep you updated. For now at least, we do not stock the vaccine. I will definitely want my three teenage sons to receive the vaccine.
The FDA has now approved a vaccine called Trumenba that helps prevent cases of meningitis due to this B strain. It is currently approved for 10-25 year olds. It is a three shot series given at a doctor's visit then 2 months and 6 months after the first. The side effects are similar to other vaccines given to adolescents: soreness of the arm, tiredness, and headache. Generally, the vaccine has been well tolerated. The Advisory Committee on Immunization Practices, the national committee of vaccine specialists that make the recommendations we follow, is going to make a further recommendation on the Trumenba's routine use in February of 2015.
I anticipate that in 2015, we will start to routinely recommend the vaccine series. I will keep you updated. For now at least, we do not stock the vaccine. I will definitely want my three teenage sons to receive the vaccine.
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