Breaking News - Previous Posts
March 2012
What's the best way to get your school age child to exercise? A recent study looked at 78 Texas children who were given a Nintendo WII and offered a choice of an active game like Dance Dance Revolution or an inactive game such as Disney Sing-It Pop Hits. When examined after 13 weeks, both groups logged 25-30 minutes of moderate or vigorous physical activity per day.
Senders Says: Previous studies have shown that active WII games burn up to 1/3 more calories than a treadmill. But what this study adds is that just because your child engages in active games, doesn't mean he or she gets more activity in a day. It is possible that the WII is supplying all of the activity for the day and the increased activity on the WII is not translating into a more active child. It is curious that the control group was active 25-30 minutes in a day. That means that the group being studied was overall, more active than many of the kids we see on a daily basis who get 5-10 minutes of activity in a day. So the message is twofold. 1) If your child is not active, get them moving on a WII. 2) If your child is active on a WII, use it as a springboard for more activity. And as we always emphasize, focus on activity and not on food intake!
Concerns about liability and academics reduce exercise opportunities in day care. 75% of preschool children in this country are in some type of day care and only 2-3% spend time in vigorous activities. A study of 34 such centers in Cincinnati found 3 main barriers to physical activity. 1) Injury concerns - State and federal licensing codes intended to reduce injuries on playgrounds rendered playgrounds less challenging and less interesting. In addition, parental concern sabout potential injury caused day care programs to restrict playground participation for many children. 2) Financial - Small operating margins for many day care programs restrict their ability to purchase equipment that will challenge children. 3) Focus on academics - There is pressure from state mandates and from parents to focus on "academics" more than physical play.
Senders Says: Bravo for this team. There is an inherent danger to "living" and similarly to "going outdoors". First of all, we have to encourage our day care facilities to make exercise fun for kids and secondly, we should require them to provide "reasonable" but not foolproof safety features. To take away monkey bars because children can fall and break a bone is unreasonable. In addition, we have to recognize that day care is not about what the child "learned" in the classroom that day. Rather it is about what critical skills that were modeled that day. Going outdoors improves concentration, teaches about the world and helps children negotiate with peers. In life, these skills may be more important than how many books the child read that day.
So how many times did your teenager have a drink this past year? A study of 166,000 teens from all races, geographic locations and socioeconomic groups found that asking teens this simple question was very helpful in predicting alcohol use behavior and alcohol use disorders. The guidelines developed from this study are being incorporated into our daily interview of teenagers. For 12-15 year olds, drinking >1 days in a year is a sign of risky behavior while >6 days is a sign of alcohol dependence. For 16-17 year olds, drinking >6 days per year is a risk sign while >12 for a 16 year old and >24 for a 17 year old is a sign of dependence. For 18 year olds, the risky cut off is >12 days per year and >52 days per year (4 days per month) is a sign of dependence.
Senders Says: Don't wait for us to ask the question. You cannot believe how much drinking is going on in your house and in the house of your children's friends. One patient told me that he drinks 3 days a week and passes out once a week. And please don't take the approach that "kids will be kids". Empower them to say no and to hang with similar minded kids.
A comprehensive review of diet and ADHD. This month, pediatric neurologists in Chicago published the most exhaustive review of medical literature on the effect of diet on ADHD. There are lots of fascinating tidbits contained in this report. Click here for more information.
Why we give Hepatitis A vaccine routinely! Hepatitis A is a food borne form of hepatitis that causes jaundice, abdominal pain, fever, loss of appetite and fever. It is a mild disease of childhood and moderately severe disease of adolescence and adulthood. It is prevented by a 2 dose vaccine which has limited side effects (even fever is rarely reported). In 2006, The Advisory Committee on Immunization Practices (ACIP) recommended universal protection of all children in the second year of life and the standard of care has been to follow that recommendation. Studies show good compliance with this vaccine (our numbers are over 90%) in children 2-5 years of age. But what about the 6-18 year olds? The ACIP recommends that it be given to children in high risk areas, children who may travel to high risk areas or anyone wishing to obtain immunity.
Senders Says: Given that the incidence in Cuyahoga County is 1.5x greater than the national average and that many of our patients travel to places like California and Texas in the US as well as to India and the Middle East, we are routinely recommending that children who have not yet received Hep A vaccine should receive the 2 dose program over 2 well child visits.
MMRV study in toddlers coming up. Because varicella or chicken pox vaccine is now being routinely recommended for senior citizens to prevent them from getting shingles, a painful and often dangerous disease at that age, there has been a shortage of varicella vaccine for children. Those parents with older children may remember that we used to combine the MMR and varicella vaccines that are given twice in early childhood into a vaccine called ProQuad or MMRV. This reduced the number of shots by 2. MMRV has not been available for many years. It is now being reintroduced using a new production method that increases the production capacity for making varicella vaccine significantly and carries the potential for reducing the shortage of varicella for the next decade. Senders Says: If your child will be 12-18 months in the next few months, we will be contacting you shortly for your interest in participating in this study.
Senders Pediatrics means quality! We have embarked on a national quality certification program about which you will be hearing more later this year. We routinely monitor a lot of things about our interactions with you, our patients and their families. We will begin highlighting some of our quality initiatives in each newsletter. We are now looking at the percentage of our patients who have completed all of the recommended vaccines. Although we always strive for 100%, we recognize that because of illness and parental preference, some of our patients may not have received their complete series of infant vaccines by 2 years of age.
Senders Says: Our goal is to insure that our vaccination protection rates are the highest in the state. Another quality initiative on which we are working is to insure that every child being treated with medication for asthma be provided with a care plan which will be reviewed at least twice a year. It may involve a few extra visits but studies show that patients reevaluated for asthma twice a year tend to use fewer medications and often will outgrow their disease earlier.
February 28th, 2012
The Chardon High School Murders
Within minutes, the shooting at Chardon High School was broadcast on Twitter and Facebook. We all saw the pictures of the alleged shooter and his victims. We saw the pictures of the guns and read the note on Wikipedia. And throughout the day, students and parents all over the country but particularly here in the Greater Cleveland area, tried to make sense of what can only be described as a senseless act.
There will be a lot of emotions spent over what exactly happened at Chardon High School. We may not really know the truth for months or years. So how do we use this tragedy as a springboard for learning more about the causes of school violence and how do we prevent similar such tragedies in the future? Part of the answer can be culled from looking at what scientific research has uncovered about such incidents in the past. The first, a book, is directed at what we as parents and loved ones, can do to identify problems in our own children. The second, a scholarly article, helps teachers and school administrators figure out when things are going wrong. The data is not sensational, it is not emotionally driven but it will give us a lot of insight about what we can really do to prevent school massacres down the road.
In his book, Why Kids Kill (MacMillan, 2009), author Peter Langman details the 10 lessons that can be learned from studying school massacres over the past two decades.
1) There are limits to privacy – Parents of teenagers are usually very respectful of their privacy. But if you discover bombs or disturbing notes or links to The Anarchist’s Cookbook in your child’s room, privacy rules no longer apply. Parents of angry children often don’t know how far to go to explore the depths of their child’s rage. The answer is that professional help should be sought for such children from us, your pediatricians or from competent mental health authorities.
2) Don’t lie to protect your child. Don’t deny a family history of mental illness if there is a strong history. Don’t lie to authorities about guns in the house or about the depth of your child’s anger. And don’t let a potential family scandal color your view of your child’s activities.
3) Follow through with due process no matter who is involved. In many previous massacres, the perpetrator was treated differently because his parents were teachers or because he came from a family of privilege. It is imperative for parents and school officials to follow the rules, no matter whose child is involved.
4) If the school is concerned about your child, pay attention. In the months before Columbine, Dylan Klebold wrote a story about a mass murder that so disturbed the teacher that she called the family in to discuss the story. Teachers read thousands of essays, many of which are very disturbing. If they call you about something that is an outlier even for them, listen carefully and take them seriously.
5) Eliminate easy access to guns. This is not a Bill of Rights issue. It is plain and simple, a safety issue. If your child knows how to get at a gun or a cache of guns, then you have just as well placed them in his or her hands.
6) Assume threats are serious until proven otherwise. In 2007, Asa Coon, a name known to all of us in Cleveland, threatened to come to school and kill everyone. Many of his friends heard him. A few days later, he came to school and went on a rampage. Empower your child to report threats. We live in a world of social networking and kids are often on the cutting edge of death threats. If they see bizarre things posted on Facebook, Twitter or any other platform, empower them to tell a responsible adult.
7) Anyone can stop a school shooting. There are many examples of arms dealers, friends and even people who found a disturbing notebook in a parking lot who were successfully able to prevent a shooting. There is a beautiful Jewish story about why there was only one person created first. The reason offered is that each person should view him or herself as the person for whom the world was created. Each person has the power to change the world by him or herself and the life and death of each person is equivalent to the life and death of all of creation.
8) Recognize possible rehearsals of attacks. In some ways, this is easier to notice today because of YouTube and Facebook. Everyone posts videos, including potential mass murders. If you see lots of guns and lots of shooting, tell someone in a position to do something about it and encourage your children to do so as well.
9) Punishment is not prevention. In fact, suspension from school often makes things worse for people already on shaky ground. Langman details the story of Kip Kinkel who was suspended from school for carrying a gun. Later that day, he killed his parents and the next day, he came back to school and wounded 22 others, 2 fatally. The point is not that suspension is not an appropriate response. But suspension without monitoring or treatment often makes things worse for kids who are in crisis.
10) There are limits to physical security. Often the response to a shooting is to increase means of identification and install metal detectors. In Columbine, there were cameras and in Red Lake, there were cameras and metal detectors. Most school massacres are perpetrated by students, not outsiders so ID badges are not helpful. And most are bent on inflicting the greatest amount of harm so they will shoot guards and blow out cameras. By the time a student is walking up the driveway, it is too late.
So how about teachers and school administrators? What can they do to prevent an attack? The answer is to know as much as possible about the profiles of school homicides. An article in the Journal of the American Medical Association in December, 2001, tells us what to look for. It reviewed 220 events resulting in 253 deaths. 202 involved a single death while 18 involved multiple deaths. Students accounted for 68% of the deaths and the vast majority were homicides. 50% occurred while official school activities were in progress with 17.8% occurring near the start of school, 17.8% during lunchtime and 21.3% occurring near the end of the school day. Over half were preceded by some action that indicated potential for such an event (like a suicide note, a video posting or a poem). Homicide perpetrators were nearly 7 times more likely to have expressed suicidal thoughts, 3 times more likely to have had a history of criminal charges, 3 times more likely to have been a gang member, twice as likely to have associated with high-risk peers, or been considered a loner and twice as likely to have used alcohol or drugs on a weekly basis. Finally, homicide perpetrators were twice as likely to have been bullied by peers, more likely to have been reported to the principal’s office for disobeying an authority figure and less likely to have participated in extracurricular affairs.
The study revealed a number of findings that should guide violence prevention activities in the future.
1) Since most events occurred during transitions, it is essential to reduce crowding, increase supervision and have protocols for handling disputes that occur during such transition times (school entry or close and lunchtime).
2) Since over half were preceded by a note, threat or journal entry, it is important to empower students to report such threats and to encourage school officials to take such threats seriously.
3) Since suicidal thinking is so common amongst perpetrators and suicidal thinking may be occurring in up to 20% of all high school students, it is important to focus on risk factors for suicidal behavior in our schools.
4) Finally, since so many perpetrators have been described as having been bullied by their peers, it is important to develop programs that sensitize teachers to recognize and respond to bullying incidents between students.
These scholarly pieces give us a lot of dry information. But armed with data about what we can “really†do, we can really do a lot.
February 2012
Mackenzie Mann, daughter of our Dr. Andy Mann, has come up with a creative and beautiful way to raise money for pediatric oncology research at Rainbow Babies and Childrens Hospital in support of her friend, Robert, who has leukemia. On her day off on Presidents Day, Monday, February 20, 2012, she will be in our office making and selling colorful hair ribbons that can be personalized for each individual. Selling for $3 each, Mackenzie can make a ribbon for your daughter that matches her school’s colors or her own favorite color. A number of parents have already purchased ribbons to outfit their daughter’s entire sports team. To preorder, please email Laura Jones at ljones@senderspediatrics.com or stop in and tell our front office staff. All monies are due at the time of pickup. For parents who would like an activity on Presidents Day, between the hours of 10 AM – 3 PM, Mackenzie will be happy to work with your 6 year and older daughter to craft a special hair ribbon. Adult supervision will be provided.
Despite the unseasonal weather, influenza is coming. The CDC reports 8 states (up from 4 last week) with regional flu outbreaks and 13 including Ohio (up from 6) with local outbreaks. This usually indicates that flu is coming to our neck of the woods sometime soon. We are seeing mostly RSV, a cause for wheezing in young children but not much flu. We still are recommending flu vaccine to all children and especially to patients with a history of respiratory infection.
What is the cheapest Calcium/Vitamin D product and where can you get it? Children under 9 years need 600 mg of calcium and 600 IU of Vitamin D while preteens and teens nine years and older need 1200 mg of calcium and 600 IU of Vitamin D. According to industry watchdog Consumer Lab and our own local research, the least expensive Ca/Vit D formulations are 21st Century Calcium 600 + D (available locally at Discount Drug Mart) and Members Mark Calcium 600 mg with Vitamin D3 (available at Sam’s Club). Both products are $.03/day for the under 9 group and $.06/day for the 9 and older. Spring Valley Liquid Filled Capsules (available locally at Walmart) is $.05/day for the younger age and $.10/day for the older children. The active ingredients of these three products are calcium carbonate which is absorbed slightly less effectively than calcium citrate. The least expensive calcium citrate product is Citracal (available at all local drugstores) with 400 mg calcium and 500 IU vitamin D at $.15 and $.30/day. (Beware generics on calcium products because the quality is not always the same). For children who cannot swallow pills, Caltrate 600 mg Chewables (all local drugstores) at $.10-.20/day and Viactive)500 mg chocolate and caramel chewables (all local drugstores ) at $.13-.26/day are good alternatives. Adora Calcium (all local drugstores) tastes like a Hershey’s Kiss but is only 500 mg calcium and 250 IU Vitamin D at $.23/day. It is an option if you absolutely cannot get any calcium into your child. Flinstones Childrens Multivitamin Plus Calcium are $.30/day for 2 ARE NOT RECOMMENDED because you don’t get enough calcium and you get too much vitamin D. Hero Yummi Gummi Bears Plus Calcium (Whole Foods and GNC) are a reasonable alternative at $.35/day for the 3 necessary to give the RDA of calcium and vitamin D. But not all gummies are created equal. L’il Critters gummies (CVS/Walgreens) ARE NOT RECOMMENDED because they give you more than twice the amount of vitamin D as advertised. Finally, there are now some good liquid alternatives for the finickiest eaters. 3 teaspoons of
Lifetime Calcium Magnesium Citrate provides 600 Ca, 400 IU vit D for $.18/day. It comes in strawberry, orange and grape and is available only online (do not get the blueberry 750 because it has too much magnesium and too little vitamin D).
Wellesse Liquid Calcium and Vitamin D3 (available locally at Rite Aid and some Walmarts) is 500 mg Calcium and 500 IU Vitamin D per teaspoon for $.11/day.
Senders Says: If your kids can swallow pills try the 21stCentury, Members Mark and Spring Valley products. Even though they are calcium carbonate products with slightly less absorption, the difference in most kids is insignificant. If they cannot swallow pills, try the Caltrate chews (they taste a little chalky like a Tums) or the Lifetime and Wellesse liquids. And if cost is no object, try the Hero Gummies because they appeal to almost everyone.
We have 2 great research study opportunities. The first for teens is a meningitis vaccine that if approved, will potentially help save the lives of over 350 teens and young adults every year. The second for 12 month olds will help insure an adequate supply of measles, mumps and rubella vaccine and reduce the possibility of side effects. For more information about either study email jsoltis@senderspediatrics.com.
Tongue tied infants show dramatic improvement in breastfeeding following a simple clipping procedure. When compared to intensive feeding consultation, patients with frenotomy, a simple office procedure, done in our office by Dr. Ann Witt, the director of Breastfeeding Medicine of Northeast Ohio, showed up to 95% improvement in nursing with significantly reduced nipple pain.
Senders Says: If you or someone you know is suffering with persistent post-partum nipple pain, contact Dr. Witt by simply calling the office. There is no longer any excuse for women to suffer while breastfeeding.
Creatine supplements are not recommended for people under 19. For almost 300 years, creatine has been used to enhance lean body mass and improve athletic performance in wrestlers, weight lifters and high jumpers. It has never been shown to be effective in endurance sports like track, basketball and soccer. Although not banned by the NCAA, it is prohibited from being given to athletes in member schools. It interacts significantly with caffeine and with medications like ibuprofen (Motrin/Advil) and naproxen (Aleve).
Senders Says: For our college students interested in the pros and cons of using creatine, please give us a call at the office.
Sexting is not as prevalent as it has been reported. If sexting is defined as appearing in or creating sexually explicit images that potentially violate child pornography laws, the incidence is low (about 1%) according to a study published in the January issue of Pediatrics. If, however, it is defined as appearing in, creating or receiving sexually suggestive images, then the incidence is closer to 10%.
Senders Says: The conclusion of the article is very apt. “Sexting probably does not indicate a dramatic change in youth risk taking or youth sexual behavior. It may just make some of that behavior more visible to adults and other authorities.†Parents should continue to monitor their children’s activities and continue to keep lines of communication open so that children, especially adolescents, have an address to call home when it comes to sharing concerns.
Smoking cessation programs for parents are very successful. Overall, the percentage of adults who smoke is lower than it has been for many decades at 19.3%. Unfortunately, over 55% of children continue to be exposed to second hand smoke (SHS). A recent study showed that signs of cardiac disease in children exposed to SHS is evident as early as the first decade of life. The good news is that pediatricians may have the best shot at getting parents to stop smoking. Another recent study showed that when pediatricians gently push parents to stop smoking (at least in the house and in the car), they are 20% more likely to be successful than other influences.
Senders Says: When we smell cigarette smoke in the office, let us help you reduce your smoking habit by pointing you in the right direction.
January 2012 Newsletter
There is a science behind “clickingâ€, that magical ability to really connect with another person. Check out our newly revamped blog, www.wefigurekidsout.comfor an in depth analysis of the “clicking†phenomenon and if you like the blog, become a subscriber and send our link to your friends and family.
And if you want to hear about how babies learn grammar from the moment they are born or how children really do remember what they learned at 2 years old or how MP3 players put over 25% of teens at risk for early hearing loss, become one of the growing legions of Facebook friends who look to Senders Pediatrics for fun contests, medical tidbits and news you can use.
Flu is coming. Please make sure you and your child are immunized. Things are heating up nationally. 40 states are reporting local influenza activity and there has been a steady increase in the numbers being reported over the past 2 weeks.
Senders Says: Since it takes 2 weeks for full protection from a flu vaccine, please call today to have schedule a flu shot for your child. And remember, if you have not yet been vaccinated this year, we are offering flu vaccines to parents as well.
Why we don’t use needleless jet injectors for flu vaccine. The FDA recommends that these devices not be used for flu vaccine administration this year because it is unknown if the immunity is the same as when the vaccine is given by a needle.
Senders Says: Our research department has heard that the company that makes the device is accumulating safety and immunity data that, if accepted by the FDA, will possibly make needles a thing of the past. Stay tuned for updates.
Parents shouldn’t worry about the shape of their infant’s skull. About 13% of newborns (its even higher with twin births) have some deformity of the head in the first year of life. It is almost always caused by in-utero positioning in a misshapen uterus or because of the decade old policy of placing infants on their back to sleep. According to the American Academy of Pediatrics (AAP), there is little benefit to the use of helmets ($900-3000) and almost all heads “shape†up by age 3 years.
Senders Says: The back to sleep program has been a huge success with an over 50% drop in the incidence of SIDS (sudden infant death syndrome) but parents need to be aware of ways to prevent flattening of the skull as a result. 1) Parents should alternate which side their infant head is placed to sleep. 2) There should be 30-60 minutes a day of supervised tummy time 3) Parents should limit the time their child is left in a swing or an infant carrier.
Taking out a child’s adenoids does little to reduce recurrent colds. Children studied for 2 years after adenoidectomy had 7.9 colds/year while those observed with watchful waiting had 7.84 episodes/year. Senders Says: The analysis also showed no increased incidence of ear infections, days missed from school or day care or health quality of life. Surgery is not always the answer. Using probiotics may, however, reduce the incidence of colds by 30%.
Fever after vaccines is actually good for your child! Infants who mount a fever soon after their vaccination actually sleep longer over the next 24 hours. This suggests that giving Tylenol (acetaminophen) to reduce fever, may actually reduce the immune response as well as reduce the time spent sleeping.
Senders Says: Here is another example of the importance of staying current. For years, we have recommended giving acetaminophen prior to vaccination. In fact, we used to actually give a sample of the medicine to our 2 month olds. For more on the possible down side of acetaminophen, read the next blurb.
There is possibly a strong link between asthma and the use of Tylenol (acetaminophen). Akron Childrens Hospital pediatrician, Dr. John McBride, reports that the data connected acetaminophen with asthma is so strong that it is possible that much of the dramatic increase in childhood asthma may be related to the use of acetaminophen. The theory is that acetaminophen increases airway inflammation in patients predisposed to developing asthma. In a study of over 200,000 children, those who took acetaminophen between 1-11 times a year had a 1.6x greater chance of developing asthma and those who took it 12 or more times had a 3.2x greater chance. The prevalence of childhood wheezing in 36 countries around the world can be predicted by each of those countries acetaminophen sales. Senders Says: The data is so convincing, that we are no longer recommending the routine use of acetaminophen at the time of vaccines (see above) and recommending that patients with asthma or a family history of asthma, use ibuprofen instead for fever and pain.
Does your child have ear tubes. If a child with tubes has drainage, please give us a call. We are conducting a fascinating study of a new combination drop for the twice daily treatment (not 3x/day) of such infections. No blood draws involved. Email Jason at jsoltis@senderspediatrics.comfor more information.
Giving cranberry juice to kids with a previous urinary tract infection reduces the chance of recurrence. Children in Finland given ½ cup of cranberry juice for 6 months after a first UTI, had 25% fewer recurrences. Senders Says: Of course, we have to balance the reduction in antibiotics with the potential for dental enamel erosions. It makes sense to use cranberry juice in moderation as an additional tool in the prevention of kidney scarring that comes from recurrent UTIs.
Arguing with parents helps teens fend off peer pressure. Research from Virginia shows that children who quickly back down during an argument with their mother (the study looked at mothers not fathers), had a harder time resisting peer pressure to use drugs and alcohol than teens who were able to calmly and persuasively make their point with their mother. Senders Says: The theory behind this is that kids who learn “do what other people say†at home, practice the same principle with their friends. This doesn’t mean you should let your teen win arguments. Rather, as with every other interaction with children, what happens at home is a proving ground for what happens in school and in peer interactions. Encourage your child to be assertive however, rather than whiney or yelling. The more assertive a child is at home, the more assertive he or she will be with friends. (This is a great pitch for Amy Speidel’s Empowered Parenting Course and her Individualized Parent Coaching. See our website, www.senderspediatrics.comfor the next course. Coaching is available daily by calling the office.)
December 2011 Newsletter
Have you ever been awake at 3:00am searching on Google or WebMD for answers to your general medical questions? Well now as part of the Senders Pediatrics family, you have a place to go to get answers to your questions from the Doctors you know, love, and trust! Ask your questions on our new "Ask the Dr.' section of our webpage, www.senderspediatrics.com. Each week we will select 2 questions to be answered by one of our providers that will be posted on our website and Facebook. As always, if you have an urgent or personal medical question, please call our office at (216) 291-9210 to speak with our nurse facilitators.
Click Here to view 'Ask the Dr." and ask your question!
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We hope you like our expanded parking options: We have added 26 spaces to our parking lot this past November. With most of our staff now parking in the new area just north of the building, we have made it easier for you to park close in to the office. This comes just in time for winter and the onset of winter related illnesses.
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Speaking of illnesses, please make sure to get your flu vaccine. The flu season begins traditionally in January and although 3000 of our patients and their parents have already availed themselves of flu vaccine in our office, there are many thousands who have not. Influenza accounts for more missed school and work days than any other disease. We have plenty of vaccine for a change. Please call to schedule your child's flu vaccine today.
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Sugary processed foods are as addictive as cocaine: 28 scientific studies have been published this year on food addiction. In one study, rats were fed Hormel Foods bacon, Sara Lee pound cake, the Cheesecake Factory cheesecake and Pillsbury Creamy Supreme cake frosting. When fed these foods one hour a day, rats began binge eating and when given access to these foods 18-23 hours a day, they rapidly became obese. Click for More
Senders Says: Fatty processed foods and high fructose corn syrup (HFCS) may be this generation's nicotine. Nicotine caused lung cancer, fatty foods and HFCS are associated with obesity, the cause of heart disease and other forms of cancer. Whether the food industry is deliberately manipulating the fat and sugar content to increase addiction is for the lawyers to determine. In the meantime, we have a responsibility to read labels and reduce the amount of processed food our children receive any way we can.
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Children need 3-4 cups a day of water. To help your child get his or her quota, came the bipartisan supported Healthy, Hunger-Free Kids Act of 2010 which requires public schools to make water available in the lunchroom. Although many schools have drinking fountains, few are located in the cafeteria so most schools are purchasing portable water coolers which can be used for sporting events as well.
Senders Says: It's about time! With all the high caloric soft drinks and juices available, it is great that there is finally some competition from zero calorie water. Not only can making water available combat obesity, drinking 3-4 cups of water a day will reduce the incidence of constipation, the most common cause of abdominal pain in school age children.
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Our Research Department is as active as ever. We have 3 meningitis vaccine studies ongoing in teenagers. We have an ear drainage study for children with ear tubes and an ear pain study for children with ear infections. And we have a new study of a fascinating new treatment for children with dust, dust mite and mold allergies. Contact Jason at jsoltis@senderspediatrics.com for more information about any of our studies.
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Don't forget to make sports fun for your child. Today's children fall into 2 major groups: those who sit inside playing video groups and those who participate in organized competitive sports like soccer, hockey and basketball. With dreams of college scholarships and multimillion dollar pro contracts, kids are playing younger and more competitively than ever. Coaches are more likely to treat children like military recruits and parents are often emphasizing winning above everything else. The end result is that many children are losing the motivation to play. And injuries are piling up. Click for More
Senders Says: Life is not all about having fun but sports should fundamentally be about recreation which, by definition, means there should be an element of enjoyment and relaxation. One small suggestion is to not allow your child to specialize in a sport until after puberty. Diversity during the year is great exercise, reduces the chance for burnout and stimulates different sets of muscles.
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Crib standards have changed for the first time in 30 years! A study published in February, 2011, found that there are 9500 ER visits and 100 deaths each year because of crib related injuries. 34% of the injuries were soft tissue injuries and 21% were concussions as a result of falls. 32% of the deaths were because of suffocation. Beginning on June 28, 2011, new federal safety regulations prohibited the manufacture or sale of drop side rail cribs because they are the most common cause of entrapment and suffocation injuries. Click for More
Senders Says: In the meantime, stop using the drop down rail of your crib. Check online to see if the manufacturer of your crib can provide you with a free immobilizer. And keep pillows, quilts and stuffed animals out of the crib. When your child is old enough to stand, make sure the mattress top is 28 inches below the crib top.
November 2011
If you had been a Facebook fan of ours last month, you would have heard that we were named one of the top 10 medical Facebook sites in the country for our blend of informative news you can use about pediatric health and our unique way of having fun while we take care of kids. Use your smartphone to scan our QR code below to connect instantly with Senders Pediatrics Facebook and see what everyones talking about!
Senders Pediatrics supports local artists: Come to our office and you will be bedazzled by more than 15 works by two local artists that can be purchased or just enjoyed. We have long championed the importance of supporting literacy through our efforts in starting and sustaining the Daily Dose of Reading Program. Now it is our turn to promote the importance of art. Walk through our back hallway (the one immediately behind the receptionist area) and you will see a rotating group of paintings and photographs at prices ranging from $25-$300 with proceeds going to exclusively to the local artists and a small percentage going to the Daily Dose of Reading Program. Yet to come is a Patient Art Contest in which we will display the best entries by our own patients. If you are an artist or a photographer who would like to participate in this neat project, please contact Laura Jones at ljones@senderspediatrics.com.
Children in large day care centers are sicker in the first few years but healthier at age 8. Exposure to germs in the "licking everything" stage was associated with more respiratory and ear infections in the short term but with fewer such infections during the school age period compared to children cared for at home during the first few years.
Senders says: It is not rocket science to find out that day care participants are sicker early on. But it is very comforting to note that the concept of "building immunity" is alive and well and that such children are healthier in their school age period when it really counts. But the best protection at any age is a flu vaccine. For the investment of time and pain, it is one of the best bargains. So if you haven't gotten a flu vaccine yet, call today. The season is around the corner, the vaccine is safe (it is all preservative free - only in our office of course), and the disease is miserable. Moreover, if your child has a history of asthma (and about 200 of your children with asthma have still not gotten a flu vaccine) it could be potentially dangerous.
Low Vitamin D levels are associated with higher allergy levels. And so is getting less sleep.In a study of 3136 children and 3454 US adults, children with vitamin D deficiency (levels <15), were more likely to have positive allergy tests to foods, pets, dust, weeks and grasses. And in a study of 1534 Chinese adolescents, children getting the least amount of sleep were 2X more likely to have allergies than those getting the most sleep.
Senders says: Increasing vitamin D in your diet and getting more sleep are two things we harp on in every visit. Although it is not known whether supplementing with vitamin D will reverse these allergy effects, it makes sense to make sure your child is getting at least 2 cups of milk or yogurt a day (there is little vitamin D in cheese) for children under 10 and 3-4 cups of milk or yogurt for children 10 and above. And it also makes sense to get at least 7.5 hours of sleep in people 15 and above (that means parents too), 8.5 hours of sleep in 12-15 and 9.5 hours in children 10-12. More about this below.
Too little sleep reduces your capacity for long term memory and clutters your brain. For years, moms and pediatricians have pushed their children to get more sleep. But now there is data to explain why. Getting less than 7 hours of sleep in adolescence, reduces blood supply to the long term memory areas of the brain meaning that information learned is available for 12-14 hours and then often, has to be relearned. This may be helpful in cramming for a test in the short term but is not at all useful in the long term. In addition, each day, our brain stores millions of facts. During phase 3 and 4 of sleep (so called, slow wave sleep), unnecessary information is deleted (technically archived) to make information storage and retrieval more efficient. What happens to your email account when it has too much information? It works slower. Same for the brain.
Senders says: Parents need to model good sleep behavior for their children. And taking naps really works. A 15 minute nap at noon makes you 30% more efficient at 6PM.
Drinking hot beverages eliminates resistant staph in your nose. In a study of 5555 adults, those who drank hot coffee or hot tea carried the MRSA (the most serious and resistant form of staph) bacteria in their nose less than half as often as those who did not drink hot beverages. And there was no effect on iced tea drinkers.
Senders says: It turns out that hot coffee and hot tea might have antibiotic properties similar to those found in the early 00s in chicken soup or the hot water vapor itself may kill the germs. More is sure to come ahead. But every little bit helps in our battle with increasingly resistant bacteria.
Adults need 10,000 steps a day, teenage girls need 12,000 steps, teenage boys need 15,000 steps and digital exercise games are as good as normal physical exercise for children. To maintain a healthy BMI, girls and boys need more steps daily than adults especially during their growing years. But a recent study of Boston children found that playing digital exercise games such as Jackie Chan Alley Run, Dance Dance Revolution, Bug Invasions, Goal Wars and the Sportwall system provided an equal or better energy expenditure than running on a treadmill.
Senders says: The key is really getting your kids (and yourself) to move. The world obsesses with diets and food interventions. But the best way to keep your child healthy long term is to get them to move. It can be on a WII or a Playstation (using one of these programs), it could be walking the dog or jumping rope or it could just be increasing the number of footsteps your child gets in a day (buy a pedometer for $10 and start counting).
October 2011
25 and going strong!
We are proud to be celebrating our 25th year of service in the Cleveland pediatric communitywith excellence in quality and compassionate care. With this milestone, Senders Pediatrics is rolling out a number of initiatives dedicated to further enhance your experience. First, you will notice that we have redesigned our logo to signify your dedication and continued involvement in making your practice outstanding in the pediatric community. We are focusing on the development of a pediatric care community of individuals who care about engaging with each other to create a resource and healthier environment for all. We are also excited to present to you a monthly email which will be filled with the practical medical information gleaned from the recent medical literature which will be helpful in your everyday lives. You will find this email delivered to your inbox on the second Tuesday of each month. Finally, we will be posting exciting information about our 25th Anniversary events, including the Senders Pediatrics Family Carnival that is scheduled for Summer 2012, on our website and Facebook page. Follow us on Facebook
Sports drinks are unnecessary and many sports drinks, and almost all energy drinks, can be harmful. In an exhaustive report on sports and energy drinks, the American Academy of Pediatrics reviewed 9 of the most common sports drinks (defined as giving additional sodium, carbohydrates, vitamins or calcium) and 12 of the most common energy drinks (defined as containing caffeine, guarana – a natural substance that contains caffeine, and taurine – an amino acid said to increase the effect of caffeine). The report is particularly relevant as a recent study of adolescents found that 56% consumed sports drinks and 42% consumed energy drinks in the 2 weeks prior to the survey. Moreover, sports drinks increased their market share in school vending machines from 14% to 20% by 2007. The conclusions are as follows:
1) With apologies to Pepsi, the makers of Gatorade and to Coca Cola, the makers of Powerade, for children taking a regular diet, there is almost no reason to consume sports drinks instead of water during a moderate exercise regimen. For most children and adolescents, daily electrolyte requirements are met sufficiently by a healthy and balanced diet. The only possible exceptions are prolonged vigorous exercise (over an hour) or exercising in hot or humid conditions.
2) Dental erosions occur in up to 57% of teenage sports drinkers in a recent study due to the low pH of these beverages.
3) The added calories in many sports drinks are contributing to a rise in obesity levels in teenagers
4) The added B and C vitamins in sports drinks are worthless.
5) The caffeine content of energy drinks can be significant and it is very difficult to measure the total amount of caffeine in an energy drink. This is because guarana contains caffeine and taurine increases the effect of caffeine. Some energy drinks can contain over 500 mg of caffeine which is equivalent to 14 caffeinated cans of soda.
Another recent study found that most teenagers readily substitute energy drinks for sports drinks. Caffeine can increase blood pressure and heart rate, increase sleep disturbances and anxiety, and trigger cardiac arrhythmias. More importantly, symptoms of caffeine withdrawal include headache, fatigue, decreased alertness, and difficulty concentrating.
The take home message: Don’t waste your money on sports drinks and don’t ever buy energy drinks for your children. Water works just fine!
Teething does not cause a significant fever rise. It has been said that if you know 2 words, you know the answer to 80% of all pediatric advice questions: Viruses and Teething. Following a recent study of 78 infants between 5-15 months over the eruption of up to 8 teeth, teething was associated with sleep disturbance, increased salivation, facial rash, runny nose, diarrhea, loss of appetite, irritability, and a slight rise in temperature (less than a degree). A previous study published in 2000 by researchers at the Cleveland Clinic found similar nonspecific signs of teething (but did not find an increase in diarrhea).
The take home message: If your child has a rise of more than one degree in temperature, is coughing and is really miserable and not eating, it is not likely that they are teething. However, they are still likely to have a virus. Contact us if you are not sure and especially if they are really out of sorts.
Counseling about sleep problems in kindergarteners really helps. An Australian study found that counseling parents about sleep problems at the 5-year check-up reduces sleep problems in even the most challenging children by 50% over a six month period. The 3 suggestions to follow include:
1) Bedtime before 9 PM, including all reading sessions.
2) Having parents disengage and not lie down with their children so as to encourage self-soothing.
3) Eliminate all electronics within an hour of going to bed, including video games, computers, televisions, cell phones, and iPODs.
The take home message: A small intervention in the sleep department can insure that your child has a successful school career.
Holding your child during a painful procedure reduces pain levels. A recent study found that in premature children undergoing painful procedures (such as blood drawing), having a parent hold the child reduced the experience of pain by 30%. Within the first minute, mothers were statistically more comforting but after a minute, fathers were equally comforting.
The take home message: In premies that undergo a lot of painful procedures on a daily basis, “kangaroo care†or skin-to-skin contact with a parent is the ideal option. This study does not address the benefit of holding your toddler for a similar procedure, but it sure makes sense that having your child on your lap should be beneficial there as well.
Influenza vaccine is safe, even when given year after year. In a 4-year, large scale study of over 60,000 children aged 2-5 years who had been given annual doses of flu vaccine, there were no serious side effects. The annoying side effects that were reported in the first 3 days were fever, vomiting and diarrhea. The likelihood of having these side effects increased slightly with more doses.
The take home message: The flu vaccine is safe. It saves lives as over 300 deaths could be prevented annually in kids alone. The side effects are annoying, and not serious.
September 2, 2011
We're back communicating with you with information that you can use to keep your children healthy, safe, intellectually challenged and emotionally nourished. In the past few months, we have been busy developing our infrastructure. We are excited for you to meet Alicia and Cassandra in our front office. They bring a gentle professionalism that we know you will enjoy. Our research department is expanding under the new leadership of Jason Soltis. We have upgraded computer systems and are on the brink of achieving quality certification by the esteemed National Council of Quality Assurance. Finally, we will soon break ground on an addition to our parking lot that will insure that you never have to drive around for a spot winter or summer.
Thanks for your patience. As many of you may have heard, we experienced a direct lightning hit to our building on Wednesday, August 31st, that knocked out our computer server, network switches that service all of our desktop computers, our laptop computers, the internet and the phones. It is humbling to see how dependant we all have become on technology and how challenging it is to have to practice snail mail medicine in an era of the information technology super highway. But due to the amazing ingenuity and flexibility of our staff including Technology Manager, Ayelet Weissmann, Front Office Manager, Taylor Czarzasty, Back Office Manager, Gina Smith, and all their staffs as well as our IT Support Team at Technology Xperts, we were up and running by mid afternoon with minimal disruption to you, our patients and their families. If you sent a fax on Thursday, September 1st or Friday morning, September 2nd, please resend it as our fax machine was down as well. Thanks for your understanding and patience as we deal with the infrastructure that otherwise works so seamlessly to provide care to your children.
Flu season is around the corner. And that means that it's time to give flu shots to everyone. For the second year in a row, the CDC is recommending that everyone 6 months and older receive a flu vaccine. As we have done for the past few years, we will be conducting flu vaccine administration clinics on Saturdays and Sundays as well as on Thursday afternoons beginning the week of September 11. As in the past, we will be offering both the injected flu vaccine and the intranasal (in the nose) flu vaccines. This year there are 2 very exciting developments.
- As a service to our families, we are happy to provide vaccine to all parents of patients. If this service is of help to you, please don't forget to schedule a flu vaccine for yourself as well as you child when you schedule them for one of our flu clinic days.
- All of the flu vaccine will be preservative and thimerosal free (except for those receiving vaccine as part of the government issued Vaccines for Children program provided to patients with Medicaid or Caresource insurances).
Our goal is universal vaccination. Last year, there were 105 mostly healthy children who died of influenza, which is lower than it has been in other years but is still 105 children too many. Although there appears to be plenty of vaccine so far, our experience is that supplies begin to dwindle later in the season. So call for your child's appointment (and your own) today. Remember, one of the contraindications for receiving flu vaccine in all age groups is a history of egg allergy. However, there is now a relatively simple way to desensitize most people to egg allergies to allow the patient to receive a flu vaccine. Call us for more information about how to do this for your child.
Teenagers, we have a study for you! We are about to start 4 new studies in teenagers.
- Second dose of the current meningitis (brain infection) vaccine. Most data supports the administration of a 2nd meningitis vaccine after age 16 years because of a drop in immunity at that point. We are doing the study that proves this. It involves the administration of a second dose of meningitis vaccine and 2 blood draws (one before and one after).
- Current meningitis vaccine given with other vaccines. All vaccines that are approved require a study that looks at giving it with other vaccines. This study looks at giving the current meningitis vaccine with the tetanus booster and the HPV vaccine.
- A new meningitis B vaccine. The current vaccine protects against 4 strains of meningitis, but not against strain B which accounts for just under 40% of cases (350 deaths per year in teens and young adults). We are testing the first successful meningitis B vaccine in teens in two different studies.
Eczema sufferers listen up! CeraVe lotion (available in all local drug stores for about $15 for a 16 oz tub) is an amazing moisturizing cream that is just beginning to receive the attention it deserves. It has a patented technology that allows for slow release throughout the day and contains ceramides which help repair multiple layers of skin. Patients who have used it have often been able to stop using steroid creams and it takes Aquaphor to the next level.
There is a better way to deal with lice. There are 2 newish approaches to this oldest of problems.
- Cetaphil cleaner can be applied to the hair and scalp, left on for 2 minutes and combed out. Eight hours later the hair is washed with regular shampoo. Because it does not kill the eggs, it should be repeated once weekly for 3 weeks. In 2 recent studies, the cure rate was found to be 95% and 97%.
- Ulesfia lotion is a combination of 5% benzoyl peroxide (the active ingredient in most acne medications) and mineral oil. Available only by prescription, the benzoyl peroxide stuns the breathing holes in the open position and the mineral oil then drowns the louse. Both approaches are simple and safe!
We love probiotics. Probiotics are so called "good bacteria" that colonize the gut and have the potential to help prevent and treat many diseases.
- Reducing illness in day care. They have been shown to be helpful in reducing colds and ear infections in children attending day care by 30%.
- Reducing the duration of viral diarrhea. They have been shown to reduce diarrhea by 1 full day (getting children back to day care and parents back to work).
- Reducing antibiotic associated diarrhea and yeast infections. Using probiotics when taking almost all antibiotics can reduce the number and frequency of loose stools. We recommend using them with all antibiotics and especially in teenagers taking daily antibiotics for acne and in infants taking preventative medication for urinary tract infections.
- Reducing the complications of eczema. Eczema outbreaks can be reduced by 30% and complications like impetigo or cellulitis can be reduced as well.
- Reducing colic pain in infants. Giving probiotics to infants in the first 2 months reduces colic scores by 90% compared to placebo.
But not all probiotics are created equal. We still prefer the Lactobacillus GG formulation found in Culturelle brand because most of the studies have been done with this probiotic, it is not broken down by the acid in the stomach and it appears to work well for many types of problems. There are 2 formulations. Culturelle for Kids contains 1 billion cells per packet while the capsule contains 10 billion. Since all the studies used 10 billion cells, we recommend the packet only up until 5-6 months when children are not taking solid foods. After that point, it is best to open a capsule and put it in their food. The store brand is often not the same good bacteria but Drugstore.com has very competitive prices (about 40% off) for those intending to use it for an entire winter.
January 19, 2011
Dear Families,
As many of you have heard on the news, there was a death over the weekend of a 1st grade student who went to Rowland Elementary in the South Euclid School district. From the information we have received from the health department and Rainbow Babies and Children’s it appears she died from a bacteria called Streptococcus pneumoniae that was in her blood stream. She initially had fever and sinus symptoms for which she received antibiotics but then the infection worsened and overwhelmed her body. She presented to Rainbow in serious condition. Despite care by the Pediatric Intensive Unit they were not able to save her from the infection. Unfortunately, the strain of bacteria was one that is resistant to most antibiotics. This is an extremely rare but tragic outcome of this infection.
The most common types of infections caused by Streptococcus pneumoniae include middle ear infections and sinus infection. Although more serious illnesses, including pneumonia, bloodstream infection and meningitis can occur, they are rare. The childhood vaccine Prevnar helps to create immunity against this disease, but only to specific strains. The new Prevnar 13 vaccine that we now give routinely to all younger children (however she would not have qualified) creates immunity to this very resistant strain of Strep pneumoniae. The old Prevnar 7 vaccine did not contain this strain. We at Senders Pediatrics have been using this new Prevnar 13 vaccine for the past year. The vaccine does not prevent the ear and sinus infections, but does help prevent more serious forms of the illness like meningitis and bloodstream infections. We should remember that vaccines can be life-saving and to take advantage of their benefits.
We have been in contact with the infectious disease specialists from Rainbow and they agree with our plan of action. For contacts that currently have congestion, fever, or other symptoms we should see them in the office for evaluation. For contacts who have no current symptoms they are not recommending any treatment at this time. Prophylactic antibiotics will not be beneficial.
As people who take care of children this tragedy hits close to home for all of us. Even though the little girl was not a patient here at Senders Pediatrics, she and her family will be in our prayers.
Dr. Doug Fleck Addresses Similac Recall
September 23, 2010
Tonight on Channel 3 News, our very own Dr. Doug Fleck addresses the Similac recall and answers your most common questions. Please be sure to tune in tonight at 7pm!
Click here for more information about the recall.
Flu Season is right around the corner! Once again, Senders Pediatrics will be hosting a series of Flu Clinics to keep you healthy throughout the season. We’ve begun scheduling with our first clinic starting September 11th from 9:00 am to 12:00 noon. Please call today to schedule your vaccination.
2010-2011 Influenza Vaccine Recommendations
It seems like just yesterday that we were communicating every few weeks about the H1N1 influenza pandemic of 2009. Now that the World Health Organization has confirmed that the pandemic is officially over, it is time to begin planning for this year’s influenza season. The first piece of good news is that there was no seasonal flu season in 2010. The other piece of good news is that nationally, as well as locally in Cleveland, illness of all types and specifically respiratory illness, is down considerably during the 2010 calendar year. Senders Pediatrics has seen a drop of close to 15% in illness compared to 2009. This downward trend which began in January 2010 is continuing to this day. In discussions with national infectious disease experts, the likely cause for this drop in illness is due to a boost in immunity that began with the broad exposure to the H1N1 influenza virus and the increase in influenza vaccine administration. In our practice alone, we almost tripled the total number of influenza vaccines in 2009 compared to the previous year. The hope is by duplicating this huge influenza vaccine distribution, we will continue to reduce the number of ill children and adults during the upcoming winter season.
So what’s the plan? Each year, the flu vaccine is composed of three strains based on national experience with the disease from the previous year. This past February, the Centers for Disease Control and Prevention (CDC) made the decision to include two strains of Influenza A and one strain of Influenza B. Included is a variation of the H1N1 strain that was responsible for the increase in illness last year as well as the H3N2 strain which has been responsible for illness in previous years.
Drift and shift: Each year, influenza disease drifts slightly. Although the strain is the same, the makeup of the virus has changed enough so that the protection that came from contracting the disease or from the vaccine given in previous years no longer helps. This is why influenza vaccine with the same strains is necessary year after year. Every once in a while the actual strain changes (shifts). This is what happened last year with H1N1 and why it was potentially so dangerous. In H1N1’s case, no one had immune protection and we were all fortunate that it was as mild as it turned out to be. Looming on the horizon is H5N1, the “so-called†bird flu, that made a brief appearance in Asia a few years ago and could represent the next big strain shift. We are excited that we have been chosen to be one of the only North American sites to study a vaccine against bird flu, a study that will take place in early 2011.
2010-2011 Recommendations: It is important for children to be protected against both H1N1 and seasonal flu. Therefore,
- Children between 6 months and 9 years who did not receive any doses of H1N1 vaccine last year should receive 2 doses of this year’s vaccine given 1 month apart. If one dose was given last year, they would still benefit from 2 doses this year.
- Children between 6 months and 9 years who have never received seasonal flu vaccine should receive 2 doses of this year’s vaccine given 1 month apart. Again, if one dose was given last year for the first time, they would still benefit from 2 doses this year.
- Children between 6 months and 9 years who have received seasonal flu vaccine in the past and have had at least one year in which they received 2 doses should receive only 1 dose this year.
- Children ages 9 and above should receive only 1 dose of this year’s vaccine
- Children under 6 months should not be vaccinated. Once they reach 6 months of age, they can be vaccinated through April of 2011.
Recap: As in the past, we will be offering flu vaccine in a flu clinic program every Saturday and alternating Sunday mornings from 9:00-12:00 noon and from 8:30-5:00pm on Wednesdays. We have plenty of vaccine available and can accommodate your child as early as this weekend (September 11-12). Please do not wait until later in the season. Remember that children with chronic illnesses such as asthma, sickle cell, diabetes and complex cardiac disease as well as premies and former premies are at a higher risk for developing serious complications from influenza. Such patients should be vaccinated as soon as possible.
As in previous seasons, we will have both the injected form of flu vaccine and the Flumist form that is squirted in the nose. Both are equally effective. However, Flumist is not approved for use in children under 2-years of age as well as children with asthma or reactive airway disease. Please note that children with egg allergies cannot receive the flu vaccine or Flumist. If your egg allergic child has asthma and is at a much higher risk of complications from influenza, please contact us for further recommendations.
If your child arrives ill to a flu clinic appointment and there is a question about vaccine administration, we will work our hardest to fit him/her in with a provider who can make a medical determination.
We are excited to have had a reduction in respiratory illness during 2010 and hope that, once again, through our vaccination programs, we will be able to do the same for your child this coming year.
Talking to Kids about Lebron - July 9, 2010
About two months ago, my 13 year old son, Joey, who is a basketball player, announced that he wasn’t interested in playing basketball this coming season. No reason. I suspect that he was consciously or unconsciously protecting himself for what happened last night. Today, we have heard many comments from parents about how crushed their children were, asking for guidance in dealing with this issue. The following is a letter that I wrote last night to Joey who is away at camp. I hope that it will provide some insight as to the type of discussions that are appropriate to have with your children. Remember, crisis, health related or sports related, is always an opportunity for growth.
Dear Joey,
Well by now you have heard that Lebron is going to Miami. I cannot tell you how angry and betrayed Mommy and I felt when we initially heard the announcement. We actually went walking around the block for about an hour, talking about what happened and why we felt so bad. And I think the main reason we felt so bad is that for a moment it made us feel like losers. If Lebron can reject you, then you must really be a loser.
But Joey, think about how silly that sentence sounds. Cleveland is no different now than it was before we heard Lebron was leaving. To be sure, there will be a huge financial impact on Cleveland. I feel sorry for the businesses that will lose a lot of money because the Cavs will not be selling out games. And I feel sorry for the salesmen who will lose money because people will not be buying his shirts and other memorabilia. I even feel sorry for Dan Gilbert who truly invested in his team, perhaps more than any other owner of a Cleveland franchise. But remember Joey, being rejected by a 25 year old person who puts a basketball in the hoop for a living doesn’t make you any smaller or less important and it certainly doesn’t make you a loser.
Despite what he said in his prime time, self-promoting interview on ESPN that he chose winning over everything else, in Mommy’s and my opinion, Lebron did not choose to be a winner. If that were really true he would not have put himself first. He chose the easy route in Miami. A true winner would have stayed with his loyal fans even if it meant working harder. Maybe at 25, he is tired of shouldering responsibility. Maybe that is what happened in Game 6 of the Boston series. Maybe he doesn’t have the fire in his belly that Kobe and Michael have/had. Although I started out feeling angry, as I think about it more, I feel sorry for him. Because what he has shown with this decision is that at least at this point in his life he doesn’t understand what a true winner is. The fame and the grandeur that goes with winning a game or a playoff or a championship ring cannot buy loyalty and it often doesn’t buy happiness. His face told it all during the ESPN extravaganza. He looked nervous and he almost gulped when he said he was going to South Beach, Florida. He knew he was abandoning his hometown but he wasn’t able to look beyond himself and give back to those who supported him and who indirectly made him so famous. Betrayed Akron fans turned on him almost immediately and were burning his t shirts while Cleveland sportscasters quite correctly pointed out that over time, he may be one of the most hated people around Northeast Ohio, just a little bit ahead of Art Modell who brought the Browns to Baltimore. This morning’s Plain Dealer quoted him as saying “…I wanted to do what was best for Lebron James and what would make him happy.†He may have a lot of money but the people who paid for tickets and bought his shirts feel that he has been disloyal to them and all the money in the world won’t be able to buy him happiness. I hope he finds happiness in Miami but I doubt it because true happiness doesn’t come from what you get, it comes from what you give.
Until last night, Lebron was a hero to many here in Northeast Ohio. He brought 7 good years to the Cavaliers and by extension to the city of Cleveland. We all wanted Lebron to continue being a hero. Human beings want to believe in heroes. We need heroes because they challenge us to rise above our own weaknesses and soar. You may remember the Greek tragic story of Icarus who had wax wings and believed he was invincible only to find that when he flew too close to the sun, his wings melted and he came crashing to the ground. Since he was 13 years old, Lebron has been called the King and the Chosen One. He has been worshipped and adored and been granted every wish he could want. Just like Jafar, the evil sorcerer in the Aladdin movie. But the danger of living a life of privilege with no limits or boundaries is it may lead to a wish to become the most powerful genie and you end up getting put right back in the bottle, you fly too close to the sun and your wings melt. A true hero quietly and modestly works to make the world a better place. Even one person at a time. At times like this, we have to remind ourselves more than ever to be on the lookout for the true heroes in our life, the firemen who risk their lives to save others, the police who keep our cities safe, the doctors who heal people, the teachers who nurture the next generation, and maybe just the person who, with a kind word, puts a smile on someone else’s face.
Joey, you know that one of my favorite lines in all of literature is the Peter Parker quote in the Spiderman comic book that with great power comes great responsibility. Lebron has great power. I don’t believe he used it with great responsibility. Remember, however, that you too have great power, in some ways as much or more than Lebron. Learn from tonight’s experience to use your great power with great responsibility.
Love,
Daddy (and Mommy)
ADHD and insecticides– May 19, 2010
In a study published online in the journal, Pediatrics, researchers at the Harvard University School of Public Health and Epidemiology found an association between ADHD and the urinary presence of insecticide derivatives. Researchers studied 1400 children between ages 8-15 culled from the National Health and Nutrition Examination Survey that was conducted between 2000-4. Parents of children in this group said to be representative of the US population in general, were interviewed and asked about the diagnosis of ADHD in their child. 12% of children met the criteria for ADHD. In that group, a 10 fold increase in the urinary presence of breakdown products of common insecticides was associated with a 1.5 times greater chance of being diagnosed with ADHD and an increase above the mean of the most common insecticide byproduct, was associated with a 2 times greater chance of being diagnosed with ADHD. There was no way of knowing how these insecticide byproducts ended up in the urine of these patients.
Senders Says: This study raises some disturbing questions. Previous studies by this group have found traces of insecticide in strawberries, blueberries and celery. To be sure, there are some potential problems with this study. To begin with, there is a much larger percentage of patients with ADHD than in other studies suggesting that it may not be a representative study. Moreover, this study is a retrospective study, meaning that it was done after the fact. The authors admit that a prospective study that evaluates the ADHD prevalence in children eating organic fruits and vegetables versus those who eat non organic foods, needs to be conducted. Until such studies can be conducted, parents should wash fruits carefully. Strawberries and other fruits and vegetables that are very fragile and will be destroyed with vigorous washing, should be eaten with caution unless you know about the insecticides used in their processing.
The Truth about the Tylenol, Motrin, Zyrtec and Benadryl Recall– May 4, 2010
On Friday, April 30, 2010, McNeil, a subsidiary of Johnson and Johnson, voluntarily recalled 7 product lines of children’s over the counter (OTC) medications including 44 different formulations. Included in the recall, which was not mandated by the Food and Drug Administration (FDA), were all formulations of Tylenol Infant Drops, Children’s Liquid Suspension and the Tylenol Plus Cold, Cough and Allergy combinations, all formulations of Motrin Infant Drops, Children’s Liquid Suspension and the Motrin Cold combination, Sugar Free, Dye Free Zyrtec Liquid and Sugar Free, Dye Free Children’s Benadryl.
According to the company “Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles. While the potential for serious medical events is remote, the company advises consumers who have purchased these recalled products to discontinue use.†Visit http://www.mcneilproductrecall.com/or call 888-222-6036 for information on how to obtain a coupon for a free bottle of the recalled product once it is available.
What does this all mean? According to Wall Street, not much! Shares of Johnson and Johnson were actually up 1% in the first day of trading following the recall notice. From a medical standpoint, it probably doesn’t mean much either. There have been no adverse reactions reported to the FDA, nor is the FDA making this a mandatory recall. The thought that there might be too much active ingredient might be frightening to some but in reality, means very little. All medications have a range of potencies and each lot or batch is required to conform to that range. If it goes slightly above or slightly below, the product is recalled. Similarly, not meeting internal testing requirements means little in the real world. The standards used by the pharmaceutical industry in the area of OTC medications are very high because the potential for misuse in untrained hands is so great. As a result, not meeting internal testing requirements still usually means that it far exceeds the requirements mandated by the FDA and that is why there is no mandatory recall. Similarly, the presence of tiny particles usually means that one of the ingredients hardened, rather than remained in solution. In and of itself, this also probably has no impact on safety, efficacy or potency.
There is always a silver lining to any medical recall story and that is the learning opportunity for us all. Brand name OTC medications are rarely necessary! Tylenol is the brand name for acetaminophen, Motrin is the brand name for ibuprofen, Zyrtec is the brand name for cetirizine and Benadryl is the brand name for diphenydramine. All brand name products have excellent generic equivalents sold by all the local pharmacies including Walgreens, Walmart, Target, CVS and Rite Aid. The product is almost always 100% equivalent and the price is as much as 33% less expensive. So use this recall as an opportunity not to get a coupon for the brand name product that we are told, will perhaps take months to reappear on the shelves. Rather, use it as an opportunity to switch to a less expensive generic equivalent. In the short run, not taking the McNeil coupon will cost a few dollars. In the end, you will be increasing competition and reducing your healthcare expenses.
The following are the NDC numbers for the recalled products. If you have purchased one of the recalled products with these NDC numbers, simply dispose of the product as you would any medication and purchase a generic equivalent or contact the company as directed above.
Zyrtec Recall – April 9, 2010
There was a recall last week for Zyrtec Grape Flavored liquid. It was recalled for potential sub-standard packaging. The UPC codes for the ones recalled are: 30045020922 & 30045020904. This is a precautionary recall. There have been no untoward effects found in patients who have received these affected lots. If you have purchased any of the affected lots, please contact your pharmacy for further information about the recall procedure.
Mumps Outbreak – March 11, 2010
There has been an outbreak of mumps in Orthodox Jewish communities in Brooklyn, New York and Lakewood, New Jersey, leading to confirmed disease in over 2000 people of all ages. Mumps is generally a mild disease that causes cheek swelling (the child looks a little like a chipmunk). In rare cases, it can cause damage to the testes which is why it is a public health concern. The Centers for Disease Control and Prevention has actually been involved in this matter, providing guidance to communities that may be affected tangentially by this outbreak. Because there is a lot of family movement around the holiday of Passover (celebrated this year at the end of March), there is concern on the part of local public health officials and the CDC, that there will be spread around the country. For some time now, there has been a recommendation to give a second MMR vaccine prior to kindergarten. This is because up to 5% of people are non responders - they don't develop immune protection with the first dose and therefore would benefit from a second dose. There is almost no incidence of waning immunity, meaning that you either respond or you don't but almost no one loses immunity to mumps over time.
The recommendations for Cleveland are that children between 12 months and 5 years, who have received only one dose of MMR and who are visiting relatives in Brooklyn, New York and Lakewood, New Jersey over the Passover holiday or are being visited by relatives from these communities, should receive their second dose of MMR by the end of this month. Children who are not travelling or welcoming visitors from communities with mumps outbreaks do not need to get their 2nd MMR at this time. And there is no need for anyone to receive a 3rd dose of MMR. If you are part of this small group of individuals, please call the office to schedule an MMR for your child. We have reviewed our records of vaccinated individuals and with our attention to providing the proper vaccination to all of our patients, we believe that very few people are potentially impacted by this recommendation.
Mary Alice Dombrowski – February 23, 2010
Unfortunately, for us, Mary Alice Dombrowski will be leaving our office at the end of March. Click hereto view her letter to the practice.
FDA Advisory on Advair– February 19, 2010
Many of you have read the article posted on February 18 on Cleveland.com and on February 19 in the Cleveland Plain Dealer regarding new Food and Drug Administration (FDA) recommendations on the use of Advair and Symbicort, medications that are commonly used for the treatment of asthma. The FDA announced yesterday that it was placing new restrictions on the use of a category of medications called long acting beta agonists (LABA). In understanding what the concerns are, it is important to understand the mechanism behind asthma and the mechanism of action of the most common asthma medications.
Asthma is now known as an inflammatory disease of the lungs. In more simple terms, people who suffer from asthma have twitchier or itchier airways than other individuals. When airways are so irritated, they produce more mucus or inflammatory substances, causing the typical blockages that are heard as a musical sound called wheezing. The causes of asthma are multiple including viruses, allergies, exposure to smoke and exercise but in all cases, the underlying problem is irritability and mucus plugging.
There are 3 categories of medications that are used to reverse the irritation of airways found in asthma.
- Short Acting Bronchodilators (SAB)– The classic SAB is albuterol (known under many brand names such as Ventolin, Proventil and ProAir). Albuterol works by directly reversing the irritability of the airways. The best way to understand this is to imagine albuterol as a toothpick. If you placed a toothpick (figuratively of course) in an irritable airway, it would work quickly to keep it open but as soon as you removed the toothpick, the irritability would continue. That is how albuterol works. It works rapidly but once it wears off, the irritability returns. A newer kind of bronchodilator is called xopenex which works in a similar fashion but without a lot of the side effects (less heart racing and fussiness) of albuterol. It is also 10 times more expensive and so, is not covered by many insurance plans.
- Inhaled steroids – Inhaled steroids (Flovent, Qvar and others) get at the underlying cause of the wheezing process by reducing the inflammatory process. They function much like scaffolding for repair of a building. It takes longer to build scaffolding but once in place, the building is kept solidly in place. Similarly, it takes longer for inhaled steroids to work (typically 3-5 days) and they have to be maintained for about 14 days for maximum effect.
- Singulair – This medication prevents the release of histamine which is the major cause of the inflammatory process to begin with.
The class of medications under review by the FDA are called Long Acting Bronchodilators (LABAs) which include Salmeterol (Serevent) or Formoterol (Foradil). It is about this class of medications that the FDA has issued its highest level warning, telling physicians not to prescribe them alone without inhaled steroids because they relax muscles in the lungs without affecting the root cause of inflammation, predisposing to worsening of asthma symptoms or sudden death. For a parent to hear that last expression is very frightening. The good news is that we and most physicians have known about these concerns almost from the licensure of these drugs and HAVE NOT PRESCRIBED them for almost 6 years. Nationwide, fewer than 5% of all asthmatics are on this class of medications without inhaled steroids.
What we have used quite a bit are combinations of LABAs and inhaled steroids which are prescribed under the names Advair and Symbicort. The FDA said nothing about these combinations of drugs because they are truly life saving. The current recommendations to which most pediatricians adhere are to start with SABs like albuterol and xopenex. If the child is continuing to wheeze or having coughing at night on SABs, then we add an inhaled steroid like Flovent. But we have many patients who simply need more control and those are the kids who end up on Advair and Symbicort. They have a long safety record and the FDA simply stated that health care providers be vigilant and use these medications for as short enough period as possible (months rather than years).
At Senders Pediatrics, we understand that management of asthma is a balancing act. The disease itself is one of the most common causes of pediatric hospitalizations and death when it is not effectively treated. The medications that we use routinely have long safety records and there is evidence that appropriate treatment of asthma actually helps remodel the lungs and increases the likelihood that a child will outgrow the disease. We follow national standards in developing Asthma Care Plans for every patient with more than one wheezing episode and encourage you to schedule an appointment to develop and update your child’s asthma care plan.
Crisis is an opportunity for growth. This new FDA report has the potential to education millions on the appropriate use of asthma medications. A generation ago, children coughed all winter. Now we have diagnosed most of them with asthma, have medications that can help them breathe, sleep and conduct normal lives. (With a nod to the Vancouver Olympics: 25% of all Olympic participants have been diagnosed with asthma and are able to function at the highest levels). Thanks for your trust!
Graco Stroller Recall – January 21, 2010
Normally, we place recalls on our Consumer Product Safety Commission link on our website. However, given the enormity of this recall (1.5 million strollers) and the likelihood that many of our patients have a Graco stroller, we are highlighting this program on our email blast. There have been 7 children who have lost fingers or parts of fingers because their hands have become caught in the closing mechanism. The recall involves providing a safety cover that will prevent such accidents.This recall involves Graco Passageâ„¢, Alanoâ„¢ and Spreeâ„¢ Strollers and Travel Systems with the following model numbers and specific hinge mechanisms:
Model Numbers
6303MYC, 6303MYC3 7240DNB, 7240DNB2
7240MKL2, 7240MKL3 7F02GLM3
6320IVY, 6320LAU 7241DDH2, 7241DHO3 7F04TAY3
6330CAP, 6330THR,
6330THR3 7255CLP, 7255CLP2,
7255CRA2, 7255CRA3,
7255CSA3, 7255GPK3,
7255GRN, 7255GRN2,
7255JJB3, 7255ORC2,
7255WLO2, 7255WLO3 7F07EMA3
6F00QIN3, 6F00RRY3 7256CLO2, 7256SPM2,
7256SPM3 7F08DSW3, 7F08LAN3
6F03GLN3 7260BAN, 7260BAN2,
7260BAN3, 7260MRA2,
7260MRA3, 7260PKR,
7260PKR2 7G00DLS3, 7G00DLS4
6G10CSE3 7270BIA, 7270BIA2 7G01CRL3
7235GGA, 7235GGA2 7E01JON2, 7E01JON3 7G04KRA3
7236CDR2 7F00LPE3, 7F00RSH3 7G05GPR3, 7G06WSR3
7237HOL2, 7237HOL3 7F01FOR3 7G07ABB3, 7G07BAT3
For additional information, contact Graco at (800) 345-4109 between 8 a.m. and 5 p.m. ET Monday through Friday, or visit the firm’s Web site at www.gracobaby.com
Details at: http://www.cpsc.gov/cpscpub/prerel/prhtml10/10115.html
or by calling the US Consumer Product Safety Commission Recall Hotline: (800) 638-2772
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