Football: Time to Admit the Danger

We Now Know that NFL Football 
can Permanently Damage Your Brain


In October, 2009, the noted author Malcolm Gladwell published a rather
breath-taking analysis of football, particularly NFL football.


http://www.newyorker.com/reporting/2009/10/19/091019fa_fact_gladwell?printable=true


Gladwell is the author of Blink and Tipping Point, who has a powerful
way of getting the heart of various matters.


In this case, the point is quite clear and devastating.  Pro football, 
as currently played, routinely permanently damages players' brains.


More worrisome for families is the point that concussions are not a 
reliable guide to the issue of brain damage.


For reasons that no one yet understands, the brain is one of the only 
organs that accumulates injury.  That means that if you have an injury
to the brain in 1986 and 2009, it is as if you had one injury in 2009 equal
to the two injuries added together.  And, any further injury to the brain 
leads further additions to those two injuries.


The experience in the NFL dramatically demonstrates that you can have
serious hits to the brain with no symptoms afterwards, but as they add up, 
loss of brain function begins to appear, and does not go away.


The force an damaged delivered to the brain by an NFL blow to the head
now is clearly shown to cause lifelong loss of cognitive function.


We are pleased to say that kids under the age of 12 clearly cannot deliver
the force necessary to cause concern, as long as they play by the rules.


But by high school kids are getting big enough that the blows to the 
head, as measured by scientists, can cause damage to the brain.


So please, read this article.  If you know your child wants to tackle people 
in the game of football, we would recommend it all happen prior to 7th grade.


Until the sport of football changes how the game is played, varsity high school and 
college, and NFL football, places too high a risk on the functioning of the brain to 
justify the risk.



Dr. Arthur Lavin 

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Vital Statistics 2009

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The Annual Numbers on Health 
in the United States


Every year, the American Academy of Pediatrics publishes a 
truly fascinating collection of stats on the health of American
children.


The publication is always the first article of the January issue, 
every year, of Pediatrics (www.pediatrics.org).


Now that Advanced Pediatrics has a solid connection to families
available via our web page, Tweeter, and Facebook, I thought 
it might be interesting once a year to see how we can 


The data presented each year represent information as of 
the end of the previous year that are completed, typically of 
2-3 years prior to the date of publication.  So for this 2010 article
the stats reflect how things were for 2006 and 2007.


Here are the most striking facts, for the United States:

• There were 4.3 million people born in 2007
• There were 2.4 million deaths in 2007
• Most births were to Moms ages 20-34
• Teenage pregnancy remains much lower in 2005-7 than 1990
• C-section rates continue to climb each year, now up to 28% nationwide for 20-29 y/o's
• A slight but real rise in the percentage of children born early continues, now up to 8.3%
• Infant mortality rate (IMR) is a valid measure of a nation's health, and health care system.
• The United States ranks #29 in IMR.  Japan's IMR is about 1/4 of ours!
• Of the 2.4 Million deaths a year in the US, a total of about 50,000 are in kids (<20 y/o)
• In infants (0-1 years old), about a third of the deaths are from prematurity and anomalies.
• SIDS remains the third leading cause of death in the first year of life, but the number continues to drop.
• Accidents are the number 5 cause of death in infancy.
• For older children, by far the most common cause of death is injury, primarily accidental.
• About 40% of all childhood deaths are due to accidents, from ages 1-19 years old.
• The chance of loss of life with an accident jumps dramatically after age 15, reflecting the dangerous nature of driving, and the rise of violent fighting, and of suicide.
• Once accidents of all sorts are eliminated, the good news is that childhood is by far the healthiest age to be.  Very few children in the United States suffer dangerous illness.  The rates of truly dangerous illness have dropped for most categories to the range of risk of 1 in 10-100,000.

Bottom Line:

By far and away the greatest threats to our children's health are prematurity and anomalies for infants, and accidents and injuries for children and adolescents.

The United States has much progress to make to claim the best health in the world.

Even so, although all diseases are far from conquered, this generation of children

remains the healthiest in the history of the world.  We should toast to their health

and enjoy the fact that so many are indeed quite well, during this coming year of 

2010.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Turns out it is good to eat food

More Evidence that Introducing Solids Early Helps

For a very long time, families have wondered:

What is the best age to introduce solid food to our infant?

In the United States, the reigning wisdom has been:

as late as possible.

Why?

The thought has been that the earlier you introduce solid foods, 

the more food allergies the infant will have.

Now an important study on this question has been published in the

January, 2010 issue of Pediatrics.  The study is from Finland, where

nearly 1000 children were observed from birth to age 5.

The study kept track of what age the kids started eating a variety of

solid foods, and to what extent they were nursed.

Now, in Finland, solids tend to be started at an average age of 3.5 months old.

The order of foods is different than in the US.

In Finland it goes like this:  potatoes, fruits and berries, carrots, 

cabbages, then cereals, meat, fish, and eggs.  This whole sequence is

introduced, on average, by 10.5 months of age.

In contrast in the US, we tend to start with cereals about 4-6 months

of age, do a few pureed fruits and vegetables, and that's about it

until 12 months old.  Very different.

In this study, a delay in introducing a solid food in Finland meant 

introducing potatoes over 4, oats over 5, rye over 7,

wheat over 6, meat over 5.5, fish over 8.2, and egg over 10.5

months of age

Now here is what they found, at age 5 years old,  if the food introduction

was delayed in infancy:

• The later the introduction of solids, the more allergies at age 5
• Food allergies were more common with late egg, oat, and wheat
• Hay fever and asthma were more common with late potato, and fish
• Age of introduction of milk had little impact on any allergy
• Results were independent of parental history of any allergy types
• Breast-feeding had no impact towards or away from allergy

The authors cite data from the US, Germany, and UK that are in line

with their observations.

As we have long stated at Advanced Pediatrics, the introduction of 

solids is not an important nutritional event. You can live on breast-milk

and/or formula for a very long number of years.

And, for many years, we have been deeply skeptical that avoiding 

foods like berries, eggs, and milk will prevent developing allergies.

Well, it looks like the evidence is coming in, and it is leaning heavily

towards starting solids early, and starting a wide variety of them.

By early we mean about 3.5 months old!

Think about a wide range, not just cereals, but be sure to introduce 

only purees to young infants, no one at any age should eat something 

they cannot chew and swallow.

Dr. Arthur Lavin

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*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Many Thanks to All

---

Dear Families,

As we enter the holiday season I wanted to wish everyone
a wonderful time, and very importantly a happy and healthy New Year.

I also wanted to thank every one in the practice, parents, children, families,
for your most valuable gift, your trust in us at Advanced Pediatrics.

And, I wanted to thank Ms. Elise Provident for drawing a special
rendition of this year's trip to the White House.  You can see Elise and
her wonderful drawing below.  Her drawing is actually hanging in our
waiting room as well.



So Happy Holidays, Happy New Year to all,

We look forward to working as hard as we can to help everyone in 2010!

Dr. Arthur Lavin
Dr. Julie Hertzer
Ms. Kelley Muldoon Rieger
And our staff, Sue, Bobbi, and Samantha

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

STD Screening at Advanced Pediatrics

STD Screening at Advanced Pediatrics

 Sexually transmitted diseases include a diverse range of infections, some more dangerous than others.  The ability to detect some of these infections has improved dramatically over the last few years.

Two of these infections, in particular, are very common, can cause a lifetime of difficulty, and are easy to detect with a simple urine test.

The two infections are chlamydia and gonorrhea.  Both infections tend to infect the duct work of the reproductive system.  They tend to cause no symptoms, but if left untreated, are responsible for at least 10% of all infertility in the United States.

To detect these infections, all that is required is a sample of urine sent to the lab, no blood test is required, no pelvic exam, no swab of the urethra.  This is because we can detect the DNA of the germ in the urine.

A recent article in the leading journal, Pediatrics (http://tinyurl.com/ycaw7tn) finds that nearly one in 20 adolescents ages 14-18 are infected with chlamydia or gonorrhea.

Given a one in 20 chance of a problem that can cause a lifetime of infertility, and a painless test to find and treat such infections in good time, and that the vast majority of those sexually active deny being so, and of those infected have no symptoms, the case for screening is compelling.

As a result, Advanced Pediatrics is now recommending that all adolescents be screened at least twice for chlamydia and gonorrhea by a single urine sample at ages 15 and 17. 

If positive, of course, the adolescent will be informed, counseled, and treated.  Further testing for other STD’s will be pursued as well.  If the tests are negative, an opportunity for important counseling will still be opened, but no further evaluation will be indicated.

STD’s can be an uncomfortable subject, clearly they involve the issue of sexuality.  But beyond sexuality, STD’s are basically an infection.  Because of the link to sexual activity, STD’s are the least well-diagnosed and treated infections people get.  It is really for this reason that they continue to lead to 10% of all infertility, and for this reason we propose the neutral stance of screening everyone.  It really is the best way to protect your children from what could be a very serious infection.

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Advanced Pediatrics Recommends HPV Immunization

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New Information on HPV Immunization

Several studies have recently been published regarding HPV immunization.

The key findings are:

• The HPV vaccine is safe
• It does, in fact, prevent genital warts
• It can save several hundred lives a year from cervical (and oral) cancer
• It can reduce the number of positive PAP smears
• But, the lives saved from cervical cancer depend on women continuing to have regular PAP smears, even if they get vaccinated, after they begin sexual activity.

HPV is the Human Papilloma Virus, the virus that causes warts.  A few of the many, many types of HPV cause most of the cases of cervical cancer in women.  Four of these types are in the HPV immunization.

The best strategy for HPV prevention is to make sure the vaccine is active during the peak time of risk.  In the United States, that peak risk time is ages 20-29, but there is clearly a rise in onset of HPV infections in ages 14-19.

An important article published in the December issue of Pediatrics (http://tinyurl.com/ycaw7tn) finds that in girls ages 14-19 in the United States, the chance of being infected with HPV was 18.3%, close to 20%!

The chance of developing HPV skyrockets after age 20, reaching rates of 60-80% amongst Americans by age 30.

An important remaining question is how long the HPV immunization lasts.  Recent reports secure that period to at least 5 years, but there are early indicators that the protection may actually last for a lifetime.  How so?  It turns out that after immunization, exposure to the virus acts like a booster.  If that really happens with HPV, the protection set up by the immunization series could last for many decades.

Over the last year or two, Advanced Pediatrics had issued concerns about the possibility of protection from HPV immunization only lasting 3 years, and further, that the actual benefit might be quite minimal.

These recent studies, however, are convincing. 

Therefore, effective immediately, Advanced Pediatrics is recommending
that girls begin HPV immunization before onset of any sexual activity, 
including oral sex, but no later than age 15.  

For girls ages 15-22, who have not yet been immunized against HPV, 
we also recommend they be immunized.

Disclaimer*

The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Radiation, CT scans, and Cancer

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Radiation, CT scans, and Cancer

A recent set of reports in the Annals of Internal Medicine has
brought to our attention the risk of developing cancer from
excessive CT scans.

The relationship between radiation and cancer is well-established.

Everyone knows that if you get exposed to enough radiation, your
risk of cancer goes up. The more radiation, the more risk of cancer, too.

What is not so well known is that the body retains a memory of every dose
of radiation it experiences. That means if your body turns out to need
say 100 units of radiation to spark a new cancer, an exposure at age 2 to
45 units will actually add to an exposure at age 25 of 40 units, meaning that 
at age 50, all you have to do is be exposed to just another 15 units of radiation
and cancer can be sparked.

What is not known is how much actual radiation in a lifetime is the least 
amount to cause a case of cancer to not only begin, but take hold.

We do know that well under a certain total amount of radiation, there appears to be no 
risk of increased cancer. So, for example, the amount of radiation you
are exposed to when you get a chest X-ray is very minimal, comparable
to the increased exposure you get when flying from Boston to Denver. This
tiny amount does not seem to cause any cases of cancer.

But some X-ray images take a lot more radiation to get the image.
The most is generated by CT scans.  

The least is by MRI scans which generate no X-rays or radiation at all, 
only magnetic fields, which appear to be very, very safe.

But CT scans need to shine alot of radiation on the area under study, to
get all the level of detail necessary to create the incredibly detailed CT image.

The information is so detailed and helpful that the number of CT scans done
in the US has exploded in the last 30 years. This year, the United States will
get 72 million CT scans done. That is 23 times the number done in 1980!

One would hope that with the explosion in the use of CT scans that there would 
also be increased control and caution in the amount of radiation used to do each one.
Turns out, in San Francisco and Alabama, that the amount of radiation turns 
out to be quite variable. The CT scan with the most radiation delivered
13 times as much radiation as the CT with the least, for the same CT
imaging!

The studies published go on to estimate how many cases of cancer are generated
by the use of CT scans in the United States.
Their conclusion was that roughly 23,000 new cases of cancer will be caused
by exposure to CT scan radiation, every year. And that in time there will
be 15,000 deaths from cancer each year in the US from CT scanning.



What is a Reasonable Response?

At Advanced Pediatrics we have developed this stance:

1. We do not recommend you ever get an X-ray or CT scan unless it is clearly needed.
2. If detailed imaging is needed, but an MRI will work as well, we would recommend using an MRI rather than CT.
3. If a CT scan is done, it should be done at a facility known to be able to keep exposure to a very clear and consistent minimum. We are pleased to state that our neighbors in our office building, Advanced Diagnostics, goes to great lengths to keep their use of radiation to the minimum. To that end, they have made a commitment to only use state-of-the-art CT scanners that use a small fraction of the radiation older scanners require.

Bottom Line

• Radiation causes cancer and each exposure is added to subsequent exposures, the body remembers.
• CT scans deliver more radiation than usual X-rays, MRI scans deliver no radiation
• We should avoid getting CT scans unless they are truly necessary.
• Keep in mind that routine X-rays such as chest X-rays and finger and toe films use tiny amounts of radiation. It takes 100-400 chest X-rays to equal one CT scan.
• No X-ray should ever be done without good reason, but CT scans will require more caution in their use than other imaging choices.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Reminder on the Essential Value of Knowing if your Child's Illness is Mild or Serious

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Reminder on the Essential Value of 
Knowing if your Child's Illness is 
Mild or Serious


On December 2, 2009, CNN asked me to present a list of highly
specific signs that would indicate a mild viral illness (cold or flu)
had become severe.


The segment was aired on CNN's morning news program, and
since it does a good job of visually presenting just what these
signs are, I am distributing the link:
http://www.cnn.com/video/#/video/health/2009/12/02/cohen.h1n1.saving.your.child.cnn


I also want to emphasize that knowing these signs allows you to draw
an incredibly important line that can help you achieve two incredibly
powerful goals:

1. If your child has none of these six signs, chances are overwhelming that the illness is mild, and there is on danger.  The line can help you be calm as you comfort your child, knowing no danger is here.
2. If your child has some of these six signs, you know you need to get medical attention. The line can help you know when to call for help, reassuring you that you can know just when to call or intervene.

To recap, the six signs are:

1. Trouble getting air in and out of your chest
2. Stiff neck- cannot move the neck
3. Blue fingernail beds 
4. Severe pain in one spot or area of the body
5. Altered consciousness- cannot wake, or acting very oddly
6. Just a sense that something is very wrong

I hope you find this list, the line it creates, and the video demonstration

helpful.

I have also appended an earlier post, from October, outlining the difference 

between mild and serious illness in a bit more detail.  It is specific for H1N1, 

but so many families found it helpful and so I copy it below so you have this post, 

that post, and the video all in one place.  (Note that I added blue fingernails and 
serious pain to my list of indicators of serious illness.)

Dr. Lavin

MILD versus SERIOUS ILLNESS:

or, Knowing When to Worry

and Knowing What to Do

As our nation and community encounter and try to deal with the very

serious epidemic of H1N1 (swine) influenza virus, it makes sense

to take a moment to think about how do you know, when your

child gets sick, when to worry and what to do?

It turns out that the best guide to knowing when to worry and

to know what to do is not the name of the virus.

That is, finding out if the virus causing your child's illness is H1N1

or not, does not help you know how worried to be or what to do.

The key item you need to know is how sick your child is, not the name

of the virus.

So how do you know how sick your child is?

The answer is actually fairly easy, since there are only two possible

answers: mildly ill or seriously ill.

Symptoms of Mild Respiratory Illnesses:

• Fever (100.8-105.8)
• Runny nose
• Sneezing
• Congestion
• Cough
• Sore throat
• Achiness
• Feeling tired
• Trouble sleep
• Decreased appetite

Symptoms of Serious Illness:

• Struggling to get air in and out of your chest
• Alterations in consciousness
• Stiff neck
• A "sense" that something very terrible is happening

Use the above symptoms to tell you how worried to be.

Mild illnesses, even if caused by potentially dangerous germs,

are still mild illnesses.

If you child only has mild symptoms of illness, and no symptoms of

serious illnesses, you have little to worry about.

Of course, should symptoms of serious illnesses ever develop,

one has alot to worry about.

What to Do if You Have A Mild Viral Illness

It turns out that medical science has very little to offer that would

actually make a difference to someone with a mild viral illness.

Antibiotics do not work.

More to the point, antivirals do not work very well either for mild

influenza infections.  

So the use of Tamiflu is not recommended for use in mild viral

infections, it does little good, and could lead

to the drug not working if you really need it.

What you can do is to keep your child comfortable:

lots of fluids, lots of hugging, lots of distractions (videos),

perhaps ibuprofen or acetaminophen if fever or pain is

bothering them.

What to Do if you Have Symptoms of Serious Illness

Call us immediately.

If severe enough, call 9-1-1 first.

If severe enough, we will recommend immediate evaluation in an ER.

Once at the ER, if tests reveal influenza is present, Tamiflu will be used.

If influenza is not present, then the cause will be sought and treated.

BOTTOM LINE

H1N1 (swine) influenza virus is potentially dangerous, like almost all

germs.

The rules for knowing when to worry and what to do are the same for

H1N1 (swine) influenza virus and all other viruses.

If you have mild illness, you are in no danger, and should be treated with

comfort measures.

If you have serious illness, you should seek immediate medical care. It is

only serious infections with H1N1 (swine) influenza virus for which

Tamiflu is helpful.

Dr. Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Large Shipment of H1N1 now at Advanced Pediatrics

Good News!

The Crisis is Over

Advanced Pediatrics Just Received a Large 

Shipment of H1N1 vaccine- shot and nasal spray

There is now currently plenty of H1N1 vaccine 

for everyone.

Today Advanced Pediatrics received a good number of 

three forms of the H1N1 vaccine:

1. The nasal spray 
2. The shot for infants 6 months and older
3. The shot for children and adults older than 3 years

The fact that we have a good supply now means that we can offer the 

H1N1 vaccine to everyone who is 6 months or older and not allergic to eggs.

This includes:

1. All children in our practice ages 6 months and up*
2. All parents of children in our practice*

*Unless, as noted, allergic to eggs, or have another reason a flu 

vaccine would be harmful to them.

The material of H1N1 vaccine is free and we have not 

and will not charge anyone for the material.

A charge for administration of the vaccine is made.

For children in the practice, those fees are submitted to the

family's insurer, as we are the primary doctor.

For parents in the practice, we are offering a discounted 

fee of $20 that must be paid at the time of service, prior 

to the H1N1 vaccine being given to the parent.  We will

also register the parent to document the vaccine was given.

Supplies are expected to be abundant,  but of course that 

is totally dependent on demand, so we will see.  

With regard to seasonal flu vaccine, our supplies remain 

limited and we do not expect that to change, the manufacturers

only made a certain amount and that turns out to be a too small

amount for the US this year.  We still have seasonal flu vaccine, but

expect to run out in the next few weeks.

Dr. Arthur Lavin

*Disclaimer*
The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.