2010-12-19

***URGENT POLIO DANGER ALERT*** Polio now reappearing in Europe!

World Health Organization Regions.Image via Wikipedia***URGENT POLIO DANGER ALERT***  
Polio now reappearing in Europe!

An increasing number of families have chosen to take charge of their infants' and childrens' immunization schedule in recent years.  As a result, a growing number of infants and children in the United States, and here, in Greater Cleveland, are not immunized against polio.  
We are very disturbed to pass along this very upsetting news:  over 476 cases of wild polio virus infection have appeared in over 53 countries in the WHO European Region.  This Region had been free of all polio cases for over 8 years!

Although massive world efforts to eradicate polio came very close to succeeding even as recently as 1-2 years ago, many West African countries have slipped in their polio coverage as a result of Islamic preachers alleging that polio immunization was a Western anti-Islamic plot.  With polio immunization rates dropping in West Africa, polio rates have climbed dramatically and cases of the dread disease are spreading across many countries in Africa.

This report from the World Health Organization (WHO), demonstrates that what has been feared now is happening.  People traveling from Africa to Europe have spread polio cases to Europe.

This posting is raising an alarm here since there is no reason why the same cannot happen here in the US and Ohio.

Any infant or child who has not received a full polio immunization program can get polio if it spreads to our region.  And, there is no reason why it cannot spread to our region.

Advanced Pediatrics urges all parents who have chosen not to protect their children against polio to reconsider their decision.  Polio is no longer a distant, theoretical risk, it could happen, and at anytime.

If your child or infant does not have full protection against polio now, please arrange for that to be done as soon as possible.

Thank you,
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.
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2010-12-15

No reason for routine urinalysis

No reason for routine urinalysis

In 1985, Dr. Lavin performed an extensive literature search to examine the proof that routine lab screening tests in children helped them.  One finding at the time was that doing a urinalysis in a healthy appearing child was a bad idea.

Based on that finding, he did not recommend routine urinalyses at well child care visits, at any age.

At the time, many medical societies, and most pediatricians, obtained routine urinalyses at annual check-ups, or at least two times during childhood.

The American Academy of Pediatrics endorsed routine urinalyses for many years following 1985, but in 2007 the AAP looked at the same data as Dr. Lavin had and came to the same conclusion, officially changing the recommendation to not doing the routine urinalysis.


Now at the end of 2010, the AAP has once again come out with a statement arguing very strongly against the practice of obtaining urine samples in children without symptoms to justify the test.


We are pleased at Advanced Pediatrics to once again have confirmation that our efforts to provide medical advice based on the best medical data available, as free from marketing influence as possible, do indeed, over time, yield reliable recommendations.

And, now you know why we do not ask for urine samples routinely at health supervision (well-child care, check-up) visits.


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.

Influenza Immunization Now Safe in Mild to Moderate Egg Allergy

Influenza Immunization Now Safe
in Children with
Mild to Moderate Egg Allergy

Influenza vaccine has virus in it grown in eggs. 

The manufacture of the vaccine washes the egg material out of the vaccine quite thoroughly, but in an effort to be extra safe, the recommendation has been, for many decades, to not use flu vaccine if you are allergic to eggs.

That recommendation has never made much sense to me given that studies of children allergic to eggs, even severely so, have no or little reaction to the flu vaccine.

So, I was very pleased to see the American Academy of Pediatrics recently report that it is now fine to give influenza vaccine to children with egg allergy, unless that allergy is quite severe, causing such extreme reactions as anaphylaxis.  They also note, that even in such severe cases, allergic reactions to the vaccine are unusual.

So, unless your child's egg allergy causes anaphylaxis or other life-threatening reactions, your child can not get the influenza vaccine at Advanced Pediatrics.


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.

2010-12-10

A False Epidemic of Pneumonia

Normal AP chest xrayImage via WikipediaNot All Pneumonia is the Same:
The Sudden Rise in Numbers of cases of pneumonia,
and the role of Virus

This year we have seen and heard of quite an explosion in the number of children and adolescents being told they have pneumonia.  

Although we cannot comment on any one person's particular diagnosis of pneumonia, an overall view of the major jump in numbers of people being told they have pneumonia does demand some comment.

First, What is Pneumonia?
Pneumonia sounds like a very precise word.  It sounds like the sort of diagnosis that means something very specific.  But it turns out to mean many, many things, and as a result is a very, very fuzzy, vague, and confusing term.
At its root, pneumonia comes from the Greek word pneuma which means breath, and so pneumonia literally means a condition that affects breathing.
Today, pneumonia has come to mean a condition in which the lung is swollen and making enough extra fluid, be it mucus or pus, to make breathing abnormal, or to put it more briefly, a condition in which the lung is inflamed.
Asthma, in contrast, is a condition in which the tubes of the lung are inflamed reversibly.

Now, here is where it can get real confusing, real quickly.  For, if pneumonia is a condition of lung inflammation interfering with breathing, then pneumonia can be caused by dozens of things that make the lungs inflamed.  These causes tend to part of one or another of two main categories of cause:  infection and toxic irritation.

Toxic irritations include inhaling smoke in a fire and getting stuff from your mouth inhaled into your lungs, a process known as aspiration.  Both smoke inhalation and aspiration can cause serious inflammation of the lungs and lead to that type of pneumonia.

When it comes to infections, the main causes in the US are viruses and bacteria.  There is a world of difference between viral and bacterial pneumonia, and it here where the great jump in children being told they have pneumonia is occurring and causing some serious confusion.

Bacterial pneumonia
Of all the various pneumonias, bacterial pneumonia is what most people think of when they say, "So-and-so has pneumonia."  In bacterial pneumonia, especially from bacteria that can act fast, like germs such as the pneumococcus or Hib, you can get dangerously ill.  The bacteria often form little balls of pus that rapidly expand.  If untreated, you can spike very high fevers, sometimes over 105, suddenly have great struggles breathing, and get very sick very rapidly.  Before the days of antibiotics, this was often a deadly illness.  Classic findings on a chest X-ray would be a ball or other shaped collection of pus.

Now, if you are otherwise well, a course of antibiotics normally cures you very rapidly, so the era of most of these pneumonias being dangerous is past.

Bacterial pneumonia, however, still presents a real danger to people whose immune systems or lungs or really any part of the body are weakened by disease.  Despite the progress antibiotics have offered, this pneumonia deserves respect.
In healthy American children, the vast majority of pneumonias are NOT bacterial.

Viral pneumonia
Although bacterial pneumonia is what most people think of when the radiologist or doctor says, "Your child has pneumonia,"  it is viral pneumonia that the child most likely actually has.

Viral pneumonia is, in many ways, a cold that has caused more than expected inflammation in the lung.  There are very, very serious viral pneumonias, but these are unusual and rather rare events compared to the millions and millions of cases of viral infection of the lung that happen in every community in the world, every year.

To understand viral pneumonia, one has to think about viral infections, in particular colds.  When you get a cold, the virus is always doing the same thing to the lining of your tissues- destroying it.  So when a virus infects your nose, it literally burns off the lining of your nose, thus causing all that misery, irritation, mucus, swelling!  This is what happens wherever a virus infects- in the eye it causes redness and wateriness, in the ear an earache, in the throat a sore throat, and in the lung, cough.  

Of all the problems one has with a cold, often cough is the worst.  It hurts to cough, it feels just miserable, and it can go on for many days, sometimes even weeks.  A child coughing heavily for days or weeks on end, up all night, is very hard to tolerate.
In general, however, if your child is breathing very comfortably when not coughing and has no fever and is otherwise acting well, their cough typically does not indicate a serious problem.

Even so, most families will feel like they have reached their limit after some number of days of non-stop cough.  This often happen when cough is at its worst, at night, and the need for medical attention at that time usually leads to a trip to the urgent care or ER.   Most urgent care or ER facilities will order a chest X-ray if someone shows up with a cough they are worried about.

Here is where it gets interesting.  Remember that with any cold, the tissue affected has its lining destroyed, and this causes alot of swelling and mucus production, just like a burn.  Well when a cold hits the lungs, it is like the lungs have been burned.  If you took a look at the lungs, their tubes would be all swollen and red and many plugged with mucus.  If you took a chest X-ray of such lungs, you would suddenly be able to see the tubes of the lungs more prominently, they would appear like white streaks.  If some tubes got plugged the segment of lung they supply would compress as its air was absorbed and would give the appearance of white wedges on the chest X-ray.

So, if you got a chest X-ray on anyone with a cold,  you would likely find some things not seen in people without colds.

In today's cautious medical world, radiologists are very careful about saying that a chest X-ray with some differences is surely not an early pneumonia, so they say, the findings could represent an emerging pneumonia.

Next thing you know, a child with an uncomplicated cold is being told they have pneumonia.  For the radiology report that states the findings could indicate a pneumonia are translated by the urgent care and ER doc into the statement- "Your child has pneumonia."

The Implications
The scenarios above are played out in every city in America every day and night, and as a result, children with colds or other ultimately harmless viral infections are getting alot more chest X-rays, and alot more diagnoses of pneumonia.  This year, we at Advanced Pediatrics have noticed these trends expanding dramatically.  Most families report that many of their children's friends have been diagnosed with pneumonia, but the children do not seem all that ill- running around playing, breathing well, etc.

What to Do
Unfortunately, if a chest X-ray is taken and a radiologist raises the question of pneumonia, one should take a course of antibiotics, just in case a bacterial pneumonia is brewing, even if the course and the child's appearance and exam all suggest the process is viral.

But keep in mind that when your child is told they have pneumonia, chances are very high that what they have is a viral pneumonia, a not so serious illness that is radically different from what most people think of as pneumonia.

BOTTOM LINE
A movement towards obtaining chest X-rays for children who are coughing has led to a big jump in the number of people being told their child has pneumonia.  In the vast majority of these situations, the findings on the chest X-ray are minimal and very consistent with mild viral illness, and in fact, most of the time the children have a viral not bacterial pneumonia.
Bacterial pneumonias can be dangerous and make one very, very ill.
Viral pneumonias, although rarely severe, are in the vast majority of instances pose no danger, and are really simply extensions of the common cold to the lung.
Keep in mind that the diagnosis is pneumonia is far less important than knowing how ill your child is.  If he or she is acting fairly well and simply has a lingering cough, the diagnosis of pneumonia does not suddenly make them more ill or in greater danger.

We at Advanced Pediatrics would be happy to help you sort out these possibilities anytime your child is told they have a pneumonia.


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.
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2010-12-02

Your Chance of Having a C-section at Two Cleveland Area Hospitals

Your Chance of Having a C-section
 at Two Cleveland Area Hospitals

The government of the State of Ohio tracks various performance criteria for hospitals in the state.

One item that should be of interest to all mothers delivering, is the chance of being delivered
by C-section at various hospitals.

The exact wording of the event tracked by Ohio is "C-section for low risk Moms having their first baby"

Curiously, the chance of delivering by C-section was quite different at two area hospitals.

At Hillcrest, the rate was quoted as 30% 

At St. John Medical Center the rate was quoted at 10%
By this measure of the State of Ohio, a first time mother delivering at Hillcrest is 3 times more likely to deliver by C-section than at St. John Medical Center.

One difference for St. John Medical Center is that about half the deliveries are done by midwives.  I do not know is this is the cause of the observed difference by the State of Ohio, but it is curious.

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.

2010-11-30

Vitamin D- not as helpful as hoped for

Vitamin D- not as helpful as hoped for 

About a year and half ago (May, 2009), I posted an essay that reflected some exciting possibilities for Vitamin D being helpful to health.

As noted at the time, the preliminary evidence suggested that increasing the level of your Vitamin D could possibly reduce the chance of a range of serious illnesses, such as diabetes, multiple sclerosis, and colon cancer, from developing.

The American Academy of Pediatrics had also recently established a recommendation for Vitamin D supplementation for all children, a policy we at Advanced Pediatrics supported.

Today, the nation's leading panel of medical experts, the Institute of Medicine (IOM) published a major report on the use of supplemental calcium and Vitamin D.

After studying over 1,000 studies on taking extra Vitamin D and calcium, the IOM found that with few exceptions, it was a bad idea.

Here are their findings:
  • With regard to calcium, most Americans take enough calcium to meet all their needs.   The one exception are girls ages 9-18.   Older women tend to actually take too much and increase the risk of kidney stones.
  • Vitamin D levels in America are much better than one would think.  An adequate blood level of 25-OH-D, the form of Vitamin D that should be measured, is 20 ng/ml, not the 80 or 100 that was once proposed as a goal.
  • Taking extra Vitamin D can cause harm to your health.  Over 9 years of age, exceeding an intake of 4,000 Units a day can be harmful.
  • The recent claims of health benefits from taking more Vitamin D than simply bone health requires are not supported by this review.
  • The recommended dietary allowance for calcium every day is 700 mg for ages 1-3, 1000 from 4-8, 1300 from 9-18, 1000 from 19-70, 1200 from 51-70 females, 12000 if over 71.
  • For Vitamin D the recommended dietary allowance is 600 units a day from age 1-70, and 800 after that.
Bottom Line:
The promise and hope that Vitamin D might do more than help bones form has been disproven.
No longer will we be recommending supplemental Vitamin D for most children.
The guidelines above will be our guide for calcium and Vitamin D intake, which is actually quite adequate for all but 9-18 year old girls who should work to make sure they take 1300 mg of calcium a day.

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.

2010-11-03

Advanced Pediatrics Upgrades its Electronic Medical Record System

Advanced Pediatrics Upgrades its Electronic Medical Record System

Dear Family,

Everyone at Advanced Pediatrics is very excited to announce that we are upgrading our electronic medical record system.

As many of you know, we have been pleased to lead the way in the adoption of electronic medical record-keeping.  Our office opened with a fully integrated electronic system almost eight years ago.  Microsoft recognized us as a pioneer in this field in 2003.

Now that eight years have nearly passed, we have found a new system that will offer a far more robust system, particularly in our ability to communicate information to every family.  More on those features later.

Right now we want to be sure you know the key items you should be aware of for our four day transition period:
  • First, we have all worked very hard to limit the time of transition to only four days.
  • Those days will be Monday, November 15- Thursday, November 18
  • Advanced Pediatrics will remain fully open during these four days.  
  • Phone access will remain completely unchanged in this time period.
  • During the days from Nov. 15-18, we will not be scheduling pre-scheduled appointments.
  • This means that during Nov. 15-18, we will not be scheduling check-ups or well-baby visits.
  • No appointments during Nov. 15-18 will be made on any but the same day.
  • During Nov. 15-18, only, in order to be fully trained on the system, the office will take a step we do not plan to do again- limit times for medical care to Noon-1 and 5-6PM.  All three providers, Drs. Lavin and Hertzer, and Ms. Rieger will be available during these times.
  • Starting November 19, our regular scheduling will resume, all under our new system
  • One last point, since the system will be new, we are going to enter insurance information at every visit, to be sure we have all your information correct in the new system.  So please be sure to bring your insurance card to every visit for awhile, and plan for a few extra minutes to check in.
We appreciate everyone's understanding during these four days.  We will work hard to be sure we can answer all questions anyone has at anytime during this interval, just as we do everyday.

Once completed, we will be very excited to share many of the advances our new system offers.  A couple examples include:
  • Electronic prescribing, no more carrying prescriptions to the pharmacy (unless you ask to)
  • A secure web page where you can see your family's lab results, and communicate with the office electronically

As with our current system, the overall goal is to get rid of as much frustration as possible when it comes to getting information to or from our office.   Helping you is our key goal, and managing medical information is central to that purpose.




*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.

2010-10-19

A Word on Getting the Word Out

Dear Family,

This is a quick note to discuss how we let everyone know about activities of interest at the practice.

As you all know, Advanced Pediatrics is committed to developing responses to the most pressing
problems and challenges families face.  With that in mind, we have developed programs that range
from lactation counseling, to parenting, to school and cognitive issues, to nutrition, and beyond.

So far, we have decided that when a program is developed at Advanced Pediatrics, we will let everyone
on the email list know about it.  We do realize that not all families are interested in any specific program, far
from it.  After all, most of our programs are relevant to only one age group, and the issue at hand may not
be an issue even for all the children in the relevant age group.

But there are two reasons we do send the information out to everyone:

  1. It may turn out you have a friend whose family would be interested or helped by the program
  2. It may be nice to know the full range of what goes on at Advanced Pediatrics.
We will try not to send too many emails out to avoid clogging in boxes as well.

So if you get notice of an upcoming approach to children with attention issues but your oldest child is 2 years old, or if you get notice of a lactation counseling service but your youngest child is 15 years old, please don't think we want your 2 year old to get help with math or your 15 year old to address infant issues, it really is just our attempt to circulate information as widely as possible to help as many as possible.

Thanks again for your trust in us,
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.






2010-10-18

Flu Vaccine Appointments still Open

Flu Vaccine Appointments still Open


Dear Families,

We wanted you to know that our prediction that this flu vaccine season would be far calmer than 
last year's has seemed to come true.

We have plenty of vaccine, so face no shortages, at this time.

And, we wanted everyone to know that appointments to get a flu vaccine at Advanced Pediatrics
are still open and available.

These appointments are currently on October 26 and October 28, both in the early morning period.

So if you want to come in for a flu vaccine, just call 216-591-1515 during normal office hours and 
you can get an appointment.

We are very pleased this year's provision of flu vaccine has gone so smoothly and once again appreciate
your patience and cooperation in ensuring that all children in our community will be protected in time.

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.

2010-10-15

Flu Vaccine Update

Dear Families,

Just a quick note that the flu shot clinics are underway.

I did want to let you know that all indications are that the supply of influenza vaccinations this year appears to be abundant.  

Shipping of vaccine remains one set of vaccines at a time.  That is why we are offering one or two flu shot clinics in every email.

It's understandable if you get notice that a flu shot clinic is on a single day or even two days, that one might think they better hurry to grab an appointment, after all only one or two days are being offered.

But the point of this note is to emphasize that we will be offering a series of days, perhaps announcing one or two at a time, but enough over time to accomodate everyone.

So, in great contrast to prior years, in particular last year when we had a scary pandemic and two flu vaccine programs to administer, we look to this year being wonderfully calm.

So please, when you get notice of a flu shot clinic here, don't feel any pressure, we will be offering a number of such opportunities.

Thanks again,
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.

2010-10-05

Bringing Neuroscience Breakthroughs Home:
Advanced Pediatrics at the 2010 International Meeting on
Evidence-Based Cognitive Training

Advanced Pediatrics at the Forefront of Neuroscience
On September 24, 2010, some of the world’s leading neuroscientists, doctors, and psychologists gathered at the annual Cogmed Conference, held this year in Chicago, to review recent research on evidence-based cognitive training. 
            Advanced Pediatrics was pleased to once more take its place as the first clinical office in the United States to offer Cogmed working memory training, widely regarded as the most substantial form of evidence-based cognitive training to date.
            Every year, the Cogmed Conference has drawn an increasing level of attendance and level of expertise.  This year was no exception.  The number of professionals present was double the prior year’s total.  Clinicians from Korea, Singapore, Sweden, Costa Rica, South Africa, and from over 100 sites across the United States were present.

TOPICS DISCUSSED 
What is evidence-based cognitive training?
Evidence-based cognitive training is any program that has the brain conduct exercises that improve the function of the mind enough to significantly improve the person’s life.  Many programs make such claims, but evidence-based cognitive training are only those programs that can point to research published in well-regarded peer-reviewed journals.

What is Cogmed Working Memory Training?
Cogmed working memory training is perhaps the evidence-based cognitive training with the most evidence of successful impact.  The program is the result of many years of highly regarded neuroscience research at the Brain Institute of the Karolinska Institute in Stockholm.  Its founder, Dr. Torkel Klingberg, received the Philips Award as one of the world’s leading neuroscientists in 2008(?).  After spending years in careful development and evaluation, many thousands of people have completed Cogmed Working Memory Training with results very consistent with the research findings: 80% of those trained have improvement in cognitive function large enough to improve the lives of those trained.  Improvements cited include better attention, organization, and success at school, work, and home.  Centers that have studies and published their findings on Cogmed Working Memory Training include Harvard, Stanford, New York University, Notre Dame, York University (UK), and the Karolinska Institute (Sweden), among a very rapidly growing list of the world’s leading centers of research on the brain.

What is working memory?
Working memory is the ability of the mind to consciously hold more than one piece of information at one time and do something with those bits of information. 

And so, working memory is not really memory as we think of memory.  Memory is about remembering something from the past. Working memory is about doing something with information at hand in the present.

Perhaps the best way to appreciate this idea is to think of the brain’s job falling into three connected goals:
1.To take in information
2.To understand information it takes in
3.To do something, complete a task, with information it understands
 Working memory is the function of the mind that connects understanding and doing. 
 Once you know something, working memory appears to be the most important function of the conscious mind that translates knowing into doing.

How important is working memory?
As noted above, Dr. Alan Baddely developed the concept of working memory about 40 years ago.  Ever since then, neuroscientists have found more and more proof that working memory may be at the root of many of the most common problems in thinking, namely:
·   *Getting something done
·   *Understanding complex directions
·   *Completing assignments on time
·   *Remembering what you were asked to do
·   *Being socially successful
·   *Doing well in school
·   *Doing well at work.


WHO PRESENTED? 
Present were some of the world’s leading experts on how the mind generates attention.  These included:
Dr. Susan Gathercole, head of the British lab where some of the most important work on defining the core element of attention, working memory, has been done.  She presented recent studies that demonstrate how nearly all children who struggle in school have a deficit in working memory, and, further,  enhancing working memory can improve nearly all children’s level of academic achievement.  www.yorkU.edu.en

Dr. Mark Rapport, one of America’s leading researchers on ADHD, from Florida, presented just published ground-breaking work on exactly what in the mind of a person with ADHD.  Key to his findings was the actual causes of the impairments that ADHD causes, namely school failure, social isolation, disorganization. www.childrenslearningclinic.com

Dr. Rosemary Tannock, widely regarded as one of the top authorities on the management of ADHD, presented her recent findings on the impact of evidence-based cognitive training on school performance and the symptoms of ADHD.  www.

WHO BENEFITS FROM EVIDENCE-BASED COGNITIVE TRAINING?
The conference also featured presentations from a wide variety of practitioners across the US and the world sharing their experiences on the impact of evidence-based cognitive training.  Their observations offered proof that evidence-based cognitive training has a positive impact in these settings:
Schools.    Several schools presented their findings that students who undergo evidence-based cognitive training do better in their studies- more organized, calmer, more confident, less distracted, better able to follow directions and expectations, more homework completed, with improved grades.  As noted above, one study demonstrated such improvements for children with and without working memory deficits.

Traumatic Brain Injury (TBI).   Adults who had evidence-based cognitive training noted improvements  on task completion, occupational performance, and satisfaction with performance, overall health.  The adults described being more alert, more awake, more aware of what is happening, lifting the fog, better able to help their children with homework, more focused, and overall more confident.

Down Syndrome.   This presentation was also from Dr. Gathercole’s group, the leading authorities on the working memory in the world.  They found that initial observations on a group of children with Down Syndrome, with intellectual level of function averaging at the five year old level, responded well to evidence-based cognitive training. Teachers of these students, who were unaware of their training, spontaneously reported to parents that these children seemed calmer, more focused.  Parents agreed and also noticed decreased hyperactivity, less frustration, and that they remembered instruction sets better.  Based on the strength of these observations, the group will be conducting a randomized controlled trial to prove and measure the impact of evidence-based cognitive training in children with Down Syndrome.

Depression in the Elderly.  This study from Georgia demonstrated that evidence-based cognitive training can reduce the burden of depression in the elderly.

Cognitive Loss from Cancer Treatment.  Children whose brains are exposed to chemotherapy or radiation lose cognitive abilities an often suffer a loss of ability to concentrate or focus.  This team from Duke presented many years of work demonstrating that evidence-based cognitive training can restore enough of this lost function to make a significant difference.


BOTTOM LINE
·         An explosion of understanding of how the brain actually works is just now leading to applications that can help each of us think better and more effectively.

·         Evidence-Based Cognitive Training represents the best of those applications.

·         Cogmed represents the best of the evidence-based cognitive training protocols.

·         Advanced Pediatric is the first clinical office in the United States to offer Cogmed Training to its patients and to the general public of all ages.


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.

Advanced Pediatrics Earns the Respect of Angies' List Customers

Advanced Pediatrics Earns the Respect of 
Angie's List Customers

We wanted to share some very good news, and thank everyone in the practice 
for their good words.

This week I received notification from Angie's List that Advanced Pediatrics has an "A" rating in their Health Category.

We are thrilled to have earned your respect, appreciation, and trust, and will continue to work hard to earn it.

Some of the comments were quite moving, we are truly very grateful to be able to help out.

Here are two sample comments from families:

"Dr. Lavin has been our family's pediatrician since we moved to Cleveland over 15 years ago. He has helped me raise my three kids into healthy teenagers. He almost always leaves time to just chat and usually listens well to our concerns."

"My daughter had been sick and I took her into Advanced pediatrics They saw her immediately, we got a "same day" appointment. Kelly (the P.A.) listened to my daughter's breathing, then sent her literally next door for an x-ray. How convenient! Then the x-ray walked us back to Advanced Pediatrics and handed the radiologist's diagnosis off to the office. We got a prescription and were on our way, in less than an hour. Then I was concerned that my daughter wasn't recovering at a good rate. They got me in immediately with Dr. Lavin, he listened to my concerns, then checked out my daughter. He let me his opinion and backed it up with research and a personal anecdote, which was reassuring. Neither Dr. Lavin nor Kelly makes me feel silly when I have a worry, they value my opinion and work with me toward my daughter's best health!"




Thanks to all once more,
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.
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2010-09-30

Great Site for Caregivers http://nfcacares.org/

Great site for Caregivers  http://nfcacares.org/

This is a posting for any family that has a child with special health care needs.

Last month I was honored to present at a national conference of an organization devoted to the 
understanding and care of a very rare metabolic disorder, metachromatic leukodystrophy (MLD).

At this conference, I was introduce to an organization that helps parents of children with 
any disabling or complex condition.

The National Family Caregivers Association is a treasure chest of great ideas to help families find support, namely:
  • thinking about how to obtain benefits to support care
  • finding approaches to care that make a huge difference
  • managing family time away, together and apart
In short, a very, very valuable source of ideas that make a real difference.

Hope you find it helpful whenever you may need it.


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.



New Vision and Hearing Tests at Advanced Pediatrics

 New Vision and Hearing Tests at Advanced Pediatrics


Advanced Pediatrics is very pleased to announce that we have now updated our
approach to testing for vision and hearing.    

Effective immediately, we are now using state-of-the-art technology to precisely determine if your child's vision or hearing is normal.  Each test takes less than 5 seconds, and does not require the child's input.

For the vision test, a tiny beam of light is pointed at the eye and within seconds a determination of the child's ability to focus in that eye is made by a rapid scan of the fovea, the center of vision of the retina.  The test can determine if vision is normal or not beginning at age one.

For the hearing test, small sounds are sent into the ear, and, again, within seconds, the device can actually measure if the small hairs on the nerves of hearing are working properly.  This is the same technology used by hospitals to screen newborns for hearing function.  Our device will also be able to screen for hearing normalcy as early as the first days of life.approach to testing for vision and hearing.   

Determining normal vision is important during throughout childhood and adolescence.  Early in life, differences in visual ability in the eyes can cause long-term loss of vision, a problem called amblyopia.  And from ages 5-16,  a large percentage of people develop abnormalities of vision that require correction with glasses or contacts.  Our new vision screening system can determine if vision problems are developing beginning at age one.  

Hearing once was an issue mainly at birth, if your hearing was normal at birth, chances are that it would remain so until later in adult life.  This is no longer the case.  The explosion of use of headphones and earplugs has led to an epidemic of hearing loss by early teen years.  Some estimates put the risk of hearing loss as high as one in four teens!  Our new hearing screening system can now determine if a trend towards hearing loss is happening before the loss of hearing becomes significant.       

A key point to remember, both of our hearing and vision screening systems are screens.  That means an abnormal result does not mean your child has a hearing or vision problem, but that a more detailed measure is needed.  It does mean, with very good reliability, that a normal result means vision and/or hearing is indeed functioning well.    

We are very pleased to be bringing the latest in vision and hearing measurement to Advanced Pediatrics.  Gone are the frustrations of asking very young children to read charts or raise hands, now we can determine if your toddler, child, or adolescent's vision or hearing is normal with great reliability, in very short time. approach to testing for vision and hearing.         

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.






2010-09-28

Flu Vaccines for 2010-2011

Flu Vaccines for 2010-2011

Dear Family,

Every year a virus called the influenza virus appears in our community.  This usually happens in a regular, predictable manner, appearing in late December or early January, and leaving our area altogether by May.

Last year, as you know, an influenza virus appeared off this schedule and thereby earned the name pandemic influenza virus.  

Every species of influenza virus that appears can also be described as a type, usually by giving the H and N proteins on the virus each a number.  The pandemic virus of last year was H1N1.

This year we are expecting to see only the seasonal influenza viruses, appearing in late December or early January until May.   There is no indication that any other influenza viruses will be here.

With that in mind, we anticipate a very calm delivery of flu vaccine this fall.

There are no reported shortages, and in marked contrast to last year, there is only one flu vaccine (in shot or mist form) that needs to be given.  Everyone over 9 years of age, and everyone under 10 years of age who got the H1N1 and seasonal flu vaccine last year, just needs one dose of flu vaccine this year.

Advanced Pediatrics will be making special times available for flu vaccine in an orderly fashion, as we receive our supplies.

Please know that we anticipate having plenty of flu vaccine available well before the time it is needed (around January 1).

That means, if your child gets the flu vaccine in early October, late October, early November, or even late November, the level of protection for the January-May influenza infections will be the same.

So that means there is no rush, plenty of vaccine, and so stay tuned to your emails as we announce the days and times of our flu vaccine clinics.

We appreciate your trust, and are very, very glad that this year the provision of protection via flu vaccines will be far simpler than last year, and that no shortages are expected.  We are so pleased we will be able to protect your child(ren) in plenty of time.

Thank you once more,
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.






2010-09-04

Enjoy your soy!

Soybeans grow throughout Asia and North and So...Image via WikipediaEnjoy your Soy

For many years a debate has been brewing about whether soybeans contain compounds that could alter human puberty and sexual development.  Evidence now clearly proves it does not.
The specific concern has been that the soybean contains compounds called isoflavones, and at times phytoestrogens, that look suspiciously like estrogen.

Now, clearly eating estrogen could dramatically disrupt normal human pubertal development.  Eating compounds that have estrogen powers could lead to very early puberty onset in women, and could delay puberty in men, decrease their ultimate sperm count, and cause infertility.

But one thing to keep in mind is that truly tiny differences the estrogen molecule can create rather massive differences in what the molecule does.  For example, if you take actual human estrogen and only take away 3 atoms, all on the outside boundaries of this large molecule, you end up with a compound that looks almost exactly like human estrogen, except it is now called testosterone.  As you all know, estrogen is the central hormone of human femininity and testosterone of human masculinity.  How much more different can you get, and yet the molecules are only 3 atoms different.

Now lets consider the isoflavones, also known as phytoestrogens, found in soybeans.  They look like human estrogen, but what do they actually do in the human body?



It turns out, not much.

Perhaps the most dramatic proof of this statement comes from a 2009 study 
They gave young men rather massive quantities of pure soy isoflavone for nearly two months and then looked at their sperm.  They made sure the men took their medicine by measuring each man's isoflavone level in their urine- all the men had a huge rise in their soy isoflavone level.
And yet, by many, many measure of sperm health (count, motility, semen quality, etc.), there was no impact from the soybean isoflavone.  Soy isoflavone levels went up and absolutely nothing happened to the sperm.
It really does look like soy isoflavone may do something for soybeans but does nothing to people.
So enjoy your soy sauces, your tofu and its mimicry products, your edamame, and soy lecithin!
Bon Appetit,
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.
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2010-09-01

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Acetaminophen: A Serious Question Leads to the Recommendation to Suspend Use

Over the last several years, a growing body of evidence has raised a troubling question about the use of acetaminophen (Tylenol™, Feverall™). A number of studies have proven an association between the use of acetaminophen and the risk of developing asthma. These studies have approached the issue from a number of different perspectives and in each instance have found an association.
            A recent study has tracked the use of acetaminophen in children (ages 6-7 and 13-14) over many years Their most recent publication described the experience of 320,000 young adolescents from 50 countries. What they observed was that if a child took acetaminophen once a month or more, that child had double the risk of developing asthma.

            Other studies have found:
*1.  The more acetaminophen a child uses, the greater the risk of developing asthma. In some series, the risk has gone as high as sevenfold. That is, a group of children taking acetaminophen has been observed to have seven times the risk of developing asthma as children who do not take acetaminophen.
*2.  As countries have adopted the use of acetaminophen, the rate of asthma in those countries has gone up.
*3.  The risk of developing asthma in association with taking acetaminophen has been observed in utero, in infancy, in early childhood, in school age children, and in adolescence.

Advanced Pediatrics has been following these studies and our initial reaction was disbelief. How is it possible that something so widely used as acetaminophen could cause such a serious problem as asthma, and no one noticed? Further, if acetaminophen causes asthma, why doesn’t everyone have asthma, since nearly every child in the US has taken acetaminophen? And, what harm could be caused if Advanced Pediatrics sounded a false alarm? What if acetaminophen turns out to be harmless and we have obstructed access to a very helpful medicine?

One story that may turn out to be quite relevant is the story of aspirin and Reye’s syndrome; both obscure concepts to most parents since almost no children take aspirin anymore, and almost nobody has heard of Reye’s syndrome. But prior to 1980, nearly every child in the US took aspirin when they had a fever. And at that time in most major children’s hospitals in the US, there was often a child with Reye’s syndrome in their ICU in any given month. Reye’s syndrome was a rare but devastating collapse of the liver due to a very severe metabolic problem that would often lead to death. The idea that somehow Reye’s syndrome and aspirin use might be connected seemed far-fetched when first observed. After all, aspirin was used like water, all the time, and with no serious resultant problems. In stark contrast, Reye’s syndrome was a very rare problem, characterized by a very complex set of metabolic errors leading to the death of a vital organ. How could these two problems be related?

When the first observations were published suggesting that those who took aspirin had a higher risk of Reye’s syndrome, the observations were met with nearly unanimous skepticism. Millions took aspirin, only hundreds got Reye’s syndrome. Aspirin is safe and common; Reye’s syndrome is deadly and rare.

But the observations kept rolling in. Eventually the question of a link could no longer be ignored and studies were set up in which very large numbers of children did not take aspirin, and wonder of wonders, none of them got Reye’s syndrome. Soon the FDA began warning that aspirin use in children, especially those with flu or chickenpox, could cause Reye’s syndrome. Parents suddenly stopped giving their kids aspirin. Since that moment, Reye’s syndrome has virtually ceased to exist. This last step was the final and definitive proof that aspirin caused Reye’s syndrome. Astounding as it was to all involved, the cessation of aspirin use by children saved many, many lives.

What about the question, if acetaminophen causes asthma, why doesn’t everyone have asthma? Well, consider the possibility that children run a 1 in 20 risk of developing asthma, which is indeed true, since about 5% of kids have asthma in the US. Now, if acetaminophen doubled the risk of developing asthma, the incidence would go from 5% to 10%. That would be a stunning level of harm. That would mean that of the 4 million kids born in the US every year, an additional 200,000 children would develop asthma, every year. And yet, 90% of children would still not develop asthma, even if they took acetaminophen.

            We are not yet at the point where we know that acetaminophen causes asthma to develop. But enough information has been gathered to say we should find out.
            It is in light of the Aspirin/Reyes Syndrome experience, the quality of the current studies on acetaminophen and asthma, and the fact that ibuprofen adequately covers the same medical needs, that Advanced Pediatrics has taken its position of not endorsing the use of acetaminophen for children of any age for the foreseeable future.  .  Please note that for the rare circumstance in which a child faces a danger from fever and cannot use ibuprofen for medical reasons, acetaminophen may still be a reasonable choice to use, but only under a doctor’s recommendation.




Addendum:
The New York Times has published an article, December 19, 2011 supporting the concern that acetaminophen may cause asthma to develop:
http://www.nytimes.com/2010/08/17/health/research/17risk.html



*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.