The Allure of the Pill- All Interventions Carry Risk- Even "Supplements"

The Allure of the Pill-  

All Interventions Carry Risk- Even "Supplements"

This coming week, the world's leading medical journal, The New England Journal of Medicine will be presenting a haunting reminder that every intervention needs to be weighed for possible harms.

The article tells the sad story of what once was thought to be a harmless dietary supplement, a protein pill to help build muscle called OxyElite Pro.   It turns out this substance actually can kill your liver.  In 2013, many cases of hepatitis, many hospitalizations, even 3 liver transplants and 1 death all were found to be due to use of this pill.

What's really troubling is that the United States, largely under pressure from those who sell these things, has created a whole category of pills that no one must study to know what harm they can cause, or ever prove if they work.  That category is called dietary supplements.  The products categorized as dietary supplements are typically not dietary or supplemental, they just are sold under this title, so that their manufacturers and sellers never have to prove if they work or find out if they might hurt you before they sell them to you.

What sort of products are sold under the legal category of dietary supplements?  Many.  They include essentially all vitamins, minerals, amino acids, botanicals, probiotics, and many more.  The combinations of such items total over 85,000 (that's right 85,000!) different pills and potions.  The law that protects them and exposes all of us to harm is called the Dietary Supplement Health and Education Act of 1994 which actually states that if a product is sold under the category of dietary supplement it is, by this law, assumed to be safe unless proven otherwise.

It turns out given this liberty, manufacturers fail to purify their products or add dangerous but popular items such as stimulants, anabolic steroids, novel antidepressants, and other untested drugs, without putting them on the label or finding out if they cause harm.

One sports supplement that looks very harmless turns out to have a novel form of methamphetamine (remember Breaking Bad?) in it.  The FDA recently found a new type of amphetamine in nine other supplements.

Untested substances in pills and potions can cause hearts to stop beating properly, damage livers, induce strokes, make guts bleed, and alter vision.

Bottom Line

New pills are all the rage.  The promise of something that sounds as harmless as a supplement is very enticing.   But keep in mind, every substance taken carries risk, whether it's a traditional medicine or a dietary supplement.  Most pills don't help very much, many may be harmless, but some can hurt.  We recommend not taking any pills unless truly necessary, and not taking anything that has not been studied and proved to be what it claims and safe.

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.

Time to be Sure your Child has had an MMR- Measles and Mumps are showing up

Time to be Sure your Child has had an MMR- 

Measles and Mumps are showing up

Measles is now showing up in New York City, with 20 cases recently reported.

Measles is actually a very dangerous disease.  About 1 in every 1,000 children who get it will be left with quite severe, and permanent, brain damage, from a complication called SSPE.

In the developing world, measles is responsible for 5% of all childhood deaths.

And, there is no reason we should have to worry, since the measles immunization works very well.

In fact, back when parents were less concerned about immunizations, and nearly every child got the measles immunization, there was no measles to be worried about.

But all that is now changing.  Years of worry about immunizations, and in particular, the hoax played on the world by Dr. Wakefield of England in which he conjured up a connection between measles immunization and autism that took hold, have led to falling rates of immunization for measles.

At Advanced Pediatrics we try to be very attentive and responsive to the wide range of concerns immunizations can raise, and are happy to do so.  But when our community makes choices that can cause harm, we also need to alert the community that some choices could put your children at risk.

The fear created by Dr. Wakefield surrounding the only measles immunization available in the US, the MMR, has led to record number of children not being protected against measles, and now children in the US are getting measles.

The same drop in MMR use seen in NYC is happening here, and so we anticipate measles appearing in Cleveland, or at least see this as a reasonable possibility.

If your child is 1 year old, or older, and has never received an MMR, the time is now to consider the risk.  
We recommend that your child be protected against the risk of contracting measles, and, ultimately, the risk of SSPE, the terrible complication seen in 1 in 1,000 cases of measles.

BOTTOM LINE

• The MMR was once thought to cause autism, but the evidence is overwhelming, it does not.
• MMR use rates have dropped enough that measles is coming back.
• Measles can cause permanent brain damage from a complication called SSPE
• If your child is 1 year or older, and has never had an MMR, the reappearance of measles puts your child at risk for SSPE, we recommend you protect them by giving the MMR

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.

The Flat on the Back of the Head in Infancy

The Flat on the Back of the Head in Infancy- It's Safe

In 1992, the American Academy of Pediatrics made it official- all infants should sleep on their backs.

This major change has had a tremendous impact on the lives of all infants and families.

The risk of the outrageous tragedy of SIDS has indeed dropped in half in the US.

But sleeping on your back as a newborn does tend to flatten the back of your head.  Well worth the dramatic reduction in SIDS, but still can be an issue.

The flattening is very common and has a typical look to it.  It is always the back of the head that flattens, sometimes one side or the other, sometimes in the middle.  Sometimes the flattening is very mild, sometimes more pronounced.

The most important thing to keep in mind is that no matter how much flattening occurs, the brain is safe.

Whether the flattening is mild or pronounced, one one side or the other, in the middle, it never has any impact on your child's brain.  It does not slow down brain growth, it has no impact on how your child's development will unfold or progress, and it has no impact on how your child's brain will work over time- no impact on intellegence, coordination, or personality.

The reason is that the reshaping of the bones of the skull, even if very pronounced, simply does not move the brain enough, or cause enough pressure to be applied to the brain, for the brain to notice or be impacted.

The other good news is that once your infant starts sitting, the flattening typically stops getting worse.  So by 5-8 months of age, flattening hits a peak.  At that age, the head still has lots of growing to do, so from that age on, the head growth restores normal roundness and erases much of the flattening.

Occasionally the flattening is so severe that even subsequent growing of the head after age 6-9 months will leave what is seen as an unacceptable amount of shape change.

Again, the only issue that is relevant is appearance, the flattening from lying on your back cannot cause actual harm or dysfunction.

If the flattening is developing to a degree that raises concern for later appearance, there are options.

One option that is not acceptable is to place your infant on his or her stomach to sleep.  That could spare some flattening but puts infants at risk for SIDS, a bad idea.

But one approach that could help would be to see a pediatric plastic surgeon who is able to create a computer generated helmet that fits to the infant's head to reshape the head as it grows to be more round.

This is an intervention that is harmless and painful, but still a major effort involving fitting for a helmet, your infant wearing a helmet, and repeated adjustments.

Given that most flattening is mild, and that it usually resolves well enough to yield a very nice looking head, interventions like the helmet are only rarely a good idea.

BOTTOM LINE

• Being put on your back to sleep is a very powerful way to cut the risk of SIDS dramatically, and it has.
• Being on your back during infancy does cause flattening of the back of the head.
• This flattening has no impact on the brain, its growth, its development, or its function
• Flattening typically reverses once the infant can sit, as the head grows more round subsequently.
• Rarely the flattening can be severe enough to justify creation of a helmet that will adjust head growth for some months.

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.

A New Lab- just for Children

A New Lab- Just for Children

Advanced Pediatrics is very pleased to announce that a new lab has opened near our office.

This the Child Lab.

Child Lab is the only laboratory in our region whose work is limited exclusively to children.

This offers your children some special value when and if it comes time to do lab work.

• First of all, this lab can do an amazing amount of testing on tiny drops of blood.  This means the whole process of blood tests is suddenly so much easier and so much less painful.
• The lab is set up to do the tests we need to do in pediatrics, so if we have a concern about your child, Child Lab will be almost certain to have the test available, and will report normal ranges for children.
• All their technicians only draw blood from babies and children.  Again, this makes the experience a lot less painful.  They will be far more likely than a general lab to get the sample on the first attempt.

This lab is located on Chagrin Boulevard across the street from Eton, in Woodmere Village.

Their info is:

Child Lab

Hours- Open Mon-Fri 8:30 AM to 5:30 PM

28420 Chagrin Boulevard

216-595-1231 (phone)

216-595-1281 (fax)

We have worked with Child Lab for many years and trust them as the premier lab facility for children in our region.  It is actually very exciting to know they are now in our neighborhood, so your children can now experience their expertise if the time for a lab test should ever arise.

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.