2015-04-24

Support the Race! Created by kids, real support for curing Breast Cancer

 April 2015


Dear Friends and Patients,

Our practice group is dedicated to using tools that work to create real change in your child's health, school performance and emotional mastery; and to improve family harmony.  Part of developing initiatives such as family and school successes is involvement in activities in which children learn that they can not only become part of a larger community, but change makers in their community and in the world community.

Once again this year, Advanced Pediatrics is supporting The Race.  This event is a one mile walk/run charity event that empowers children and their families to make a difference in the lives of those touched by breast cancer by raising awareness and money for breast cancer research. 

Twelve years ago Advanced Pediatrics patients Josh and Danielle Berns had the idea for The Race to help a close friend’s mother who was entrenched in a courageous battle with breast cancer.  It was their way to demonstrate to young people that all of us can be agents of change when we work together for a cure.

Now in its twelfth year, The Race continues its mission in supporting research that will contribute to early detection, advancing treatment options for breast cancer patients, and ultimately increasing the rate of survival of breast cancer patients. 

Since its inception, The Race has raised over $ 850,000 for the cause, and on Mother’s Day morning, May 10, at Legacy Village in Lyndhurst, kids and their families will once again join together to participate in The Race and in the fight to eradicate breast cancer. 

We would be grateful if your family would consider participating in The Race.  Unique to this charity is that every dollar raised goes directly to breast cancer research and awareness at University Hospitals Seidman Cancer Center.

To learn more about The Race, please visit The Race’s website www.dotherace.com


Sincerely,
                                                                       
Advanced Pediatrics











*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.

2015-04-15

It's Spring Allergy Season- Some Allergy Basics

It's Spring Allergy Season- 
Some Allergy Basics

As we glory in the return of a warm sun, of the return of new life as plants start to grow and green, we also start to think about allergies.

Of course, allergies to many things occur all year round, including food allergies, allergies to pets, allergies to dust and mold.

But there is one sort of allergy that is defined by its seasonality- allergy to pollen.  Like dust and mold allergies, pollen allergies are responses to substances in the air.  But these substances only appear during cycles of plant reproduction, which largely go dormant during the winter, but burst onto the scene every spring.

This week we can all see trees flowering, and so the great burst of spring pollen allergy is upon us.  Before talking specifically about this, let's do a quick reminder of what all allergies are about.

What is an Allergy?
All allergies are reactions to some substance from outside the body, and they are reactions that appear to serve no helpful purpose.  All allergic reactions are also united in being in the category of inflammation.

If all allergic reactions are types of inflammation, what is inflammation?   Inflammation is a series of events that living organisms use to fight off other living organisms.  It turns out all sorts of inflammation involve some combination of five events:  redness, swelling, warmth, pain, and loss of function.  A great example of a common inflammation is a mosquito bite.  The mosquito saliva causes four aspects of inflammation to occur- redness, warmth, swelling, and pain (or itch).

But there are lots and lots of inflammations, including all infections, many types of injury, auto-immune events, nearly every medical situation finds inflammation present.

So what makes any inflammation an allergic sort of inflammation?   The answer to that requires us to mention that there are two sorts of allergies- classic and alternative.   Alternative allergies are reactions that are not yet fully described, as when someone states they have an allergy to gluten.

Our discussion will focus on classical allergy.

What is Classical Allergy?
So classical allergy is a very specific type of inflammation that only happens when some item outside the body connects to a special type of antibody and once connected that paired unit activates the allergic reaction.

The special type of antibody is the E-class of antibody. There turns out to be 5 such classes.  The M and G classes are involved in fighting off infections.  An A class provides a barrier to infections in all the linings of the body.  There is actually a class, the D class that no one knows what it does.  And then there is the E class, which does two things- it helps clear out infections from worms, and it causes all classical allergies.

The way classical allergies work, all such allergies including to foods, pollen, dust, pets, molds, is that the item you are allergic to is able to connect to an E-class of antibody.  Once that link occurs, the antibody triggers a release of compounds such as histamine that create the allergic inflammation, the allergic reaction.

Four things are common to all classic allergies:
1.  One is that there is a very specific E-class antibody that will only accept attachment to one and only type of molecule.
2.  The second is that a key property of the E-class antibodies, is that they all have their stem planted in a special cell called the mast cell.
3.  The third universal of all classic allergies is that all mast cells are packed with compounds that cause blood vessels to get leaky and draw in inflammatory cells.   If those contents are released for any reason, the area around these cells gets red, swollen, very itchy.
4.  The sequence in every classical allergic reaction, then, is always the same:

  • Item that you are allergic to connects with the antibody that will only connect with that item
  • Once the allergic material and antibody link, the stem of the antibody activates release of inflammatory chemicals that create the allergic reaction
A key property of all allergic reactions is that once the inflammation, the allergic reaction, passes, no lasting harm to the body remains.   Of course, the most severe allergic reactions can drop blood pressure and impair breathing.  But the point here is that once the allergic reaction is over, there is often no lasting damage present.  This is in marked contrast to more damaging forms of chronic inflammation like arthritis, diabetes, or Crohn's disease.  So, if the allergic reaction can be blocked, usually all harm is avoided.

Spring Allergies- How Best to Manage and Treat
When it comes to the hay fever appearing now, in the spring, we are talking about a classic allergy to pollen.
Pollen is in the air, so the allergic reactions to it are seen where air hits the body- the nose, the eyes, the throat, and the lungs.

In every part of the body that pollen contacts and causes a reaction, the same inflammatory reaction described above happens.   The only difference is in the impact of inflammation in different parts of the body.
What does that mean?  Well, for every part of the body affected, another symptom occurs:

  • In the eyes- red, itchy, watery and/or mucusy eyes, with or without swelling
  • In the nose- runny nose, congestion, itchy nose, sometimes redness and swelling
  • In the throat- sore throat, mucus in the throat
  • In the lung- cough and/or wheeze, mucusy cough
So what to do?  There are 4 key strategies to manage springtime (and other) allergies:
  1. Avoid contact- this is hard, pollen is in the air, so avoidance is hard, but some homes have air filtration systems that might help do this at least a bit.
  2. Antihistamines- these common drugs are incredibly safe, and incredibly helpful.  They allow the pollen to link to the anti-pollen antibody, and even allow histamine to be released, but they block the impact of histamine and so block any allergic reaction!   There are two types of antihistamines:  oral and ocular- swallowed or dropped in the eye.  The common oral antihistamines- claritin, zyrtec, and allegra- are non-sedating and each last 24 hours a dose.  Benadryl is also oral, but is more powerful, lasts only 4 hours a dose, and does make people sleepy, and young children agitated.   There are also eyedrop antihistamines that are very safe and are great for eye symptoms- these include Naphcon and Opticon (over the counter) and Patanol (by prescription)
  3. Antileukotrienes- these drugs like antihistamines block all allergic reactions.  The main drug used in this category is Singulair or Monteleukast.
  4. Steroids- Steroids are a very potent treatment option as they work by wiping out the mast cell, the cell that the allergy antibody attaches to, and that is the source of all the allergic reactions.   No mast cell, no allergic reactions.   The main steroids used are nasal and lung inhaled steroids and steroid creams for eczema.
The usual strategy is to start with antihistamines and/or Singulair.   If allergic symptoms remain problematic then steroids are added- usually inhaled steroid for the nose and or lung.

Usually these steps suffice.  But sometimes spring allergies are so severe that further steps need to be considered, including allergy shots which can actually change the production of the person's allergic antibody.

Bottom Lines
  1. Every spring we seem surprised at just how dramatic spring hay fever is.  TV and magazines often dramatize the sudden flare of hay fever with headlines such as, "This is the worst allergy season in **** years."  But the fact is that every spring there is a very dramatic burst of suffering from pollen allergies, to don't be surprised when it hits.
  2. Allergies are a type of inflammation.  One that is marked by itch, and always be reaction to something outside the body, but once the itchy inflammation passes, usually no lasting harm is noted.
  3. Classic allergy always involves the sequence of some specific item you are allergic to connecting to an E-class of antibody, thereby opening up a mast cell to discharge a slew of inflammatory chemicals- histamine for example.   To be allergic to something means you have that E-type of antibody and that it is loaded on mast cells, ready to go if that item contacts the antibody.
  4. Spring allergies occur from such a reaction to pollen.  Mainly tree and grass pollens.
  5. Pollen allergies cause reactions where air hits the body- eyes, nose, throat, and lungs.  And, it should be mentioned sometimes an itchy skin rash.
  6. First line of treatment usually is an antihistamine.  Oral for nose, throat, and lung issues, ocular for itchy eyes.   These include once-a-day forms like Claritin, Zyrtec, and Allegra.  For more severe reactions, Benadryl should be used every 4 hours.  For eye reactions, antihistamine eye drops are very helpful.
  7. If antihistamines and/or Singulair fail to help well enough, steroids come next.  Nasal steroids include Flonase, Flovent, Rhinocort, Nasacort.  These are essentially identical medications and very interchangeable, and many are now over the counter.  Nasal steroids are helpful for nasal symptoms.  For wheeze and cough we turn to inhaled steroids such as Flovent, Asmanex, and Pulmicort.
  8. The use of antihistamines, Singulair, and and/or steroids (nasal, lung) help the vast majority of people with spring allergies.  But, for those few who are not helped, other interventions are available as well.
Spring Allergies are a big event every year.  We are here to help and can often offer tremendous relief.

So, here is to a glorious spring and to your health!

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.

2015-04-13

Women who used the drug during pregnancy gave birth to babies with birth defects, including cleft palates and lips, club feet, heart defects and craniosynostosis – a condition in which the skull is abnormally shaped and may not have enough space for the brain. This can cause vision problems, eating issues and mental impairment.

The study of 900,000 Danish women in August 2013 review found “2-fold increased risk of cardiac malformations with ondansetron (Zofran), leading to an overall 30 percent increased risk of major congenital malformations.”



*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 Major New Initiative to PREVENT Autism and other Neuro-Developmental Disorders- Project TENDR

A Major New Initiative to PREVENT Autism 
and other Neuro-Developmental Disorders- 
Project TENDR

As so many families know all too well, the chance that our children will develop some form of autism, or other neuro-developmental disorders such as ADHD or intellectual and learning disabilities has risen dramatically in the last 20 years.   The risk has risen to the point where now roughly one in six American children will develop on of these neuro-developmental disorders (NDD).

For most the time that we have watched these risks expand, there has been little hope of actually reducing the chances that our children would develop one of these NDD's.  Much progress has been made in the diagnosis of these disorders and in approaches to treatments.   But what about actually halting this most cruel epidemic?  Imagine if a path forward could be created that would reduce the chance that a family's child would develop autism, ADHD, and/or a learning disability.

This is not such an improbable hope.  We have known for many decades that a number of chemicals can have profound effects on how the human brain develops.  The most familiar example is lead. Exposure causes many complex neuro-developmental disorders, and removing from the environment is saving a tremendous number of children from these troubles.

Many years of solid, scientific research is just now coming to fruition, opening the door to identifying just which chemicals in our environment are causing autism, ADHD, and learning disorders.   Many of the nation's leading researchers in this field are ready to gather the findings they have observed over decades of work.  Roughly 50 of these top experts will be meeting in June and September of this year to craft 2 public position papers.

This effort is organized under the name of Project TENDR (Targeting Environment & NeuroDevelopmental Risks).   Project TENDR is being led by Dr. Irva Hertz-Picciotto, widely regarded as one of the world's foremost epidemiologists of neurodevelopmental disorders, and Ms. Maureen Swanson, of the Learning Disabilities Association of America.  They have put together an Organizing Committee of 15 leading authorities on this subject, including researchers from Harvard, University of Washington, University of California, California EPA, Columbia, and the NIH.  I have been deeply honored to serve on Project TENDR's Organizing Committee primarily to help with policy implementation efforts.

The participants in the two workshops include the full breadth of expertise on this subject and include scholars from all the same schools as the Organizing Committee, as well as the American Academy of Pediatrics, the US EPA, Johns Hopkins School of Public Health, and many other leading schools and agencies.

The first position paper from Project TENDR will be crafted in June of this year, and will identify the chemicals in our environment likely to cause the most autism, ADHD, and learning disorders.

The second position paper from Project TENDR, to be crafted in September of this year will propose an approach to actual reductions from these neurotoxins.

We all are used to being barraged by claims of this or that item causing this or that malady or medical problem.  And we have seen it turn out in too many cases that the dangerous substance really presented no harm at all.  So it is only natural to be skeptical, to wonder, will this Project TENDR really identify substances that truly cause these terrible conditions?   Even more to the point, can we truly expect that if exposure to the key chemicals Project TENDR identifies is reduced, will fewer children have autism, ADHD, and/or learning disabilities?

I am very hopeful the answer is yes.  Project TENDR is not the result of a casual inference, or an emotional hope, or a passing fad.   The statements and plans from Project TENDR will be reflecting decades of careful scholarly study, by dozens of nationally recognized leaders in this field, from a wide array of the nation's leading institutions and agencies.

Given the depth of this effort, I have been very pleased to participate by introducing the concept to two leaders in our Federal government, Senator Sherrod Brown, and the United States Surgeon General, Dr. Vivek Murthy.   Dr. Hertz-Picciotto has been active in presenting Project TENDR to US Congresswoman Doris Matsui of California's 5th District.

Earlier in March of 2015, I was deeply honored to be able to present Project TENDR to Senator Brown's health care aide, and to meet with the Surgeon General, Dr. Murthy.

Senator Brown has long been an advocate of helping families with autism, and to finding a path to reduce the risk of developing it.  He is a long-time member of the Congressional Autism Caucus.  Many families who come to Advanced Pediatrics have seen the photo of the Senator meeting with me here in our pediatric office in 2010, and it was at this meeting that we began our collaboration in the issue of autism.  In 2011, the Senator hosted an Autism Roundtable in the US Senate meeting rooms, where the head of the National Institutes of Mental Health, leading researchers, met.  I was honored to chair this Roundtable, with the goal of finding a path towards preventing autism, of reducing its incidence.  

Our Surgeon General, Dr. Vivek Murthy was recently sworn into office.  I was very honored that he accepted my request to meet and discuss Project TENDR.  Of course, the Surgeon General cannot endorse a scientific claim or a program unless it has met particularly stringent evaluations.  I am very pleased that as a result of our meeting, the office of the Surgeon General will be giving Project TENDR guidance on how best to pursue this necessary level of independent evaluation of our claims that certain chemicals in the environment, if their exposure was reduced, could reduce the chances of a family's child developing a neuro-developmental disorders.  Attached is a photo of the Surgeon General with me just after our meeting.

Preliminary estimates from the Project TENDR experts suggests that if we reduced the exposure from the top neuro-toxic chemicals by as little as 20%, the country could experience drops in the chances of our children developing autism, ADHD, and/or learning disabilities by 15-40%

Above all else, I am most excited that families in our community could one day experience some relief from the very real worry that their child may develop one of these very difficult conditions.

I will be keeping everyone updated as Project TENDR begins its work.  Let us all hope for much success.

To your health,
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.

2015-04-10

A Visit with My Granddaughter, Some Thoughts on Infancy

A Visit with My Granddaughter, 
Some Thoughts on Infancy

Photo

My wife and I just concluded an incredibly wonderful and moving visit with our son, daughter-in-law, and 8 month old grand-daughter, all visiting from Hong Kong!

As nearly everyone would agree, children are astounding.   They bring such amazing powers of optimism, youth, newness into our world, and much. much more.    I have been incredibly blessed to live in the midst of childhood all my life.   Our work grants us the incredible gift each of you grant us, the gift of trusting us with helping you care for your child.

The experience of grandparenting introduces a new perspective, an additional level of amazement with childhood, in addition to that we relish from parenting and being a pediatrician.

As a friend who recently became a grandparent observed, when you are a parent, you are very excited about the next step your child is about to take, their is a bit of urgency in wondering how they will turn out.   But as a grandparent, you are less concerned about next steps, and you take a special pleasure in simply immersing yourself in the moment.

And so it is with this in mind that my wife and I immersed ourselves in Evie's later infancy.  We have an incredible set of days together, and we both truly got to feel the power of this stage of life.  Together with the richness of sharing this stage of later infancy with many of you, these experiences inspired some thoughts about infancy.

The main thing that impressed me about infancy this time was its mystery.  No newborn speaks in words.  Emotions that seem very familiar to us- happiness, sadness, rage, frustration- are clearly in evidence from day one, but the actual nature of the thoughts behind the feelings is mysterious, since no young infant speaks.  Further, it seems that if they could, we would likely be very surprised at how different their thoughts are from ours.  Again, since no one that age has spoken, we don't know how their thinking would be different, but it certainly appears to be different.

The very word infant emphasizes the non-verbal nature of their world.  Infant literally means, cannot speak (in- Latin for not, and -fant comes from a Latin word meaning speak).

So this is a world of non-verbal connections and communications.

The other aspect of infancy that is so distinctive and powerful is that many infants, though not all, love to be held, cuddled, to be close physically with those they care for and love.  It is nearly impossible to feed an infant (by breast or bottle) without holding them.   Most love to be rocked to sleep, or held during the day.  We don't really have this sort of contact with older children.  Having that much contact with an older child is even called "babying" them.   So being a baby means lots of contact, which is a unique hallmark of this stage of life, but one that endures in tender moments all our lives.

One more thought to share has to do with personality.  I find personality profoundly interesting.  We all know that each person we know has a particular way about them, a flavor, a style, a personality, that endures across a lifetime.  We can see it emerge soon after birth, and we see it stay steady over many years and decades.  Even after not seeing someone for many, many years, it is always remarkable how very much the person remains the same person no matter what troubles and time have occurred.

We see the power of personality, really of being human, in infancy, in full force.  Those of us with several children always remark on the power of how each child's personality is very different, and how those differences are evident at birth.

Our time with our granddaughter brought the power of personality to our attention in full force.  As our granddaughter and given the extensive time we had together, we had the great pleasure of truly connecting to this young 8 month old girl.  She turns out to be a very happy baby, beaming a smile and curiosity nearly all day long, in a very individual way.   What came to mind in enjoying our time together is what it takes for someone to sustain a positive outlook.  This infant gets hungry, she gets dirty diapers, during this trip she was exposed to a huge number of new people, she experienced jet lag, her routines were disrupted, and yet she time and again found a way to return to her style, a happy outlook.    We were able to directly observe stresses occurring, and her mind and system's work to maintain her stance.  

And what we saw is present in all infants, but our close look with our granddaughter made this aspect of being human so powerful and dramatic.   It is truly remarkable that each of us walk around, with all that happens to us at any moment, in any day, across time, and maintain our equilibrium, remain who we are.  And in the moments of infancy, before speech can cover our tracks at all, this power of steadying, of creating a stance, of being who we are is truly spectacular.   What an accomplishment our mind achieves all the time!

Bottom Line
This may turn out to be simply another gush from a proud grandparent, and in many ways it is.  But also I hoped to share some observations, some experiences that are so moving when spending time with our infant granddaughter.  They include:

  • The wonder of personality, how the mind creates it and sustains it no matter what happens over such long times
  • The centrality of touch in infancy, an age of being held
  • The non-verbal nature of infancy, a stage of life that literally means cannot speak
  • And, ultimately, the wonderful mystery of infancy.
And no discussion of infancy would be complete without mentioning how powerful love is.  How we all yearn to connect and how having a baby in the family brings everyone together. 

We are very grateful for being in the world of children and families, including ours!

To your health,
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.