MILD versus SERIOUS ILLNESS

---

MILD versus SERIOUS ILLNESS:
or, Knowing When to Worry
and Knowing What to Do


As our nation and community encounter and try to deal with the very
serious epidemic of H1N1 (swine) influenza virus, it makes sense
to take a moment to think about how do you know, when your
child gets sick, when to worry and what to do?


It turns out that the best guide to knowing when to worry and
to know what to do is not the name of the virus.

That is, finding out if the virus causing your child's illness is H1N1
or not, does not help you know how worried to be or what to do.

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

So how do you know how sick your child is?

The answer is actually fairly easy, since there are only two possible
answers: mildly ill or seriously ill.

Symptoms of Mild Respiratory Illnesses:

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

Symptoms of Serious Illness:

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

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

Mild illnesses, even if caused by potentially dangerous germs,

are still mild illnesses.

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

serious illnesses, you have little to worry about.

Of course, should symptoms of serious illnesses ever develop,

one has alot to worry about.

What to Do if You Have A Mild Viral Illness

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

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

Antibiotics do not work.

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

influenza infections.  

So the use of Tamiflu is not recommended for use in mild viral
infections, it does little good, and could lead

to the drug not working if you really need it.

What you can do is to keep your child comfortable:

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

perhaps ibuprofen or acetaminophen if fever or pain is

bothering them.

What to Do if you Have Symptoms of Serious Illness

Call us immediately.

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

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

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

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

BOTTOM LINE

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

germs.

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

H1N1 (swine) influenza virus and all other viruses.

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

comfort measures.

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

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

Tamiflu is helpful.

Dr. Lavin

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

Thank You From the Rose Garden

Thank You From The Rose Garden

Dear Families,

As some of you have heard, I was invited to represent the State of Ohio in the Rose Garden at The White House on October 5, 2009.

The event was an address by President Barack Obama, letting the country know the extent of physician support for reform and calling on all doctors to let everyone know the historic extent to which this support has reached. As of now, for example, the AMA has endorsed reform for the first time in its history, 525,000 out of

700,000 doctors belong to such organizations that have endorsed reform, and the New England Journal of Medicine has published data that show about 75% of US physicians when polled individually support reform.

It was a singular honor to represent Ohio doctors in the Rose Garden and a thrilling

moment in my life. After clearing White House security, we were greeted with the

beautiful music of the Marine Corps brass band, in full dress uniform.

Soon afterwards, we were escorted along the Southern entrance of The White

House, into the Rose Garden. I was able to sit in the second row, near the center

aisle, about 15 feet from the President.

As I watched President Obama come out of the Oval Office and then address us

directly, and via the cameras surrounding us, the nation, I was moved by his

evident awareness of the suffering our current health care system causes-

both physically and financially.

I also noted that a surprising proportion of the 50 doctors representing the

country were practicing physicians, from practices similar to Advanced

Pediatrics- privately owned, often small 2-3 doctor offices. They represented not

only pediatrics and family practice, but a wide array of specialties as well. None

were chosen for their titles or positions in an organization.

And that is why I write this posting as a thank you note. Not everyone agrees

with the current health care proposals, almost no one supports every provision

in them, but a very broad agreement has emerged that something needs to be done.

So my thank you, is for your trust in myself, Dr. Hertzer, and Kelley. We are daily

reminded of the critically valuable nature of that trust, and the importance of our

response to it. This is the center of what medical care is all about, and it was

physicians whose careers are centered on this trusting provision of care who were

chosen to represent their states. And so thank you, for it was your trust that led

to my opportunity to be there.

And of course, all the more importantly, thank you once again for your trust which

allows us to try to practice the type of medicine that will truly be responsive to

your very real concerns and needs, and will hopefully make a real difference in

your children's lives.

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.

Another Inconvenient Truth

---

Another Inconvenient Truth: Booster Seats Should be Used

There are now two reasons for all people who weigh more than 40 pounds

AND are shorter than 4 foot nine inches to be in a booster seat in a car:

1. It really could save your life.
2. It is now the law in the state of Ohio.

Seats used in cars at any age are not "infant" or "baby" seats. They

have nothing to with being young.

These seats exist for only one purpose, to physically provide a framework

so that a seat and shoulder belt will work.

Nearly all cars are designed for adult-sized people, and so those less than

4 foot nine inches tall need a device to have a seat and shoulder belt work.

All people in a car need to have their pelvis held by a seat belt

and their shoulder held by a shoulder belt.

The reason is that if your pelvis and shoulder are held snugly, the chance

of serious injury during an accident is dramatically reduced.

And so various devices have been made for various sized people, all with

the one purpose of holding the pelvis and shoulder snug while in a car.

• For young infants, the device holds infants 3-20 pounds backwards.

• After one year of age AND being 20 pounds, the device should be
• designed to hold 20-40 or 20-60 pound children facing forward.

• And once you outgrow the 20-40 or 20-60 pound device, you should
• be in a booster seat until you are at least 4 foot 9 inches tall.

In the case of the booster seat, if you are over 40 pounds and shorter than

4 foot 9 inches, your chance of serious injury happening in a car accident

is reduced if you are in a booster seat by 59%!

That means proper use of a booster seat prevents over half of all serious injuries from

car accidents.

There was a time when seat belts, then shoulder belts, then infant car seats were

shunned as inconvenient. Now they are routine.

It is time for us to have all our children who weigh more than 40 pounds and are less

than 4 foot 9 inches tall be in a booster seat when riding in the car.

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.

H1N1 Influenza (swine flu) Immunization: Update for Sept 22

---

H1N1 Influenza (swine flu) Immunization:

Update for Sept 22

We now have news to report on the H1N1 Influenza (swine flu)

immunization. Please note that this immunization program is

being designed by the US as an emergency program. We do

not order vaccine, the government distributes it. It will not be

available in the usual office appointment fashion, but more

as a special set of times once the facility that receives it has

it in hand. With all that in mind, here are the most recent facts:

• The immunization will come in nasal spray and shot form
• Children ages 10 and up need only one dose
• Children ages 6months through 9 years need 2 doses
• A regular flu shot and the H1N1 Influenza (swine flu) can be given on the same day
• Not so for regular flu nasal spray and H1N1 Influenza (swine flu) vaccine
• The H1N1 Influenza (swine flu) vaccine is made in the same way as the regular flu
• This means it should have the same, excellent safety profile

At this time, we still do not know if the H1N1 Influenza (swine flu) immunization

will be given via offices such as Advanced Pediatrics, or via schools.

We also should note that the H1N1 Influenza (swine flu) infection is now in

Cleveland. So far, it remains a very mild infection, of very little concern

medically, except for pregnant women and the very ill.

Please stay tuned for further updates. Within the next few weeks, the final

distribution of the H1N1 Influenza (swine flu) immunizations will be made and

we will know how many doses we will be given. No practice can purchase this

immunization, each will be assigned a fixed number.

Once that distribution is decided and we know how many doses Advanced

Pediatrics is to receive, we will know exactly how we will be offering

the H1N1 Influenza (swine flu) immunization, and will let you know as well.

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.

H1N1 Influenza (swine flu): Update Sept. 13, 2009

---

H1N1 Influenza (swine flu): Update Sept. 13, 2009

When will it return?

This influenza virus has its own schedule. It was in our community

earlier this year in the spring and earlier summer. Since then it has

left us for the Southern Hemisphere. Now this virus is going to come

back to Greater Cleveland. It is uncertain when it will come back

in full force, or how severe an illness it will be this time. Some

reports suggest that it is appearing on some college campuses.

But the H1N1 Influenza (swine flu) virus is not widespread in our

community at this time.

This means if your child has a cold or flu-like illness, at this time,

it is highly unlikely to be from the H1N1 Influenza (swine flu) virus.

How severe will it be this next time?

No one knows. The first round in the spring and early summer

was fairly mild. It has remained mild in the Summer Hemisphere.

Chances are good that it will remain mild on its return, but we will

not know until it is here.

With two exceptions: like all flu viruses, the very ill and very old

can get seriously ill from this virus, and one special group is at

particular risk: pregnant women.

What's new on the vaccine?

The good news is that the vaccine for H1N1 Influenza (swine flu)

virus is very closely related to the usual annual flu vaccine,

making the chance of unexpected side effects more remote.

Further, the vaccine gives adults protection within 10 days

(rather than the expected 3 weeks) and requires only 1 dose

(instead of the expected 2 doses).

As of this date, we have no such information regarding how

many doses children will need.

Who should get the vaccine?

At this point, the H1N1 Influenza (swine flu) virus

appears to cause only very mild illness in nearly all

healthy people who catch it. And so for healthy

children, unless the illness becomes more dangerous,

Advanced Pediatrics is not yet recommending

all children get the new H1N1 Influenza (swine flu) virus

vaccine.

It is very important that all pregnant women receive this

vaccine as soon as they can. Please contact your

obstetrician now to see how you can get this vaccine

ASAP.

If your child gets a cold, or flu-like illness, how

worried should you be about H1N1 Influenza

(swine flu)?

Please read this answer carefully, it is a very important

point:

Knowing how worried to be about Illnesses from the

H1N1 Influenza (swine flu) virus is no different than

any other illness.

If you have a mild illness, there is nothing to be worried about

beyond managing the discomfort.

You only need to be worried if you have symptoms of

serious illness and these are:

1. Struggling to get air in and out of the chest

2. Severe pain

3. Stiff neck (i.e., cannot touch chin to chest)

4. Altered consciousness (unable to awaken to

normal alertness)

H1N1 Influenza (swine flu) virus is like all other illnesses, if

you have mild fever, achiness, runny nose, or cough, it really

is a mild illness, even if H1N1 Influenza (swine flu) virus is causing

it.

Bottom Line:

It's not the name of the virus that determines how

concerned to be, but rather the severity of the illness.

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.

The Most Reasonable Statement on Swine Flu to Date

---

The Most Reasonable Statement on

H1N1 Influenza (Swine Flu) to Date

The New York Times has published an editorial

on how to approach the possibilities we face

in the H1N1 Influenza (Swine Flu) virus coming

back to us this fall and winter.

http://www.nytimes.com/2009/09/01/opinion/01tue1.html?_r=2&hp=&pagewanted=print

The key points they make and that I support are:

• The virus is likely to return
• It is likely to infect even more people than this summer
• The virus has not gotten stronger as it now travels the world
• The virus is likely to return now that schools are now open
• The vaccine will not be available until later this fall
• Therefore, the vaccine will likely not stop a fall epidemic
• If all indicators are right, when it comes back it will remain mild
• Medications are not recommended at this point
• Only if someone gets seriously ill would the medication help

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.

Dr. Lavin on NPR's Morning Edition to Discuss HPV vaccine

---

Dr. Lavin on NPR's Morning Edition to Discuss HPV vaccine

Tune in to your favorite NPR radio station Labor Day morning to

hear Dr. Lavin be interviewed by Ms. Brenda Wilson,

Science Desk Correspondent and Editor for National Public

Radio.

The segment is scheduled to run on the half hour sometime

between 6AM and 9AM on Monday, September 7, 2009 on

NPR's "Morning Edition," nationwide.

The topic of the interview is HPV immunization. Dr. Lavin

reviews the latest medical literature and the variety of concerns

that have recently been raised on this topic.

*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.