Constant Contact: Why it doesn't matter if you are contagious

Constant Contact:  

Why it doesn't matter if you are contagious

With very rare exceptions, it does not matter at all if you or your child is contagious with an illness.

This is because we are all very heavily exposed to the viruses that cause nearly all the illnesses that circulate in a community, namely colds, flus, and stomach flus.

This is not the message we are usually taught by schools and by our parents.  

We have all been raised to think that it is only common courtesy to stay away from friends when ill for fear of "giving them" our cold or flu or stomach flu.  Everyone has complained at some time or another about the child who returns to school or co-worker who returns to the office while sick, and upset that they might gives us or our child their illness.

So how can it makes sense to say it does not matter if you are contagious?

The reason lies in the superabundance of viruses in the air and their extraordinary ability to jump from person to person.

Virus Stats
Let's start with the numbers:

• Every single human being gets viral infections, and loads of them.   
• The average is 8 every year from birth through the elderly years, and every year in between.
• With colds, people fill the air with their virus with every breath for about 3 weeks, that means every person is pumping virus into the air about 24 weeks every year.
• With some stomach flus, the viruses can be spread by a person for a whole year after the illness.
• For mono the virus can be spread easily for a year after the illness.
• Given that just for colds the average person is pumping virus into the year nearly half of every year, it is hard to imagine just how much virus fills the air of a major city.
• Put it all together, and with every breath, we breathe in about 1 billion live viruses, every breath!

How well do Viruses Get Around?

Now, how about how well viruses move around?

Viruses turn out to be little packets of genetic material, either DNA or RNA.  They are wrapped in proteins that hold the key to entry in a cell.  Once in a cell, the viral DNA/RNA activates the cell to make more virus.

That's it, that's what viruses do.

Viruses have been doing this for about 3 billion years.  Humans have only existed for about 100,000 years.  So viruses have been jumping from cell to cell 10,000 times longer than humanity has even existed.

The point is, they are very, very good at getting around and spreading.  

We are all soaking in virus- contagion is essentially irrelevant

So if you or your child has a viral illness, it turns out to not matter at all if they are contagious, because everyone, including their family and friends, is so heavily exposed to viruses with every breath, that they will be heavily exposed to virus whether you or your child are with them or not.

When a well person wonders if someone with a cold or flu might make them ill is very much like a group of people playing in the ocean wondering if a new person, who happens to be wet, can play with them for fear the new person can make them wet.

Exceptions to the Rule

What rare situations demand isolation for contagious persons?

The main such situation is if someone has a weakened immune system and is actually isolated from other people.  For example, someone critically ill in a hospital, or some people undergoing intense chemotherapy, or a recent organ transplant recipient.  Most of people in this situation are avoiding contact with nearly everyone, and are fairly isolated, so a visit from someone who is contagious could make a difference.

Bottom Line

• Viruses surround us, we breath in a billion with every breath
• People are contagious after a viral illness for weeks or months
• So, with the rare exception of a person who is critically ill, it makes little sense to remain fully isolated if you are contagious for a virus.
• Schools and families need to reconsider their traditional approach to limiting the spread of viruses, such policies have a nearly 100% failure rate and so should no longer be used.
• If you have a viral cold or flu, stay home if you feel sick, but do not remain isolated just to avoid the spread, the virus has already spread.

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.

When a Hoax has Real Roots

When a Hoax has Real Roots

Dr. Andrew Wakefield is a British doctor who had to flee England to avoid charges relating to his authorship to one of the cruelest, and most effective hoaxes in recent history.

For a number of years, Advanced Pediatrics has been presenting facts that demonstrate that Dr. Wakefield's hoax was indeed not true.  Recently, the Sunday Times of London concluded an investigation, being published in the British Medical Journal, that provides definitive proof that Dr. Wakefield's initial paper was, in their words, "an elaborate fraud."

What was Dr. Wakfield's big lie, who did he fool, and what harm did he cause?

The Lie

Dr. Wakefield's lie was that he had proof that the MMR vaccine caused autism.  How was it a lie?  He published a paper that presented 12 cases of children becoming autistic after getting the MMR.  It turns out that nearly half of these children had abnormal development evident before they ever got the MMR, and the allegation that any of the children developed autism in relation to the shot was, simply put, fabricated.

Dr. Wakefield's paper had 13 authors, 10 have retracted their claims, and several have faced charges in British courts.  When charges were brought, Dr. Wakefield fled to the US.

Who Was Fooled

Millions of people.  Sadly, a handful of celebrities joined the bandwagon and whipped up a frenzy that covered the hoax in a persuasive cloak of credibility.  Leading this phenomenon was the actor Jenny McCarthy, but Ms. McCarthy was hardly alone.  Even today, despite the ignominous exposure of Dr. Wakefield's hoax, millions of Americans still believe his discredited claims.

Who Was Harmed

Infants and young children.  Enough families were taken in by the hoax, deciding not to immunize their children, that a pool of susceptibility grew to allow epidemics of measles.  In California in 2010, at least 5 infants died from measles infections that would have never occurred without Dr. Wakefield's actions.

Lessons Learned

1. The first lesson to be learned is that hoaxes still happen.
2. Just as importantly, the claim that immunizations cause autism turns out to truly be a hoax.
3. One lesson I do not take from Dr. Wakefield's dishonesty is to drop a deep skepticism of pharmaceutical industry marketing.

The Real Roots of the Hoax

Around the same time that Dr. Wakefield was being exposed, an important article in Vanity Fair (January, 2011), documented that roughly 200,000 people actually die from the use of prescription medications, used as prescribed, each year in the United States.  The article details a growing trend towards testing new drugs overseas, outside of the regulatory glare of American rules for testing drug safety and efficacy.  One drug profiled, Avandia, became the world's number one oral drug for diabetes, and caused over 80,000 unnecessary heart attacks before being taken off the market.  These are powerful and deeply disturbing numbers and trends.

The point is that the public has a very keen and accurate sense that something has gone terribly wrong with the way drugs are developed and promoted.  A sense of trust has been broken, and I support that perception.  The US pharmaceutical industry has retained tremendous integrity in their manufacturing, a bottle of penicillin can still be absolutely trusted to contain penicillin.  But when it comes to marketing, the integrity has been shattered.

In an era in which trust in the safety and promised efficacy of medications has been put into question, Dr. Wakefield's allegation that immunizations turn out to cause autism fell on very fertile ground.

Bottom Line

• The distrust of claims of safety and efficacy for drugs is profound and based on real experience.
• Immunizations do not cause autism, Dr. Wakefield's bold assertion that they do has been fully discredited.
• Advanced Pediatrics will continue to work hard to maintain an objective view of the drug industry, with these key policies maintained:
• Drug companies will continue to be barred from offering any items to the office, and also will continue to not be allowed to physically enter the premises.
• Medical literature reviews will continue to be used to determine if a new drug actually works and what its actual side effects are.
• Advice to families will continue to be based on the most objective information Advanced Pediatrics can bring to our discussions.

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.

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

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

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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.

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

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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.

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.

A False Epidemic of Pneumonia

Image 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

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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.

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% 

http://ohiohospitalcompare.ohio.gov/HospitalMeasuresOrganizationQuality.aspx?PARAMETERHOSPITALNAME=Hillcrest%20Hospital&PARAMETERHOSPITALCOMMENTS=&PARAMETERHOSPITALTYPE=Acute%20Care%20Hospital#

At St. John Medical Center the rate was quoted at 10%

http://ohiohospitalcompare.ohio.gov/HospitalMeasuresOrganizationQuality.aspx?PARAMETERHOSPITALNAME=St.%20John%20Medical%20Center&PARAMETERHOSPITALCOMMENTS=&PARAMETERHOSPITALTYPE=Acute%20Care%20Hospital

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

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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.