Thoughts on Crying in Infancy

When Babies Cry- What are they Saying, What can You Do?

Everyone alive has felt the power of a young baby crying.   Their cry for help pierces our minds, demands a response, and leaves us suffering if no response happens, quickly.

All parents have felt the tie their baby's cry creates.  All airline passengers have felt the power of a baby's cry.

But what is the baby's experience of the cry, and what sort of response is the baby looking for?

At one level, nothing could be more obvious about an infant's crying- it is simply a cry for help.  To be held, to be fed, to be cleaned, to be helped.

But it may be helpful to think for a moment about the situation we all find ourselves in when we were infants, needing some way to communicate with the world.   As full grown adults we have a tremendous range of ways to communicate with the world.  We can talk, email, text, video call, even write letters.  Our communications can be crafted to the most subtle level of nuance.  We can describe with great accuracy exactly what we are wanting, and we can do so directly, indirectly and with a broad pallette of emotional flavoring.

An infant's communication situation could not be more different.  The infant has no words, none. This leaves all communication forced into a very narrow range of choices.  For the newborn who also has not yet learned to use their hands or face, and so cannot even gesture or smile, there are very, very choices to get a message of any sort out to the world.  For the first days after birth, babies cannot even fix their eyes in a gaze.

In fact, the only communication channel open to a very new newborn is crying and some very rudimentary grunts and breathing noises.   Crying is the main vehicle for newborns to communicate.

Equally interesting is how very wired all adults are to the communication of infant crying!   That is the power of the baby's cry.  After all, if we did feel the urge to respond, the cry would never work.  But we do feel it, our minds create a very, very powerful urge to do something.  As parents, we are compelled to find out what our baby wants and make sure it happens, as an observer we are compelled to pray that the parent is around and can do something to quell the cry.

What do Babies Want?

If the cry of a newborn is their total communication channel and medium, what are they communicating? 

The list is very familiar to all, here is the list and what to do:

• "I am hungry"   Feed your baby
• "I want to be held, cuddled, rocked"  Hold the baby and provide the requested comfort]
• "I want to go to sleep"  Initiate the sleep routine that helps your baby get to sleep
• "I want my diaper changed"  Change the diaper
• "I am in pain"  Find out what is causing the pain (e.g., a bad position, a reaction to a food, a stomach ache, etc.)

Bottom Line

Crying is often experienced as a crisis.  The baby is crying, now what do we do??

But if we see crying as the newborn's way of talking writing, and emailing us, we can respond to it as we would any communication:  figure out what the person is asking for, and respond accordingly.

This approach sets up a nice dance of parents and their young babies communicating and connecting and caring for each other.  Crying moves from hazard to connection.

Dr. 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.

Ebola- Finally some good news in the US

Ebola- Finally some good news in the US
[updated October 20, 2014 11:34 AM]

As those who have followed our account of the story of the Ebola virus in the US already know, there has been no Ebola virus epidemic in the United States to date, and the chances of one actually occurring have been very low all along.

Today, the first actual data on how well an exposure to Ebola virus in the community can spread in the US has been reported.  The information comes from Dallas, Texas, the only city in the nation where Ebola has spread, so far.   

As we all know that spread to date has been to a total of two people.   These two people, and the original patient, have been found to have exposed 149 people in Dallas and two flights, one to Cleveland and one from Cleveland.  

Today we now know how many of the first 43 [was reported as 50 earlier today] of these 149 exposed people actually caught Ebola virus infection from these two nurses and the patient.  These 43 are the first of the 149 to be tested and fully monitored for the full 21 days needed to prove or disprove if they caught the disease.

And how many of these 43 people were proven to catch the Ebola virus?  The answer is zero!

Not a single person of these first 43 to be observed for a full 3 weeks caught the virus, none of them!

We of course need to wait a full 21 days for the rest of the 155 in Dallas and on the planes, and for another 153 people here in 16 of Ohio's counties to know for sure if the patient and Dallas and two of his nurses spread Ebola to anyone in the United States.  Note that another 5 people in Dallas are so far negative and are only a few hours from full clearance later today.

But these initial results from the first 43 exposed Americans to reach the 21 day waiting period mark could not possibly be more reassuring.  A very low rate would have been better news than a high rate of contagion, but zero transmission across 43 people clearly bolsters the evidence that this virus is not very contagious.

One of the 43 who did not catch it was a man who used the ambulance used by the actual patient in Dallas to get to the hospital before the ambulance was cleaned.   The fact that he did not catch it increases the chance that people on the nurse's plane but not same flight are more likely to be safe, too.  Another two, lived with one of the nurses who got infected, the one who did not come to Ohio.  One of these two people was her fiance who cared for her while ill at home and the other her child who lived with her.  Both of these people with very close contact were cleared today, they did not catch Ebola.

The fact that 0 of 43 exposed people caught Ebola should go a long way towards reassuring all of us in Ohio that the risk of an Ebola virus outbreak or epidemic in Ohio is exceedingly remote.  We have every hope that the next days will establish that there is no Ebola risk in Ohio.

Again, until all 258 in Texas and Ohio, who are waiting to be cleared like the 43 already cleared, are cleared, caution and concern are still in order.  But indicators are good that there will be on Ebola crisis here, at least for now.

To your health,
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.

Ebola Update- A Broader View, and a Clarification from Hathaway Brown

Ebola Update- A Broader View, 

      and a Clarification from Hathaway Brown

[as of October 17, 2014 at 8:45 AM]

As we take a look at the state of the Ebola virus in the United States at this time, a few key observations seem most relevant:

1. We have had two phases of the infection, and wait to see if other phases will develop or not.
2. The first phase was the arrival in the United States of a small handful of people who got the Ebola virus infection in Western Africa, primarily Liberia.  By a small number, we mean less than a dozen.
3. The second phase has been the spread of Ebola virus from those infected in Africa to people in the United States.   At the time of this posting, a total of two people have been infected in the United States.  Further, everyone who has actually been infected by Ebola virus in the United States has gotten infected only by caring medically for a person ill with Ebola.
4. There has been no third phase of infection at all so far.  Of course, it is too early to know if there will be a third phase, but as of today, we know of no one who has actually been infected by either of the two nurses, the only people who actually got infected to date in the United States.

The Broad View, Right Now

These facts lead to the following observations:

• Ebola is a scary illness because it is so deadly and there is no specific treatment for it.
• There is no Ebola epidemic active at this time in the United States.  Out of a population of 300 million people to have a disease spread to a total of two people does not constitute an epidemic.  
• It is also striking that the only people who have caught Ebola infection in our country were two nurses who were placed in very close physical contact with an infected person's bodily fluids.  Early reports suggest their infection may have resulted from breaches in protocols that can protect medical caregivers.  If so, the only documented infections in the United States, to date, are the result of something almost none of us will be actually experiencing- providing very close medical care with someone dying of Ebola infection and doing so with breaches in the proper technique.
• At the same time, very careful vigilance is in order to prevent or minimize a third wave of infection, the spread of the Ebola virus from the two nurses to others.
• The main observation to make at this moment is that although Ebola is raging in Sierra Leone, Liberia, and Guinea, it is really not raging in the United States.  At this time, there is very little danger of infection to nearly all of the 300 million people who live in the US.
• And again, the experience of Nigeria is instructive.  Even if a third wave of infection occurs, this disease is containable, and I have every confidence that if a third wave occurs, the US will be able to keep it from actually moving into epidemic mode.  That is, we are all very safe right now, and the outlook remains very good that we will continue to be safe.

The Clarification from Hathaway Brown

A number of highly reputable news sources reported yesterday that at student at Hathaway Brown was asked to remain home yesterday because the infected nurse who flew from Cleveland had visited the home of a Hathaway Brown student.  Please note that these news reports, and my posting, were very clear to avoid stating or implying that anyone else at Hathaway Brown actually was exposed to a contagious person.

Hathaway Brown has clarified what took place.  It does turn out to be true that Hathaway Brown asked a student to stay out of school pending further information, and asked her to stay home because of a possible exposure.  The clarification is that the exposure was not to the infected nurse, but to a person who was a passenger on the plane with the infected nurse.  But that passenger and the infected nurse shared a flight on October 10, not the 13th, that is, the flight to Cleveland, not from Cleveland. At that time the infected nurse was most certainly not contagious, if it remains true that her first symptoms occurred on October 13.  As Hathaway Brown put it in their statement, they asked their student not to attend school for now, out of "an abundance of caution."

In re-reading our post yesterday, it is clear that our message was not that any risk of infection with Ebola had come to the Hathaway Brown community.  This welcome clarification from Hathaway Brown makes this point even more emphatically.  These facts, as we currently understand them, establish that the student was never in contact with anyone who could have been contagious.  It makes sense for any school to be cautious, we make no comment on the whether the student should attend school or not, or when.  But we can say with this clarification, and assuming no new facts emerge, we still have no reason to believe anyone in NE Ohio is infected with Ebola virus.

Bottom Line

This virus is very scary, for good reason.  Fortunately, it has not spread in the United States to any degree that makes us think we are in any danger.

Let us hope this remains the case, even if several more cases of infection are identified.

Here is to your health, and to this threat passing as soon as possible.

Dr. 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 Masterpiece- A New Book Presents a Magnificent Treatment on Thoughts on Immunizations

A Masterpiece

A New Book Presents a Magnificent Treatment on Thoughts on Immunizations

On Immunity:  An Inoculation
by Eula Biss, Greywolf Press, 2014

Many people, families and doctors both, have struggled with questions relating to immunizations.

It turns out these questions have a rich and compelling history, and also relate to very powerful trends in concerns that inform our current society.

For families and doctors alike, it only helps to better understand the questions and concerns that are raised surrounding immunizations.

Now comes Ms. Eula Biss who is an award winning essayist and observer of our society, with what I think may be the best book ever written on the topic of immunizing, and perhaps on the overall topic of medical care.

This book stands out for several reasons.

First, the author is an outstanding writer, so it is a great read, well crafted, deeply thoughtful.

Second, the author is recounting her own recent experiences of giving birth, experiencing crises, living through weighing scary choices.  This is not a dry listing of various arguments for and against immunization, but a deeply felt exploration of what it is truly lived when you have to decide amongst conflicting choices for the health of your baby and child.

A third distinction, is that Ms. Biss takes a very serious look at all the concerns raised by immunizations.  She discusses each concern in its deep historical and societal context.  It turns out people have been concerned about immunization for many centuries.  Also, many of today's concerns about immunizations are rooted in very deep trends in modern American society.  Ms. Bliss presents each of these concerns, their history and their context in an incredibly thorough and open-eyed manner.

As a result, Ms. Bliss has created a book that should be read by every doctor and by any parent with any questions about immunizations at all.   It's an important book for doctors, because it gives a clear picture of what families are contending with whenever they make any medical decision for their loved ones, in particular immunizing their children.  It's an important book for parents, because it presents one of the best and most thorough discussions of current concerns available.

I have found the debates surrounding immunizations too often sink into stalemate.  On one side are the scientists, armed with powerful facts about what life is like without the protection of immunizations.  On the other side are organizations militant against immunizations, presenting frightening scenarios of possible harm.  The scientists have little patience for worries in the face of facts.  The opposition has little patience for those who do not take their sense of potential harm seriously.  As a result, facts have little impact on those worried; and, worries have little impact on those with facts.  Stalemate.

This is the special power of On Immunity: An Inoculation.  I think it breaks the stalemate with poetry.  This is not a scientific paper, and it is not a cry of terror.  It really is a poem.  It is a set of essays, there is no formal chapter or topic organization.  Each essay is a very poetic reflection on what this Mother's thoughts were on this or that issue that immunization confronted her with.   The special power of a poem leads to everyone being able to relax and consider the issues at hand.  It allows for facts and feelings to come together towards figuring out what makes sense.

Here are a few choice examples from the book, that hopefully will demonstrate that this is a special read.

• On fear and facts, Biss notes that the noted philosopher, Cass Sunstein has observed:  "Perhaps what matters," Sunstein muses, "is not whether people are right on the facts, but whether they are frightened."
• On the nature of danger from a substance:  "For toxicologists, 'the dose makes the poison.' . . But most people prefer to think of substances as either safe or dangerous, regardless of the dose."
• On the appeal of alternative medicine:  "One of the appeals of alternative medicine is that it offers not just an alternative philosophy or an alternative treatment but also an alternative language."  This launches a very interesting exploration of the power of the concepts of being "cleansed," "supplemented," protected from the corrosive effects of oxidation.
• On the development of two sides to the immunization debates: "These dualisms pit science against nature, public against private, truth against imagination, self against other, thought against emotion."
• A powerful experience in being denied access to her child during a procedure: "The implication that I was a hysterical woman and a threat to my child was making me so angry that it seemed possible I might actually become hysterical."
• On the Sears approach to immunization: "The Vaccine Book is not even-handed as much as it is equivocal."

These examples are just a small sample of her eloquence, passion, thoughtfulness, that allow a very full treatment of today's debates on immunization.

The book is also a treasure trove of interesting facts.  For me, one of the most powerful was that smallpox, once truly a great killer, was a killer up until its end.  Smallpox was made extinct from the natural world in the 1970's.  The virus only exists today in the military labs of the US and Russia.
But prior to its elimination, smallpox killed 500 million people, just in the 20th century.  Smallpox killed more people in the 20th century than all the wars of the 20th century, combined!

This fact reminded me of a very central fact about viruses.  Medical science, with rare exceptions, has been unable to find any treatments to rid us or effectively manage or limit the harm of a viral infection.  The only real exception to this is the use of immunizations.  The smallpox example is very relevant.  Without smallpox vaccine, the world's first immunization, it would be killing about 500 million people a century, even today.  Instead, it is now effectively extinct.  Remarkable.

I will not go into any further details, but rather leave you to enjoy this extraordinary book, a most helpful guide, and incredible read.

To your health,
Dr. 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.

Ebola Update- Solon and Hathaway Brown

Ebola Update- Solon and Hathaway Brown
This morning, two schools in Solon- the middle school and the Parkside Elementary School- and the Hathaway Brown School took steps relating to the Ebola virus.

In Solon, a staff person in the middle school was said to be on the same plane, but a subsequent (not the same) flight, as the nurse who flew from Cleveland to Dallas on October 13.  The two schools are closed today for disinfection.

At Hathaway Brown, a student was said to have had contact with the infected nurse who was visiting NE Ohio, and that student is not attending the school today.

In both instances, Solon Schools and the Hathaway Brown Schools are taking precautions.  There is no indication that anyone in NE Ohio, or any part of Ohio actually has an Ebola virus infection, even today.

In the case of the middle school staff person in Solon, being on a flight following the infected nurse's flight, even on the same plane, should not pose any risk to that person getting the Ebola virus infection.  But, even if that person did, she would not be contagious for typically a couple of weeks, and so could not be contagious now, and is very very likely not even infected at all.

In the case of the student at Hathaway Brown, it is again, likely that she is not infected.    But, even if someone did get infected this week, again, they would not be contagious now.

This note is no comment on the decisions taken by the Solon Schools or the Hathaway Brown School.  They have all the facts of their situation, we do not.   But it is clear that these steps were taken, as a precaution, not because anyone else in Ohio has been found to be infected with the Ebola virus.

Precautions are quite fine and prudent, of course, but the message has to be very clear: there is no Ebola virus epidemic in Ohio, or even one threatening to occur.

Again, we appreciate that even the mention of Ebola virus in our own community is a frightening event.  We take your concerns very seriously, and respect the concerns of all involved.

We will continue to update you as information becomes available to us.

Right now, the situation is actually quite good and reassuring.  To the best of everyone's knowledge, there are no people in Ohio currently infected with Ebola virus.  Steps are being taken to track and contain any such possibility.  And so today we are safe, and the outlook is excellent that we will remain so.

Dr. 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 Evidence of Ebola Exposure in Akron or Cleveland as of October 15, 2014

Questions on Ebola Exposure in Akron or Cleveland

[NOTE: This is an update from our original post earlier on 10.15.14]

Many of you have contacted our office with questions and concerns regarding the recent Ebola news. We appreciate that you have reached out to us for information and support during this time. 

It was reported on Wednesday, October 15, 2014, that the second health care worker in Dallas to come up positive for Ebola virus infection was in the Cleveland area a few days ago.

At this time, there is no evidence that this person exposed anyone to her Ebola infection in the NE Ohio region.

Here is what we know.

September 28, 2014

The second health care worker, who I will refer to as Ms. SW (second worker), was exposed to a contagious patient with Ebola virus infection on September 28, while caring for the patient in the Dallas hospital.

September 28 -October 12, 2014

Ms. SW felt perfectly well and had no fever or sense of being ill.

Ms. SW was in the Akron/Cleveland area during some of this time.

October 13, 2014

Ms. SW flew from Cleveland to Dallas on Frontier AIrlines #1143 which landed in Dallas at 8:16 PM.

She is now known to have had a fever while on this flight.

October 15, 2014

It was reported that after getting ill, Ms. SW was tested for Ebola infection and found to be positive.

KEY POINTS

1.  Ebola, to the best of our knowledge, is not contagious until symptoms such as fever appear.  That means if you spend time with someone with Ebola virus infection before they get sick, you cannot catch Ebola virus from them.

2.  Since Ms. SW had a fever on October 13, she was possibly contagious during her flight.   Anytime prior to her getting symptoms, such as fever, she was not contagious, and contact with her prior to onset of symptoms should not lead to catching the Ebola virus.

3.  All the passengers on Flight #1143 of Frontier AIrlines Ms. SW was on are being evaluated, since they were in the airplane with while she had symptoms.

4.  Ebola virus is contagious only by contact, NOT by breath.  So one would have to be touching Ms. SW in some way, have actual physical contact sometime after she got symptoms, that is, sometime October 13 or later, to be at risk.

4.  ANYONE who is concerned that they may have been in contact with Ms. SW on the flight on October 13 or later, should call the CDC HOTLINE at 1-800-232-4636.

My impression, at this time, is that this second health care worker from Dallas, who spent time in Akron/Cleveland, is likely not to have spread her Ebola virus infection while in Akron/Cleveland, unless someone was actually in physical contact with her around October 13.    To be clear, if someone did have physical contact and did so while she was contagious, they may have been infected with Ebola virus, but that person could not spread it until they developed symptoms.

We will keep you updated as more information becomes available.  We understand the anxiety and fear that this Ebola outbreak is causing here in Northeast Ohio, as well as nationwide. We endeavor to be a voice of knowledge and reason and will keep you updated on the most recent facts and concerns as they become available. We appreciate your trust in our opinions regarding this issue. 

Again, any questions on worries about exposure to this person should be directed to the CDC at 1-800-232-4636.

Dr. 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.

Enterovirus D68- What is it, What to Do?

Enterovirus D68- What is it, What to Do?

This summer a new outbreak, an unusual outbreak, from a virus called Enterovirus D68.  This virus is causing some very serious trouble, and so we thought it would be helpful to explain what we know about it, and what to do.

What is a Virus?

As the name makes clear, all enteroviruses are types of virus.  

Viruses are very strange sort of thing, they are packages of information wrapped in a coating that forces cells to make more copies of themselves.  The information comes in the form of genetic material, either DNA or RNA and in every virus known these genes always code for instructions that force a host cell to activate the viral genes and then create a huge number of copies of the genes and new protective coats.

The protective coats of viruses are always made of a set of proteins that shield the virus from attack from an immune system, and contain properties that allow the virus to spread from person to person, find the right cell to infect, enter the cell, and deliver the viral genes to that cell to make copies.

What is an Enterovirus?

An Enterovirus refers to a very large number of viruses that cause a large number of viral illnesses in people.  One subset of the Enterovirus family is the common cold virus, or Rhinovirus, but most Enteoviruses are described as belonging to a several subsets designated by letters, such as Enterovirus A, Enterovirus B, Enterovirus C, etc.

The prefix entero-, means having to do with the intestines, so the word enterovirus really minus, a gut or intestinal virus.

This makes sense since the typical Enterovirus causes a range of illnesses that include most of the stomach flus that happen in the summer, hand-foot-mouth disease, a high fever/stiff neck illness, and a simple bout of very high fever without any other symptoms.

One curious property of these, the typical Enterovirus illnesses, is that they only happen in the summer months, or close to them.  This is a very important point and quite striking.   The usual enterovirus is nowhere in the US in the winter.  Almost no city in the US in the winter has the typical enteroviruses that cause stomach flu around in January.  But come July, suddenly every city in the country is loaded with these viruses, in every neighborhood.  No one knows why they disappear in cold weather and how they so suddenly erupt in the summer everywhere.

Another key property of Enteroviruses is that each subset or type has its own character, and some subtypes appear in clusters of cases over discrete periods of time.  So there can be an outbreak of one particular Enterovirus subtype that creates a large number of cases over a few months, or even a few seasons, then disappears for many years, perhaps to never return, or to return in a few or many years hence.

We have seen years in which an Enterovirus creates a large number of cases of high fever, stiff neck, and very severe headache, for example.  There have been stretches of 4-5 years of many such cases, followed by 10-20 years of far fewer.

So a particular subtype of Enterovirus can appear suddenly, then disappear as quickly, causing a stretch of time in which a striking illness occurs across the nation, followed by a stretch of time when such an illness disappears or becomes far less frequent.

What is Entervirus D68?

Remember that there are groups of Enteroviruses grouped by letters, like Enterovirus A and Enterovirus B?  Well, this Enterovirus D68 is part of the Enterovirus D species of Enterovirus.

And it happens to be the 68th one in the group, hence Enterovirus D68.  (There really are hundreds of all the different subtypes, or serotypes, of Enteroviruses, and five known Enterovirus D's.)

Enterovirus D68 is one of the subtypes of Enterovirus that come in clusters.  There have been prior outbreaks of infection with Enterovirus D68, but none as large or concerning as the current one.

We do not know yet, but the hope is that with winter, this Enterovirus D68 will act like prior outbreaks, and like most Enteroviruses and stop causing illness during the winter.

Even more importantly, the hope is that this outburst of Enterovirus D68 is only this season, or if more, just a few years.  This is a real hope, as noted such striking subtypes as Enterovirus D68 often drop off over time.

What Illnesses Does Enterovirus D68 Cause?

The Enterovirus D68 is different than most classical Enteroviruses in that it infects the lungs more than the guts, so it causes more breathing problems than vomiting and diarrhea.  But sadly, it also seems to attack the nervous system, although not as commonly as the lungs.

Here are the key symptoms seen.  That means, if one gets an infection with Enterovirus D68, it causes these symptoms most commonly.  It does not mean if you have these symptoms you have Enterovirus D68:

• Nose symptoms:  runny nose, sore nose, sneezing, headache
• Throat symptoms:  sore throat, hoarseness
• Lung symptoms:  cough, wheeze, real trouble breathing
• Nerve and Muscle symptoms:  less commonly than the above- weakness, inability to move limbs (paralysis).  These symptoms are not yet proven to be caused by Enterovirus D68, in one outbreak in Colorado, nine children developed loss of movement function (paralysis) and have Enterovirus D68 infection, but none of the virus was found in their cerebrospinal fluid, so we need further study to know if this symptom is indeed possible with this infection.
• Some gut symptoms:  mildly loose stools, stomach aches
• Skin symptoms:  various rashes

What to DO!

The answer to what to do is the same for Enterovirus D68 as it is for every virus:  if symptoms are mild, just keep your child comfortable.  If symptoms are worrisome, call us for help, and we will arrange for care to reduce the danger the infection presents.

Why do all viral illnesses have the same advice?  Because for nearly all viral infections, there is no drug or treatment that kills the virus or heals its inflammations. 

When to Worry

Even if one is infected with Enterovirus D68, if the only symptom is a mild runny nose, there is no cause for any concern.

And of course, even if the virus is not Enterovirus D68, if someone is struggling to breathe, you should call for help right away.

So, for Enterovirus D68, we are less concerned and there is very little to do, if symptoms are limited to this list:

• runny nose, sore throat, cough, mild stomach aches, mild rash, and/or slightly soft stools;  but, breathing fine when not coughing.

If any of the following symptoms appear, call for help right away:

• Severe difficulty breathing, meaning your child has to work very hard to get air in and out of his or her chest
• Muscle weakness beyond the mild tiredness of being ill.  Your child seems very weak, and of course, if they cannot move an arm or leg

If we see your child and they have the mild symptoms, the treatment will be to keep your child comfortable at home without any specific testing.  As long as the symptoms remain mild, it makes no difference what the virus is, the treatments and care remain the same.

If we speak to you or see your child and they have the more severe troubles of struggling to breathe or having significant changes in muscle strength, then the treatment is quite different.  In this situation we would arrange for evaluation and care at the hospital.  Tests for Enterovirus D68 and other viruses and germs would be done, and specific therapies to help a person breathe and to help a person who is getting weak, would all be started.

Bottom Line

1. The Enteroviruses are a very common and large number of viruses that typically cause the summer stomach flu, hand-foot-mouth disease, and other mild summertime illnesses.
2. Now and then subtypes of the Enterovirus family show up in outburts that bring unusual and severe disease.  This is what is happening with Enterovirus D68, a strain causing quite severe and unusual breathing problems.
3. As with nearly every virus, there are no drugs to cure or heal the infection.  
4. When it comes to knowing when to worry, when your child gets a cold or respiratory infection, it does not matter so much what the name of the virus is, even if it is Enterovirus D68.  What does matter is how sick your child is.  If the cold or respiratory infection is mild, no worries.  If the infection is causing your child to struggle to breathe or become severely weak, then it is time to worry, to call us for help.   Again, this is true no matter the name of the infecting germ.
5. Lastly, this outbreak of Enterovirus D68, which has caused so many cases of severe trouble breathing, will hopefully go away.  Time will tell.  Enteroviral outbreaks of severe illness typically appear mainly in the summer for several years, then seem to stop happening.  Our hope is that this round of Enterovirus D68 is limited solely to the summer of 2014, goes away this winter, and does not return.  We will watch to see how it goes.

To your health!

Dr. Lavin

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