Food Allergies: Do you have them or not?

Food Allergies:  Do You Have Them or Not?

A recent study found that there is a large difference between testing positive for a food allergy, and having one, so we thought it would be helpful to clarify, how do you know if you have a particular allergy to a food?

Let's start by making clear that food allergies are very, very real.  There is no question that lots of kids have them and that they can cause lots of trouble.

It turns out that there are essentially three types of tests available to find out if someone has an allergy to a food (or anything else).

To understand how these tests work, it will help to know a few basics about allergies.

An allergy is a reaction that happens when something you are allergic to connects with a very specific antibody, unleashing a general reaction.

To be clear on each of these elements of an allergic reaction:

• The something you are allergic to:  This is usually a unique molecule, often a protein, in the food or thing one is allergic to.  For example, if someone is allergic to milk, they react to just one protein in the milk.  So, the whole reaction will not happen unless that protein is present.
• A specific antibody:  Antibodies most distinctive property is that they only bind (connect) to one type of molecule.  The body can make trillions of different antibodies, but only chooses to make many thousands.  You cannot be classically allergic to something without making an antibody that attaches to that item, and only that item.
• A general reaction:  Here is how the allergic reaction actually happens:  the thing you are allergic to connects with the specific antibody, once that happens that connection activates the antibody to turn on the allergic reaction.  No exposure to what you are allergic to, no reaction.  No specific antibody to that item, no reaction.   

So you need 4 things to happen to be have an allergic reaction to a food:

1.  You have to eat or contact the food.

2.  There has to be an antibody to that food not only present in the body, but armed and ready to ignite the reaction once the food comes by.

3.  The food molecule and antibody need to connect, that complex needs to activate the allergy reaction, and then the allergic reaction happens.

The Three Tests

So with that in mind we can understand the three test for food allergy:

1. Blood Test
2. Skin Test
3. What Happens if You Eat it Test

Blood Test

This test simply measures how much specific antibody to the food in question is circulating in your blood.  This is not the same as measuring how allergic you are, since only antibody linked to particular cells that actually activate the allergic reaction are relevant.  That is, one could have enormous quantities of antibody to shrimp, for example, circulating around in your blood, but none actually connected to the cells that cause a reaction.   You could do the blood test, find a very high level of antibody, but nothing happens when you eat the shrimp.   Or the other way happens too, where there is no or little antibody circulating, but lots on the relevant cells, the blood test is negative, but every time you eat shrimp you have a big reaction.  Now, it does turn out that the more antibody to a food circulating, the more likely someone will react when they eat it; and, the less antibody present the less likely someone will react when eating the item, but not always.

Skin Test

This test actually sees if exposure to the food can create a visible allergic reaction.  The problem is that it only really tells us if scratching the food molecule into the skin will cause a reaction.  Again, it does turn out that the more skin reaction to a food being scratched into the skin, the more likely someone will react when they eat it; and, the less reaction in the skin the less likely someone will react when eating the item, but not always.

The What Happens if you Eat it Test

This is by far the most reliable of all three tests.  And for an obvious and good reason- if you eat a lot of peanuts and you experience no reactions, then either you have no antibody to peanut molecules, or the antibodies are not activated to create a reaction, you are not allergic.  And if every time you eat peanuts you develop hives, lip swelling, and wheezing, you are most definitely allergic.   This test, therefore, trumps all other tests.  For that particular meal, there is no error rate, you either react or you do not, that time.

The Study

In 2010 Dr. Liu et al (J Allerg Clin Immunol. 2010; 126(4): 798-806) found that about 17% of children in the United States have a positive blood test for allergy, but only 2.5% of children in the United States actually react when they eat any food.

Simply put, a person is nearly 7 time more likely to have a positive blood test for food allergy, than to actually have a food allergy.

What to do?

Given all the above, what's the best way to find out if your child is allergic to any particular food?

Here are some tips on how best to proceed:

• Guage how urgent finding out is.  If your child has a very slight symptom that has only occurred once, that is clearly less urgent than if your child has trouble breathing each time something is eaten.
• If the reaction is very mild (and the best guage on severity of reaction is the degree of trouble breathing caused by the reaction), you have the option of trying to see if the symptom goes away if your child stops eating the suspected food.  This is half of the "What Happens if You Eat It" test.    If you are very confident that the reactions you are seeing are very mild, one can try out the other half of this test, see if any reaction happens when your child eats the suspected food.   Of course, if there is no reaction on eating it, and no change in symptoms when not eating, he or she is not allergic.  And, if there are allergy symptoms when he or she eats it and those symptoms go away, there is an allergy to that food present.
• If the reaction is not mild, then it becomes prudent to do some of the indirect tests noted above, namely skin and/or blood tests.  These tests, as noted, are not 100% predictive of food allergy, in fact the national survey quoted above suggests the blood test will overcall a food allergy diagnosis quite a bit.   But if the skin and/or blood tests are negative, it gives you a bit more ease of mind (not proof) that you can do the "What Happens If You Eat It" test, at least with less risk.
• If the reaction is severe, that is, trouble breathing in the chest or mouth/throat, occurs, then the first step needs to be elimination of the suspected food(s) from your child's diet immediately and consultation with an allergist to sort out just what is causing the reaction.  Again, skin and blood tests will likely be used in this situation, too, and will again help point the way to a conclusion, but even here they cannot be the final word on what your child is allergic too.

Bottom Line

The question of whether your child has a food allergy always will hinge on whether they actually have an allergic reaction when they eat that food.

Skin tests and blood tests measure indicators that one may or may not be allergic, they are not proof of an actual allergy sequence being active in your child.

In the case of blood tests, nearly 7 times as many children test positive as actually react.

This makes the What Happens if I Eat it Test the most reliable way to know if your child has a food allergy to that food.   This test is safe when the reactions are very mild.

But, if there is any question of a reaction involving trouble breathing, an allergist should be consulted to sort out what is causing this level of reaction.

As always, we hope this information proves helpful.

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.

A Special Ebola Update: A Briefing by Dr. Tony Fauci set by The White House

A Special Ebola Update: 
A Briefing by Dr. Tony Fauci set up by The White House

[Updated October 23, 2014 9:00PM]

Dear Families,

At Advanced Pediatrics we have worked hard to try to keep up to date with the rapidly changing picture that the Ebola virus and its infection has been presenting to the world.  Lately, we have focused on the nature of this infection in the US.

The Briefing
Tonight, I am very honored to share with you the very latest information available in the United States on Ebola.  As a state director for Ohio in the organization, Doctors for America, I was invited this evening to be part of a special, invitation only, briefing by Dr. Anthony Fauci put together by The White House, on the state of Ebola.  No press were invited, so this information is not part of the usual news cycle.

The White House selected a small group of doctors from across the United States to help get as accurate a picture of what is happening with Ebola right now.  This posting is the first communication I have made to anyone on what I learned from Dr. Fauci.

Dr. Tony Fauci
Leading the briefing is one of the world's great minds in the area of new, deadly, viral infections.  Dr. Fauci currently serves as director of the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Health charged with research and care of such diseases.  He is known across the world as one of two scientists who led the work that revealed the cause of AIDS and its nature, namely HIV.  As such, he is uniquely positioned to know in depth the details of the virus Ebola.

The briefing was moderated by Ms. Andrea Purse, The White House Director of Broadcast Media.  

I was joined by roughly 15-20 doctors, each from a state across the US, from NY to Utah.

What We were Told, What We Learned about Ebola Tonight
Here are the key points communicated to us tonight:

• Ebola is not changing its nature much despite many mutations.  Dr. Fauci did note that the Ebola virus is a type of virus in which the genes change rapidly as it transmits across a population, but the vast, vast majority of these changes in its genes, have no impact on it actual nature or function.   These sorts of virus change their genes frequently, but do not really change their behavior much over time.
• How it spreads remains very stable and unchanging.  An enduring feature of the Ebola virus spreading is that all strains studied need direct contact.  None of them have developed the ability to survive being dried out and spreading across the air for any large distance.  The virus must remain in a wet state, hence the repeated references to bodily fluids.  It is most concentrated in sweat and blood.  Sneezing and coughing can produce wet particles that can travel several feet and create direct contact.  So for example, if someone with Ebola coughed, in particular if they had bloody sputum, wet droplets landing on an uninfected person who then wiped their eyes while the droplets were wet, could catch Ebola.  But if that person coughed and the droplets in their cough dried out before landing on someone else, which is what typically happens with sneezes and coughs, then it will not spread.   Dr. Fauci noted that across the whole history of viruses, none that required direct wet contact have ever mutated into one that could be spread by dried out airborne transmission.
• There is no American outbreak now, nor is there likely to be one.  A total of two people to date have caught Ebola in the United States and not one of their contacts so far have caught it from them.  Therefore, the only instance of Ebola spreading, in the United States, is in the very unusual setting of being a health care worker exposed during care of a sick patient in protocols that are no longer current.
• A note on how the two nurses in Dallas got Ebola.  Dr. Fauci is also the doctor caring for the nurse from Dallas now in an NIH hospital in Washington.  He shared his impressions after having had the chance to talk with her about her exposure.  It turns out that when she was caring for the patient with Ebola in Dallas, the protocols in place were developed in Africa, for exposures limited to care such as IV placement in a relatively informal quonset hut like setting.  These protocols contained over 20 Ebola outbreaks in Africa in such settings.   But in the ICU setting in the US, so much more can be done, including intubation, deep central IV lines, etc.  This leads to a far more intense level of exposure to far more bodily fluids, and the old protocols did not protect against that.  These protocols are now updated which will protect health care workers much better.  But the main point here is that the Ebola case caught in the US, are limited to only 2 cases, to situations that no longer exist:  health care workers intensely exposed in an ICU setting without the new protocols for ICU exposures in place.
• The status of the Ebola vaccine.  There are two vaccine trials in place.  Each use a harmless virus as a transport virus to deliver the not infectious Ebola fragment to the immune system- thereby creating safe immunity to Ebola virus infection.  Both have worked in monkeys.  One is being tested in humans now and as of Sept. 22, has not shown any harm to people.  By sometime in November, results should be known of how well it protects people.  The plan, if the results look good, is to have a many thousand person trial in West Africa launched by the end of November.  If that goes well and no bad reactions are found, a vaccine for Ebola that can stop this illness may be in hand.
• Our current US Strategies.  The key challenges are threefold:
• Identify all those infected
• Transport without spread to qualified facilities
• Care for those with Ebola infection

           The US plan is to have every hospital in the country able to identify anyone who comes to their facility who has an Ebola infection.

There are currently 3 hospitals in the US, per Dr. Fauci, that are fully ready to care for anyone with an Ebola infection:  one in Nebraska, the NIH hospital in Washington, DC, and the Emory Hospital with the CDC in Atlanta.

Plans are to focus actual care of those infected in these three hospitals, but to develop a small network of hospitals with various levels of expertise in a tiered system providing care across a range of regions.

• The current Ebola strains seem to affect children less than adults.
• What about travel bans?  Many people wonder, why not simply keep everyone from the most concentrated areas of infection, Sierra Leone, Liberia, and Guinea out of the US.  It turns out a complete travel ban may have a paradoxical effect.   Right now, the US has a policy that travelers from these 3 countries can only enter the US via two airports in NYC, and one at Dulles, Atlanta, and Chicago.  Anyone from these 3 countries must go through an intensive Ebola screening process before they enter the US.  About 96% of travelers from these three countries entered the US via one of these five countries before the policy was in place that all had to. Now 100% do and they all undergo the Ebola screen.  If a ban were imposed, we would not know where they are coming from, their travel will then go undetected, perhaps via another country and go anywhere into the US.  Further, the only real hope of eliminating the chance of a US outbreak is to eliminate the outbreak in W Africa.  A travel ban would not only be cruel and deliver a signal that the US shuns them, but such a signal could lead to a collapse in efforts to contain and conquer this outbreak in W Africa, leading to an explosive spread across their borders.
• What are the key misunderstandings?  The #1 key misunderstanding is that impression that some mis-steps constitute an actual outbreak.  There is no Ebola outbreak in the United States at this time.  Dr. Fauci anticipates a small number of people with Ebola will continue to get through even the best policy to limit US exposure [one man in NYC may be such a case, he came in from Liberia], but seriously doubts that number will rise beyond a handful of people, particularly if efforts to reverse the outbreak in W Africa succeed.   But he does recognize that having some cases come into the US, a hospital missing the diagnosis, 2 nurses getting Ebola, all erode trust, and raise worry.  But that worry must be put to good use, to learn about how Ebola really acts, to support good science and its principles in winning the fight against Ebola.  Dr. Fauci sees no benefit in reacting purely out of fear.  Diverting planes, closing businesses when there is little reason to believe anyone could catch Ebola on these planes or in these businesses only raises fear, and does not reduce the spread of the virus.

Bottom Line

• Ebola is a dangerous virus that will require great human ingenuity to contain and, ultimately eradicate.
• At this moment, there is no Ebola virus epidemic in the United States.  The total number of people who we know have been infected with Ebola in the US is 2. 
• A key feature of the Ebola virus spreading is that all strains studied need direct contact.  None of them have developed the ability to survive being dried out and spreading across the air for any large distance.  The virus must remain in a wet state, hence the repeated references to bodily fluids. 
• There is good hope for an effective vaccine. This along with a worldwide effort in West Africa establishes a good reason to believe that human ingenuity will indeed defeat this virus.
• It is critical that efforts to eradicate Ebola infection in West Africa prevail, that careful care of the small number of infections that will appear in the US and other countries is very doable, and is being done.
• Ebola demands our respect and care.  But a very thoughtful response is rapidly coming into place.  We have every reason to not only hope, but expect this infection will not pose danger to us here in the US, and that the world can defeat it in West Africa.

We will of course continue to keep you as informed as we can be.

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.

Good Rx- a great app

A New App to Help you Find the Right Price-

For Prescriptions

UPDATE 1/29/15

I wrote this note some months ago, and just today, Good Rx let me know that 7 patients in the practice have used it and saved a total of $980.68!  (NOTE:  I have NO relationship with Good Rx, I do not collect any fees from them, or the drug stores.  I only recommend it as a fellow consumer and advocate for your family).

Take a look at GoodRx

It's an app that will, based on your location, and the medication your are buying, lists the cost of your prescription at area pharmacies, and available coupons.

Some of the ranges can be quite dramatic- one place may tell you that it will cost you $100 and another, with coupon, $30, for example.

Once you locate the best price, many pharmacies will then price match.

So take a look, see if it helps.

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.

What is a Virus?

What is a Virus?

In the last few months, three viruses have gripped our attention.  The influenza virus because of a few weeks of possible flu immunization shortage, the emergence of the Enterovirus D68 a summertime virus that turned into a real attack on the breathing system, and of course, the Ebola virus.

And, of course, we all know about colds.  Everyone gets them, they cause so much agony, and they are so common.

All these, and many other infections are caused by a very peculiar type of life, the virus.  So we thought it might be interesting to present in a little more detail what is a virus.

The Basics- what's in a virus, how do they work?

Viruses are the simplest and one of the oldest forms of life.  Other forms of life include the bacteria, the yeasts and fungi, the animals, and the plants.  All these forms of life consist of either single cells (bacteria, yeast), or groups of cells (fungi, animals, and plants).  But not viruses.  Viruses are the only type of life that has no cell.  Because they are not cells, some even wonder if they are really alive.

But all agree that viruses can reproduce and adapt, so by that skill many consider them very much alive.

Viruses are also a very old form.  They are at least several billions year old.  Compare that to the current human line, which at most is  150 thousand years old.  No comparison.

Viruses do reproduce and change, but can only do so using some other form of life's cells.  No cells, no viruses.  Without their own cells, how do they reproduce and evolve?

The answer is very interesting.  They are actually packages of information.  Every virus has a bit of genetic material (DNA or RNA) inside, wrapped in a protein coat.

The protein coat picks the lock to the cell that virus can infect.  Once inside, the protein coat then delivers its inner contents, the genetic core, to the cell's genes.  There the virus takes over the cell's machinery and forces it to spin out a huge number of copies of the viral genes and their protein coats. In this way, one virus in one cell can lead to the creation of a staggering number of new viruses, ready to repeat the cycle over again.

Why Viruses are Often so Specific to One Type of Life
So this means that to live, a virus has to find a way into a cell, and a way to go from cell to cell.  This is no mean feat, in fact it is astounding.  It is so challenging, that with few exceptions, every virus can only get into the cells of one species.

The cold virus for a chicken can only give chickens colds.  Measles virus can only give humans measles.  Other viruses can only infect certain bacteria, others only one species of plant, and so forth.

There are also viruses that have figured out how to crack the code of various species, usually on type of life.  So there are viruses that can infect several animals.  But there are few, if any, that can infect various animals and plants.

Perhaps the most prolific virus is the influenza virus which infects nearly all humans during the winter, but only infects animals in the spring and summer- usually barnyard animals and birds.

How do Viruses Make us Ill?
The answer to this question has two answers:
1.  Viruses destroy cells
2.  Viruses change the function of cells

In many of the most common and mild viral illnesses, like colds and flus, viruses actually destroy the cell they use to reproduce.  Remember that the way all viruses work is that their genetic material takes over the host cell gene machine and forces it to make copies of the viral genes, to make more viruses.   If in that process a zillion viruses are copied, the cell often pops from the expansion, and dies, releasing the zillions of viruses.  This kills the cell.   If enough cells die, then a patch of tissue is left destroyed and inflamed.  This is what happens to your nose when you get a cold.  It really is very much like a mild burn, the lining of the nose gets destroyed by viruses popping sheets of cells.
Any viral infection like this makes us ill by literally burning away a sheet of cells, causing pain, inflammation (this is where fever comes from), and lost of fluid leaks (runny nose, vomiting, diarrhea, for example)

Sometimes, though, the cell is not exploded from rampant viral copying.  In these situations, the virus still takes over the cell's gene machine, but the virus has it create an ongoing production line of viruses, not enough to pop the cell, so the cell continues to live, but it stops working normally.  The most famous example of such an infection is AIDS, where the cells of the immune system are infected but not destroyed.   In many ways, we are better off with viruses that kill cells, especially if they are superficial cells, for then the body makes new, healthy cells to replace the dead ones.  But if the cell lives and lives well enough, it will continue to work (even if abnormally) and this can cause much and long-lasting dysfunction and trouble, as in AIDS.

And then, some viruses can lie dormant for years.  They insert there genes into the host cell and then just sit there and do nothing.  In this situation the person is not ill, but if the virus kicks on and starts making tons of copies at some point, an illness could erupt.  This is the story of chickenpox and shingles, where once the chickenpox illness is over, the same virus just sits dormant in the cells near the spinal cord.   Every now and then they reactivate, travel down the nerve to the skin and this is shingles.

How do we Recover from a Viral Illness?
The only way our body can recover from a viral illness is to kill every cell that is actively infected with a virus.  We can't actually kill a virus since on its own it is hardly alive.  But if our body kills every cell that contains a certain virus, then that virus will be cleared from our body.  This strategy works only if the body can identify every cell containing that virus and kills all of them.
And, this is exactly what happens in colds and flus.  Our body goes after every infected cell, and the infection and virus is completely eliminated, new cells are made to take the place of those destroyed by the virus, and we heal.
If our body cannot do this, the viral infection becomes chronic, like AIDS, and many hepatitis viral infections.
And, in the case of dormant viruses, the body leaves these alone, the cells that contain the virus look no different from normal cells because the virus is not doing anything, so the infection is lifelong, but dormant, like dormant chickenpox that simply sits there unless a shingles flare occurs.

How do We Treat Viruses?
A handful of viruses can be cured by treatment with anti-viral drugs, viral antibiotics.
These include influenza, hepatitis C, and some herpes viruses such as CMV and herpes simplex.
In each of these examples, the drugs do help, but are not 100% effective.

But, for nearly all other viruses, there are simply no drugs that actually kill the virus, speed up the healing from all the havoc they cause, or even end the symptoms they create.  This is most vividly experienced with common colds and stomach flus, where drug stores have shelves bursting with products promising an end to runny noses and coughs, or diarrhea, but always fail to deliver.  At this time about 500 drugs promising relief from viral symptoms are under investigation by the FDA for false claims. Five hundred such drugs under investigation!

Two viral symptoms that can be treated by drugs are fever and pain, and we recommend ibuprofen (Advil, Motrin) over acetaminophen (Tylenol) due to questions about whether acetaminophen may boost the development of asthma.

How do we Prevent Viral Infections?
We are all strongly drawn to the idea that if we simply take this or that action, we can stop the spread of viruses through a classroom, school, or home.  The evidence, however, is overwhelming that viruses travel from person-to-person astounding well, despite kids being kept home when ill, despite hand-washing, despite nearly any effort.  Just looking at the sweeping waves of viral infections that cover continents in a matter of days dramatizes the fact that trying to stop a virus from spreading, especially common, very contagious ones, is like trying to stop the wind.

Given that very few viruses can be treated, and none of the very contagious ones can be stopped from spreading, that leaves us with only one control measure that has had any real impact- immunizations.

The body has figured out how to protect itself in one of the great triumphs of clever evolution, one we recover from a virus, it is almost always the case we cannot get it again.  If you get measles, you never get it again.  If you get cold variety #281, you never can get sick from cold #281 again (of course, you can still get cold #282).

This very natural, very important key to our survival is the whole basis of the idea of immunization.  If you can't get a viral illness twice, why not deliver a very mild case of that illness, so when the real thing comes along, you can no longer get it.

Do immunizations work?  Just take a look around.  Smallpox in the 20th century killed 500 million people, more than World War I, World War II, the Korean War, and the Vietnam War, and all other wars in that century, combined.   But because of immunization, and only by this strategy, smallpox is now eliminated from the planet.  It worked.

And, it has worked in every case- measles, mumps, rubella, even chickenpox, hepatitis B, polio, all are sharply reduced.  In areas where immunizations are used by nearly everyone, these diseases are essentially eliminated.


Bottom Lines
1.  Viruses are curious packages of genes wrapped in proteins.  The proteins gain access to the target cell, the genes make the cell make more viruses.
2.  In destroying the cell, the virus causes the illness.  When sheets of cells are destroyed, the illness is where the irritation takes place- runny nose in the nose, sore throat in the throat, cough in the lung, diarrhea in the gut.
3.  Only a small number of viruses can be killed by a medication, almost none of their symptoms can be relieved by medication.
4.  It is next to impossible to stop the spread of a very contagious virus.  Some viruses are quite rare and do not spread well, and these are the very, very rare examples of viral infections that can be controlled by containment (e.g., SARS, Ebola).
5.  The only action that has ever really spared us from the diseases caused by viruses has been immunization, which has had a spectacular and dramatic record of success.


To you 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.

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.