The Zika pandemic:  
UPDATE FEBRUARY 26, 2016

Two items are new since the last update:

1.  There are now over a dozen documented cases of Zika infection being transmitted by sexual contact in the US.  So Zika as an STD seems to be a real and established route of contagion.

2.  There are doubts being aired about whether Zika causes birth defects.  What we know is that when Zika erupted in Brazil, cases of very small heads in newborns, microcephaly, erupted as well.  Is there a connection?  It is not yet known.  Major investigations to answer this question are underway.

The last update from a couple of weeks ago remains, therefore, very current, and is placed here for your reference once more, some edits to update this post are included:

The Zika virus continues to erupt across the tropical Americas.

A great resource as this epidemic unfolds will always be the CDC at:
http://www.cdc.gov/zika/index.html

Please note that there have been zero (0) cases of the Zika virus caught BY MOSQUITO in any state of the United States.    This is still true at the end of February.

There have been new cases caught by mosquito in Puerto Rico and the US Virgin Islands, but none in Florida, Texas, or any other state.

With more cases of sexual transmission of the Zika virus documented, Zika viral infection is more established as a known STD.

Now, how long is a man with Zika virus contagious, via sexual contact?  No one knows, but one semen sample was positive 10 weeks after the man was infected.

It still remains the case that by far the gravest danger posed by the Zika virus may be to developing babies.

But some deaths have been reported from people infected with Zika, so the risk is no longer considered solely born by the fetus.

The bottom line at this time is that if you want to avoid getting infected by the Zika virus, you and your family need to stay out of areas where it is now very active, namely the tropical Americas [Mexico, Central America, Northern half of South America, the Caribbean], Samoa, and the Cape Verde Islands.  Men who travel there should abstain from sexual contact or practice completely safe use of condoms for an indeterminate number of months.  If their wives are or may become pregnant, the precautions must be taken for the duration of the pregnancy.

BOTTOM LINES

1.  A virus long dormant in Africa spread to French Polynesia in 2007, and now is exploding across the tropical Americas, the Zika virus.

2.  In adults, the vast majority of infected people either don't get sick at all or have mild symptoms.

3.  Less commonly, adults can get significant pain in muscles and joints.

4.  Adults with the infection can have the neurologic complication of Guillan-Barre syndrome which is typically transient.  Now some have died from the infection.

5.  A very disturbing aspect of the Zika virus is its ability to infect babies of pregnant women and that it might cause damage to brain development.

6.  Adults and children need to weigh the risk of serious infection if they plan to travel to tropical Americas, Samoa, and Cape Verde Islands.  The risk of getting infected is real.  There are neurologic complications and now even death reported.

7.  Pregnant women should know that traveling to tropical Americas, Samoa, and Cape Verde Islands could be catastrophic for their developing baby.
8.  If a woman who even may become pregnant has a partner who has traveled to the  tropical Americas, Samoa, or Cape Verde Islands, she should abstain from sexual contact during the entire pregnancy.

The main point is that no one in Ohio can currently, or is likely ever to, catch Zika virus while in Ohio, except through sexual contact with an infected partner.  Travel to Zika active areas is a very real risk to all.

To your health,

Dr. Arthur Lavin

---

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

The ZIKA Epidemic: Update Feb. 12, 2016

The Zika pandemic:  
UPDATE FEBRUARY 12, 2016 

The Zika virus continues to erupt across the tropical Americas.

A great resource as this epidemic unfolds will always be the CDC at:
http://www.cdc.gov/zika/index.html

Please note that there have been zero (0) cases of the Zika virus caught BY MOSQUITO in any state of the United States.  

There have been new cases caught by mosquito in Puerto Rico and the US Virgin Islands, but none in Florida, Texas, or any other state.

There is a bit more information on sexual transmission of the Zika virus, but the key fact still today is that we do not know much about sexual transmission of Zika.   To date, there have been 3 events of actual or possible sexual transmission.  All were from men, none so far from women.
Two were from a man to a woman, and one was the finding of Zika virus in the semen of a third man.
The men all had symptoms.

Now, how long is a man with Zika virus contagious, via sexual contact?  No one knows, but one semen sample was positive 10 weeks after the man was infected.

It still remains the case that by far the gravest danger posed by the Zika virus is to developing babies.

But some deaths have been reported from people infected with Zika, so the risk is no longer considered solely born by the fetus.

The bottom line at this time is that if you want to avoid getting infected by the Zika virus, you and your family need to stay out of areas where it is now very active, namely the tropical Americas [Mexico, Central America, Northern half of South America, the Caribbean], Samoa, and the Cape Verde Islands.  Men who travel there should abstain from sexual contact or practice completely safe use of condoms for an indeterminate number of months.  If their wives are or may become pregnant, the precautions must be taken for the duration of the pregnancy.

BOTTOM LINES

1.  A virus long dormant in Africa spread to French Polynesia in 2007, and now is exploding across the tropical Americas, the Zika virus.

2.  In adults, the vast majority of infected people either don't get sick at all or have mild symptoms.

3.  Less commonly, adults can get significant pain in muscles and joints.

4.  Adults with the infection can have the neurologic complication of Guillan-Barre syndrome which is typically transient.  Now some have died from the infection.

5.  A very disturbing aspect of the Zika virus is its ability to infect babies of pregnant women and cause damage to brain development.

6.  Adults and children need to weigh the risk of serious infection if they plan to travel to tropical Americas, Samoa, and Cape Verde Islands.  The risk of getting infected is real.  There are neurologic complications and now even death reported.

7.  Pregnant women should know that traveling to tropical Americas, Samoa, and Cape Verde Islands could be catastrophic for their developing baby.
8.  If a woman who even may become pregnant has a partner who has traveled to the  tropical Americas, Samoa, or Cape Verde Islands, she should abstain from sexual contact during the entire pregnancy.

The main point is that no one in Ohio can currently, or is likely ever to, catch Zika virus while in Ohio, except through sexual contact with an infected partner.  Travel to Zika active areas is a very real risk to all.

To your health,

Dr. Arthur Lavin

---

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

Introducing Healow- Your Web Access to Your Child(ren)'s Health Record

Introducing Healow- 

Your Web Access to Your Child(ren)'s Health Record

Dear Family,

As many of you know, 2016 is the year Advanced Pediatrics will be rolling out exciting new online services for you and your family.

The first was made available on February 10, 2016, and is called Healow.

Healow is the name given to the web access app of our electronic health record company, eClinical Works, or eCW.  We have worked with eCW to manage your child(ren)'s charts for many years and have been pleased.  The fact they are one of the largest means they are also very reliable.

So it was good news to us when eCW created Healow.

What is Healow?

Healow refers to a website that provides secured access to you to your child(ren)'s medical information.

With the right username and password, and practice code, Healow will direct you to a web-page that allows you to:

• Request appointment times from actual times made visible to you that are open on our scheduler.
• Request refills on ongoing medications
• View your child(ren)'s lab results
• Access health records, including the ability to view and print your child(ren)'s immunization records.

These functions are now available to you on any device, including smartphone, PC, tablet, laptop, etc.

The Patient Portal

Ultimately, Healow, the website, operates via a function of the electronic medical record called, The Patient Portal.   The Patient Portal is a highly secured communication function that allows us to send messages to your family and for you to send messages to us with all the confidentiality required to meet HIPPAA requirements, but more importantly, ensuring the communications are kept private.

The Patient Portal allows for secured email communication, and is now open to use.

Getting Started

To access all the functions of Healow and the Patient Portal here is what has to happen:

1. Only families of children who receive their care at Advanced Pediatrics can enroll in these services, of course.
2. Call the office, or when you are here, talk to our front desk professionals and simply ask them to set up your username and initial password.   They will do that and print out directions for how to use your username and password to access the Patient Portal and Healow

Using Healow

To use Healow:

1.  Go to the App Store and/or to Google Play to download the Healow app.  
2. When you open the Healow app, on any device, enter our practice code GDGIAA, enter your Patient Portal username and password, and you will enter Healow for Advanced Pediatrics, strictly in relation to your child(ren) and no one else.
3. Once in, the functions available will be made visible and available to you.

Some notes on Appointment Requests

We are very excited to make online appointment requests available. 

Here is how that works:

1. When you choose this function, you will be asked to pick a provider you want to see.  
2. All the times in the coming few days available will be placed on the screen, pick one.
3. Enter the reason you want to come in.
4. Once you do these three things and submit the request, the request will enter that time and date on our master schedule.  Our front desk professionals will make sure the reason for the visit makes sense in the time slot requested.  If all makes sense, they will email a confirmation that the visit is set to you.  If not, they will call to make a mutually better arrangement.
5. Keep in mind that once you place your request, the appointment is not made.  The system requires our front desk to confirm the appointment before it is set.  In every instance though, you will hear from the office, either: the appointment will be confirmed via your email, or you will hear from us how it needs to be changed.

Future Innovations

We are currently trying out an ear examination module that is built of the iPhone camera, that will allow parents to take a picture of your child's eardrum and allow us to see if an ear infection is present via a virtual office visit.  Other image and video based technologies are being explored as well.

Of course, as these innovations designed to make working together as easy as possible are put into place, you will be notified right away.

To your health,

Dr. Arthur Lavin

---

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

The Zika epidemic- UPDATE February 4, 2016

The Zika pandemic:  
UPDATE FEBRUARY 4, 2016 

The major development since our first posting was the report of a case of Zika virus infecting a person via sexual contact with another person with Zika virus infection.

http://www.nytimes.com/2016/02/03/health/zika-sex-transmission-texas.html?ref=health&_r=0

This event changes the chances of getting the Zika virus infection.  Until yesterday, it was thought it could only happen via a mosquito bite in areas of the world the mosquitoes carrying Zika virus live and are very active, currently tropical Americas.  

Now the possibility of catching the virus from a sexual partner has developed.  We do not know if this is an extremely rare happening, or common, or anywhere in between.  But it has happened so it is very likely to happen again, we just don't know how often.

It still remains the case that by far the gravest danger posed by the Zika virus is to developing babies.

This means only pregnant women are a great risk from the infection, because only if a pregnant woman gets infected can the developing baby be harmed.

Our observations and recommendations remain largely unchanged, but for the consideration of partners traveling to the tropical Americas, Samoa, and the Cape Verde Islands.

For any woman who might even possibly become pregnant, it is important that if their partner travels to the tropical Americas, Samoa, and the Cape Verde Islands that they be sure their partner did not get a Zika virus infection during the trip.  This turns out to be impossible to know without testing, as 80% of adults infected develop no symptoms.    There are tests, though that can be done.

The incubation period of the infection is 1-7 days, so your partner could get the infection 1-7 days after being bitten by a mosquito in the tropical Americas, Samoa, or the Cape Verde Islands.

The blood banks are accepting blood after 28 days after a person leaves a Zika active area, so the risk of transmitting the virus is likely to have passed after 28 days.

We recommend that if you are a woman who has any chance of becoming pregnant with a partner who has traveled to the tropical Americas, Samoa, or the Cape Verde Islands, that you abstain until your partner has been tested and determined to be free of Zika virus infection.  This should be done under medical guidance.   It is helpful to know that simply waiting 28 days, as far as we know today, should be sufficient to be safe.

BOTTOM LINES

1.  A virus long dormant in Africa spread to French Polynesia in 2007, and now is exploding across the tropical Americas, the Zika virus.

2.  In adults, the vast majority of infected people either don't get sick at all or have mild symptoms.

3.  Less commonly, adults can get significant pain in muscles and joints.

4.  Adults with the infection can have the neurologic complication of Guillan-Barre syndrome which is typically transient.

5.  The most disturbing aspect of the Zika virus is its ability to infect babies of pregnant women and cause damage to brain development.

6.  Adults and children need to weigh the risk of serious infection if they plan to travel to tropical Americas, Samoa, and Cape Verde Islands.  The risk is low.

7.  Pregnant women should know that traveling to tropical Americas, Samoa, and Cape Verde Islands could be catastrophic for their developing baby.
8.  If a woman who even may become pregnant has a partner who has traveled to the  tropical Americas, Samoa, or Cape Verde Islands, she should abstain from sexual contact until her partner is proven to be not infected.

The main point is that no one in Ohio can currently, or is likely ever to, catch Zika virus while in Ohio, except through sexual contact with an infected partner.  Adults traveling to Zika areas are at low risk.  Pregnant women face real danger to their babies if they travel to Zika active areas.  Given that it can be transmitted sexually, women who even may become pregnant must take precautions if their partner travels to Zika active areas.

To your health,

Dr. Arthur Lavin

---

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

2016:  

An Exciting Year Ahead- 

Starting with Refridge Art!

Dear Families,

Happy New Year, Welcome to 2016, we hope the year brings much health and happiness to us all.

This year promises to be one of tremendous activity, renewal, and excitement at Advanced Pediatrics.

THE OFFICE

The first change is the office itself.  Those who have been in have noticed a major renovation in the works, and it is almost completed.

Thanks to the generosity and personal attention of our tremendous landlords at ORG Property, a gifted young architect helped us redesign our floor and wall color schemes, and create a new front desk and reception structure.  The new carpeting, the new wood-like flooring, the calm greens create a new, updated look.  Our TV is now flush with the wall eliminating any chance of bumping heads.

We also have a new look to our alcove in our check-in area.  We have elevated the look from the lovely clouds to the inspiring artwork that reminds some people of stars across the universe, and others of neurons connecting across our brains, and still others of atoms blinking their light.

Still to come are re-framed diplomas and art work to fit with the new decor, a really neat set of coat hooks that look like type-set letters.

We have had many, many thank yous from families for taking this step.  We are so, so glad the changes are accomplishing what we hoped, to let everyone enjoy an updated look, one that reflects our way of providing care- calm, effective, uncluttered, and friendly.  We even think of our waiting room as no longer built as a place to wait, but rather a place to check-in.  There will be some waiting, especially of parents waiting for their older child's appointment to be over, but hopefully not many will be sitting there long.

REFRIDGE ART

Our landlord had this wonderful, whimsical idea and our architect made it work.

So now there is a truly very old refrigerator door that has been re-enameled and mounted on our office wall.  No worries, there is no refrigerator to open to, it is just a door to hang your child's art.

The concept is really easy.  Just offer any art your child has made that can be held by a refrigerator magnet, and we'll display it for a time on that door.

Art will be cycled, as new art comes in, already displayed art will go into a box.  Any family member can retrieve the child's art from that box during regular office hours.  Art not collected after some time will end being disposed of.

So bring the art in, it should be a great addition to our office look.  It will be fun to see your child's art on display.  Do know that we will occasionally take photos of that door and post them on public social media, such as Facebook and Instagram, etc.  So the art may be seen by many!

EXCITING INITIATIVES

Reducing Autism

There are few fates as frightening as autism.  Rates are on the rise, and no one has found a way to reduce the chance that the next child will have it.

I am very excited to be one of 10 members of a national Organizing Committee that is doing something that could reduce the chance of a family having a child with autism for the first time in history.

The project is called Project Targeting Environmental NeuroDevelopmental Risks, or Project TENDR.  Our Organizing Committee has assembled 45-50 of the country's leading experts, from Harvard, and the NIH, and across the country, to help identify the top chemicals implicated in causing not just autism, but ADHD and learning disorders.  The Project is soon to release its first statement, identifying these compounds.  The experts anticipate a reduction of exposure to these compounds of even 25% could lead to a 15-40% drop in the risk of a child developing autism!

I am also very honored to represent the Project TENDR in direct conversations with Senator Sherrod Brown and the Surgeon General of the US, Dr. Vivek Murthy.  I am working with them and their staff to ensure Project TENDR has the best approach to changing actual US policy to see real reductions in the exposure of our children to the neuro-toxins.

I hope soon to be distributing this first Project TENDR report, it will state what compounds we should all avoid.  

In early March I will be attending the workshop in California that will devise specific policy approaches to reaching this incredible goal of actually dropping the risk of autism, ADHD, and learning disorders.

ADHD

Although I cannot yet state the outcome of work being done with the American Academy of Pediatrics, I can share that I am on the Committee of the Academy charged with developing policy for matters relating to the psychological well being of children in America.  And, that I am working on what may be an important report on ADHD.  I hope in 2016 I will be able to share more on this very important topic.

NEW BLOGS, NEW PUBLICATIONS, NEW SOCIAL MEDIA

2016 promises to be a very exciting year in the practice, especially in a look on-line.

E-mail Essays

We will continue our many year tradition of writing substantive pieces that are geared to really help families deal with many common, and some uncommon but troubling, issues.   A word of thanks to all the families who have expressed such wonderful enthusiasm for these email essays.  It really encourages us to keep it up.   And many thanks for sharing these emails with friends and family, we have been very touched by the spread of these ideas, and so glad they help.

Edible Cleveland

In 2016, I will continue to serve as the health columnist for a gorgeous and very thoughtful journal, Edible Cleveland.  This publication comes out 4 times a year, one for each season, and so do its sister magazines across the US.  It is a great honor to be part of this publication effort, and I encourage all to get a free copy in our office whenever you like.

Our New On-Line Look and Functionality

The last couple of years have seen Advanced Pediatrics begin to have an online presence.  

2016 promises to be a year of a whole new look to our web page with much greater integration of our web page and our social media presence.  Look for this to be unveiled later this year.  The new look will also feature a far more robust delivery of messages, and will in time include many of the technology innovations listed below.

Exploring New Ways to Connect
We are very excited about exploring new approaches to helping you connect with us to answer questions and concerns.  We have already initiated explorations of on-line services.  The services we are exploring include approaches to online appointment requests, a virtual office visit process, and even some exciting approaches to examination from a distance.  We are definitely in the exploration mode, but are finding very good leads, and hope to have some solid news about these ideas in the coming weeks.  

CONTINUED COMMMUNITY BOARD SERVICE

This year, 2016, will continue to see Drs. Hertzer and Lavin offer their time to two of our community's great non-profit organizations.  Dr. Hertzer serves on the Board of Trustees of Bellefaire, which will be reaching 150 years of extraordinary service to the youth of our region (http://www.bellefairejcb.org/).  And, Dr. Lavin serves on the Board of Trustees of the Saint Luke's Foundation, formed by the sale of St. Luke's Hospital, it is now one of the five largest private foundations in NE Ohio and grants funds for improving life in the old St. Luke's neighborhoods, and Cleveland (http://www.saintlukesfoundation.org/).

BOTTOM LINES

1.  Happy New Year.  We hope 2016 is a very Happy and Healthy Year for us all!

2.  We have a new look to the office, and are so glad so many families have found that its great.

3.   Part of our new look is Refridge Art.  Feel free to post your child's art on our refrigerator door, we would love to see it on display.

4.   Advanced Pediatrics is very much in the center of  big developments in the world of autism- helping to do something never done before- actual reduce the number of families whose children will develop autism.

5.   E-mail essays continue, columns in Edible Cleveland continue.

6.   A whole new look to our webpage, and a much advanced approach to social media is coming in 2016.

So, lots happening for families at Advanced Pediatrics, be sure to let your friends know we are welcoming new families to the new practice this year.

To your health,

Dr. Arthur Lavin

---

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

Thermometers are Inherently Inaccurate, and That's OK

Thermometers are Inherently Inaccurate, 

and That's OK

One of the most common questions we get asked is what thermometer do we recommend, and questions related to temperatures taken.  Is an ear thermometer better than an axillary thermometer?  Do you add a degree if you take it axillary (under the arm)?

Some background on fever

These questions all have to do with the question of fever itself.  At the heart of the concern of fever is the very real worry, how will I know if this illness is going to be dangerous or mild?  Fever turns out to be a bad guide.   How is that possible?  Just think, someone can have a very mild illness, a harmless cold, but still have a fever of 105.8, or someone could have a very dangerous infection such as a meningitis, and only have a fever of 101.  The height of the temperature does not indicate the seriousness of the infection.

So when we hear your child has a fever, we think, the fever means an infection is present, now let's determine if it is a mild or serious infection.  Mild by the way means that the infection poses no harm and once gone will leave no trace, not that your child will feel good while they have the mild infection.  In fact, most mild infections, like colds, flus, and stomach flus, cause tremendous discomfort, but they don't cause any lasting harm.   So even though the discomfort is not mild, the danger is very mild, because there is no real danger in such infections, as long as they do not change into more serious conditions, of course.

What is normal temperature inside the body?
So with the fact that the temperature, as long as it remains at 105.8 or below, is not an issue of concern by itself, in mind, let's take a look at how thermometers used in our homes work, or don't.

The real definition of fever by the way, is an elevation in core, not skin temperature.  The core temperature is very close to constant if no fever is present.  Across all humanity, the average core temperature is 98.6 degrees Fahrenheit (or 37 degrees Celsius).  This is an average, normal temperature for an individual ranges from about 97 to about 99 or even 100.  That range is a range across all people measured.  For any one person, their normal temperature is a number in that range, with some, but not much variation from time to time.  Again, these numbers describe the actual temperature of organs inside your body, like your blood, lungs, kidneys, etc.

The temperature of our skin varies quite a bit as part of our body's mechanism to keep our inner core temperature as constant as possible.  If our inner body temperature is dropping, the skin diverts blood flow away from the skin to preserve heat, this causes the skin to get cold.  This is experienced by anyone outdoors for some time in the cold, or if a fever is going up and is experienced as feeling chilled.  If the body's inner temperature is too warm, the skin boosts blood flow causing it to flush and feel warm.

But the temperature that counts is the actual temperature of the inside of the body, the temperature of the organs all of which only function well in a very narrow range of temperatures, really about 96-105.8, and typically around 97-99.

How do the thermometers in use perform?
About 40 or more years ago, the standard thermometer parents used was the rectal thermometer, and it gives a pretty accurate read of the actual temperature of the inside of the body.

But no one uses this technique routinely anymore.  The new thermometers are ear, axillary, and infrared thermometers.  All of these thermometers measure skin temperature, and as we just discussed, the skin and inner temperature often vary.

One recent study found they vary quite a bit:

http://www.ncbi.nlm.nih.gov/pubmed/26571241

This study looked at 75 publications with about 8,600 patients tested.  They found that if a surface thermometer (ear, axillary, or infrared) found an elevated temperature, the child had a 96% percent chance of having a truly elevated inner or core temperature.   So a temperature over 100.4 by any thermometer in common use almost certainly means your child has a fever for real.

The surface thermometers were fairly inaccurate with common levels of error hovering around 1/2 to 3 full degrees Fahrenheit.  So the actual number on your thermometer is not nearly as important as whether it is over 100.4.

BOTTOM LINES
1.  Fever is not as important as how your child is doing to determine if the illness present is mild or serious.  (See post from 2011 below).  Therefore, the number of the thermometer is not that important.
2.  What is important is whether your child with a fever is having trouble breathing, in significant pain, or has a stiff neck.   If none of these symptoms are present and they seem comfortable, a serious infection is much less likely.
3.  Therefore, taking a temperature is not a very helpful indicator of how sick your child is.  A rise in temperature is related, however, to how uncomfortable one is.
4.  The relative unimportance of the temperature is good news given how unreliable the read of the temperature is on the surface in relation to the inner or core temperature.  Whether using ear, axillary, or infrared technology, you are getting mainly surface temperatures which vary from 1/2-3 degrees Fahrenheit off the actual core temperature.
5.  But, if your thermometer registers a temperature of 100.4 or higher, it is almost certain a fever is present.
6.  If you do take a temperature and report it to us, just tell us the number the thermometer gave you and how you took it.  There is no value in adding a degree or subtracting a degree for various techniques.
7.  Put it all together and we have that taking a temperature is not very important, it often bears little relation to the actual inner temperature.  This is fine because of much more value is knowing if your child has symptoms of more severe illness, such as trouble breathing, stiff neck, or significant pain.

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.

 Reminder that Fever is Harmless (Posted March, 2011)

Advanced Pediatrics was very pleased to be contacted by a reporter from Suite 101.com to discuss the recent American Academy of Pediatrics (AAP) campaign to remind families that fever is not a harmful symptom.

Suite 101.com is rated as one of the top 10 blog spots and receives 28 million hits a month, so we were especially pleased that we could get our message out to over 300 million people a year.

Here is our interview, we hope you find it informative and helpful.

http://www.suite101.com/content/american-academy-of-pediatrics-launches-fever-phobia-campaign-a357897

Our key points are:

• Fever remains a fearsome symptom for two key reasons:

1. For most of human history, infections were the number one cause of death in childhood, causing as many as one in four children to pass.
2. Even today, fever makes everyone feel terrible.

• Fever today should no longer create fear for two key reasons:

1. In the US and the rest of the developed world, death from infection is now very, very rare in childhood.  Fever no longer indicates a likely hazard.
2. Fever, although uncomforrable, is not dangerous.  Everyone gets fevers, everyone.  With almost no exceptions, fever itself causes no actual harm.

• More important to be concerned about than fever are signs of serious infection:  Stiff neck, trouble getting air in and out of the chest, severe pain, worrisome rashes.

Dr. Arthur Lavin 

Updates on Three Key Infectious Epidemics This Winter (2015-2016)

Updates on Three Key Infectious Epidemics 

This Winter (2015-2016):

• Influenza
• Stomach Flu
• Hand-Foot-Mouth Like Illness

As we approach February, we thought it would be of interest to hear how the winter flus and illnesses are shaping up for this year.

Every December we brace for the onslaught of influenza virus infections, the germ for which we offer flu vaccine, but this year was a surprise in two big ways.

INFLUENZA VIRUS

The first very big surprise has to do with the 2015-2016 influenza virus epidemic.  Keep in mind that every typical year, the influenza virus suddenly appears across North America sometime in December, peaks around New Years, and fades away in the next 2-3 months.

Not this time.  This year, so far, is officially a big dud.   We are experiencing some of the lowest incidences of illness from the influenza virus.  No one knows why.  It may have to do with more people getting the influenza vaccine, but we await more information before knowing if that is the case.

Take a look at the map and graphs at the CDC influenza tracking site:

http://www.cdc.gov/flu/weekly/index.htm#ILIMap

The US map turns red as the virus becomes epidemic, green means hardly any has appeared.  In January, nearly every year, the US looks very red, I have never seen it this green in this graphic.  Truly a very low influenza year, very nice!

STOMACH FLU

The stomach flu is an illness usually unrelated to influenza, which causes more respiratory troubles.  It's typical season, during the era of rotavirus infections, was in February.  But rotavirus infections have nearly disappeared given mass immunization against it in the US.  But now comes noravirus, the famous virus of the big cruise ships, taking the place fully of rotavirus, and causing the same symptoms:  fever, vomiting for a few days, and diarrhea for a week or two.

We have been impressed at the number of cases of stomach flu starting late in November of 2015 and cooking along at a good clip still in January 2016.

No surprises here.  The good news is that if your child can sip some fluids during the 1-2 days of heavy vomiting, we don't see much dehydration or any other complications from this year's infection in the gut.

THE HAND-FOOT-MOUTH LOOK ALIKE

A few weeks ago, we saw a number of children in the office all with the same unusual rash:  blotchy red bumps on the face around the mouth along with small pimple-like dots on the body, sometimes including the palms and soles.  On the body, the rash appeared in a variety of forms on the same child:  blotchy red bumps that could be 1-2 inches across, red bumps with a tiny white head to them, red bumps that look more like mosquito bites do.  The mouth is often fine, but sometimes large cold-sore like lesions are seen on the back of the throat.  None of these children have tested positive for strep.

The occurrence of rash on the mouth, foot, and hand, is reminiscent of hand-foot- mouth disease (HFMD), but HFMD usually has more uniform rash, and rarely has that blotchy large red bump appearance on the face.  Further, HFMD is caused by a species of virus called enterovirus which typically appears in June and goes away by September.

This infection may be an odd winter appearance of an atypical enterovirus, but is more likely simply a different virus, and not true hand-foot-mouth disease.

The course and care are similar though:  no drugs clear the rash, but comforting helps and should be offered.

BOTTOM LINES:

1.  GOOD NEWS:  Almost no influenza infections this winter, so far.

2.  NO NEWS:  Stomach flu is rampant but that's expected.

3.  BAD NEWS:  An odd hand-foot-mouth like illness is here, completely unexpected.

4.  For all three infections, the approach is the same for all viruses, know that antibiotics do not kill or heal viruses, comfort and care is the best treatment, fever is a normal event, but call if signs of serious illness occur:  severe pain, trouble breathing, not urinating or looking limp or weak, stiff neck.

To your health,
Dr. Lavin

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