Participation in a Major New Paper- from the AAP, on Poverty

Participation in a Major New Paper- 

from the AAP, on Poverty

The American Academy of Pediatrics (AAP) has published a major new policy statement on the topic of poverty in this month's (April, 2016) issue of Pediatrics.    And I am very honored to be listed as one of the authors as the member of an AAP Committee that participated in the drafting of the document.

http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339

As many of you know the AAP is one of the world's leading pediatric professional societies.   It has a very wonderful history of helping children.  The AAP, in fact, was founded in protest against AMA actions that tried to block the government from providing free milk to poor children, in the 1920's.  When the AMA lobbied Congress to block this bill from passing, the pediatricians walked out of the AMA in protest and created the AAP.

Since that time, the AAP has been one of the only doctors' societies whose main purpose has not been the doctors, but rather the children we serve.

This major paper is firmly in that tradition.  Every few years, the AAP identifies the top three priorities facing children in America.   When the Academy identified poverty as a top priority, that was a major event.  Our Academy found that one of the top three priorities defining the health of children was not a disease, was not an infection, but a creation of our own national community.

I applauded that decision, as I agree with our Academy that poverty creates worlds of suffering and dire impacts that are at the root of many of the major catastrophes children face today, including
mental health conditions, lethal and disabling injuries from gunfire and other violence, malnutrition, and higher rates of more traditional diseases such as asthma.

It is a real honor that for several years I have served on one of the national committees of the AAP, the committee charged with setting policy for the Academy on matters pertaining to the psychological and social health of children and their families.  One of the jobs of this committee is to draft and/or review policy statements adopted by the Academy and published in Pediatrics, widely regarded as the leading journal for pediatric papers in the world.  

I would encourage you to read this paper, Poverty and Child Health in the United States.

http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339
I consider it an historic publication, as it calls our national community to witness that poverty is a problem we have created, that we can dramatically reduce, and that not doing so has very real, durable, and identifiable health consequences for our children.

As our committee publishes other policy statements of the Academy, I will be keeping you informed.

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.

Zika Pandemic Update: April 13, 2016

The Zika pandemic:  
UPDATE APRIL 13, 2016

Three items are new since the last update:

1.  The Zika virus has now reached close to complete confirmation that it does grave harm the developing brain of the embryo and fetus, at anytime during pregnancy, not just the first trimester.

2.  There are Americans who have traveled to areas where Zika have spread and have come home to the US infected with Zika virus.  Over 300 such cases now have been reported in nearly every state, including Ohio.

3.  Men seem to harbor the living virus in their reproductive fluids longer than women.   For men with the virus, therefore, it can be transmitted for over a month after the man gets infected, whereas once the woman recovers from the infection, typically a week or so after the mosquito bite, she is no longer able to pass the virus along to a partner or baby.

4.  There are still NO KNOWN CASES of transmission of the Zika virus from someone who is in the continental US to a person in the continental US via a mosquit0.   However, enough people in the US have the virus, that once the mosquitoes come out, it is very possible that transmission via mosquito will start taking place.  It is currently thought that such outbreaks in the US will be in small clusters, and mainly in the southernmost parts of the country, namely southern Florida and Texas, but only time will tell.

The last update from February remains 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 as of April 13, 2016/

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 now fully 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.  But the infection in anyone from childhood through adulthood is very unlikely to cause harm, 80% of all people infected, at any age, have no symptoms.

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 is now known to  cause damage to brain development at any time during pregnancy.

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.  This would only change should mosquitoes in Ohio start carrying the virus, a very unlikely possibility.

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.

Strong, Frequent Hits to the Head aren't Good for the Brain

Strong, Frequent Hits to the Head aren't Good for the Brain

This may be one of the dumbest headlines we have written ever.

Who wouldn't guess that hitting your head hard, and often, could increase the chance of brain damage?

But it turns out to be very big news for any person who plays football or has a child who plays football, or other head impact sports.

The Journal of Neurotrauma has just published a study that shows that the number of times your head is snapped back during sports play after your body (not just your head) is hit, predicts later loss of brain function better than the number of concussions.   http://online.liebertpub.com/doi/abs/10.1089/neu.2016.4413

The New York Times has a summary of their findings.  http://www.nytimes.com/2016/04/01/health/study-focuses-on-repeated-hits-not-concussions.html?rref=health&module=Ribbon&version=origin&region=Header&action=click&contentCollection=Health&pgtype=Multimedia

The findings, although very plausible, are very disturbing.  The key findings were as follows:

• The risk from snapping of the head to the brain begins in high school.  It is not an NFL only problem.   Head injuries and high school and college can cause lifelong impairments.
• The harm to the brain can come from direct hits to the head, or body blows that snap the brain.  It is the acceleration of the head, moving suddenly, even more than a blow to the head that hurts the brain.
• The life-long impairments following such blows to the body and head include:
• Loss of the ability to think clearly (cognitive impairment)
• Impaired ability to complete tasks at home and work (impaired executive function)
• Depressed mood and energy levels (depression)
• Loss of interest in life (apathy)
• The development of outbursts of abnormal behavior (behavioral dysregulation)
• These impairments can start to show up anywhere from age 25 to 85, well after the person stops playing the sport that causes the head injuries.
• Even if the person experiences few or no concussions, these head snapping injuries still are associated with all these impairments.

BOTTOM LINES

• Sports are not free of risk- the most worrisome risk is the risk of losing brain function from sports that ask our kids to hit or snap their heads, hard
• Loss of brain function can be set in high school and college
• Sports that involve injuries to the brain may cause impairments in thinking, mood, even ability to be effective in the world that can last a lifetime and appear long after the person leaves high school and college.
• Football in particular stands out as a sport that can hurt the brain, even in young people, even in high school and college, not just the NFL.  In many ways, the impact of football on the brain is being revealed as more and more like boxing.
• The choices are also becoming very clear:
• Change football so that the brain is no longer hurt
• OR, protect our youth from these injuries by not playing football.
• Football is not alone, heading the ball in soccer, and other sports that require hitting the head in the sport should change their practices, and avoid brain injury.
• Since tracking concussions may miss most of the harm done, it becomes all the more important to focus efforts on making sure our children don't engage in activities that hit their head frequently.
• THE BOTTOM LINE:  The brain is important.  Frequent hits to the brain may cause permanent damage.  Some responses are inadequate, including trying to treat these injuries.  The only approach that makes sense is to stop the injuries from happening to begin with.

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.

Influenza Infections in Ohio: February 2016

Influenza Infections in Ohio:  

Update as of February 2016

The influenza virus is one of several very curious germs that show up in our part of the world in a seasonal pattern.  That is, there are months in every year when essentially no one in Ohio gets infected with the influenza virus, and there are also months in every year when the virus is rampant.

Typically, the influenza virus arrives in Ohio in December and leaves us by March and April, peaking around New Years.

The virus causes mainly colds, aches, and fevers, with runny noses, sore bodies, high fevers, terrible coughs, as well as some familiar complications like ear infections and viral pneumonias.  Altogether, these illnesses are also known as respiratory infections.

In a typical winter in Ohio, about a third of respiratory infections from viruses are from influenza viral infections.  That's right, even during a heavy epidemic year of influenza virus, about 2/3 of colds and flus are from other viruses that are completely unrelated to the influenza virus.

The 2015-2016 influenza virus infection, so far

So how about this year's influenza epidemics, how is it going here in Ohio?

Two facts really stand out:

1.  It showed up late.   The appearance of the influenza virus, not just on Ohio, but across the United States, did not really burst on the scene in December, or January.  Around the usual peak time, New Years, it wasn't even at epidemic level.   But as of mid-February, we are seeing a big jump in its appearance in the US, almost two months late!  The jump is mostly in the American SouthWest.

2.  Ohio is starting to see more, as of mid-February.   State-by-state tracking shows Ohio was essentially dormant for the influenza virus all through 2016, until very recently.  Even now, the latest reports show Ohio being a relatively quiet state with only local, isolated outbreaks of influenza.  But Kentucky, Iowa, and New York are now showing very widespread influenza viral appearances.

BOTTOM LINES

The influenza virus is a very seasonal player, but rather than peak around New Years, it appears to be emerging later in the year, around now actually.  

So stay tuned, we may be seeing a big jump in respiratory colds and flus now and in the coming weeks.

Of course, even if the influenza virus does not jump forward, the other viruses that cause respiratory colds and flus of course have been very active and causing plenty of them.

Also, a brief note on Tamiflu.  I always pay careful attention to the disclaimers in drug commercials, they only state the worst of the side effects, so if they are mentioned, you can be sure those side effects happen and are deeply troubling.  The current ad on TV for Tamiflu states something to the effect that children in particular are at risk for suffering a seizure if they take Tamiflu.  This does fit with known side effect profiles of Tamiflu.  Further Tamiflu is not very effective in pediatric influenza infections, providing only modest relief.

Given that it tends not to offer substantive relief, and puts children at risk of having a seizure, we do not advise use of Tamifly routinely for flu infections in children.

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.

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

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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.