The Fieldstone Farm Therapeutic Riding Center

The Fieldstone Farm 

Therapeutic Riding Center

Last week I had the distinct pleasure of being shown the Fieldstone Farm, one of our region's most incredible agencies for help and change.   My extraordinary tour was led by the President of the Board and longtime friend, Mr. Tom Rathbone, and the inspired Executive Director, Ms. Lynnette Stuart.

The Fieldstone Farm was created 35 years ago, and offers a unique form of help to those in need- the relationship of people and horses.  This relationship is old enough that we can say with confidence that we as humans evolved together with horses so that we are both who we are in some measure in relation to each other.

With that in mind, riding a horse, being with a horse, being connected to a horse, offers benefits to any person.

And it is for that reason that riding a horse can help people with a wide range of troubles and challenges, in particular those of us with issues in these categories:

• Physical disabilities
• Cognitive disabilities
• Psychosocial disabilities

In each instance, the unique dimension of connection between horse and rider changes the life of the rider, often changing their experience of their challenge, opening up new directions for growth, change, and recovery.

Consider the fact that if you tape a video of a rider while simply sitting on a horse while the horse walks, the rider's spine and limbs fully and automatically replicate the normal motions of walking.  This opens the world of walking to a child or adult with problems that might keep them from experiencing the sensation of walking.  These would include conditions such as severe cerebral palsy, progressive deteriorating conditions such as ALS.

Or, consider the power of the horse, a large animal connecting with the rider, on the rider's own moods and perceptions of self.  The Fieldstone Farm experience has helped large numbers of our community help advance social skills, increase confidence, stabilize moods, relate to other people more effectively.

The Fieldstone Farm has taken the impact of the horse and rider relationship to the world of academics and runs a great high school, Gaitway, that is very successful in finding motivation in students who seem to have lost it all.

The program also has a very vibrant volunteer program that involves formal training and certification.  In 2011, 650 people volunteered over 22,000 hours of time, learning a lot about horses, and people.

This remarkable program has been a great help to many families in our practice over the years, and so I thought it would be helpful for you to hear about the great work being done there.

If you are interested, check out their fascinating website:  www.fieldstonefarmtrc.com

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.

Beware of the False Pneumonia

Beware of the False Pneumonia

Pneumonia.  

We are seeing a continuing and rather dramatic rise in how often families are told their children have pneumonia, especially in ER's and Urgent Care Centers.

But it turns out that the pneumonia that these centers are talking about is quite different than what most people think pneumonia is.   

For most of history, and in most everyone's mind, pneumonia was a very dangerous illness, caused by potentially very deadly bacteria.  Pneumonia was an illness where bacteria created a lot of pus in the lungs, causing a very rapid decline and significant danger.  

Technically, this is a form of pneumonia called bacterial pneumonia, and when you get this disease, you get very sick, very rapidly, and in its more severe forms, you can get quite a bit sicker every hour.  Some forms of this disease can also be quite dramatic in their recovery, with some people getting so much better on antibiotic that they feel good within hours of starting antibiotic.

This is not the disease that is being diagnosed as pneumonia thousands of times a day in ER's and Urgent Care Centers across the country.  The pneumonia being diagnosed so frequently now is a type of pneumonia, and so technically is not a "false pneumonia," but it often is an illness that really has no relationship whatsoever to bacterial pneumonia.

The illness being called pneumonia, most frequently in children, is really a type of cold, that in the vast majority of circumstances poses no risk to the safety of a child, and will not benefit at all from use of antibiotic.

What is this form pneumonia that is so unrelated to what we have all long thought pneumonia was about?  It is an illness called viral pneumonia.

Viral pneumonia can be very severe, but in the vast majority of cases seen in kids, it really is, as noted above, much much more like a cold than like bacterial pneumonia.   

Bacterial pneumonia in its full form tends to be a very rapidly progressing process where you get seriously ill very rapidly and can get worse every hour.  Left untreated, bacterial pneumonia can be a very dangerous illness.  At its heart, bacterial pneumonia destroys lung tissue and creates a ton of pus in the lungs.

Viral pneumonia, typically, makes you breathe faster and cough a lot, but does not much more than that.  It can also cause fever and feeling lousy, but it tends to make you ill to a certain degree- a certain amount of fever, misery, cough- and then you stay that sick for a few days or weeks, then recover.  There is typically, in the most frequent  mild forms, no progression.  Rather, you just sit there at that level of illness for a long stretch of time.  Viral pneumonias, at their heart, cause swelling and mucus production, some pus, but not nearly as much as with the unrelated illness, bacterial pneumonia.  

And, there is essentially no drug that cures viral pneumonia.  Antibiotics are useless for this disease, since antibiotics only kill bacteria, and there are no bacteria to kill in the illness, viral pneumonia.

Now here is the core source of confusion between these two very different, unrelated diseases, you can't tell the difference between them by looking at a chest X-ray.  The X-ray, CT Scan, and MRI cannot tell the difference between pus and mucus.  Bacterial pneumonia makes pus, viral pneumonia mucus, no imaging scan or X-ray can tell the difference between the two.

This confusion led the nation's two top professional societies on the subject of pneumonia* to make a formal recommendation that a chest X-ray NOT BE DONE ROUTINELY when a child is seen in the ER with a question of pneumonia.  Further, these societies noted that the vast majority of pneumonia in childhood is viral, not bacterial, pneumonia; and, therefore antibiotics should NOT BE PRESCRIBED ROUTINELY, if it clear the illness is more viral in nature.

BOTTOM LINE:

1. The two diseases, bacterial pneumonia and viral pneumonia, are not similar, related, or have anything to do with each other, beyond both affecting the lung.
2.  Bacterial pneumonia can be very dangerous, making you sicker by the hour, and involves production of lots of pus in the lung.
3. Viral pneumonia, in its typical form (note that it too can be very severe, but 99% of the time is not) causes much misery from fever and cough, but tends to hover at a certain level of intensity, not changing dramatically over time, but lingering.
4. In children who are not dangerously ill, that is who do not require oxygen, can breathe fairly easily, the vast majority do not have bacterial pneumonia, they have the other illness, viral pneumonia.
5. Chest X-rays and antibiotics are not useful for mild, viral, pneumonias.  In fact, in their milder forms, the viral pneumonias are more accurately described as bad colds in the lung and not "true" pneumonias.  At least they bear no resemblance or connection to what most of us think of as a real pneumonia- which is the bacterial form.
6. Here is the key point:  more than anything else, the difference is in how sick your child is.  That, far more than a Chest X-ray, will determine if the process is dangerous and bacterial or very safe and viral.

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.

What is a Virus?

What is a Virus?

Every child ever born, indeed every one of us, will experience an infection with a virus in our lives, on average about 8 a year.  These infections cause the vast majority of colds, flus, stomach flus, fevers, aches, and so it makes sense that as parents, you know what is causing all this misery, and why it always seems that nothing helps.

What is a virus?

It turns out that a virus is a very, very peculiar thing.  It is in someways alive, since like all living things, it reproduces.  But in other ways it is not alive, since unlike living things, it an exist in a dried crystal form for nearly forever.

My own sense is that a virus is a form of information.  You might wonder, how could knowing something make you so sick?  It turns out the sort of information that is a virus is the information that commands and controls processes, in this case the genetic codes of our body's cells.

Every virus contains just two elements- a strand of genes and a coating of protein.  Each of these elements has one simple purpose.  

The coating of protein picks the locks of the cell and allows the strand of genes entry to the cell's genes.

The strand of genes also has only one purpose- to force the cell to stop what it was doing and turn all its resources towards making copies of the strand of genes and coating of protein.  Once zillions of the strands of genes and coatings of protein are reproduced by the hijacked cell, zillions of new viruses are unleashed to repeat the process, zillions of times.

What does a virus do?

Often, the takeover of the cell is complete and the reproduction of the virus is so explosive that the cell is completely destroyed in the process.  More rarely, the takeover of the cell and reproduction of the virus is very slow and does not kill the cell, just distracts it from its regular duties.

The pattern of slow control over the cell, leaving it alive but a touch altered is seen in very few acute viral infections, mainly in a set called retroviral infections, the most famous of which is AIDS.  AIDS is so destructive precisely because the virus messes with the cell without destroying it, leaving it in place to malfunction.

But for every single cold and flu virus, the pattern is complete cell destruction.  This causes a week or two of very real misery, but at least the infected cell is cleared away and what follows is completely normal function and health.

The heart of the usual virus experience is in very many ways exactly like having a burn.   Cold and flu viruses, when all is said and done, simply burn off the lining of whatever the virus is infecting.  If the virus gets into the cells lining the nose, then when zillions of viruses pop out of those cells, they are destroyed.  And then they do the same thing to the cells right next to the ones just exploded.  So like a slow burning flame, the  infection burns slowly across the lining leaving the lining of the nose essentially destroyed, just like if it was burned.

The analogy continues, for the fuse once lit in the nose typically burns down the throat and into the lungs.

Nearly every symptom of a virus can be traced to its essential nature as a burn.  Whatever is burned defines the problems experienced.  Just like if you have a burn on your hand, your hand hurts but not your foot, if you have a virus in your nose, your nose hurts and weeps fluid, but not your chest.   

Here is how the location of a viral infection defines your symptoms:

If the virus is in your nose you have a sore, runny nose, and lots of sneezing as a result.

If the virus is in your throat, you have a sore throat.

If the virus is in your lungs, you have a cough.

If the virus is precisely on your vocal cords, you have a barking cough, or hoarseness, or croup.

If the virus is in your eyes, you have pink eye (with redness and mucus, that can accumulate, and mat, but not cause constant pus dripping).

If the virus is in your stomach, you have vomiting, and stomach ache.

If the virus is in your intestine, you have diarrhea, and stomach ache.

The virus is doing the same thing in every spot, causing the lining of cells to be destroyed as more virus is made, but the experience varies according to which lining is being wrecked.

Whereever the lining is infected, some things happen to the body, caused by the body's attacks.  Those symptoms would be fever, achiness, lethargy, loss of appetite, increased or decreased sleep.  These are the famous symptoms of viral infection, and they are not caused by the virus alone.  All these symptoms can be created by giving someone the chemicals found in our white blood cells, stuff like cytokines and interleukins.  this is what make us all feel so miserable when we get sick from a virus.

How to Treat a Virus, how to Get Rid of a Virus?

Since having a viral infection with colds and flus is very much like a burn, we are stuck with the same frustration treating a virus as we are a burn- namely, waiting for it to heal.

Think about a cold.  As we just saw, a virus infecting the nose, throat, and lung burns off the lining of these parts of our body.  Once burned off they ooze fluid, just like any burn would.  Initially the fluid is a clear fluid, but over time it starts to contain elements of healing tissue, as the burned off tissue regrows, making the oozing fluid more thick, more mucusy, and more yellow and green.

To get rid of the runny nose, sore throat, and most of all- cough- that this process creates, two things have to take place- all the remaining virus needs to be destroyed so no new burns are created, and the already burned tissue must be immediately healed.

I am all for both of these events happening, but there is one reason they cannot be quickly made to happen:  no one has yet invented a substance that would either kill a virus [and leave your cells alone], or rapidly heal a burn.

Now, that does not stop companies from peddling products that claim to solve the problems viruses cause.  One ruse most often used is to admit they cannot actually stop a cough or get rid of a sore throat, but they might offer temporary relief.  That's not a hard thing to do, since even halting a cough for few seconds might qualify as helping.

But time and again, whenever cold and cough remedies are tested against water, water does as well or better than them all.  In fact, in March of 2011, the FDA launched an investigation against 500 cold and cough remedies for fraud.

So, if no medication has yet been invented that would kill a virus or heal the burn and inflammation it causes, what to do?

Fortunately, there are things that can be done, and they all are about comforting:

1.  Keeping warm.

2.  Having warm, misty air around

3. Sitting up

4.  Sipping soothing liquids

5.  For sore throats, ice cream and popsicles.

6.  Ibuprofen.  (Avoid tylenol, a question on its power to increase the risk of asthma is being investigated.

7.  Anything that distracts and comforts.

Keep in mind that if the goal is comforting, the judge of whether it works is the person being comforted.

For example, a humidifier might make one person feel much better but might bother someone else, simply ask your child or observe if it is comforting or irritating to them.

What's the Point of Viruses

Very briefly, there appears to be a very large component of our DNA and RNA, our genes, that has something to do with viruses.  Viruses have been transporting bits of genes from cell to cell across every form of life since the beginning of life.  There are major viruses that infect only bacteria, for example.

Over the eons, it is now estimated that as much as 60% of our genes originated in the viral sweep of DNA across the whole range of life.  That means quite a bit of who we are, and how we became humans originated in the swirl of information that is the virus.

So as we ache, suffer, and groan from our colds and flus, it may help to keep in mind this may be the creaking of a very necessary machinery.

How to you know your illness is a virus, not something more serious, or treatable?

For coughs and colds and plain old fevers, the vast, vast majority of such illnesses are viruses.

They cause undue agonies, but no lasting harm.

They seem to last forever, but always end.

There are three common bacterial conditions seen in colds that can be treated with antibiotics:

1.  Strep throat- usually causes a sore throat as a key symptom, usually not so much cough

2.  Ear infection- causes bad ear pain

3.  Pneumonia- suspected when your child struggles to breathe when not coughing

So if the sore throat is more scratchy than sore and seems due to a bad cough, and your ears do not hurt, and you are breathing in and out of your chest well when not coughing, it's likely a virus.

What would be a sign the illness is dangerous, like a bad pneumonia or meningitis?

These three signs:

1.  Stiff neck

2.  Can't breathe in and out of your chest without a lot of struggle.

3.  Severe pain

A NOTE ON ANTIBIOTICS

Antibiotics kill bacteria, they do nothing to viruses.  You can put a bottle of virus in a vat of antibiotic and they will live very comfortably there.

Bacteria are radically different than viruses.  Viruses as we saw are little packets of information, not really alive.  Bacteria are like us, they are cells that live and eat.  Their chemistry is different than ours and antibiotics wreck their chemistry but not ours.

That is why antibiotics don't work when you try to treat a viral infection with them.  

Not only do they not work, but since the vast, vast majority of colds and flus are viral, using antibiotics to treat them exposes millions and billions of people to these drugs for no very good reason.  Worse, such mass and constant exposure of our species to antibiotics has caused real, observable harm.  Many tens, likely hundreds of thousands of people have died as a result of this silly practice, from emergence of resistant bacteria and proliferation of harmful ones like C diff.

At Advanced Pediatrics we remain committed to not giving people drugs that do not good and can cause harm.  Giving someone an antibiotic when we know you have a virus will not help at all, and could cause harm, so we don't do it.

BOTTOM LINE

1.  A virus is a little packet of information that burns the lining of various parts of your body.

2.  That burn can only heal, it cannot be suddenly cleared with medicine.

3.  Comfort measures are the key help for our kids suffering with viruses, and the best way to judge if a comfort measure works is by asking your child if it helps.

4.  When it comes to colds and flus, the vast, vast majority of them are caused by viruses and so antibiotics to do not help.

5.   Cold and cough remedies are products riddled with fraud.  None have been proven to work any better than water.

6.  The key signs an illness is no longer viral and now may be dangerous are: Stiff Neck, Trouble Breathing when Not Coughing, Severe Pain.

All of us at Advanced Pediatrics hope your time with viral illnesses is as brief as possible.  We stand ready to help.  And hope you and your family have a wonderful holiday season and a Happy and Healthy New Year!

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.

How Does A Nation Change the Chance of Tragedy Occurring?

How Does  A Nation Change the 

Chance of Tragedy Occurring?

The tragedy of Newtown, Connecticut sears our hearts and tears at our minds.

Since the outrage of December 14, we have all been overwhelmed by how to respond.

As a person, I share the grief we all feel, and concern for the impact of this outrage on all it has touched.

As a doctor, I am compelled to respond.  It is in its ability to prevent needless tragedy that the medical profession is at its best.  Why wouldn't the medical profession want to offer its best in response to the senseless loss of life in Connecticut?  Particularly since without doing something, it is likely to happen again.

You might consider an expectation of this happening again too pessimistic, but consider that in our nation, nearly 3,000 children are killed every year by being shot.  Compare this to the number of law enforcement officers who lose their lives every year across the country by being attacked, 75, and it becomes rapidly clear that something is so wrong, it may be time to do something about it.  As a pediatrician, American, and person, I can no longer ignore the urgency of protecting the next child's life.

I have talked to many people since December 14, people from across the political spectrum, and for once I have found complete agreement- this must stop.  We may disagree on what will stop it, but everyone seems to agree that it is no longer acceptable.

And here is where the power of the medical profession may prove important.  Doctors have responded to a large number of causes of needless death, at times with dramatic success.  It is time for our profession to turn such expertise to this epidemic afflicting our children, and communities.  The process is always the same:

1. Determine the cause(s).
2. Determine the mechanism of how the cause(s) actually cause the problem.
3. Measure a variety of interventions to prove which one(s) work, and implement the best intervention(s).

If these three steps are not actually taken, then all we have is everyone's opinion, lots of strong feelings, large collection of guesses, and no changes.   Early indications are that the causes may be found in one or all three of the following categories: guns, mental health, culture of violence.  It is not clear to me exactly what role each of these will play in actual solutions that work.

So we are supporting a serious look at what actually causes the completely senseless deaths of nearly 3,000 of our children every year.   We support efforts to find how those causes operate.  And once we know what works, we will be working with all families to implement the changes that will save lives.

The word gun has become controversial in our nation, I am reassured that the idea of saving a child's life remains a point of broad agreement.  I look forward to working together with our nation's leading public health groups, physician's organizations, and other groups to find a path toward changing our nation from one of the most dangerous for children to one of the safest.  My expectation is that we may all be surprised at what will actually save lives, my mind certainly is committed to remain open to what will work.  I remain hopeful that if a path is found that truly could assure saving nearly 3,000 children's lives every year, that all of us would rush to support it.  

The events in Newtown could tempt us to simply grieve.  As my heart goes out the families of Newtown, and to all who grieve for them,  I also find that these events urge us to go beyond grief towards action, actions that will truly spare other towns and neighborhoods this all too common American experience.

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.

Dr. Lavin appointed to national expert panel

Dr. Lavin appointed to national expert panel- 

and he would like your help

Dr. Lavin has been appointed by the American Academy of Pediatrics (AAP) to serve on the national Middle Childhood Expert Panel for the Bright Futures program. http://brightfutures.aap.org/

Bright Futures is the program of the AAP, established with the Federal Government, to promote the health of America's children.   One of the purposes of Bright Futures is to define standards of pediatric care.

One of the provisions of Obamacare will be implementing the Bright Futures standards of care as the definition of basic pediatric care all insurers will need to offer as part of the basic benefit package in the US.

The Middle Childhood Expert Panel that Dr. Lavin will be serving on is charged with developing updated standards of care for children aged 5-12 years old.  When completed these standards will be the key reference for American pediatricians, guiding them on what needs to be done at the routine visit to the doctor for children ages 5-12 years old.

Here is where you come in.  I would highly value your thoughts.  What would you as a family like to see pediatricians doing for you while your children are in the age range of elementary and middle school?

Just let me know at info@advancedped.com, or drop a note to our office:

3733 Park East Drive- Suite 102

Beachwood, OH  44122

I look forward to bringing the best ideas to craft the best possible standards for the practice of pediatrics for these children in the United States.

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.

Newborn Jaundice

de: Struktur von Bilirubin en: Structure of bilirubin (Photo credit: Wikipedia)

Newborn Jaundice:

Not Really Jaundice

Not Really Harmful

Nearly every newborn develops some sort of yellowish tinge to the whites of their eyes or their skin sometime in the first week of life.  This tinge is commonly referred to as newborn jaundice, a phrase that suggests something is quite wrong.

But the facts are that this yellowish hue reflects normal functioning of healthy bodies.   The chance that the accumulation of the yellow material that causes the color change causing any harm, you will see, is remarkably remote.

The story of the yellow hue in the first week of life revolves around a most interesting pigment, called bilirubin.  Bilirubin turns out to be the waste product after the body is done getting rid of old stores of another brightly colored pigment, the red chemical hemoglobin.  Now, in nearly every animal, hemoglobin is gotten rid of by a conversion to biliverdin.  Biliverdin is a beautiful soft-blue pigment (its the pigment in robin's eggs), and it is cleared from the body simply via urination, it never accumulates.  But in humans and only one other animal, the biliverdin is processed one more step to the yellow pigment bilirubin.

Bilirubin does not dissolve in water, at all, which means it must be further processed to be converted to a form that does, and that step requires your liver to take that action.

During pregnancy, the bilirubin made by the fetus is cleared from both fetus and mother by the mother's liver.

After birth, the newborn's liver takes 1-2 weeks to start clearing the bilirubin.  This is exactly why all babies born see a rise in their bilirubin level.  It's during that 1-2 weeks that they wait for their liver to process their own bilirubin that it rises, often to a point where the whites of the eyes and/or skin takes on the yellow hue of the bilirubin.

Most items written about this yellow glow seem to suggest this is a sign of liver dysfunction, that the 1-2 weeks of waiting for the liver to start clearing the bilirubin is a defect, a lapse.  It is not clear this is the case.

It costs the body a lot to make bilirubin out of biliverdin, remember that not many animals do that.  And once it is made, it costs a lot of energy to clear the bilirubin.  So one could make the case that the body goes to a lot of effort to create bilirubin when it could simply clear old hemoglobin by letting it stay converted to biliverdin.  

Dr. Anthony McDonough of the University of California in San Francisco offers an intriguing insight.  Tony just won an award from the American Academy of Pediatrics as one of our nation's top research scientists.  He has devoted his life to the study of these brightly colored molecules: hemoglobin, biliverdin, bilirubin, chlorophyll, all of which are closely related to each other.   He taught me many years ago, and still teaches, that bilirubin is a very strong anti-oxidant.  Not too long ago, proof of this concept was supported by an article demonstrating that the higher the normal bilirubin levels are, the more protected the group is from events like heart disease and cancer.

The point is that the body might actually be going to great lengths to offer the newborn a boost of bilirubin, the yellow glow may actually reflect something good happening.

Given all this, why is so much fuss made over this nearly universal occurrence?  The reason is that in very special and unfortunate circumstances, bilirubin has been found to be irritating to the brain.  Those circumstances are severe prematurity combined with very severe illness, such as a serious infection.  In settings where the body is under rather extreme distress, bilirubin in the blood is able to enter the tissue of the brain and cause harm.   When a newborn is healthy and full-term, a very sturdy barrier keeps bilirubin out of the brain.

So then why any concern about bilirubin in full-term, healthy newborns?   Not too long ago, some reports documented an instance or so of bilirubin, when in excess levels, getting into the brain of even a healthy, full-term infant.  The chance of that happening is nearly astronomically remote.  About 4 million babies are born in the US every year, and the number of healthy newborns where bilirubin causes harm is less than one every year.   To my mind, when a substance causes harm less than 1 in a million exposures, that says to me its pretty safe.  Consider penicillin which causes serious harm in 10 of every million doses, and we consider that risk of harm so remote it is deemed to be very, very safe.

Another sign that the mild rise seen in nearly every baby in bilirubin after birth is normal and perhaps beneficial is that the rise is higher in babies who are breast-fed than formula-fed.  For many years this was viewed as one of the only disadvantages to nursing, but it may be a further hint that the body is really trying to bump the bilirubin level up a bit for the few weeks after birth.

BOTTOM LINE:

Nearly every baby born experiences a transient, 1-2 week rise in their level of the yellow molecule, bilirubin.

Very many have sufficient increase to look a bit yellow.  In healthy, full-term infants this experience is overwhelmingly harmless, and may even be designed and helpful.

When to worry?  If the yellow glow becomes a deeper, more severe, orange hue.  Bilirubin levels should not rise so high to cause your newborn's color to get too intensely orange.  If that happens let us know.

But the mild yellow hue, the glow seen so often, is not harmful, and may turn out to be just what the baby needs.

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 New Edition Defining Mental Illness is Approved

A New Edition Defining Mental Illness is Approved

It was reported today that the DSM-V has officially been approved by the organization responsible for its editing and publication.

http://www.nytimes.com/2012/12/11/health/a-compromise-on-defining-and-diagnosing-mental-disorders.html?hpw

The DSM is the Diagnostic and Statistical Manual, and it plays an enormous role in many American's life.

How so?  Because this book contains all the definitions used in the health care world in the US that define mental health, mental illness, and mental conditions.  

If you turn to a doctor or clinician to determine if you have a mental health issue, it is very, very likely that  the answer will rest on where the line defining normal and abnormal rests in the DSM.

The current edition is the DSM-IV, so the new edition which you will be hearing a lot about, is the DSM-V. These books are created and updated by the American Psychiatry Association (APA).

The most interesting aspect of the article describing the end of a 5 year process of creating the DSM-5 was how little agreement there was across the mental health and medical professions on just what is the definition of a wide range of mental illnesses and conditions.

For example, is someone grieving for the loss of a loved one depressed?

Or, does someone who has excellent language function but is awkward socially have a form of autism?

At what point does someone who eats in binges qualify for being designated as having an eating disorder?

I remember vividly when a top clinician at one of our country's leading mental health facilities once taught at a seminar that every symptom in the DSM is experienced by nearly every healthy person at some point in their life.

So how does one know if their symptoms are severe enough to reasonably be considered a mental illness or condition?

The story of how the DSM-V got approved suggests that this question has no clear answer.  Senior leadership devoted to answering this question quit over the development of this edition.  Patient advocacy groups became quite vocal in opposition or support of various definitions of mental illness.    

The article documents a startling illustration of how tricky the line that defines abnormal thinking and feeling is.  In the 1990's and 2000's there was a big jump in the number of kids told they have bipolar disorder.  The article states that most of these kids, duly diagnosed by physicians with bipolar disorders, did not in fact turn out to have that.

Another very important consequence of this difficulty is that where the line where normal becomes abnormal is drawn automatically dictates how many people will be considered ill.    By adding a new diagnosis, binge-eating disorder, literally millions of Americans will now be considered diagnosed with this condition, once the DSM-V is actually published; but, right now, and for the years prior to its publication, they were not considered mentally unhealthy.  With one book being published, suddenly millions of people went from well to ill.

Of course, this is not to minimize the rather extraordinary reality that our human minds are not a finished product, and contain real instabilities that put us all at risk for serious difficulties.  Just consider that no matter how one defines depression, nearly everyone has either experienced a very serious bout of it or loved someone who has.

So take a look at this article, it is a rare glimpse into the intricacies of defining just who is mentally well and not well.

It emphasizes the reason that we find the focus on functionality so helpful when thinking about how to help respond to issues relating to the mind.   By that we mean, we take our stance as assessing and doing all we can towards helping each person function well- at home, with family, at school, and at work.  This focus seems to be more productive than simply relying on diagnosis.  

Dr. Arthur Lavin

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