The Summer Bug- Hand-Foot-Mouth, Sleepy Fever, Stomach Flu- All from the Enterovirus

The Summer Bug- 

Hand-Foot-Mouth, Sleepy Fever, Stomach Flu- 

All from the Enterovirus
We are all familiar with the influenza or flu epidemic that happens every winter, but many of us are not so familiar with a virus that causes a tremendous number of fevers and infections every summer, the enterovirus.

What is an Enterovirus and What Illnesses Do they Cause?

Entero- means intestinal in Greek and so enterovirus means, virus of the intestine, and it frequently is.

The enteroviruses cause many epidemics typically only seen in the summer through early fall- June to October- with major flares in July and August.

We are right now (July 17, 2014), experiencing a major outburst of enterovirus infections in our community.

The enteroviruses can cause a very wide range of infections, but the most common are the following:

1. Stomach flu- fever, vomiting, and diarrhea
2. Hand-foot-mouth disease- small very uncomfortable red, small-fluid filled bumps on the palms and soles and many tiny cold-sore like lesions in the mouth, usually with fever.
3. Viremia- just fever, no other symptoms except at times a rash at the end of the fever
4. Colds and pink eye- runny nose, cough, fever, red eyes with or without discharge
5. Mild CNS [central nervous system] infections- these can cause pronounced tiredness or even sleepiness, fever, at times with severe headache and even stiff neck.   They are mild because complete recovery is the rule.

If you look up Enteroviruses, you will find they come in various families of viruses.  The two main categories of Enteroviruses are the Coxsackie and ECHO viruses.  Coxsackie viruses are named after a town in New Jersey, Coxsackie, where the first strains were found.   ECHO comes from an outdated acronym that implies this is a virus found in the stools of children with no illness, but we now know that the ECHO viruses can cause the enteroviral illnesses.

There is one, perhaps most famous enterovirus, that no longer causes infections in the United States, the polio virus.  It turns out that when polio was rampant, most people who got this enterovirus got a stomach flu, like other enteroviral infections.  But occasionally this virus would also cause a CNS infection, but in the case of polio virus, the infection of the central nervous system is far more severe and actually does cause damage, the dangerous infection of polio.  

How do they Spread, Incubation Periods, How Long are You Contagious?

Interestingly, one enterovirus can cause several of these infections, so you could catch an enterovirus from someone with hand-foot-mouth disease and experience a viremia.

With the exception of colds, most enteroviral infections are spread not by breath but by hand contact.  Handwashing should block contagion.

If you are exposed to a person with an enteroviral infection, and catch the illness, it typically takes 3-6 days to develop symptoms, so the incubation period is 3-6 days.

Children and adults with enteroviral infections are contagious, otherwise they wouldn't have caught the illness.

Someone remains contagious as long as their body sheds live virus.  This typically goes on for some time after fully recovering, which explains why the period for being contagious can seem surprisingly quite long.

For those with mainly respiratory infections like colds and pink eyes, they remain contagious for 1-3 weeks.  But for those with stomach flu, one can remain contagious for months.

Right now we are seeing a very large number of cases of hand-foot-mouth diseases, viremias, and mild CNS infections, as well as some stomach flu, all likely due to the enteroviruses.

What to Do

When it comes to what to do if your child gets infected with an enterovirus, there are several key points:

• Like nearly all viral infections, medical science has not yet developed any medication to rid us of the infection, so antibiotics do nothing to help a person with enteroviral infections
• These infections, as uncomfortable as they are, are typically harmless.  Given that we cannot cure them, our job is to make our children comfortable.  Comfort varies according to the problem.  For viremias where the only symptom is fever, ibuprofen is often sufficient.  For the painful sores of hand-foot-mouth there are a variety of soothing measures for the sore throat- cold liquids, ice cream, comfort foods, etc.
• All these infections go away in a few days to a week or two and typically leave your child as healthy as before the illness.
• As for contagion, we all spread virus long after we get well, especially for stomach flu where you can remain contagious for months.  Further, these viruses are rampant now, so even if you isolated your child completely while she or he is contagious, the viruses would spread exactly to the same extent.  So we do not recommend isolation for contagiousness.

BOTTOM LINES

This summer is no exception, we are experiencing our annual summer epidemics of enterovirus infection right now.

• These viruses cause a wide range of illnesses, nearly all of which are quite harmless.   The one variant that is harmful is the one we immunize against and no longer is in North America.
• There are no medications to get rid of these viruses, to care is limited to keeping your child comfy.
• The most common forms of infection with the enteroviruses are hand-foot-mouth disease, stomach flus, simple fevers with and without rash, and fever and severe lethargy with and without headache.
• No need to isolate, once your child feels better, back in action.

Here is to a safe and healthy summer,

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.

Vitamins: Turns out we could be harming our children with an excess

The chemical structure of niacin. 

Vitamins and Minerals:  We are overdosing our children

A recent report from the Environmental Working Group (EWG) establishes that American children are not deficient in vitamins and minerals, they are actually overdosed on them, and it could hurt some children.

http://www.ewg.org/research/how-much-is-too-much/up-to-half-of-young-children-get-too-much-vitamin-zinc-and-niacin

The EWG is a non-profit organization that has long been devoted to helping prevent harm coming to children in the food chain.

In this report, information from reliable surveys offers us a new look at how many children are exposed to overdosages of particular vitamins and minerals.

Here are the data for children of ages 2-8 years old in the United States:

Vitamin A- 13 % of children are fed too much- 10 million 2-8 year olds a year

Niacin (Vitamin B3)- 8% of children are fed too much- 5 million 2-8 year olds a year

Zinc- 42% of children are fed too much- 15 million 2-8 year olds a year

These are rates of overdosage from food, not vitamin pills.  The main source of overdosage comes from highly fortified cereals, crackers, and breads.

If you look at the chance of  your child being overdosed on these three items, if you also give a vitamin pill, the numbers jump to:

Vitamin A- 72%

Niacin- 28%

Zinc- 50-80%

Now, why should this matter?

It turns out that each of these compounds, when taken in excess, can cause real harm to children.

Excess Vitamin A and niacin can cause liver damage, and excess zinc can cause harm to the immune system.

We have reported earlier that there is no benefit to giving children vitamin supplements, except in the special and rare situation where the child has a true vitamin deficiency due to a condition, such as an abnormal gut that cannot absorb vitamins.

Now come these data, establishing that even without vitamin pills, a great number of our children are getting overfed vitamins and minerals, and that this excess could cause harm.

Our recommendation is to not give children vitamin supplements and to be reasonable in what crackers, breads, and cereals are used, leaning towards ones that are not so heavily fortified.

Bottom Lines:

1.  Our children get plenty of vitamins and minerals, the only exception being calcium.    

2.  But in the case of Vitamin A, niacin, and zinc, many of our children are fed too much, even without vitamin pills.

3.  We recommend that you do not give your children vitamin supplements or pills.

4.  We recommend that the cereals, breads, and crackers you give not be too heavily fortified with vitamins.

5.  It is still a good idea to be sure your children get enough calcium, and for girls once they start having a period, folic acid.

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.

Bacteria Really are Good- Even during Pregnancy

Bacteria Really Are Good- Even During Pregnancy

A recent article in The New York Times Science section broke new ground in our understanding of how very closely connected our cells are to bacteria.  

http://www.nytimes.com/2014/05/22/health/study-sees-bigger-role-for-placenta-in-newborns-health.html

We have long known that bacteria live on our skin and in our gut, but until recently the insides of our body were considered completely sterile, only our cells, no others, no bacteria certainly.

Now researchers in Houston's Baylor University have looked at over 300 placentas from healthy pregnancies and examined their interiors for evidence of bacteria being present. http://stm.sciencemag.org/content/6/237/237ra65 

I was astounded to read that the average placenta is about 10% bacteria, by weight.  So a 1 pound placenta is about 1 and half ounces bacterial.

Not only that, but the bacteria deep inside the placenta are from a variety of sources.   Mainly Mom's mouth, but also her gut and genital area.

It has been known for a very long time that when we chew, or brush our teeth, a spray of oral bacteria enters our blood stream, but it was thought the body cleared out all these bacteria.

Now we know that they are put to use.

The article notes that the deeper areas of our skin and our eyes also are about 10% bacterial!

A very compelling set of observations is beginning to connect the nature of the bacteria in the placenta to the chances of the baby reaching full-term at a good weight, or facing premature birth or low birth weight.

This is not to say all bacteria are good, but of the thousands and thousands of bacterial species that live on (and in) us, only a dozen or so can cause disease.  The rest appear to be essential to our cells working, that is, to our health.

It goes well beyond this or that stray bacteria offering a bit of help.  Our body is made up of cells, and the bacteria amongst us are cells too.  Our body needs these bacterial cells in order for our cells to work well.

This is now proven in the gut.  The loads of bacteria in our intestine are absolutely necessary for the cells of our intestine to do their jobs- digest and absorb food, etc.

It is still far too early to know how to support the bacteria essential for our health and well-being.

But even now, we know enough to say that the #1 hazard or risk in using antibiotics is the disruption and damage they cause to the bacteria we all depend on to live.

BOTTOM LINE
New research reveals that bacteria live deep inside of us, specifically, in our babies' placentas.  As much as 10% of a placenta is actually made up of bacteria.  These bacteria may play a major role in determining of a pregnancy will reach full-term and if the baby gains good weight.

Yes, bacteria can cause terrible disease, but only a tiny number do.  The vast, vast majority of bacteria are essential to our health and well-being.

Dr. Arthur Lavin

Thanks to Ms. Carolyn Stulberg of The Alexandria School for bringing this article to my attention.

---

*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.

Now Tylenol, Pregnancy, and ADHD

Now Tylenol, Pregnancy, and ADHD

As followers of our postings know, acetaminophen, the active drug in Tylenol, has been associated with increased risk of asthma developing in childhood.  This is why we recommend the use of ibuprofen for pain and fever control in children.

Now this spring, the Journal of the American Medical Association, Pediatrics, published a very intriguing study of the risk of being hyperactive, using ADHD medication, or having ADHD behaviors,  at age 7 years old- each in relation to whether the mother used acetaminophen during that child's pregnancy.

The results were rather interesting.  The study looked at 64,000 Danish children and their mothers during 1996-2002.

About half the mothers used acetaminophen during pregnancy.   

If a mother used acetaminophen during pregnancy, the risk of her child having each of the three outcomes by age 7 years old went up as follows:

• For being hyperactive the risk went up 37%
• For taking ADHD medications the risk went up 29%
• For having ADHD behaviors the risk went up 13%

If the use of acetaminophen was during more than one trimester the risks were even higher.

The higher the dosage of acetaminophen used, the higher the risk for each outcome.

JAMA Pediatr: 2014; 168 (4): 313-320.  doi: 10.1001/jamapediatrics.2013.4914

BOTTOM LINE

This study does not prove that taking acetaminophen during pregnancy can cause a child to have ADHD or hyperactivity.

But, it does relate the two, and until further study is conducted we would extend our recommendation to avoid exposing your child to acetaminophen to pregnancy.

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.

Height- What Establishes One's Height, can it be Changed?

Animation of the structure of a section of DNA. The bases lie horizontally between the two spiraling strands. (Photo credit: Wikipedia)

Height:

What Establishes One's Height, can it be Changed?

People come in a wide range of sizes and shapes.

Height is a quality of the body that draws a lot of attention.

In infancy, all of us use height to help us know if our baby is growing well.

Later in childhood, we all wonder, how tall will my child be, and the child eventually picks up on this wonder, asking, how tall will I be?

Many parents ask us, how is one's height determined?  Will exercise or nutrition influence how tall you can be?  When to worry about height?  What can be done to get taller?

How is Height Determined?

The maximum height a person will attain is set very firmly by that person's DNA, or genetic code.  It turns out there is not that much range to human height.  Nearly all humans are somewhere between 4 and 8 feet tall.  If you take a brief look at all of life, the range is far more dramatic.  Some forms of life never get taller than a tiny fraction of an inch (e.g., bacteria), and some forms can grow to be several hundred feet tall (e.g., trees).

Notice that for every form of life, though, there is a very narrow range of heights.  Dogs can only grow so tall, elephants attain a similar size across families of elephants, etc.  Just so for us humans.  These patterns give clear evidence that our height is as strictly dictated as the number of arms we will develop, or how many eyes we will have and where they appear on the face.  In short, a person's height is a structural rather than functional property of the body.  It's how the body is built, is the product of the structural design, and is not defined by how we use our bodies.

Not so with weight.  Weight varies far more dramatically and is defined by how much we eat and exercise. Our weight does reflect what we do.

Although we do not have the technology to do so yet, we do know that how tall a person will be, and the day they will reach that height, is all set in the information inside a fertilized egg.   Once a person's DNA is set, so is that person's ultimate height.

Will Exercise or Nutrition Change my Height?

One can make your height shorter than expected by severe malnutrition, but a healthy, well-nourished child cannot get taller by eating differently, or via specific exercise programs. Further, it takes quite a severe degree of malnutrition to decrease one's final height.  Sadly, this is not rare.  Much of the world is exposed to malnutrition severe enough to shorten ultimate height, and many more American children suffer this fate.

But the fact remains that if a child is well-fed, there are no foods or exercises that can increase one's height.

This makes sense if you think about the structural nature of height.  At conception, how tall someone will be is defined, so if the right materials are on hand to make that happen, it becomes difficult to add more to get more height.

When to Worry about Height?

There are two main reasons that raise concern when it comes to height: 

An abnormally slow rate of height gain, abnormally low height itself.

Before we look at each, a word about normal rate and height.
As noted, there are two aspects to height- your actual height at any age, and the rate of growth.
Normal actual height at any age is defined by a range of normal.  The most important word here is range.
For example, at 5 months of age, a male infant could be anywhere from 24-28 inches long and have perfectly normal height, even though the average is 26 inches.  That range of 24-28 includes about 95% of all male 5 month olds.  But not all.  About 1 in 20 very healthy, very normal 5 month olds will be a bit less than 24 inches long or more than 28 inches long.  

When it comes to rate of growth, there is more uniformity.  By age 2 or 3 years old, up to puberty, most children, boys and girls, grow about 2-2 1/2 inches a year.  Interestingly, that rate is pretty much the same whether the child is tall or short.  So kids destined to be 6 feet tall and those destined to be 5 feet tall both grow about 2-2 1/2 inches a year.

Last point on normality:  the percentiles are fun to observe and watch, and to share with family and friends, but by themselves, there is no "normal" percentile.  It is just as normal to be at the 10th percentile for height as it is the 90th.   As noted below, it is the actual height and rate of growth that determine if there should be concern, not the percentiles in the normal range.

So, the two situations when we get concerned are:

1.  The rate of growth is abnormally low.

Children who grow much less than 2 inches a year during the ages of 3-puberty do raise concern and should have their height gain evaluated.   The rate of growth in infancy varies quite widely, with younger babies growing faster than older infants.   Often during the newborn and early infancy stage, an infant can attain yearly, annualized rates of growth of 12 inches a year!  This rate, of course is not sustained. One of the great powers of the growth curve is that it can tell us at any age, at any height, if your child's rate of height gain is normal or of concern.

2.  The height is too low
As noted above, actual height has a bigger range than rate of growing.   Again, thinking about the 5 month old, there is an average height at that age in boys of 26 inches, but the range is 24-28 to cover about 95% of all boys this age.   We would typically say any height in the range that covers 95% of people is normal, but if it is far less, it does raise concern and should be evaluated.

What Can Be Done to Get Taller
As already mentioned, it is very hard to change your height upwards.  Since height is set by complex mechanisms set forth by one's DNA, boosted nutrition, extra nutrients, special exercises, and/or customized herbal mixes cannot increase your height.
The only mechanism yet proven to be able to increase a well-fed person's height is growth hormone.
Growth hormone works by turning on the division of various cells in the body, mainly bone cells.
But even when daily injections of growth hormone are given to a child, sometimes there is no increase in the eventual outcome of that child's height, dramatically demonstrating how hard wired a person's growth is.

A mention should be made of the special case of growth hormone deficiency.  Some children have a deficiency in this hormone and they typically will have lower than normal rates of height gain that lead to evaluation, as outlined above.  Or they may present with very short stature.  Injections of growth hormone are the only known treatment for this condition, but even in this setting, some children do not grow faster, although most do.

BOTTOM LINES
1.  Height is set very firmly by each person's DNA.  
2.  One's final height can be shortened by severe malnutrition or serious diseases, but in healthy children it is very difficult to increase their ultimate height.
3.  That is, special diets and exercises and medications cannot increase height, with the sole exception of growth hormone.
4.  The use of growth hormone is a very serious intervention that subjects the child to daily injections and exposure to a powerful hormone.  It should not be used except after very careful evaluation.
5.  The concept of normal for height is defined by a range of actual height and of rate of height growth at any age.
6.  Most boys end up somewhere between their Mom's height plus 5 inches, and their  Dad's height.
7.   Most girls end up somewhere between their Mom's height and Dad's height minus 5 inches.


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.

An Interesting Theory of How We Become and Stay Overweight

An Interesting Theory of How We Become and Stay Overweight

Researchers have long been curious- how does significant weight gain happen?

Most theories propose that the key mechanism is that intake of energy (i.e., calories via food) exceeds output of energy (metabolic rate, exercise).   That is, if you need say about 2000 calories a day to meet all your internal and exercise related energy needs, and you eat 2500 calories a day, you will gain enough extra weight over time to cause severe obesity.

An interesting fact:  A calorie really is a unit of energy.   In fact, it is the amount of energy to raise 1 kilogram (about a quart) of water, 1 degree Celsius.

One observation made many years ago, but seems to be still held as true, is that the average excess intake of calories needed to reach obesity is surprisingly small.  It only takes 2% over your needs for 10 years to add 100 extra pounds.  Using the model of 2000 calories a day for someone, that person would only need to take in an average of 2040 calories a day, for 10 years, to gain 100 extra pounds in 10 years!

The New Observation

The new look at this issue puts more of the blame on insulin- and its great trigger, sugar and starch.
Insulin is a hormone that has many effects, a major one is to store energy.  Whenever you eat more than you need, insulin is produced to help store the extra fuel for later use.

Now, if I boosted my insulin level over where it needed to be, much of the fuel circulating in my body would suddenly be placed in storage.  At that point, my body would suddenly miss its fuel, and my brain would start screaming for more fuel, I would suddenly become wildly hungry, even with plenty of energy and fuel at hand, in storage.

Of course, most people, even those with diabetes, never give ourselves extra insulin beyond what we need.
But there is something any of us can do, and most of us do so frequently, to give ourselves a big jump in insulin levels:  eat sugar or starch.  Starch turns out to be a long string of sugar, and once eaten, becomes sugar.   Whenever we eat sugar or simple carbohydrates, insulin levels are raised.

So, when we eat candy, pretzels, bleached flour bread, cookies, chips, crackers, etc. we boost insulin, fuel gets stored, and appetite soars.  It is this last step that creates a serious urge to eat that then causes the obesity.  If the urge to eat is slaked by sugar or starch, storage is promoted leading to even more obesity.

Bottom Line
Eating more than you need is still a bedrock cause of obesity, but these new observations add another caveat:  not all foods cause obesity equally- cookies, crackers, chips, pretzels, and candy trigger the insulin cycle- increasing obesity and appetite.

Dr. Lavin

---

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

Pregnancy, Cravings, and Aversions

Pregnancy, Cravings, and Aversions

Food and pregnancy have a powerful and complicated relationship.  Obviously one of the key goals of pregnancy is for Mom to deliver nutrient to the baby-to-be.  

So it is curious that so many odd events happen to the pregnant woman's appetite.  Cravings for items that don't help, aversions to foods that are helpful, and of course the bane of nausea and vomiting all seem to block an easy approach to eating well for the baby.   What are the cravings and aversions about?

First of all, they are very common.  Both cravings and aversions occur in about 50-80% of all pregnancies.

Some say the most common craving is for ice, but many studies document the top craved foods are strong tasting foods (sour, savory, sweet), ice cream, fruit, and milk.   

Common aversions include coffee, fish, meat, and fatty foods.

Curiously, some reports suggest that aversions often follow bouts of vomiting, and the food that one avoids simply is the one associated with a heavy bout of vomiting.

Vomiting itself varies widely from population to population with some groups in rural Africa only seeing about 3% rates of nausea and/or vomiting.  Whereas, more developed societies such as the US see rates for both of about 20%.

Pregnant women also tend to have very sensitive sensory function.   They notice nearly any stimulus more easily and so many sensations are more irritating, particularly odors.

Many have wondered, why does pregnancy cause nausea and vomiting?  What causes the cravings and aversions?

Turns out we still do not know.  A popular theory is that the nausea and vomiting and aversions protect the growing embryo and fetus from toxins in foods, but no proof has been found for this idea.  In fact, some studies suggest it is not so.

Perhaps the most intriguing observation we saw was that many babies whose mothers had the most severe nausea and vomiting were more drawn to salty fluids at age 12 weeks than other babies.

We may not know why, but pregnancy clearly alters our sensory functions, heightens reactivities, causes lots of nausea and vomiting, and cravings and aversions still happen.

We wish all those pregnant an easy gestation and hope all these sensory phenomona are gentle to you.

---

*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.