Safe Sound Levels to Protect from Hearing Loss

Safe Sound Levels to Protect from Hearing Loss

Sadly, our ears are not built for loud noise, when exposed to it loud enough or long enough, the nerves that sense sound begin to lose their function.  If that happens enough, we lose hearing.

Hearing is one of the only senses where overuse leads to permanent loss.  Think about vision.  A bright enough light can cause sudden loss of vision, but a blink and some time almost always allows vision to recover fully.   It takes a very unnatural amount of light to lead to permanent blindness, a level none of us are likely to experience.  The same goes for taste, touch, and even smell.

Why do the nerves of hearing lose function is overstressed, and at what level of loudness does that happen?

Why the nerves of hearing can lose function permanently

Hearing a sound happens when vibrations in the air are translated into nerve signals, that are then transformed into the experience of hearing.   That sentence lists 4 distinct steps that have to happen if we are to hear anything:

1.  Air vibrating.  If there is no vibration in the ear, there is no sound, and nothing to hear.  It is interesting that everything we, or any animal, hears is the result of air shaking regularly, vibrating.

2.  Translation of air vibrating to nerve signals.  This is the step that explains how hearing ability can be lost from loud sounds.   The translation occurs along the pathway of ear to nerve.  When you hear a sound, that means that the little column of air is vibrating in a pattern specific to that sound, and that air is vibrating in your ear.  Those vibrations make your eardrum, then auditory bones (remember the anvil, stirrup, and hammer?), vibrate.   Once these tiny bones vibrate they create identical patterns of vibration in a spiral of fluid they connect to.  The spiral is called the cochlea.

Now, lining the spiral of the cochlea are the nerves of hearing.  Each of these nerve cells have a border featuring little hairs.  Each cell has a set of these hairs that go from very short to longer, creating a brush like structure of varying hair lengths.

These hairs have one end inside the nerve cell, and the other end is dipped in the fluid that fills the spiral of the cochlea.  When the fluid in the cochlea vibrates, hairs that are the right length to vibrate at those frequencies begin to vibrate.  Whenever a hair on the nerve cell begins to vibrate, it creates an electrical signal.   Now air vibrating has been translated to an electrical nerve signal.

3.  The nerve signal is delivered to the brain.  Once the nerve fires, that electrical signal is shot down the auditory nerve from the inner ear to the auditory part of the brain.

4.  You hear.  This happens when patterns of these nerve signals excite the auditory part of the brain in such a way that you perceive hearing that sound.

Here is the sad news.  If you make the hairs on the nerve cells of hearing vibrate too strongly, they break off or separate, and will never again translate a vibration into a nerve signal.  If you lose all your hairs on all the nerves of hearing, you would be forever unable to hear again on your own.

Seeing involves no such moving parts, and neither does touch or smell, so they are not as prone to damage as this mechanism of hearing.

The ear does have a muscle in it called the stapedius muscle that can protect.  When we hear very loud sound, the muscle contracts and thereby keeps one of the bones of hearing, the stirrup (stapes) from vibrating, making the sound much softer.  But it takes a moment for that to happen, and if the sound is loud enough, even that protection will not prevent permanent loss of some hairs on the nerves of hearing.

What level is harmful?

Now that we know that loud sounds can cause permanent loss of hearing, what levels of sound are safe, and in what settings is sound not safe but harmful?

Loudness can cause harm in two ways, as noted above.   The first is a burst of loud sound.  Even a few milliseconds of sound loud enough can damage hair cells of hearing.  

The other way is by sustained sound.  By sustained we mean either for a few minutes, or few hours, or all day.

Loudness is a real physical force.   It relates to how powerful the vibrations are in the air.  A more powerful vibration is experienced as louder.   Sound vibrations are not usually experienced as physical forces, but the vibration of a loud bass can be felt in your body and on tables and floors, and certainly cars.

The unit of loudness usually used is the decibel.  The decibel is a complex number for two reasons: it is created by the ratio of two measures- the actual loudness of the sound, divided by a reference value for loudness.  The other aspect of decibels that make it complex is that they are the logarithm of that ratio.   But good news, all we need to know is that the higher the decibel level of a sound, the louder it is.

The rate at which increasing decibel levels gets louder goes like this.

Start with a sound that is generating 0 decibels of loudness, and call that 1 Unit of Loudness- this is barely loud enough to hear.

If you go up to 10 decibels, you go up to 3.162 Units of Loudness- the loudness of a rural night

If you go up to 20 decibels, you go up to 10 Units of Loudness- the loudness of a whisper

If you go up to 40 decibels, you go up to 100 Units of Loudness- the loudness of a library

If you go up to 50 decibels, you go up to 316.2 Units of Loudness- the loudness of a dishwasher one room over

If you go up to 60 decibels, you go up to 1,000 Units of Loudness- the loudness of normal conversation at a distance of 3 feet away

If you go up to 80 decibels, you go up to 10,000 Units of Loudness- the loudness of a garbage disposal 3 feet away.

If you go up to 100 decibels, you go up to 100,000 Units of Loudness- the loudness of a lawn mower 3 feet away.]

If you go up to 110 decibels, you go up to 316,200 Units of Loudness- the loudness of a rock band 15 feet away.

You can see doubling the decibel level more than doubles the loudness of the sound.

Sounds that are softer than 80dB do not hurt the hair cells of the nerves of hearing over any length of time.  Note- that means sounds should be softer than the loudness of a typical garbage disposal 3 feet away.

If you go over 80dB, permanent hearing loss begins to occur.  The louder the sound, the faster that happens.  At 85dB, one needs to be exposed to this level of loudness several hours a day for many years to lose hearing.

But, at 100dB you can start to lose hairs on the nerves of hearing in two hours, and at 115dB it only takes 15 minutes.  Much over 115dB, one loud burst of sound at that level can cause permanent loss so at least some hearing.

How does that connect to our audio devices?  The main problem is with earbuds and headphones.

One study found students listen to music at these levels:

55% of kids listen to music at 85dB or higher

Another reference is that the earbuds that come with Apple products, when plugged into an iPod at maximum volume, will deliver 102 decibels of loudness, loud enough to cause hearing loss in 2 hours.

For most devices, 80% of maximum volume will deliver about 90 decibels of loudness.  This is safe for listening for under 90 minutes, but over many hours for many years, hearing loss will happen even at this level.

Bottom Lines

1.  Sound is just vibrating air, but it has power in those vibrations.  Too much power and the delicate hairs on the nerves of hearing can be lost, never to return.  As these hairs are lost, hearing begins to weaken, and can lead to real hearing loss.

2.  The damage to these delicate hairs and loss of hearing are related to how powerful the air is vibrating and how long the nerve cells are exposed.   More force takes less time to cause damage, but some lighter forces can cause damage if the exposure lasts long enough.

3.  The force of sound is measured in decibels.  The very, very faint sound in a hearing test can be as low as 0 decibels.   The safe level of loudness for our ears is 80 decibels, or 10,000 times louder than that barely audible signal at 0 decibels.   

4.  The loudness of a garbage disposal at 3 feet, or ear buds on a device set at about 75% of maximum is what 80 decibels sound like.

5.  Keep sounds in your home, around your infants, children, adolescents, and adults to 80 decibels or less and sound will not harm your hearing.

6.  If you do listen to TV or music above 80 decibels, hearing loss begins to happen.  At 85 decibels you need to have sound of that loudness blaring in your ear for many hours a day for years to see actual hearing loss.  But at the max on many devices, you hit 100 decibels and hearing loss can appear within 2hours.   115 decibel blasts can hurt those hairs on the nerve cells in 15 minutes.

So, keep sound levels at 80 decibels or below and spare your hearing for your long life!

To your health,

Dr. Arthur Lavin

PS- Many thanks to a family with a young infant in the practice for asking me the threshold of loudness that is safe!

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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.

Hives- What are they, When to worry

Hives- What are they, When to worry

Hives are a paradox with a happy ending.  Typically harmless, and more treatable than nearly any other rash, hives cause a tremendous level of concern.

The concern is based on the association of hives with a far more serious condition: a very severe form of allergic reaction called anaphylaxis.   In anaphylaxis, not only does the person have hives, but they develop very dangerous levels of trouble breathing and even drop blood pressure.

Even though nearly everyone with anaphylaxis has hives, almost nobody with hives has anaphylaxis.

How can this be?   Because millions of people, including millions of children have hives, but far, far fewer people actually ever experience anaphylaxis, fortunately.

What are Hives?

Hives are a rash caused by the release of a chemical called histamine.  The word hives has an unknown origin, the main guess is that it comes from a very old Scot word for rash.  The other name for hives is the very medical term for the rash, urticaria, which comes for a Latin word meaning burn.

Whatever the origin of the word, hives are a very distinctive rash that has these elements:

• The appearance is described as welts.  Specifically hives, or welts, are a patch of skin that is raised or swollen, typically a pale red or even pink in color, and often with a central area that is pale or even whitish
• Itch.  This rash is one of the itchiest known, for good reasons which we will note below.
• It shifts.  Described medically as evanescent, the pattern and location of the hives moves over time.  In an hour entirely different parts of the skin can show the rash.  Where it was is now normal, and where it wasn't now has hives.
• Antihistamine clears it up.  Most hives respond to use of benadryl, claritin, or other antihistamines.  More than any other rash, one dose of a medicine can make them vanish.

All these features come from the basic cause of hives.  As noted above, hives are almost always the result of cells in the skin releasing a particular chemical- histamine.   Histamine is a chemical found in a type of cell that populates all our skin, the mast cell.  Histamine, once released, makes all the capillaries around it leaky.  This is designed to allow elements in the blood stream to flood into an area that needs help.   But if a big pulse of histamine floods a patch of skin, the blood vessels in that patch get very leaky, fluid accumulates, and the skin develops the swollen, pale red, whitish look of hives.  Histamine is also a very powerful stimulant of itch.  It turns on the itch signal in nerves in the skin.  Finally, histamine usually once released is quickly cleared, so the release is like a flowing wash of histamine, it comes and it goes.  Releases of histamine can happen wherever there is skin.

These properties of histamine release easily explain all the features we see in hives:

• The property of histamine to make local blood vessels leaky explains the swollen appearance
• It's ability to cause itch nerves to fire explains the intense itch
• The fact that histamine is like a wash explains why hives seem to appear and vanish so quickly, to move around the body.
• And the fact that hives are due entirely to histamine release explains why antihistamines work so well.

What Makes Hives Happen?

Most people think hives are mainly the result of allergic reactions, but this is not true.  The most common reason hives appear is viral infections.  For some reason, having viruses growing in you often leads to histamine release, and so, hives.  Kids with colds and flus often get hives. 

At the same time, hives are of course a common experience of those with allergies.  This makes sense since the classic allergic reaction almost always includes the release of histamine.  It's histamine, along with other like compounds, that makes our noses run, our eyes itch, and our lungs wheeze and cough when an allergic reaction hits.  So it's no mystery that with all that histamine released in an allergic reaction, that hives appear, too.

When to Worry?

If hives appear and no change in breathing is seen, there is nothing to worry about at that time.

Hives are always harmless, it's other types of reaction that are potentially dangerous.

This bears emphasizing, if someone develops hives and their breathing is fine, the hives themselves are 100% harmless.  They do cause discomfort, they itch like crazy, but itch is not dangerous, it causes no threat to any important function of the body.

Further, hives typically respond well to antihistamine, so not only are they safe, but they can often be cleared away with use of a very safe medicine.

If when hives appear breathing starts to be labored, then it is time to worry and take emergency action.

Of course, whenever breathing begins to be hard, that is cause for concern.

In the setting of hives, any sense that your child is starting to struggle to breathe raises concern for an allergic reaction that is going to cause serious lung reactions.   This is quite different than a rash, or skin reaction.  As noted, skin reactions are harmless if unpleasant, but lung reactions can be dangerous.

The first step when you see hives with trouble breathing is to give a teaspoon of benadryl.  If the trouble breathing appears to be worrisome, call 9-1-1.  If the trouble breathing is very mild and not at all worrisome, you then have time to call us.

How to use Benadryl

Benadryl, or diphenhydramine (di-phen-hy-dra-mene) is a very, very safe, old medicine, a basic antihistamine.  It comes in liquid and pills, there is no child version.  So it's the dose that makes it right.  

For mild reactions and rashes, like just hives, the dose for young children is 6.25 mg and for older children 12.5mg.

For breathing issues, the dose for young children is 25 mg and for older children 50 mg.

The liquid comes as 12.5 mg/tsp, and the pills are 25 mg or 50 mg each.

The main side effect is tiredness, but in young children it can cause agitation.

BOTTOM LINES

1.  Hives are a particular type of rash, notable for their appearance as welts, intense itch, ability to come and go rapidly, response to antihistamine by clearing and itch ending.

2.  Hives are most commonly caused by viruses, but of course are also seen in allergic reactions.

3.  Hives by themselves are harmless.  If there is no accompanying trouble breathing or threat of trouble breathing, there is no danger.

4.  It is only in the setting of a very serious allergic reaction with struggle breathing that hives are of concern.  If trouble breathing is present in any situation, seeking medical help is very important and urgent.

5.  The use of an antihistamine can help clear away hives and restore comfort.

To your health,

Dr. Lavin 

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

The new meningitis B vaccines

The new meningitis B vaccines-

Not yet recommended for routine use

As you have recently read in our postings, bacterial meningitis is a particularly horrible and deadly infection, and there are immunizations that can prevent it.

A very new immunization for meningitis is now available, and being heavily marketed to the public and to doctors.  The immunization is for a very specific subset of meningitis, the bacterial meningitis caused by one of the five types of the meningococcal germ, Type B meningococcus.

The meningococcal type B immunization is being marketed under two brand names, Bexsero and Trumendba.  (These names once again remind me of my wonder at how drug names are created, these, like most drug brand names, are so odd and unusual).  Our office has received very expensive promotional materials, including audio materials, very compelling photography, multi-color layouts.

Of course, as with all promotional materials, we do not accept or keep, or refer to them, but instead we try to get the information directly from trustworthy scientists.

With that in mind, I recently asked Dr. Walter Orenstein his thoughts on this new immunization.

Dr. Orenstein headed the National Immunization Program for many years, and currently heads the vaccine program of research and study at Emory University, down the street from his old office at the CDC.

It turns out that Dr. Orenstein attended the meeting of the ACIP this summer that weighed the case for and against use of the meningococcal type B immunizations.   The ACIP is the nation's group of experts that weighs all data concerning immunizations and crafts the best recommendations on their use.  ACIP stands for Advisory Committee on Immunization Practices.

The ACIP met this summer and reviewed these new vaccines.  After careful review of the new meningococcal Type B vaccines, their recommended that these vaccines not be given routinely, but that patients and their doctors can discuss its use.  They also recommended this vaccine be given to those few individuals with immune system deficiencies that make getting meningococcal infections more likely.

The ACIP decided against recommending routine use for two key reasons:  they had concerns about safety, and they had concerns about how well it would help.

Safety concerns from the ACIP

The safety concerns had to do with reports that adolescents who got this immunization had some serious problems, including a painful condition called rhabdomyolysis in which muscle can become inflamed severely, and seven other serious events.   It is not clear if the adverse events were due to the vaccine, but until that is settled, routine use is not recommended.

Does it really help?

The ACIP, according to its report, and what Dr. Orenstein told us, raised concerns that trends showing meningococcal Type B infections are becoming less common even before this vaccine was created.   It is also not clear how long this vaccine remains effective.  These and other concerns made the ACIP wonder if use of this vaccine would offer enough benefit to recommend it.  At this time, the ACIP concluded it did not, but awaited further information to see if it might be someday.

BOTTOM LINES

1.  The meningococcus is a nasty bacteria that causes very dangerous infections, including meningitis.

2.   The Menactra immunization protects against 4 types of meningococcus- the A, C, Y, and W-135 types.  We use this routinely and it works well and safely.

3.   There is a tremendous amount of publicity and marketing heralding the arrival of an immunization for the 5th of the 5 types of meningococcus, the B Type.  And it is sold under two brand names, Bexsero and Trumenba.

4.   We consulted one of the country's top authorities on immunizations, Dr. Walter Orenstein, who reviewed the nation's top agency's (ACIP) thoughts on the pros and cons of use of the meningococcal Type B vaccine.

5.    The ACIP has concluded that concerns about the safety of this vaccine, and of how limited its benefits may be lead them to recommend that it not be used for routine use.

6.    At the same time, the ACIP did recommend that patients and doctors discuss its use.

7.    We at Advanced Pediatrics have concluded that we will keep the meningococcal Type B vaccine in stock, and available.   It is to be given to those with specific defects of their immune system.  But also, for families that have a strong concern about the risk of any meningococcal infections, the vaccine can be given with the understanding that its safety and ability to protect are not yet fully established.  Finally, families should know that it is not yet known if insurers will pay for it.

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.

Tetanus- A distant but not eliminated danger

Tetanus- A distant but not eliminated danger

Tetanus is most likely the most widely accepted of the immunizations, and so more people are immunized against the disease tetanus than any other, and so we are likely to never see someone with it.

And yet a recent report on tetanus in India is a reminder that this illness is not yet gone, and that the only reason we do not see many cases is that so many of us are immunized against it.

http://www.nytimes.com/2015/09/01/health/india-virtually-eliminates-tetanus-as-a-killer.html?_r=0

Tetanus comes from a Greek word meaning stretch because the hallmark of the infection are extreme muscle spasms that literally stretch the body.  The muscles remain in intense spasm for 3-4 weeks, and full recovery can take months.  The toxin the tetanus bacteria makes is considered one of the most poisonous substances known in nature.  

Tetanus is a very unusual infection for several reasons:

• The germ is a bacteria that does not really invade or attack the body like nearly all other bacterial infections.
• The germ simply grows a bit in a cut and then produces a toxin.
• The toxin forces the body's muscles into extremely painful and constant spasm, to such an extreme extent that the jaw, along with all other muscles, is locked into a tensed position, hence the nickname lockjaw.
• Unlike nearly any other infection, the germ goes dormant outside of living bodies, and turns into a spore that can rest out in the world for many, many years.   Much of the earth has tetanus spores on the surface of land.  Tetanus spores are found in every country, and even in the air of clean spaces.

The report from India dramatically demonstrates that tetanus only becomes rare when nations immunize most of their children against it.   

Before worldwide immunization work succeeded, there were about 800,000 newborns died every year from neonatal tetanus.  Newborns are especially susceptible if their mothers are not immune and if their cords are not clean.

The advent of higher immunization rates has dropped the number of newborns dying from tetanus to 50,000 per year.  India has achieved a 95% immunization rate and has seen newborn tetanus nearly disappear.

BOTTOM LINES

• The key message from this story is that tetanus is a terrible and deadly disease that we no longer see only because of tetanus immunizations.
• The many years of immunization against tetanus in the US has done nothing to clear our land from very widespread tetanus spores.
• There is nothing to stop tetanus from occurring in unimmunized infants, children, and adults.
• Finally, the story of India dramatizes how tetanus occurs when immunization rates are low, and disappears when they rise.
• So, we do urge all infants to get immunized, the risk of developing tetanus begins at birth, and never goes away, unless immunization occurs.

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.

New Schedules for Immunizations before College

New Schedules for Immunizations before College

An increasing number of American colleges and universities have sharply increased the formality of their requirements for students attending college.

As a result, students are increasingly finding that as they prepare to go to school, these requirements must be met before they can begin attending college.

In response to these more formal requirements, Advanced Pediatrics is making the following recommendations regarding three required, and one recommended vaccine.

The Tetanus Shot (TDaP)

Actually this immunization protects against 3 diseases: tetanus, diphtheria, pertussis (or whooping cough).   In the past, the accepted practice was to give this immunization every ten years starting at 7th grade.  But now colleges are requiring many to have a recent TDaP the year of entry to college.

So our new recommendation is that a TDaP be given to every senior at their senior year health supervision visit (check-up).

The Chickenpox Vaccine (Varicella)

The universal use of varicella immunization across the US has essentially eliminated naturally occurring chickenpox in America.  As a result, it is very unlikely a child will emerge into adulthood protected from getting chickenpox as an adult by having chickenpox as a child.  It turns out that one dose of the varicella vaccine gives very good protection from the serious danger of getting a full case of chickenpox as an adult.   Getting two varicella immunizations goes further and nearly eliminates the 10% chance those with one dose have of getting a very mild bout of chickenpox (a handful of red dots, no serious illness.

With these facts in mind, elementary schools have been requiring everyone who enters kindergarten to have two varicella immunizations, for many years.

In the fall of 2015, colleges began to also require two doses of varicella be received to attend class.
So our new recommendation is that everyone have two doses of the varicella immunization by their senior year health supervision visit (check-up)

The Meningitis Vaccines
Bacterial meningitis is a very serious infection of the brain and spinal cord.  There are a number of bacteria that can cause such an infection, but most of these bacteria cause meningitis in the very young and the elderly.   The Hib and pneumococcal immunizations of infancy protect against these bacteria.  But there is one bacteria that causes bacterial meningitis in young adults, and that is the meningococcus.

Although a devastating disease, meningococcal meningitis is thankfully very, very rare, happening in about 1 in 100,000 young people a year.  There is a slight rise in the risk in crowded living conditions, so the risk goes to 4 in 100,000 for the first year of college dorm living, and much higher in military barracks.

The meningococcal germ comes in at least 5 types, referred to as A, B, C, Y, and W-135.  The currently used meningococcal immunization, Menactra, has been proven to be safe and effective in reducing the risk of meningococcal infections for the 4 types A, C, Y, and W-135.   This immunization only lasts 5 or so years, and since the risk of this infection begins to increase in high school, the standard practice is to give a dose in 7th grade, then again in 12th.
So our new recommendation is that everyone have the Menactra immunization going into 7th and then again going into 12 grade.

A note on the Meningococcal B immunization
You may notice the Menactra immunization does not protect against the B-type of the meningococcal germ.  A new vaccine is now available to protect against Meningococcal B infections.  However, the nation's review board for immunization practice, the ACIP of the CDC, met in the summer of 2015 and concluded that they do not recommend routine use of this immunization at this time.  The experts found that the actual incidence of meningococcal infections from Group B is already decreasing even without immunization, that we do not yet know how long it lasts, and that some people have had serious reactions to this immunization.
Our recommendation is that unless there is reason to take the risk of an immunization not yet approved for universal use, we would not recommend your young adult receive the new Meningococcal B immunization at this time.

HPV Immunization
The human papilloma viruses cause all the warts on all the parts of our bodies.   There are many hundreds of types of these HPV's.  Nearly every human alive has had an HPV infection from at least one of these wart viruses.
But a small subset of these HPV's cause warts only in the genital area of the body.  These genital HPV's are transmitted by sexual contact, but still are very widespread- about 2/3-3/4 of all adults have genital HPV's.
The real danger from these genital HPV's is that they, on rare occassion, can cause cancer- throat cancer in males, cervical cancer in females.
The HPV vaccines available protect against 4-9 of these genital HPV types, and are recommended
for use prior to onset of sexual activity.
Colleges are not requiring HPV immunization, but Advanced Pediatrics recommends that this three shot series be started near the end of middle school or the start of high school.

Summary
We are all familiar with the fact that infants need their baby shots.
Now there are four vaccines that becoming a routine part of the high school aged child's routine.
In summary, here is there timing of recommended immunization:

• 11-12 years old, going into 7th grade:  TDaP, Menactra
• 14-15 years old, going into 9th grade:  Begin HPV series (three shot series)
• 17-18 years old, going into 12th grade:  Menactra, 2nd Varicella if needed

Having these immunizations up to date will protect your adolescent from tetanus, diphtheria, whooping cough, meningococcal meningitis, HPV caused cancers, and chickenpox.  

Having them done in this timely fashion will also prevent rushes to vaccinate before the first day of college, and avoids having to give too many shots at one time.

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.

Flu Immunizations at Advanced Pediatrics 2015-2016

Flu Immunizations 2015-2016- later this fall

Advanced Pediatrics is pleased to announce that this year’s influenza immunizations will be available in our office this fall.

Many of you may already know that the influenza virus changes every year.  That's why it's the only immunization that needs to be done every year.   Just think about the measles vaccine, you get it twice then never again the rest of your life, because the measles virus in 1880, 1995, 2015, and likely 2054 will be exactly the same.

Not so with influenza virus, so every year public health experts monitor the world to see trends that will help them predict which strains will appear this winter.

This year the public health experts recommended that the flu immunizations for this year change their strains, causing those manufacturing influenza immunizations to delay shipment.

We are told we should have influenza immunizations- by nasal spray and shot- available sometime later in October.

The good news is that the influenza virus only begins to arrive in the United States around late November, rising to real epidemic levels only by mid-December.  So if you get your influenza immunizations by mid-November, you will be protected against the flu epidemics of 2015-2016.

Advanced Pediatrics will be announcing the dates of when influenza immunizations will be available soon, and once again we will be offering our FluFest as the easiest and most fun way of getting your child(ren) protected.

Keep in mind that the influenza virus is responsible for a rather astounding amount of winter illness, causing fully 1/3 of all colds, flus, and ear infections.

Influenza immunization is now recommended for everyone, except for those less than 6 months old.

Influenza immunization comes in two formats:  a shot and a nasal spray.  The shot contains dead virus and is fine for anyone over 6 months of age to use.  The nasal spray contains live virus and should not be used by anyone less than 2 years old, older than 50 years old, or anyone with a chronic illness, including asthma.

With regard to how many influenza vaccines is a complete series, the answer is very simple.  Anyone under age 9 who has never had an influenza vaccine, needs two influenza vaccines at least one month apart to be fully protected.

That also means anyone who has had an influenza vaccine in the past only needs one this year.

Overall, the data show that the nasal spray tends to work better- the immunity covers more strains than are in the vaccine and lasts longer.  But, at the same time, the shot works quite well, too.

We at Advanced Pediatrics are very pleased to be able to help make sure this winter is as healthy as possible.

So, stay tuned.   The immunizations for influenza for 2015-2016 will be here later in October.  We will be announcing when they will be available as soon as we are informed.   FluFest 2015 will be announced soon, too, so stay tuned.

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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 Sweet Sorrow

Going off to College- 

A Loss or a Gain?

Every August, we are honored to share with many families the powerful experience of seeing their first child go off to college.   We are sharing such experiences right now.  This year, we have learned from several families some interesting insights into this very dramatic moment in a family's life.

More than most years, for whatever reason, the sense of loss seems to hang a bit heavier in the air.

It makes sense, after all, here is the firstborn, who has been a child in your home all the years you have been a parent, about to move out of your home, and start their life in their own place.  No matter what, this is an enormous change.   And for many families, there is a very deep sense that a special time, a powerful era, is drawing to a close.   This makes sense, too, since the difference between your child having your address as their main home, and their own separate address as their main home is profound.

Thinking about this very dramatic moment it is also clear that the change has been building for many years.   We all start off as newborns, a period in our lives when we are so connected to our parents that there is so little about us that is not really still part of our parents.   From birth onward, there is a steady growth of our child's abilities and powers.   By the time they enter school they are capable of doing rather amazing amounts of work on their own, an ability that grows dramatically as they go through the early grades, middle, and then, high school.   And, of course, emotionally, our children go through a predictable sequence that leads them to move from their chief joy being with us their parents, towards seeking a home of their own.

At the same time, I thought it would be helpful to share reflections on the connections that not only remain, but actually grow as our children leave home to pursue their own future.   First, though they may be moving away to college, and in time setting up their own homes, they often remain very connected to their parents.   I have found this generation more than most likes keeping the deep connection with parents very much alive.  From email to cell phone to Skype, the ability to stay connected is now so much improved, and most of our young adult children do that.

Perhaps most interesting is how enriched parents' lives are by the lives of their adult children.  In many ways the joy experienced is very similar to a parent's joy at seeing their infant first smile, take a first step, or at the first school play.   It is not discussed very often, but when our children do something in the world, it seems to expand our world, it seems to bring to life the love we have for them from the beginning.   That excitement and sense of love coming to life, only grows as our children leave home.   And so, in some ways paradoxically, leaving home actually makes the love for our children only grow.   Yes, they are leaving, but they are also arriving, on a larger world stage, and so able to do larger acts, which in turn means so much more to share.

So, as so many of our children graduate from high school, and this week and the coming weeks go off to college, we feel for your sense of an era coming to an end, but also for the excitement and love to come as new eras emerge.

Be well,
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.