Friday, October 31, 2014

Poisonous plant guide

Poisonous Plant guide

Just this month I had several calls from parents whose young kids who decided to nibble on some house plants. Those kids weren't giving any obvious signs that there was an issue. Typically if someone eats something that they shouldn't, you would expect vomiting, diarrhea, rash or fussing if there is cause for concern.  Just in case I had the parents check in with the poison control center.
In California that number is 1-800-222-1222
I would hazard a guess that many of us can't actually identify the plants we have in our homes and yards and therefore have no idea about whether or not they are a potential hazard.

It might be surprising just how many common house and garden plants have poisonous bulbs, seeds, berries, leaves, or flowers to tempt inquisitive babies and toddlers. Many youngsters are poisoned each year by sampling the greenery in their own houses and yards.
If you have an exploring baby or curious toddler, it is time to take a close, suspicious look at your potted plants and garden.
Keep in mind that you should check out the plants at any nanny share and/ or Grandma's house as well.

Remember the best offense is a good defense. Since one or more of these plants may be found in so many homes, gardens, or parks, try to train your child not to chew leaves, berries, or flowers. Move the very poisonous plants out of reach (watch out for fallen dead leaves too!) or get rid of it. If you are attached to a plant that is on the list, perhaps lend it to a friend or neighbor until your little one is out of the "everything in the mouth" stage. If you are a gardener, make sure that all bulbs and seeds are stored where your kids cannot get at them.

Just like a sensitivity to food, not all kids will be equally reactive to an exposure.
Reactions can range from mild vomiting and stomach cramps to more severe seizures and heart irregularities.

Pets can also have different reactions to certain plants. It is worth getting a list of plants that are toxic to pets from your vet.

It is not as much as an issue here in California, but now that it is Fall many folks may be in the habit of moving some of the outdoor plants in before the frosts come. Back in Pennsylvania just this week, my mom is moving all of her lovely porch plants inside for the winter. Do pay attention to any plant that you child has access to.

Below is a list of some of the common house and garden plants with poisonous parts.

Plants causing severe or fatal poisoning are marked *.
Plants causing rashes are marked with°.

When in doubt, call the California Poison Action Line.

            Plants                                         Poisonous Parts
African violet                                           Leaves
Amaryllis-garden                                      Bulbs
Azalea *                                                   Leaves
Castor bean                                             All parts
Cherries *                                               Seeds and leaves
Citrus fruits                                               Leaves
Crown of thorns°                                      Milky sap
Cyclamen*                                              Tuber
Daffodil*                                                 Bulbs
Delphinium                                              Young plant, seeds
Elephant ear*                                          All parts
Figs°                                                       Milky sap
Four o'clock*                                         Root, seeds
Foxglove*                                              Leaves
Holly-English                                          Berries
Hyacinth*                                               Bulbs
Hydrangea                                              Leaves
Impatiens                                              Young stems, leaves
Iris°                                                      Rhizomes
Ivy-English, German, ground                 Leaves, stems, berries
Larkspur*                                              Young plants, seeds
Laurel-Australian mountain                      All leaves
Lily-of-the-Valley                                     Leaves, flowers
Lilies                                                       Bulbs
Lupines                                                  Leaves, pods, seeds
Mistletoe*                                               Berries
Narcissus*                                               Bulbs
Oaks                                                       Acorns, foliage
Oleander*                                              All parts
Peaches                                                  Seeds, leaves
Philodendron                                          Stems, leaves
Plums                                                    Seeds, leaves
Poinsettia*                                             Milky sap
Potato-Irish                                          Green skin on tubers
Primrose                                                   Leaves, stem
Rhododendron*                                    Leaves
Rhubarb*°                                            Leaves
Sweet peas                                           Stem
Tomato                                                Green foliage
Tulip*                                                  Bulbs
Wisteria                                               Pods and seed
Yew*                                                   Foliage, bark, seeds

Plants can cause other hazards even if not eaten. Many folks in the Bay Area have gardens full of marvelous succulents. Some of my patients have shown up with some impressive scratches from getting too close.

Teach your kids NEVER to eat any wild mushrooms.
Keep in mind this wonderful saying....

There are bold mushroom hunters and there are old mushroom hunters, but there are no old bold mushroom hunters. --- A wise person

Be Safe!!

Friday, October 24, 2014

Halloween safety tips 2014

It is always so interesting to see the trends in popular Halloween costumes.

I am probably dating myself, but I remember my years as a young nurse working at Children's Hospital of Pittsburgh. We would take our little band of patients who were well enough to be ambulatory trick or treating to all of the nursing stations throughout the hospital. One year 80% of the kids were dressed as ET. Another year most of them were Hulk Hogan.
 The costumes mostly consisted of little cardboard masks held on by an elastic band.

I think  that many people have gotten more creative with the costumes over the years.
Any Noe Valley pediatric patients (past or present) who want to show off their costumes on our website, send along a photo and I will get it posted!

I am brushing off the Halloween post from last year. I know it is a week early but some of the tips are all about prepping for the big day.
Have a fun, safe and Healthy Halloween

Halloween Safety Tips

Halloween can be such a fun holiday, but as you can imagine, as an advice nurse we tend to hear about some of the misfortunes that can come along as part of the festivities.


Carving a pumpkin can be a very fun tradition.

Please make sure that your child's level of participation is consistent with their age and ability.

*Do watch out for the sharp implements and make sure you assign your younger child to the safer tasks. (young kids can draw on the pumpkin rather than carving.)

*Clean up the mess. Pumpkin flesh is slippery and can cause falls and injuries when dropped on the floor. Layer newspaper or old cloths under your carving workspace and clean up spills right away so no one slips or trips.

* Skip the candles, which may cause fires. A burning candle in a pumpkin may become a blazing fire if left unattended. Instead, use a glow stick (available in many colors) or flameless candle to safely illuminate your jack-o'-lantern.

Choosing a costume

Want to hear a terrifying statistic?

Children are more than twice as likely to be hit by a car on Halloween than on any other day of the year.

*Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors.

*Have kids use glow sticks or flashlights to help them see and be seen by drivers. Is your dog going along with the trick or treaters? Have them wear a glow in the dark collar!

*When selecting a costume make sure it is the right size to prevent trips and falls.

* Be sure to wear flame-resistant costumes. Remind your child that they need to pay very close attention to their surroundings and avoid walking near any candles or flames...especially if they have loose flowy costumes.

*If a sword, cane, or stick is a part of the costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he or she stumbles or trips.

*Since masks can sometimes obstruct a child's vision, try non-toxic face paint and makeup as another option.

*Always test the make up in a small area first.  Always completely remove it before bedtime to prevent possible skin and eye irritation.

*Make sure that your child doesn't have any latex sensitivity before you do too heavy of an exposure. Many masks are made of latex. We actually just had a patient who had an allergic reaction to the hair tinsel.

You may want to do a test run of the costume and make up a couple of days ahead of time to rule out any allergies.

Trick or treat rules

*Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without supervision, remind them to stick to familiar areas that are well lit and trick-or-treat in groups.

*Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so be especially alert for kids during that time if you are out driving

*A good meal prior to parties and trick-or-treating may discourage youngsters from filling up on Halloween treats.

*bring plenty of water along when you go trick or treating. Just trust me on this one.

*Make sure that your children know that after trick or treating, the grown up needs to pick through trick or treat bag and toss anything that looks suspicious. There is a warning out in Colorado this year about "pot Laced" treats.

That could happen here just as easily. Anything that looks like it has been tampered with should get tossed. 

* Some candies are real choking hazards. If you have a younger child in the house, make sure they don't have access to the stash

* If you have a child with nut allergies (I am sure this is NOT your favorite holiday) make sure that they turn over ALL the candy so that you can separate out anything that might cause trouble.

Expecting trick-or-treaters or party guests?

*Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.

*Provide healthier treats for trick-or-treaters such as low-calorie treats and drinks.(Okay, fine...maybe you don't want to be  that house, but I had to put it on the list)

*Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls.

*Keep candle-lit jack o'lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.

Now..what do we do with all this candy!!!

Make a plan about how much candy they can eat at one time.

It is okay to be a little more liberal than usual for a day or two, but come to an agreement about a reasonable candy intake over the next few weeks.

Some dentists and orthodontists have buy back programs, where they will give your child a reward for turning in their candy.

You may need to be extra vigilant with teeth brushing this season.

Remember that candy freezes (and some of it is actually better that way...frozen snickers bars, yum)

My daughter Lauren was about 6 when she caught on that mom and dad were pilfering through her trick or trick bag and stealing all the good stuff. After that she guarded her stash more carefully.

Friday, October 17, 2014

Enterovirus D68

A couple of months ago, while my husband and I were watching the news, a story came on about a scary new virus in the Midwest that was causing many children to be hospitalized. He turned to me and said "Your phones will be ringing off the hooks about this tomorrow."  He was right of course. Whenever the media widely circulates a story it is hard not to get concerned.
That virus now has been identified at Enterovirus D-68 and it has subsequently spread to most of the country. We do have cases here in California.

Every year, enteroviruses and rhinoviruses cause millions of respiratory illnesses in children. This year, EV-D68 has been one of the most common type of enterovirus identified, leading to increases in illnesses among children. It affects those with asthma most severely. This strain last circulated back in the 1960s so older adults already have some immunity.

Viruses can be frightening. Every year different ones make the rounds and infect millions of people. With most viruses, the majority of the people with the illness have mild or moderate cases, but unfortunately there are a number of people with severe cases. Fatalities do occur. These are the folks of course who make the news. Luckily we have vaccines developed to protect us from some common viruses such as Influenza. Alas there is no current vaccine for this strain of enterovirus. Because most patients with the most common viruses are untested and unreported, it is hard to get a full sense of the accurate numbers.
We likely have seen some cases in the office. We did in fact have a few patients that needed to be admitted with severe cases of wheezing that seemed a bit unusual. Luckily everyone has fully recovered.

In our office when we are suspicious about flu, we often do run the test because with a diagnosis in hand, we can offer a medication like Tamiflu that might shorten and ease the symptoms. Identifying the actual virus would eliminate any uncertainty but testing for this enterovirus would be of limited use; we don't really have anything to offer beyond supportive care.

Testing for the enterovirus has also not been simple. Unless someone was actually in the hospital, the CDC wouldn't run the test. We actually did try to test of few of our sicker children in the office but didn't succeed. Just this week however (October 14th,) the CDC has started using a new and faster test. This new lab test will allow the CDC to rapidly process the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will NOT reflect changes in real time or mean that the situation is getting worse.

The CDC expects that, as with other enteroviruses, EV-D68 infections will likely begin to decline by late fall.

The parameters for knowing when to be seen are the same as they are for any virus illness.

There are some ways that you can be proactive. If your child has a history of wheezing, have a current asthma action plan that you are familiar with. Have unexpired medication on hand.

If you have a very young infant, avoid crowds. Politely ask anyone who has any signs of illness to "Please step away from my baby." Wash hands with soap and water and friction.
Alcohol hand sanitizers are a good start, but enterovirus is not as susceptible to those as it is to soap. Teach your kids a hand washing song that might help encourage them to take a bit longer with it.

Friday, October 10, 2014

What's in your medicine chest?/ get rid of expired meds


 If you or your child becomes ill in the middle of the night, that  3:00 am visit to Walgreen's may furnish you with some interesting anecdotes, but generally it is something you want to avoid. Try to have some basic medications on hand ahead of time. A little preparation is wise.

Oral Meds

Fever reducers/Pain relief
Acetaminophen and Ibuprofen are the most common medications used for this.
Remember that you never want to give actual Aspirin to a child.
Acetaminophen/Tylenol now has an fairly new infant label.
It is the same concentration as the children's, so they are actually interchangeable, but the infant bottle comes with a nifty little measuring system and a spill proof bottle which is safer. Acetaminophen also comes as a suppository, which is great for a child who is vomiting or resisting medication by mouth. Ibuprofen is also known as Advil or Motrin. This medicine comes in a more concentrated infant dropper. Make sure you understand your child's proper dose

Benedryl and/or Zyrtec are the ones we most commonly use. 

These would be given for allergic reactions, itchy skin rashes or insect bites. 
Benedryl will make many kids (and adults) very sleepy.
The generic name for Benedryl is Diphenhydramine HCL. There is no special liquid for infants. Most of the bottles have a caution not to use for children under 4. In our office, we DO use it for younger patients if indicated. Don't give to a young child without speaking to your health care provider. Zyrtec (Cetirizine) also comes in a liquid. It is supposed to be non-sedating but if you are an adult, I would test that out before taking it and driving. It makes me sleepy. 

They are both worth having on hand.

Tip: With any of your medications, put a strip of masking tape on the side of the open bottle and sign and date your doses.
This will avoid the common incident of parents double dosing their babies. This also will help you keep track for yourself when you are sleep deprived. I get plenty of frantic calls from parents who have inadvertently overdosed their kids by giving the medications too often. If there is a concern your first call should be to Poison Control.
1-888-222-1222   (California

*Pedialyte or Drip Drop
These are oral rehydration solutions that would be used if your child is vomiting. 
Breast milk is also great for that, but not everyone is lucky enough to always have it on hand. Pedialyte is the one you most likely have heard of. Unfortunately it tastes a bit like soap. They claim to have recently made it a bit more palatable. It also comes in Popsicle form, which is great for older kids. Drip Drop is new on the market and tastes a bit better. Some Walgreen's carry it, but alas it is not always easy to find. This is where planning ahead will help you out. You can get it from Amazon. It comes as a powder which you mix with water (this stuff is very handy for traveling.)

Have a working thermometer that you have tested for accuracy before someone actually has a fever. As long as your baby is over 2 months, I am not one who is going to focus too much on the exact degree of the fever, but we do want to get a sense of how high it is.

Topical creams

*Triple antibiotic ointment for cuts or scratches
*Anti fungal cream for yeasty rashes or fungal infections
*Arnica for bruises
*OTC hydrocortisone cream for mild itchy irritations

It is easy for tubes of ointments to get contaminated. Think about it. If the tip comes in contact with bacteria from a finger or directly from the body...there you go. Yuck! One study that I read suggested that more than half of the tubes of creams and ointments that people have laying around are contaminated with Staph. The best way to avoid this is to make sure that you don't directly touch the tip to anything. Try to keep it sterile. Squeeze the desired amount onto a spoon and then use whatever applicator you want (clean fingers are usually fine.)

You also want to make sure you have some basic first aid supplies, like band aids and gauze. 

Secondary list

If your child is prone to constipation make sure you have Pedialax or glycerin suppositories on hand.

If you child is prone to mouth sores or irritations, I find Glyoxide very helpful and healing.

If you child has a history of wheezing, now is the time to make sure you have asthma medications available. Please check the expiration date and see when they were opened. Many of those are light sensitive so you should always mark the package when you open them. If your child uses a nebulizer, the tubing should be replaced every 6 months.  If you or your child use an inhaler, it should be rinsed out at least once a week. If it hasn't been used for more than a week it may need to be primed. Check the directions on your specific medication. Pro Air, which is one of the more popular inhalers, needs to have 3 extra puffs to clear it if it hasn't been used in 2 weeks.
Make sure that all your medications are stored in a safe, child proof location (a steamy bathroom is possibly not the best place.) Don't underestimate the ability of a climbing child who knows where the gummy vitamins or yummy medicine is stashed.

Do a routine check for expired medications. Even though I try to stay on top of this I can be occasionally stunned by the old stuff that I find lurking in the back of my own medicine cabinet (it runs in my family.)

Please don't randomly toss expired medication down the drain or flush it in the toilet. Medicine can pollute the bay and ocean, or be accidentally misused or abused. Waste-water treatment plants are not designed to remove medications or other chemicals in waste-water, so after traveling down your drain, medicine may affect our environment.
There used to be special days where you could drop off your expired meds, but they are no longer needed because there are currently ongoing programs. Here in SF you can take your expired medications to:


Central Drug Store  4494 Mission Street
San Francisco, CA 94112
(415) 585-0111
Charlie's Pharmacy
1101 Fillmore Street
San Francisco, CA 94115
(415) 567-0771
Daniels Pharmacy   943 Geneva Avenue
San Francisco, CA 94112
(415) 584-2210
Four Fifty Sutter Pharmacy  450 Sutter Street #712
San Francisco, CA 94108
(415) 392-4137
Franklin Pharmacy  1508 Franklin Street
San Francisco, CA 94109
(415)- 775-3917
Joe's Pharmacy  5199 Geary Boulevard
San Francisco, CA 94118
(415) 751-2326
MOMS Pharmacy  4071 18th Street
San Francisco, CA 94114
(415) 255-2720
Post Divisadero Medical Pharmacy  2299 Post Street
San Francisco, CA 94115
(415) 346-2663
Torgsyn Discount Pharmacy Inc   5614 Geary Boulevard
San Francisco, CA 94121
(415) 752-3737
 VisitacionValley Pharmacy
100 Leland Avenue
San Francisco, CA 94134
(415) 239-5811
Additionally all San Francisco Police Stations will accept expired drugs: 
Bayview Police Station  201 Williams St.
San Francisco, CA 94124
Central Police Station  766 Vallejo St.
San Francisco, CA 94133
Ingleside Police Station  1 Sgt. John V. Young Lane
San Francisco, CA 94112
Mission Police Station
630 Valencia St.
San Francisco, CA 94110
Northern Police Station  1125 Fillmore St.
San Francisco, CA 94115
Park Police Station  1899 Waller Street
San Francisco, CA 94117
Richmond Police Station  461 - 6th Ave
San Francisco, CA 94118
Southern Police Station  850 Bryant St
San Francisco, CA 94103
Taraval Police Station  2345 - 24th Ave.
San Francisco, CA 94116
Tenderloin Police Station  301 Eddy St.
San Francisco, CA 94102
  • Mix pills in a ziplock bag or in as few containers as possible.
  • Tighten the lids of liquid medicines or place the entire bottle in a ziplock bag.
  • Controlled substances(ex: Vicodin, OxyContin, Ritalin, Adderall or Valium) Are only accepted at the Police Stations.
When you visit one of the pharmacy sites, simply deposit your medicine in the green drop-box. If you visit a police station, take your medicine directly to the window.  At police stations, you may be asked for your name and address. You are free to decline to give them that information.