Friday, June 28, 2019

Alternative Allergy Treatment option

This week's topic
Alternative Allergy Treatment option

Allergies are driving a lot of folks crazy this week so I updated this post from several years ago.

A few years ago, a patient came in to our office for a visit. This little girl had a strong history of asthma and had a regular regimen of medications to manage it. At that visit, the doctor took note that our little patient was no longer taking her medications. Her asthma seemed to have mostly cleared up. The mom explained that they had done some treatments at a local place called Advanced Allergy Solutions and that the medications were no longer needed nearly as much. The Doctor asked me to find out more. The patient's mom was happy to tell me all about it. She herself had done some treatments and that as someone who used to be allergic to dairy, she was now able to enjoy ice cream. For both her and her child the treatments had been life changing.

At our request, Advanced allergy solutions promptly sent over the records but there was simply not a clear translation from this mode of treatment over to "Western Medicine". I was intrigued though. Both of my daughters have seasonal allergies. They also have had trouble with gluten since becoming adults.

Lauren was the first to discover that her frequent migraines went away when she went on a gluten free diet. Alana, my youngest would have severe episodes that made her feel like her throat was closing. This was frightening and upsetting to say the least. Myriads of western MD's had tried unsuccessfully to figure things out before we had ascertained that gluten seemed to be the culprit for her as well. Anything that could ease these symptoms was worth a shot. Even though Alana was on a gluten free diet, gluten is sneaky and she had accidental exposures every so often.

Alana set up an appointment at Advanced Allergy Solutions and she invited me to come along to observe.
They put a cuff on her arm and sent frequencies of different allergens through the cuff. If she was sensitive to something her arm would lift. It was hard to believe what I was seeing, but then......

We looked at the list of allergies that they had identified and to my surprise, I saw that it was very consistent with the results from testing done at UCSF years ago. I had watched the process with the cynical eye of a scientist and was impressed with the results. They told us from the get-go that they don't always have success treating gluten intolerance, but they did treat Alana for some food sensitivities, including wheat. Her symptoms noticeably shifted. When she gets an accidental gluten exposure she still bloats up and feels gross, but she no longer has the same throat tightness. That is an important improvement. 

My brother-in-law was also interested in hearing about our experience. He was severely allergic to cats. Richard couldn't go into a house that had a cat without having significant wheezing and distress. He did a couple of treatments with great success. He now can do a cat house visit with the aid of a Zyrtec and have only mild symptoms.
My husband Sandy (Mr. Nurse Judy to those of you who enjoyed his Father’s Day post) got very significant relief from an itchy rash that had been plaguing him for some time, and that had also not responded to western medicine. Fascinatingly, they found that he was allergic to his own histamine. Lauren still has allergies but she used to be super allergic to something here in San Francisco that would set her off every time she came home. Now that she lives here again, she did a few treatments and the symptoms are much better than they used to be.

This is not just ‘a waving of the hands’. This company gets results. Back when I ran this post for the first time, we had a meeting with the Advanced Allergy folks and talked about all sorts of ways that their treatments could benefit people with stomach issues, respiratory issues, attention issues, get the idea. It of course doesn't fix everything, but for some lucky people it is an absolute magic wand.

Over the years I have certainly told quite a few people about this treatment option, and some of my patients have seen significant success. It is such a different approach than the standard western medicine that we are familiar with, that I sometimes forget to mention it as widely as I should. I just recently had a few success stories so I decided to rerun the post. It still feels a bit mysterious but it is completely non-invasive and reasonably priced so I decided to spread the word and ask them to do a better job explaining what they offer. 

Here are some words from the owner Denise Wood
It’s been a pleasure for us over the years to treat not only Nurse Judy but also her family at Advanced Allergy Solutions!

We are a holistic allergy assessment and treatment center dedicated to resolving the symptoms associated with allergies and sensitivities. We have dedicated our clinic to identifying and treating allergies, and have the honor to have helped thousands of patients since we opened our doors in 2010. We understand how stressful it can be when your child is being affected by allergy symptoms, and if you’re looking for more information about how we can help, our staff is happy to answer any questions you might have about our services.

The methods we use at Advanced Allergy Solutions allow us to identify allergies and sensitivities and treat the associated symptoms. Our holistic approach is accurate, painless, and easy for both parent and child. We are able to treat children of all ages, including infants -- our youngest patient to date was two weeks old! There are no needles or scratch tests required for the allergy assessment and no medications will be prescribed for the treatment.

Here are some common symptoms our patients come to us with:

  • Asthma
  • Night cough
  • Hay Fever - sneezing, itchy eyes + throat, coughing, fatigue
  • Sinus + Chest Congestion
  • Pet allergies

  • Eczema
  • Hives
  • Acne
  • Rashes

  • Infantile reflux
  • Colic
  • Tummy aches
  • Diarrhea

  • Headaches
  • Food allergies
  • Behavioral problems

Our goal at Advanced Allergy Solutions is to bring long-lasting relief to those who suffer from allergies and other sensitivities. We are located at Webster and Geary in San Francisco with ample FREE parking. We are excited to continue working with Nurse Judy and the team at Noe Valley Pediatrics. Feel free to give us a call or reach us by email to find out about booking an appointment for your child.

Friday, June 21, 2019

Travel safety check list

This week's topic
Travel Safety checklist

Now that summer is here and families are traveling, I am going to do a post that my dad would have loved.

My father’s birthday was June 21. He would have been 92 today. He was a physicist who looked at the world from a unique perspective. How do things work? What is broken, what can I fix, but even more importantly what might go wrong and how can I prevent it?

When he was teaching me to drive I remember him pointing to a boy with a ball on the sidewalk.

“What could happen”?

The ball could drop, fall into the street and the boy might rush into the street to follow it. Anticipating what could go wrong was the first step to prevention.

My regular readers have heard me say that we can’t keep our children wrapped in bubble wrap. I really do encourage folks to go off and have grand adventures.

On the other hand, it is important to be aware of potential hazards. Knowledge is power and some accidents can be prevented. Others can be handled with less stress if you are properly forewarned.

I have done several previous posts on traveling with your kids that have more of a “managing the voyage." Here is the link to the most recent one:

This one has some overlap but a different focus.

The travel safety checklist

Do you or your family need any travel vaccinations where you are going? Make sure you get these done at least a month before the trip if possible. It generally takes a few weeks for things to take effect. The only exception would be the early MMR, which can’t be given earlier than 6 months of age. It isn’t a bad idea to have a copy of your immunization records with you on your travels. Make sure tetanus is up to date. The CDC's Travel website is a great resource

If your child gets ill during the trip, it is important to know where to get care.

What local urgent care options are available? Are you visiting family that has a doctor who will see travelers? Do your homework, check with your insurance if that is applicable to see what will be the most cost effective choices.

If your child has a history of wheezing, even if they have been fine for years, take your inhaler with you. If they have ever had an anaphylactic reaction, make sure you have your epipen.
Also have fever reducer and an antihistamine with you.

We can NOT call in prescriptions to another country! (Including Canada!)

Are you visiting friends or family?
It might be awkward, but do it anyway - Ask your hosts if they own a gun. It is essential to make sure that any guns are locked away, separate from ammunition. (This has nothing to do with the second amendment.)

Ask about poisonous plants

Make sure that medications are child proofed. Grandma and Grandpa might have medications in areas that are easily accessible if they aren’t used to having young kids visiting. I had one little patient who got a dose of oxycontin right out of a nightstand drawer. Thank goodness she was okay.

Is there a pet? Is the animal comfortable with kids? If animals are even the least bit growly, make sure they are kept in a different room. Some pets get stressed from having little ones around. I have dealt with more dog bite cases than I can count

Staying in a cabin/ Air B&B
Make sure there is a carbon monoxide detector or bring your own. This is more important in the winter if there are wood burning stoves or space heaters

Most places have a smoke detector. Do a little test to make sure it has working batteries. Fire extinguishers are useless if you don’t know where it is and how to use it.

Check the mattress before you unpack to make certain there are no bedbugs. The best way to do this is lift the sheets and make sure you don't see any red spots. Bed bugs are large enough to spot.

In some cities like NY they are rampant. This is not a souvenir that you want to bring home.

If you are traveling internationally, be aware that cribs may not have the same safety standards that we have here in the US

Food safety
We have had quite a lot of calls regarding international travel and loose stools. If there is vomiting, diarrhea and fever, this is likely bacterial and you should be seen.

Making sure that you have clean water is essential. Make sure to avoid ice unless you are in a resort area that assures the safety of the water. It is worth asking the place where you are staying if the water is filtered.

Street food, raw fruits and veggies, raw or under-cooked meats and fish, can all lead to trouble.

Swimming and Water safety
If you are going anyplace with water nearby, appoint a water guardian.

Make sure there are alarms and fences around any pools, but there is no substitute for watching the kids like a hawk.

Will you be out in large crowds? Take a photo of your child before the outing so you know exactly what they were wearing in case you get separated. Consider bright, recognizable colors. Write your cell number on their arm and cover it with liquid bandaid so that it doesn’t wash off. Make certain that your child knows the safety plan and where you should meet up if you get separated.

Do a head to toe Tick check every day.
Make sure you have plenty of bug spray and sunscreen.
Use appropriate insect repellent. Dr Anne especially likes Sawyer lotion .

Watch out for poison oak or ivy

If you are above a certain elevation, it takes some folks a bit of time to adjust.

You have to pay extra attention to sun and hydration.

My San Francisco kids aren’t used to hot humid weather. Make sure everyone is getting plenty of fluid. Pedialyte has little packets that can get mixed with water to create a perfect electrolyte solution.

Protect the Lovey, blanket or stuffed animals that come on the trip

Deciding which security items come along on your travels is a big decision. If your child has a favorite blanket that they snuggle with, losing something in the hotel sheets can be a nightmare.
We learned this the hard way with Alana's stuffed Bambi that she had chosen to accompany us on a family trip to New England.
When we returned to the hotel room after a day out, Bambi was no where to be found. We had the hotel check the laundry multiple times, to no avail. Alana was heart broken. Several weeks later, Sandy and I were passing a Disney store and found a similar Bambi.

"This isn't my Bambi!" Alana knew. There is no replacing a lost and well loved stuffy.

"I will call him Benjamin."

Benjamin has survived and is still in Alana's childhood room.

Dr. Anne's daughter also lost a stuffed animal in an airport. I think this happens a lot.

Friday, June 14, 2019

Father's Day/Mr Nurse Judy posts

This week's topic
Father's Day Post
from Mr. Nurse Judy
In honor of Father’s Day, I am running two of my most popular posts from the past few years. They are Mr. Nurse Judy’s (aka Sandy) thoughts on his relationships with our daughters. Warning, they had more than one of my readers crying...

Happy Father’s Day!

In honor of Father’s Day, Nurse Judy has invited me pen this week’s column and share some of my thoughts about why I have, and you the dad can have, the absolutely greatest relationship with your kids through all stages of their lives. I believe that inherently, mothers are more nurturing, protective, overtly emotional, physical, and “maternal” in their instincts, beliefs and behaviors towards their children. But from the moment I first saw Lauren, a day that all who know me recognize as the most impactful day of my life, I knew I was going to give Nurse Judy a run for the money. I, like many of my generation, had an ok relationship with my parents. But it was not the one I wanted with my kids, and that became immediately obvious that day Lauren was born.

I have been called a lot of things over the years. I am frequently referred to as Mr. Nurse Judy. After years of taking our golden retriever to the park up the hill in the afternoon when the local elementary school let out, I became known to a few generations of kindergarteners and first graders as Java’s daddy. I was known as a business executive. But the grandest name I treasure is that of daddy (or father or papa bear or…) Why? Because after building a relationship with Lauren for 28 years, and with Alana for 25 years, I continue to have new and grand experiences with them, experiences that are direct descendants of the beliefs I had in raising them. And now I have a daughter who jumped at the opportunity to go on a daddy/daughter cross country road trip when she left for grad school, where we got to eat yellow (yes, there’s a story there) in Indiana, and simply cross a bridge into Kansas, make a U-turn, leave and say “we’re not in Kansas anymore.” And I have a daughter who is still my roller coaster buddy every August, and is accompanying me on what may be the stupidest thing I ever try – climbing Kilimanjaro. So how did I get here?

First of my early parenting philosophies was simply make time. I’m not talking about the “I’ll play with you when I get home and I’ll read you a bedtime book” type of time. I’m talking about the “take a morning off to hear your 2nd grader say one line in a play; use vacation days to chaperone school outings; play Barbie for hours on end; and supervise a cabin full of 5th grade boys on the school trip” kind of time. A typical dad probably spends more time away from their child than the mom. So take advantage of the time that you can have! As soon as my kids came home from the hospital, I never missed an opportunity to be with them. Each night, when an infant would wake up and cry, I went in. It was pickup and delivery to Judy to nurse them. Judy thinks I was doing this for her but she was just a benefactor. I picked them up, sang softly or told stories to them as I cleaned them up, and then brought them to our room. And then back to their cribs. Every night. We built up quite the relationship. Bath time? That was mine too. Nightly bedtime ritual? Well we both had one. But much of my daughters’ love for the great rock and roll of my youth comes from that time we spent every night. As they became toddlers, every weekend I took them to Miz Brown’s diner in Laurel Village. So Judy could get more sleep? Hmm, ok, but not really. It was completely selfish on my part. Want more time? Be the home that welcomes the gathering of the friends. While perhaps not directly involved in your child’s life at that moment, the benefits are extraordinary in what you get to witness, the welcoming environment you’re modeling for your kids, and the lifetime of relationships with your childrens’ friends, who consider you an extra dad. (2019 update - as a result of that, I will be officiating, for the second time, the wedding of one of my extra daughters!)

Next on my list of dad-parenting beliefs is “don’t look for a reason to say yes; assume that’s the answer, and instead force yourself to look for a reason to say no.” It’s simple but at least for me, it was initially uncomfortable and unnatural. But once I grew comfortable with this practice, it was an epiphany! Saying yes to as much as you can say yes to, is so much easier than saying no. And it has such wonderful benefits. Questioning, exploring, learning, experiencing…and you get to be a cool dad! Talking about going on a family camping trip when you’re asked if they can try camping in the house? Say yes, and set up the tent in the living room, light the fire, roast marshmallows, and sleep in sleeping bags. We can all think of valid reasons not to do this and I’m certain my instinctual reaction was “too much time; too much effort, and then I have to clean it all up and put it away.” But saying no wasn’t going to lead to the magnificent shared family memory we now have 20+ years later, and I certainly don’t remember anything about setting it all up or taking it down. “Dad, can I help?” Of course there are reasons to say no; it will certainly take more time. And you may have to watch your language. Unless it’s urgent, so what? Invite your 3-year-old to crawl under the car with you. Rub some dirt on their nose to make it official! And let them help! “Can I go someplace?”; “can someone sleep over?” Yes. And yes. Unless something is a threat to their health and well-being, be quick with the yes! Might some of these yeses have less than ideal implications to you and your free time? Probably, but that’s not what you’re going to remember! Only after saying yes can you then figure out if there is a “no” reason significant enough to change your mind. The more you say yes, the more they will ask you. As school children. As teenagers. And now as adults.

You will recognize my last pearl of wisdom as a modification of the Peter Pan syndrome. Let them be kids as long as possible!  While it may be cliché, as we all know and live every day, once that’s gone, it’s gone forever, and I know that I, and maybe you, wish you could get it back! So don’t take it away from them. Don’t be in such a hurry to “help” them see things as you see them, through adult eyes and perceptions. They are emotionally, physically, and intellectually naïve – it's a wonderful time so don’t rush to take that away from them. In fact, for a truly wonderful relationship, force yourself to see the world as they do! That’s why I once found a pet/fish store open till midnight so I could go out and replace the fish that had died when Lauren was asleep (and yes, I brought the dead fish with me to try to get a match!) Of course she would have to learn to deal with the death of a beloved pet, and eventually beloved humans. But she didn’t have to learn about it that day, and it let her be a kid a little bit longer. 

Don’t try to explain why work is so busy, that you need to do it to pay the bills that benefit them, and thus you don’t have time to play Chutes and Ladders for the 5th time in the past 2 hours. Instead, see it through their filters – why would anyone want to deal with things that are drudgery and frustrating when you can have fun playing a grand game? They didn’t ask to be your child – you decided to make them your child. I hope that decision was made with an appreciation for the fact that this responsibility instantly became the single greatest responsibility you have ever undertaken. The consequences of that decision are literally life changing for all involved. If it’s not your greatest responsibility, then something’s awry and you will miss out on immeasurable joy.

In the summer of 1988, my family of 3 (Lauren was 1) was invited to a swimming party at the home of my then senior VP. He had 4 adult daughters. While everyone was subtly vying for his attention, I spent the greater part of the day with Lauren in the pool. Late in the afternoon, the VP’s wife found me and pulled me aside to tell me that her husband had spent much of the day watching us play in the pool. Why? As she explained, he had been the wonderful corporate soldier. Moved all around the country when he was asked to. Frequently travelling. Successfully moved up to senior VP of one of the world’s largest companies. And she told me that if he had to do it all again, he would rather have spent the time in the pool with his daughters, because now he was here, envying me and the relationship I was already building with my child. Over the course of my career, I was often asked to make those same sacrifices, but by then I had already learned my golden rule – I worked to live; not lived to work. And while I had a satisfying and rewarding career, I never reached for those corporate stars that were dangled in front of me. Because one day I was hoping that I would have the type of relationship with my children that allows me to eat yellow with one of them, and climb a mountain with the other.

Part 2
I want to thank you all for the kind comments I received after last year’s post about my wonderful relationship with my children, a relationship that continues to get better, even now as I close in on the end of my 6th decade of life, and my daughters near the end of their 3rd decade. It is a role that is paramount to me, and I refuse to let time and distance interfere with my efforts to continually improve it. So far, I think I’ve been pretty successful, and the rewards are immeasurable. Certainly it’s a lot easier when they are young, living in your home, and “need” you to be involved in their lives. But the foundation you create early for how you want that relationship to be makes it a lot easier to enable it to grow, flourish and blossom at any stage of life, even now as they establish their own lives, careers, and relationships.

I want to make clear that I have no special training or educational background in this area. What follows are simply my own philosophies about fatherhood; you may disagree with some or all of them. But this is what has worked for me and I cannot really imagine a father with a better relationship with his adult kids than I !

So first an update on my relationship with my daughters. At this time last year, Lauren and I were weeks away from traveling to Tanzania for the challenge of a lifetime. AND WE DID IT!!! We summitted Kilimanjaro on the morning of July 19th, an absolutely grueling climb that took me to the very limits of physical, intellectual, and emotional endurance. In fact, I couldn’t have done it without Lauren’s support, and I was quick to make sure she knew that. We spent two weeks together in very close quarters, most of that time unwashed, extremely sleep deprived, and cold. Summit temperature was 24 below zero! The only cross words that were exchanged were over a misplaced towel (I both misplaced it and spouted those cross words!) I never want to face an ordeal like that again!! At least not until April 2018 when we climb to the base camp on Mt. Everest! See – the relationship just keeps giving!

If you are an avid reader of Nurse Judy’s blog, you may remember that when she was in grade school, Alana ended every night by telling one of us all about her day…in exquisite, and often lengthy, detail! The big, the little; the important and the minutiae. Well, more than 20 years later, I get to do that with her all over again. Every day. And I look forward to it and resent it when another friend has a need for Alana’s time! After obtaining her MSW last June, Alana is now a practicing therapist in a community mental health center in Michigan. She has about a 30-minute commute in each direction and on her car ride home, I get to keep her company!!!! And we talk all about our respective days. The time flies past and she is home before we both know it, but not without each of us learning a little bit more about something in each of our lives. What I have primarily leaned is that her counseling clients are the luckiest people in the world because they have Alana as their therapist. I listen in wonder and respect as I get to share in the progress they make dealing with the issues that brought them to her in the first place. She is changing lives on a daily basis and I get to be the fly on the wall. I am overjoyed that she still wants to spend that time of her day with me. I frequently tell her that I am in awe of what she is doing and remind her that she has to take the time to sit back and reflect on that also, and not just move on to the next client… which brings me to my first point of this year’s father’s day recommendations for building that relationship with your children:

Find reasons to be proud, and praise them whenever you can!

From the first time they can lift their head by themselves, to the first crawl, to standing up, and that first use of the potty, let them hear your voice filled with pride and encouragement. Let it become ingrained in them that you are their number 1 supporter, for both the little and big accomplishments in life. As I mentioned last year, that’s why I took a day off of work to go see a VERY shy 2ndgrade Alana (right now, all her friends are saying “who the heck are you talking about?”) get up on stage just to say one line in a play; it was a grand small accomplishment that deserved to be recognized. When younger, even though they can’t understand the words, they can hear and feel the sentiment in your voice, and for the rest of their lives, that sound will provide great sources of satisfaction and comfort, and it will provide a lifetime of encouragement for future exploration. Now, I am not one of those in favor of participation trophies and I am not saying that everything they do should get this level of exuberance. But be generous with the praise, especially in their formative years.  This brings me to my next recommendation:

Value the efforts too, not just the successes!
There is an old saying that good judgement comes from experience; experience comes from bad judgement! It is a cycle that cannot be completed without falling down. So let them fall down, but don’t bemoan the failure; commend the attempt, and any part of the effort that will help them gain “good judgement” next time. It is quite easy for children to focus on your critical evaluation of whatever it is they are attempting, while underappreciating the praise you may simultaneously be conveying. For example, if you’re trying to teach them to throw a ball, don’t focus on the fact that the ball landed by their feet. Appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them, so focus on the things that they can do well (gripping the ball, placing the feet, shifting the weight…) and celebrate these building blocks that will one day end up in those ultimate tasks being that much easier, and enjoyable! Simply focusing on the failure of achieving the end result will certainly lead to frustration, and possibly anger and resentment.

It's ok to be wrong. In fact, it’s good! Admit it, and apologize!  
It is sad when I see a parent who either insists they are never wrong, or twists circumstances to make it seem that they were not wrong in a specific situation. It’s very easy to play that mental game with a child in an effort to demonstrate that you always know what’s best, or think you will be respected because you are always right. Satisfied that you out-strategized a child in this mental arena? Get over it; it’s not that hard. And it’s not that smart. I (and I think my daughters would agree,) created some of our most profoundly important relationship building moments by admitting I was wrong about something, and apologizing for it. Think about it – is there anything more empowering to your young child than having a person in a position of authority implicitly say to them “I not only heard you but I really listened to what you had to say. I thought about it with all my years of advanced experience, education, and knowledge, and I realized that you were right and I was wrong.” Trust, confidence, consideration, kindness, communication…. there are innumerable benefits to acknowledging your own fallibility to your child! And it tells them it’s OK to be fallible too! You don’t expect/need/want perfection, and they don’t have to live up to that standard. And it teaches them that being wrong is a part of life, not something to be defensive about, and can be dealt with responsibly and respectfully.

I mentioned above that you should “appreciate that there are things they may simply be incapable of at any given age. It’s up to you to understand that, not them…” You must accept very early on that you are incapable of thinking like a child, nor they as an adult. Kind of like the “Men are from Mars, Women are from Venus” paradigm, you and your children speak the same language, live in the same environment, are familiar with the same behavioral mannerisms, yet you have such different frames of reference, experiences, emotions, intellect…that at times it will seem to each of you that the other is speaking a foreign language. And you are!! It is so very easy at those times to get frustrated, and even worse, angry. But it is unrealistic for you to expect them to be able to think, analyze, and express themselves at the level you do. They don’t have your emotional and intellectual development and it is unfair to simply use your advanced capabilities as the measure of their intent. When you feel that coming on, take a break, remind yourself of this, and try your best to see things as they do. You most surely won’t completely succeed, but every little bit of empathy you can muster will bridge that gap just a little. It’s also never a bad idea to voice this self-realization; let them know that you are consciously aware that you are cross communicating and invite them to help think about how each of you can get your respective thoughts out. They’ll develop patience, compassion and problem solving skills!

Establish ground rules for how to disagree!
My girls and I had a very useful rule – we weren’t allowed to go to sleep mad! The rest of the argument or disagreement could proceed along its natural course, but ultimately it had to end at this rule. It was really quite simple in its effectiveness since it forced (encouraged?) us to resolve our differences. There were times long after bedtime that one of them would either come out of their room to say “I’m still mad” or amusingly, would slip notes under our door detailing the issue (Alana was the talker; Lauren the writer!) This led to frequent comical exchanges of notes going back and forth under each other’s doors but it was such an easily understood rule that it almost always worked! The key though is to take it to heart! As my brother-in-law sometimes says “gravity, it’s not just a good idea, it’s the law.” My daughters and I made this a law, and if one of us was “violating” the law by claiming fatigue, or anger, or issue complexity, or…etc., the other party was free to demand that we follow the law, sometimes leading to late nights and missed bedtimes! But always successful resolutions of the issue. And guess what? Most of what I have written about here represents the philosophies that I tried to use to help make sure each day ended on a happy note.

Happy father’s day to all. See you next year when we get back from Everest!

Update 2019
Last year, Sandy had more milestones and amazing experiences with our daughters.

Two weeks after I broke my right arm last winter, Alana decided that she wanted to be just like mom. She slipped on some ice and broke her left arm. Sandy caught a red-eye flight that night so he could be with her for the surgery she would need. He knew she was frightened and that his orthopedic experiences (5 surgeries) would serve her well! The change in her demeanor was instant when she realized daddy would be there. This was a week prior to his scheduled big trek with Lauren.

On April 2nd, my birthday, I got a call from Lauren and Sandy from Everest Base Camp! They had an epic adventure. For those of you considering climbing mountains, the 38 hour summit day on Kilimanjaro was the single most challenging day of either of their lives, while the Everest trek was more difficult on the whole. But they did it! And on Lauren's wedding day, outdoors on a chilly San Francisco August evening, Lauren was quite cold while we walked her down the aisle. So Sandy turned to her and whispered "Just remember, it was 24 below zero on the summit of Kilimanjaro!" Her reply - "Not helping dad!"

And since Alana was returning permanently to San Francisco from Ann Arbor in August, he and she did another cross-country road trip, exploring the Black Hills of South Dakota, the Badlands, Mt. Rushmore, Yellowstone, the Grand Tetons, and more, singing and laughing their whole way across.

Wednesday, June 12, 2019

Measles by the numbers

Measles by the numbers

I understand that it goes against the grain of any parent to be told that you must do something to your child that you don’t agree with.

Prior to the California state law 277, which mandates that all children who attend daycares and schools be fully vaccinated, the pediatric office where I have worked for many many years had a few families who made the choice to delay or even skip some of the immunizations. The owner of the practice opted to continue care for these children, while many other offices had a policy in place that refused to have them as patients. Our goal was to develop a trusting relationship with the families and educate them to the best of our ability. We had hoped that these parents would feel comfortable enough to make the choice to protect their kids by weighing the facts and recognizing the value of the vaccinations. Most of these reluctant families ultimately did have their children get at least some of the shots. Others had their minds made up and no amount of data was going to sway them.

There is an enormous amount of misinformation and misleading statistics out there. It is easy enough to see why someone who has deep beliefs has a hard time being convinced to change their mind.

I have been around long enough that some of the diseases we are now able to prevent are very real to me. I worked in a hospital where children died from illnesses that we no longer see. I admit to being a fan of the state law. I think it saves lives. These numbers don’t lie.

Measles is a leading cause of vaccine preventable death and illness. Worldwide it kills 100,000 each year. In the year 2000 it was declared eliminated in this country (absence of continuous disease transmission for greater than 12 months) Since the year 2000 it is estimated that the measles vaccine has prevented 21 million deaths. Sadly, this illness is roaring back. Between January 1 and May 31 2019 we have had 981 cases. That is the highest number in decades and the year is only halfway over.

People with no immunity have a 90% chance of contracting measles if they get exposed. Of those people who get the illness, 1 in a 1000 will have potentially fatal neurological complications. The complication subacute sclerosing panencephalitis occurs in approximately 1 in 10,000 cases.This is always severe and usually fatal.

Here are a few examples that make these number more relatable.

41,000 seats at Oracle stadium:  41 seriously impaired for life/ 4 dead
20,000 attend Carnaval in SF’s mission district:  20 impaired/2 dead
2,700 Lowell students:  at least 2 impaired or dead

I have come up with an analogy that those of us who live near recent wildfires can relate to. If there is an ember in a forest in the middle of the rainy season, it is unlikely to do too much harm. The same ember in a dry forest can be devastating. Every unvaccinated person is like a dry tree.

Prior to the past several years, even a single case of measles made the news. The health departments immediately went to high alert, tracked down and attempted to quarantine any potential contacts. They were in essence the fire department. They managed to keep the cases to a minimum. Unfortunately the embers have turned into small fires, and there are more and more “dry trees.”

Each infected person can transfer the disease to 9-18 people who don’t have immunity. Measle is so hard to control because the virus can remain airborne in a room for hours even after the infected person has left.

In 2015 a single child with measles in an oncology clinic infected 23 other children, of whom 50% had severe complications; they had a 21% fatality rate.

The highly contagious nature of the disease requires almost near perfect vaccine coverage to prevent a full resurgence.  Infants and some people with health issues can not get the shot. EVERYONE ELSE who opts out of the shot is potentially contributing to an impending crisis.

Several years ago, if someone was resistant to give the MMR,  due to the ‘herd immunity’ the chance that their child would actually be exposed to measles was very unlikely. The odds are no longer in their favor.

What does all of this mean?
If you are someone who is still hesitant to give your child the MMR, thank you for reading to the end. I hope that you can gather enough real data to make the decision to protect both your child and those vulnerable people around you. Many of us turn into mama bear or papa bear. I get it. We, ourselves might take one for the team, but we not willing to offer up our children if it isn’t in their absolute best interest. In this case, it is no longer simply about getting the community immunity levels back up. You are making the choice that is in the best interest of your child by getting them the MMR.

For children over 12 months, if they haven’t done it yet, get the shot as soon as possible. If you are going to an area where there is an outbreak, 2 MMRs are recommended. The doses need to be separated by 4 weeks. There is no harm in getting both doses done now. If you are not traveling, the second dose can be given at the standard time when your child turns 4.

For children over 6 months but not quite yet a year, if you are going to an area that has an outbreak an early MMR is suggested  This dose will not count towards the required two doses and may not be covered by insurance. If you are not traveling to a high risk area, there is no current recommendation for having the shot done early.

For children under 6 months, the shot is simply not an option. Fortunately the younger infants may have some maternal protection, but I would still bend over backwards to avoid exposure.

I am giving my frank opinion here. If you have a completely optional trip that includes air travel and crowds and your child is too young to get the MMR vaccine, I would probably change plans and find a local vacation that you can drive to. If you are in the SF Bay area, there are so many great choices.

Every situation is unique. If you have an important family event, such as a wedding, it isn’t so simple. I would NOT give as hearty of a “don’t go”. I am not ready to have us all hunker down in underground bunkers.

If your child has had the MMR, take a deep breath and have fun on your trip. One dose of the MMR gives 93% protection and the second dose bumps that up to 97%.

Sources Paules CI, Marston HD, Fauci AS. Measles in 2019 - Going Backward. N Engl J Med. 2019 by way of Contemporary Pediatrics May 2019

Friday, June 7, 2019

Melatonin/Is it useful/ Is it safe?

Melatonin is a hormone that occurs naturally in the body. It is produced in an area of the brain known as the pineal gland. Melatonin is released and helps control the body's circadian rhythm. It is not a sedative, but works in combination with light to get the body drowsy when it is time for sleeping. It is not habit forming. It is interesting to note that melatonin production tends to decline with age.

Some studies suggest that melatonin may help adults and children fall asleep faster and improve the quality of sleep. It is best to give it about 30-60 minutes before bedtime. There are no known ill effects but there is little research into the safety of long-term melatonin use in children. Ongoing studies are taking place to see if it is useful for treatment of migraines. The neurologists don’t seem to have concerns about safety, but until study results are available, many people are reluctant to give it an official recommendation as a routine sleep aid.

Melatonin is becoming more widely available with various pediatric friendly options. This makes melatonin easier to access but unfortunately there are no clear dosage or safety guidelines in place. For routine sleep I would start my focus on some common sense tips

Have a regular bedtime routine. Do some soothing activities, make the room progressively darker and darker. Don’t include any electronic devices as part of the bedtime ritual. The blue lights that are emitted are disruptive and should be avoided for at least an hour before bedtime.

Going to bed and waking up at the same time can get the body into a healthy rhythm. You may hear this referred to as 'sleep hygiene'.

Keep the bedroom cool. According to the National Sleep Foundation the ideal bedroom temperature is actually between 60 and 67 Fahrenheit. You can bump that up a bit for infants and toddlers to 65-70, but cooler rooms are better for sleeping.

If you have low iron or vitamin D levels, that can impact sleep, so if you are having insomnia, that is another factor to check out. A couple of nights of melatonin to help get into a good habit is probably quite safe. I would just avoid having it become a habit.

Not a day goes by these days without getting a call or email asking if melatonin is a viable option. Most of the families calling about it are planning travel and have seen it mentioned out there in parent chat rooms.  All of the package directions have that ‘hot potato’ phrase “Please check with your doctor.” The problem is that many doctors have different opinions and those are generally based on gut instinct. Studies are ongoing, but we simply don’t have solid data.
In our office, Dr. Schwanke feels that a few doses are likely safe but not uniformly effective. Dr. Hurd agrees with him that she isn’t sure that it is the magic wand that parents are hoping for.
Dr Anne would skip the melatonin and try the natural calm gummies, which are simply magnesium. These help get you a good night sleep (as well as a great poop): I am a big fan of these as well.

Dr. Kaplan, over at Town and Country Pediatrics, says that it is fine for her patients who want to use it to get over a few days of jet lag. If there are longer term sleep issues, it is worth seeing the doctor or being referred to a specialist.

Nurse Judy’s two cents:

The best approach to beating jet lag is to focus on hydration, and get as much light as possible when you land. If you are arriving someplace after 2 pm, try hard to stay awake and then crash early. If you are getting in earlier than that, a short nap might be necessary.
I tend to agree with Dr Kaplan here and wouldn't worry too much about using the melatonin for a night or so. According to many of my patients who have tried it, giving a dose of melatonin before the new bedtime does seem to be helpful. I would not suggest it for kids under 3 years old or for breastfeeding moms. For kids 3-5, start with 1 mg 30 minutes before bedtime. Ages 6-12 can take 2 mg and over 12 can take 3 mg

Melatonin might interact with some medications, so for you grown ups out there I am going to pass the hot potato and have you check with your adult physician. Medications that you need to pay attention to include some contraceptives, blood pressure medications, diabetes medications and most sedatives.

Thank you to the wonderful Dr Rothman, my 'go to' pediatric dentist, for sharing this additional tidbit.
In the anesthesia literature it has been shown that giving melatonin does not increase depth of sedation during a procedure and therefore may be helpful in getting a good night's sleep prior to dental work, thereby decreasing anxiety.
Keep this in mind and chat with your dentist if you have a procedure coming up.