Febrile Seizures 2022

 

Febrile Seizures

Are you familiar with febrile seizures? If you aren’t brushed up on your Latin, The word febrile refers to having a fever. Someone who is afebrile has a normal body temperature. For parents who have no idea that these exist, the first time it happens it is often described as one of the most horrifying moments of their life. Awareness helps. It is by no means a fun experience, but it is nowhere near as terrifying as it appears. General statistics indicate that seizures happen in about 4 -5 % of all children. If you have a family history of them, this puts your child at a bit of an elevated risk. Most of the time the first febrile seizure happens between 6 months and 3 years. Typically kids completely outgrow them by the time they are five. These seizures are NOTassociated with epilepsy.  The symptoms may range from smaller tremors to large jerky movements. The eyes may roll back. Some kids actually lose consciousness. It is common for kids to seem quite drowsy and "out of it" for a period of time right afterwards. Please note that It is very common for kids who are in the process of spiking a fever to look quite pale and seem a bit trembly; that is NOT usually a seizure. The seizures themselves do not usually lead to any ongoing medical issues, but care needs to be taken to make sure the child doesn't sustain an injury or choke while they are seizing.  If you see your child having a seizure your primary job is to keep them safe. Immediately remove them from any water, ledges, traffic...etc. If your child is laying down, turn them on their side. Don't stick anything in their mouths. Make sure their airway remains open.  Do not try to put them in the tub or give fever medications when they are in the midst of a seizure! Link:  Basic seizure first aid Febrile seizures usually come on when a fever is in the process of shooting up rapidly, but it is NOT the fever that is causing the seizure; the trigger is whatever is causing the inflammation. That being said, it is rare to have them associated with a temperature under 102. Febrile seizures usually last less than 2 minutes. If you are able to stay calm enough, take a look at a clock, watch or phone to get a sense of the time. If a seizure is lasting longer than a minute (especially if it is the first time) it is perfectly appropriate to call 911. If the seizure is short and your child seems stable you don't need an ambulance, but you still should get them some medical attention right away.  One of the things you want to figure out is the source of the fever. Viral syndromes are the most common cause, but the medical team will want to have the other suspects ruled out (ears, throat, lungs, urine.) Once your child has had one febrile seizure, they have a lower threshold and unfortunately it can happen again. It is important to keep in mind that fevers are the body's way of fighting an infection. As long as a fever is lower than the 101 range and the child seems happy, I generally tend to leave the low grade temps alone and not treat. This was not the case with my seizure prone patients. I was in the habit of being a bit more aggressive with those little ones.  I learned recently that there is new data about this. It turns out that while this might make your child more comfortable, it isn’t likely to prevent subsequent seizures. In any event, have the correct medications on hand and make sure you stay up to date with the proper dosage for your child’s weight. Dr. Ted’s Research: Those recent studies that show that keeping the fevers down won’t necessarily prevent recurrent seizures can be hard to wrap your head around. This is a good example of something called a “true-true-unrelated phenomena." In these kids something is causing inflammation. It is the inflammation which is causing the seizure. The same inflammatory process is causing the fever. It is NOT the fever causing the seizure. Sometimes the seizure actually occurs before the fever. In any case, as Nurse Judy mentioned above, keeping the fever down doesn’t seem to alter the potential for having a seizure.

Tick bites 2022

 

Tick Bites 2022

Ah, the twisted thinking of an advice nurse. For most folks, spring brings to mind warmer weather, longer days, lovely flowers...etc. Me? I think, "Here comes tick season." Ticks can be an issue all year long, but the nymphs are born in the spring. These tiny little ticks are the ones most likely to transmit diseases. There are many varieties of ticks out there. The ones responsible for the majority of disease transmission are the deer ticks. If you want to impress folks at your next cocktail party, our local deer tick is identified as the ixodes pacificus. Although only a small percentage of tick bites are harmful, Tick Borne diseases can have a major health impact, so we need to pay attention. There are multiple types of bacteria responsible for tick borne illnesses. Ticks here in California are known to transmit several different diseases, including Lyme. The rates for tick borne diseases are higher in California than previously thought. A study from 2021 found that about 4% of the ticks tested positive for Lyme. Interestingly that also found that there were plenty of ticks close to the beach! The key is prevention. If you are going to be playing or hiking outdoors near woods or grass, spray the clothing with the bug repellent Permethrin. This is okay for anyone over 2 months of age. Use Deet on exposed skin, avoiding hands, eyes, and mouth. If you are looking for more natural remedies, here is a list of essential oils that are associated with insect control: Lavender - This smells sweet to us but bugs tend to hate it. It can repel mosquitoes, flies and other insects. Lemongrass - this essential oil comes from tropical lemongrass. It has a nice citrusy scent. It is a natural flea and tick repellent that can be sprayed directly on the skin. Eucalyptus - use this alone or along with citronella oil to keep bugs away. According to the Journal of Medical Entomology, eucalyptus extract can reduce tick bites. Lemon - Some lemon essential oil can work against fleas and other bugs. Dilute it and spray it on your clothing and and skin. PennyRoyal - this is a member of the mint family. It is toxic to insects. Be wary of this one.Pregnant women should avoid handling this essential oil because it has been linked to miscarriage. Sorry to say, as much as I love the natural remedies, none of the above are going to work as well as the DEET. If you are going to be walking or hiking try to stay in the middle of the path. Avoid wood piles and logs. Light colored long sleeves and long pants are recommended. But let's face it, on a hot day we are not going to have our bodies covered completely, so here is the deal.... Everyone needs to get a naked head-to-toe body check after a walk in the woods, or a romp in the grass! If you are camping, do a full body check daily. Ticks can hide in out of the way places on your body. Don't forget to check the scalp. If you are dealing with thick darker hair, you can rub your fingertips along the scalp and feel for any bumps. Check between the fingers, toes and behind the ears. Check armpits and belly buttons as well. You need to be very thorough. Many of the ticks are very tiny and hard to see. Be familiar with little moles and freckles so you can recognize a new spot which might be a little tick. Doing a daily body check is a good habit in general. If there are any new rashes, bites or bruises, you will have a timeframe for when they showed up. If you are returning to your home after a hike, use a lint roller to do a quick pass over your clothes. You may be shocked at what you collect from that. Then take off all clothing and put everything in a hot dryer for 60 minutes to kill any wandering ticks.   Don’t forget to check the car seat! it is very important to remove any ticks as quickly as possible. For Lyme disease, the tick generally needs to be on you for more than 24 hours to be a concern. The bacteria that causes Lyme migrates from the tick's gut to its salivary glands before the pathogen can be transmitted. One infectious disease expect at UCSF says that might be 36 hours! If you do find a tick, please stay calm. I have vivid memories from my time at NVP of a mom carrying her toddler into the office. She was screaming (the mom, not the kid) "HELP ME GET THIS THING OUT OF MY BABY!" There was a large tick attached behind her little one's ear. It looked like a Star Trek alien. It was indeed freaky, but put on a brave face for your child. Arachnophobia is appropriate in this case. Ticks are indeed arachnids (the spider family). For the record, the big ones are usually wood ticks and those are not the ones that carry Lyme. The best way to remove a tick is with tweezers or a special tick removing tool. Grasp the tick as close to the skin as you can and firmly pull up and away. Do not twist. This is not the time to try any of the folk remedies such as Vaseline or a burning match. If you own a dog or go hiking frequently, do yourself a favor and get one of the tick removing tools. You can get them from any sporting good or pet store. Amazon has a ton of different brands. Once the tick is out, clean the area with an antiseptic soap. Apply a dab of Neosporin and then keep watch on the area to make sure there is no infection. Okay, We got a tick bite. We removed the tick, but now what??? I am going to have you keep your antenna up for at least 30 days. If there is any odd rash, flu like illness, aches, or fever it is important to notify your doctor. They will want to know the date of the bite, and if possible the region where the tick came from. Any recent travels could provide important data. Unfortunately the blood tests for tick borne diseases such as Lyme are not all that helpful. Frequent false positive and false negative results minimize their usefulness. The tests become more accurate several weeks after the bite, Decisions about when to treat are best made earlier. Testing the tick might make more sense than testing the patient. Keep a little baggy in your backpack or diaper bag. This way you have a place to stick any ticks that you remove.  The Sonoma County Health Department will identify the tick for free. This tells you if it is the type you need to worry about. They can also take it a step further and test it for Lyme disease. The fee for testing is $36 (such a deal.) They don't test the ticks for other illnesses. They do the testing every Thursday and they will have the results by Friday. They say that about 1-3% of the ticks test positive. https://sonomacounty.ca.gov/Health/Public-Health/Laboratory/Lyme-Tick-Test/ 707-565-4711 In Marin they will also test the ticks: https://www.marinhhs.org/public-health-laboratory-services Read the instructions on their website for how to send the tick. Ah, but there are other experts who don't agree that testing the tick is worth the effort. A tick testing positive doesn't mean it was on long enough to transmit a disease. A tick testing negative for LYME might be infected with an illness that we can't test for yet It is possible that there was another tick on the body that you didn't find. Here is the bottom line. Regardless of whether or not you get the tick tested.... Watch the person who has been bitten very carefully for the next 4-5 weeks. A bulls-eye rash around the tick bite site and/or any type of flu symptoms would be a concern. Some of the less frequent tick borne illnesses might have a more diffuse rash. Not everyone gets all symptoms. If there are any suspicious symptoms speak to your doctor. They may opt to do a course of antibiotics. There are new guidelines that emerged in August 2019. In the areas where Lyme is endemic, they may now give a single prophylactic dose of doxycycline. Doxycycline can be associated with tooth discoloration, so it isn't used unless suspicion for Lyme exposure is high. Prophylaxis can be started within 72 hours of tick removal. They don't wait for symptoms to show up. We don't want to treat every tick bite with antibiotics for obvious reasons.  It is a balance. We can't keep our kids in a box. Go out there and enjoy the hike, but then do that thorough body check and you should be fine. Carefully brush out your pets as well!

Horrible Headlines/ We somehow need to 'parent' through it.

 

Horrible Headlines

I can't remember a time when we were not dealing with tough issues. Climate change, gun violence and divisive politics are examples that come to mind. Then along came the pandemic. That alone has had so many parents feeling like they were treading water for the past two years. It is exhausting. Your plates are full. Now there is a war taking center stage. Really? People have reached out to me to ask for advice. Many feel like they have reached their breaking point. How do you manage getting through the daily routines when current events make most of us want to curl up in a ball? Is there a way to completely insulate your kids from all that is going on? The first obvious step is to protect your kids from graphic news stories as best you can. Don’t have the TV droning on in the background of your lives. Are you watching the news from your laptop when they are nearby? That counts. Alas, your children don’t need to be watching tv to know when parents are devastated by things going on out in the world. Kids often pick up on the fact that something is “not right.”  Don’t waste too much energy trying to act as if there is nothing wrong. Talking about things out in the open is so important. It does more than pave the way for future conversations. Honest communication keeps things from feeling like there is a bad secret. As Mister Rogers says, "Anything mentionable is manageable" In any event, avoiding tough conversations won’t make the issue go away.  If your child seems completely oblivious, there may be no need to bring things up. If your child is more intuitive that is a different story. If you think they have a sense that something is amiss, then it is worth addressing it. You could start by asking your kids if they heard that something difficult is going on. Allow them to tell you what they have heard or seen. Make sure any discussions are age appropriate. I wish I had the perfect way to explain what is happening in the world right now. There is no way to make sense of war.  Because so many of us are feeling helpless, so I am sending out this little reminder  There are some things that are within our control and some things that are not. We need to be able to identify which is which. Things Out of our control Others being kind Others being honest Others forgiving us Who likes us The family we were born into The color of our skin Past mistakes Natural disasters Death Taxes Power hungry dictators Lets focus on things that are in our control. Being kind Being honest Friends we choose Taking care of ourselves Working hard Apologizing Asking for help How we respond to others What we do in our free time Volunteering our time (if you have a surplus) Donating to a worthy cause (if your own needs are met) Seeking out joy Yesterday I walked up to the top of Twin Peaks with my brother-in-law Richard. At the beginning of the pandemic we used to pop up there a few times a week. It has been months since we did that walk. This time there was a bit more huffing and puffing on my part. I am thrilled with the fact that my body graces me with the ability to get up there without passing out. For that hour I tried to turn off any negative thoughts. Richard has the habit of pointing out the gorgeous plants and flowers that we pass. And then there is the spectacular view which is a reward all by itself. How can I feel contentment when the world is in so much turmoil? How can any of us? Because we must.  By no means should we afford ourselves the luxury of ignoring what is happening in world these days. It is essential to listen, pay attention, learn and support each other. Allow yourself to feel heartache over current events out there in the macro world. How can you avoid it!  But parents, if you can, put some limits on it. Let your kids witness that you are still letting some light into the dark. If your microword is intact, revel in that. Find the joy. That is an essential lesson all by itself. For more resources on talking to your kids about the situation in Ukraine. Check out this post from Plinkit