Poisonous plant guide/

Different events can trigger me to update old posts. 

I have brushed off the toxic plant blog several times over the years, but I have a different twist on it this time around. 

The earlier version of the post focused solely on young kids and plant safety but the incident that brought this to mind for me recently involved grown ups. 

 A group of people who are quite close to me were out in the country. 

They came across what they believed to be some wild onions and cooked them up as part of the dinner. It was only after several of them started to feel ill that they got suspicious and did some checking to find that they had actually eaten something called a death camas. 

Nothing like a name with death in it to ramp up the anxiety level! 

I think most people have been taught over the years the dangers of wild mushrooms and potentially toxic berries. I personally had never even heard of wild onions or their poisonous twin. 

 Fortunately they hadn’t eaten enough to have severe issues, but it could have been so much worse. 

One of the women who had eaten the poisonous plant was breast feeding; no one was able to give her much information about this, so the poor mom ended up pumping and dumping her breastmilk for two full days just to be on the safe side.

 Another of the people who ate part of the meal and did not get terribly affected said afterwards that he had a feeling that this was less than prudent, but didn't speak up. 

 My brother-in-law who is a national park ranger told me of a time that he had to have someone airlifted for emergency medical care after eating death camas. 

This person was a Native American man who had grown up eating wild onions and got caught off guard by the look alike plant. 

 The takeaways here are clear. Don’t eat any wild plants unless you are 100% certain that they are safe. If you see others taking chances, don’t be shy about being a party pooper, SPEAK UP! 

Foraging plants in the wild has become more and more popular. Please be cautious! Most of the time when toxic plants are a concern of course, is when young kids decide to nibble on some house plants. This is a good reminder for all of us that we need to be knowledgeable about plants that our kids come in contact with. 

 In most of the cases of these plant eaters, the kids aren’t showing any obvious signs that there was an issue. 

Typically if someone eats something that is toxic, and there is cause for concern, you would expect to have obvious symptoms. 

To be on the safe side, the best course of action if you know your child has eaten something you aren’t sure about is to check in with the Poison Control Center. In California that number is 1-800-222-1222 

 The Poison Control Centers here in the United States report that they get more than 100,000 annual calls about plant or mushroom exposure. 

Knowing what plant your child actually came in contact with is very helpful to them. 

Unfortunately, most of the time all we know is that it has leaves and is green. I would place a bet 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. 

 Different plants will cause a variety of symptoms. Just like a sensitivity to food, not all kids will be equally reactive to an exposure. Reactions can range vomiting, diarrhea, cramping, a rash or fussing, to more severe seizures, paralysis, heart irregularities and/or death. Mushrooms are the biggest culprits for severe reactions, but as I mentioned they are by no means the only thing to be aware of.

 Step one is to teach your children not to put any part of a plant in the mouth (yeah, good luck with that…..) This means leaves, stems, bark, seeds, nuts, berries, and bulbs. 

Unfortunately kids will chew or eat things regardless of how they taste or the level of disgustingness. Depending on the plant, eating a tiny amount might not be an issue, but large or repeated doses can be harmful. 

I know it just about impossible to watch them every second, so it is important for you to be able to recognize plants that are more hazardous and limit access to those. Some plants will cause irritation just by coming in contact with them. 

Locally the most common culprit for that is poison oak. Some succulents and cacti aren’t poisonous but can cause a wicked scratch from getting too close to their spikes. 

 If you have small children or curious pets, consider removing toxic or hazardous plants. 

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. 

 In general, toxic or not, house plants should be placed out of reach of the very young. You also need to pay attention to falling leaves, which can be a choking hazard. If there are other houses or places that you frequent with your kids, make sure those plants are safe as well. 

 If you are a gardener, make sure you store labeled bulbs and seeds in a safe place where your kids and pets don’t have access to them. 

 For the older kids, I would do some active teaching about plant safety. Make a point of teaching them that it isn’t safe to suck nectar from flowers or make "tea" from mystery leaves. Never chew, or let children chew on jewelry made from seeds or beans. You might even do some role playing to help them avoid peer pressure: “I dare you to eat one of those berries” “You can dare me all you want, My family rules are more important and we don’t put mystery plants in our mouth”  

 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°. 

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

Here is a more comprehensive list of toxic plants :

Pets can also have different reactions to certain plants. This link provides a list of plants that are toxic for your pets:

When I wrote this piece a few years ago it prompted Alana to rehome some lilies with us. I am happy to report that her kitties and the plant all doing well.

Passover Musings

Passover musings 

 On October 27,2018, the Tree of Life synagogue was attacked Eleven people were killed simply because they were Jewish. Many others were injured. 

 The Tree of Life synagogue happens to be less than a mile away from my childhood home in Pittsburgh Pennsylvania. 

While I did not personally know any of the people who were killed, I knew many people who were directly connected to those who were impacted. 

 The daughter-in-law of one of the victims emerged from the ashes of this tragedy with the agenda to make a difference. 

 In memory and honor of her mother-in-law Joyce Feinberg, she created a program called 2 to the Seder, with the goal that Jewish people who were having the traditional Passover dinner invite at least 2 people to join them who were NOT Jewish. 

In her words, her goal was to push back on antisemitism with love. 

If people from different backgrounds can allow themselves to open up just a bit to connect with one another, might this help? 

 There is too much hate and prejudice in the world. We need to teach our children to do better. This idea completely resonated with me. 

The April following the shooting we opened the doors to our Seder. We were honored to have Muslims, Christians, Buddhists, Hindus, Amish, quite a few atheists. and of course some Jews. 

The conversations that we had that evening were fascinating. Passover is the holiday that celebrates the story of the Jewish people escaping from slavery in Egypt. 

The ritual dinner is called a Seder. For me the Seder is all about tradition. I feel the connection with generations past through the meal, story and the songs that have transcended thousands of years. 

I keep in mind that many Jews over the centuries risked their lives to have a seder when they were living in places where simply being identified as a Jew could be a death sentence. 

 It is also tradition for my husband to point out that the entire story is most likely completely fabricated, at which point I counter that the accuracy of the story isn’t what it is all about. 

It is about gathering with family, celebrating Spring and freedom, and having discussions about how we can end oppression for everyone. 

And of course, the Matzo Balls.

 He then acquiesces with the two little words that keep the marriage humming along - “yes dear.” 

 This holiday has certain smells that embrace me as I am preparing for it: Matzo Ball soup, horseradish, Manischewitz wine, apples and walnuts chopped up to make something called charoset that is meant to represent the mortar that the slaves used. 

I can feel the presence of my mother and grandmother as I putter in the kitchen. One of the parts of the seder is a song that is supposed to be sung by the youngest participant, Ma Nishtana ha Lila ha zeh? Why is this night different from all other nights? 

 While frankly eating matzo and drinking the traditional cloyingly sweet wine is fine for once a year, talking about freedom and oppression should NOT be a topic for just one night. There should not be an ‘Oppression Olympics.’ 

Antisemitism and bigotry are not just reserved for Jewish people. I understand that I have the privilege of being able to ‘blend in’ if I chose to, while most people of color cannot. This week, the country experienced yet another unfortunate display of racism and hatred, this time falling on the Asian community. 

Until everyone can be outside without fear of being belittled or harmed because of who they are, we have work to do. There are so many differences, races, faiths, genders, ages, sexual orientations, abilities, personalities.

 Underneath, we are human beings, mothers, fathers, siblings, grandparents, family members, friends, community members. We need to celebrate the differences instead of attacking them. 

 This year with COVID we are having a small family Seder. Next year, I hope once again to open my doors, have vibrant discussions and link with people from every walk of life. Happy Passover to all who celebrate.

Cleaning up made simple

This week's topic Cleaning up without the battle 

 Here is a post from several years ago that might help you out with your own version of Spring cleaning.

 If you start good habits early on, you will benefit on many levels... 

 Some time ago I had a phone chat with one of the moms of a patient, about some behavior issues. Her daughter was 2&1/2. 

At home, there was an unpleasant amount of parental nagging and child tantrums. Mom was astonished when she spent a few hours at her daughter’s daycare co-op. 

She watched in awe as the kids all immediately followed the request to clean up the toys. 

After lunch, this little group sat nicely, eating their healthy meal and then got up to clear their plates.

 What completely stunned this mom was watching all of the kids line up to compost whatever food scraps there were. Composting! Really?!? 

As she told me, this was a completely different child than the one she had living with her. This is a pretty good example of how important rules and consistency are. 

It is, in fact, not at all uncommon for kids to behave beautifully in some situations and completely act out in others.

 If rules are clear and simple, most kids will follow them. 

As long as rules are in the child’s best interest and reasonable, kids thrive in a consistent environment. Kids need to understand what the rules are. 

 If there are rewards/incentives what are they?

 What are the consequences for not following through? 

 Once the kids are old enough, have them be involved in negotiating the new “official guidelines.” 

What do they think would be a reasonable consequence. 

Are there certain incentives that they would like to work towards? 

 How can you implement this at home?  

Think small. Not everything has to be regimented but let’s address one common area of conflict, such as cleaning up toys, and make it simple. 

 Easier said than done, but try to have an organized system so that putting toys away is straightforward. Know where they came from so that they can be returned to where they belong.

 If you can’t do that, you possibly have too many toys and you should take some of them out of circulation. 

 Large toy boxes/trunks are okay for really large items, but they tend to become a dumping ground. You are better off investing in shelves with different bins. 

Low shelves are for toys that kids can have easy access to. 

Have a designated high shelf area for setting aside toys that need adult involvement. 

 Take a photo of the toy that lives in the bin and glue the image on.

 This can be a family project. (Great rainy day activity!)

 Maybe the picture can include your child holding the toy. 

There can be a box for little cars, a box for dolls, a box for crayons...etc. 

Perhaps have a rule about only 2 or 3 boxes being down at a time until your child shows you that they can manage cleaning up more of a variety. 

 Sorting can be a game. 

Give a transition time: “Ten minutes until clean up." 

“Five minutes until clean up." 

 Some kids may do well with a timer. Everyone needs to understand what the new clean up rules are. When playtime is over, it is time to do the full clean up. 

Put on some music or have a clean up song. 

 Children have a set amount of minutes to put the toys away. 

While you might start by helping out and setting a good example, the ultimate goal is that your kids can do this on their own. 

Make sure that they are doing most of the work. 

When the time is up, make sure you give positive feedback. The toys are safe and ready for the next time they want to play with them. 

If they did NOT clean up, now it is your turn. Anything that you clean up is yours to do with as you please. You can put it high up where the kids don’t have access until they agree to do a better job cleaning up. 

Tell some stories about children who did a good job cleaning up. Parents were so proud! Their toys stayed safe and organized. 

Tell a parallel story about a less successful outcome. Parents ended up doing the clean up and the toys went high up and away. This process eliminates potential sources of nagging: These are the clean up rules; they are clear and simple. Cleaning up is easy. It takes a few minutes. It can even be fun! Kids remain in control of the toys that they put away. Or mommy/daddy can clean up but the toys are gone for a while. Many of our kids have so much stuff (mine were no exception) that you may wish to consider rotating toys.

 If you take something out of circulation for a while it might feel new and fresh when you bring it back. Doing a toy swap with friends is another good way to have an assortment of things to play with that feel new and exciting. Keep in mind that some kids are rougher than others. Don’t lend out anything that you care too much about. It may not come back in the same shape that it went out! 

As Marie Kondo from the popular Netflix series would say, it if doesn't bring you joy, get rid of it. Start small, be clear and consistent, and problem solve so that you don't end up in nagging cycles, to kids who ignore you. Who knows, the next step might be composting!

Eczema management 2021

Eczema/Atopic Dermatitis 

 Kids get a lot of rashes, but the most common diagnosis is probably eczema. 

This is one of those topics that I routinely get questions about year round. It doesn’t appear to have a season. 

 The term eczema is broadly applied to a range of persistent skin conditions. 

There seems to be a hereditary component so it is pretty common for eczema to run in families.

 One piece of good news is that some kids can grow out of it! Some babies have buttery soft skin. Others are not so lucky. 

My patients with the diagnosis of eczema generally have fairly dry skin with rough patches. 

 Learning some basic facts about the skin can help you understand what is going on and how to deal with it. 

For the data nerds among you, the next paragraph is for you; for the rest of you, sorry if this makes your head spin... 

 The top layer of the skin is called the epidermis and the top layer of the epidermis is called the stratum corneum (SC). The SC is incredibly thin but it is the main barrier of the skin. It keeps chemicals that come in contact with the skin from being absorbed into the body, and it keeps fluid inside the skin from leaching out. The SC contains 3 types of lipids that have different chemical compositions and functions; ceramides, cholesterol and free fatty acids. But it gets even more complicated. There are nine different types of ceramides in the SC, conveniently named ceramide 1 through ceramide 9, and they account for 40-50% of the lipids in this outermost layer. Scientists are doing a lot of research on the important function that ceramides play. What they are now discovering is that people with eczema have significantly fewer ceramides in the SC than folks with healthy skin. (Don’t worry there won’t be a test on this.) 

 Skin Care

The obvious focus is to try to re-balance and add back some of those deficient ceramides. Thus, the key to treating basic eczema is moisturizing! Well lubricated skin does not get as itchy and doesn’t break down as easily. It is important to moisturize at least once a day, (twice a day is better!) but there is no downside to greasing up your kid more often than that. It is really important to break that itch cycle. 

Aside from causing misery, scratching can tear the skin, and an infection can occur. 

There are some very good products that can make a big difference. Dr. Lawrence Cheung is my go to dermatologist. He lists the following products as some of his favorites: 

 Cetaphil Restoraderm Cerave Hydrating Cleanser and Moisturizing Cream Aveeno Eczema Therapy.

 Dr. Cheung particularly likes this Aveeno product for hands. With people washing their hands more than ever these days, the dry hands can tend to get rashy.

 The Aveeno does a great job of protecting that can last through several washes. 

 Eucerin and Vaniply are a few other good brands. 

Read the labels and make sure that ceramides are on the list of ingredients. 

 If you like home remedies, my sister-in-law Barbara swears by coconut oil mixed with a bit of tea tree oil. 

A local pediatrician, Dr. Jessica Kaplan, advocates the “greased pajama” method. Put the jammies on right after applying the moisturizer. The pajamas will be a little greasy. As long as they stay clean otherwise, wear those for several nights in a row. 

 People used to recommend infrequent bathing, but it turns out that this is a myth. 

If your child likes their bath, you can give one as often as you like. 

Baths are fine, but sitting in soapy water for extended periods is not such a good idea. 

Let them do their “fun in the tub” session for most of the bath first and then do the actual washing and rinsing with gentle soap and shampoo right before getting out. 

Bubble baths and harsh soaps are pretty high on my list of suspects when I am sleuthing around for the cause of a rash. 

 Some folks find that adding a splash of apple cider vinegar to the bath water (about ¼ - ½ cup for a big tub) is soothing and may even prevent some rashes. 

 Do you have some extra breast milk leftover that is out of the safety range for feeding?

 Dump it in the tub! Milk baths are great for the skin.

 If the eczema is severe, believe it or not, a bleach bath is often recommended by many dermatologists. Here are important steps for giving a bleach bath: 

 Use regular strength (6 percent) bleach for the bath. 

Do not use concentrated bleach. 

 Use plain bleach; avoid those with various scents added. 

 Use a measuring cup or measuring spoon to add the bleach to the bath. 

Adding too much bleach to the bath can irritate your children’s skin. Adding too little bleach may not help. 

 Measure the amount of bleach before adding it to the bath water. For a full bathtub of water, use a half cup of bleach.

 For a half-full tub of water, add a quarter cup of bleach. 

For a baby or toddler bathtub, add one teaspoon of bleach per gallon of water. 

Obviously these are approximate measurements since baths will have varying amounts of water. Never apply bleach directly to your child’s eczema. While the tub is filling, pour the bleach into the water. Be sure to wait until the bath is fully drawn and bleach is poured before your child enters the tub. 

 Talk with your dermatologist about how long your child should soak in the tub. Most dermatologists recommend a five to 10 minute soak. All baths should be followed up immediately with some lotion!!!

 Identify Triggers 

 I tend to refer to atopic dermatitis as ‘reactive skin’. 

It will be under control for a while and then something will come along and ‘flare’ it up. I refer to these as triggers. 

Playing detective and learning to recognize what triggers are aggravating the rash is another important key to management. 

 Triggers can range from changes in temperature, dry air from heating the house, a new detergent, teething or a new food. 

Acidic foods seem to be a big culprit for some kids. 

Berries and citrus are big offenders. 

Dairy and eggs are way up on the list as well. 

When food sensitivity is to blame you will often see chapped cheeks and a red ring around the anal area. 

 Treat inflammation 

 There is absolutely no downside to lots of moisturizing and/ or eliminating the triggers that are flaring up the eczema. But if those measures are not taking care of things, it is really important to take steps to minimize inflammation. 

Think of it in this way - a mild rash is like embers; add inflammation and it becomes a wildfire.

 Once you have an actual fire, the entire body becomes more reactive and even more food reactivity can take place. 

I like to take the natural route as much as possible, but sometimes it is necessary to use medication or topical creams. 

Don’t hesitate to treat and ‘put out the embers before things get out of control’. 

 As I already mentioned, it is essential to minimize itching. 

If your child is doing a lot of scratching, they can break through the skin; infection and inflammation ensue. 

Make sure you keep their nails trimmed to minimize damage to the skin from the scratching. 

 Your doctor will likely suggest an antihistamine. Zyrtec (cetirizine) and Benadryl (diphenhydramine) are the two main brands that we tend to use. 

Benadryl is shorter acting. Most of the time it makes the kids sleepy, but once in a while it has the opposite effect (not something you want to find out at night.) 

Zyrtec is longer lasting and doesn’t tend to cause either the sleepiness or the jitters. 

Although the label will warn you to check with your MD if your child is under 2 years, most pediatricians have no hesitation giving Zyrtec or Benadryl to kids as young as 6 months if necessary.

Both of these  come in a liquid form. There are dosage charts at the bottom of the post. 

 Hydrocortisone creams or ointments can also be used to spot treat especially itchy areas. Start with the weaker over-the-counter strength. 

If that isn’t helping, it would be a good idea to have a doctor take a look.

 There are several options of different prescription strength ointments, creams and oils that can be tried. Most of the time simple eczema can be handled by your pediatrician's office. 

Once in a while complicated cases that are not responding to treatment may end up at the dermatologist. If the eczema is mild to moderate and not responding to simple moisturizing and OTC hydrocortisone, there are prescription medications available that range from topical to injection options and even phototherapy. 

Dr. Cheung mentioned to me that there are all sorts of new treatments now available, with more coming within the next couple of years. 

For severe cases, it is absolutely worth seeing a dermatologist who is current with updated treatment options.

 If you like to think out of the box, I have seen some patients have a big improvement in their skin from some treatments from the folks at Advanced Allergy Solutions. 

They are not the magic wand for everyone, but have been very helpful for many of my patients. 

 There are also some ongoing studies about gut health and eczema; it makes sense that there is a connection. 

The studies are speculating that probiotics containing Lactobacillus might be helpful, but there are no official guidelines yet.

 For your little ones who are eating solid foods, adding fermented foods, and decreasing sugar are easy and worthwhile things to consider. 

 In summary: 

 Keep your child moisturized daily with one of the recommended lotions or creams 

 Make sure your kids nails are kept short. 

Infants can have little mittens on their hands at night if they are doing a lot of scratching. 

 See if you can figure out what the triggers are and avoid them. Sometimes it is simply cutting out berries. 

 Zyrtec and Benadryl are fine for itching but don’t treat the underlying cause. 

 Don’t be hesitant about treatment.

 In a risk/benefit calculation, taking appropriate steps to decrease the inflammation is the right thing to do 

 Zyrtec Dosage Chart The dose of cetirizine depends on age as below: 

6 - 12 months of age: 2.5 mg given once daily (maximum dose 5 mg daily) 

12 - 24 months of age: 2.5 given once or twice daily (maximum dose 5 mg daily) 

2 - 6 years of age: 2.5 - 5 mg given once daily (maximum dose 5 mg daily) 

Over 6 years of age: 5 - 10 mg given once daily (maximum dose 10 mg daily)

 Zyrtec comes in a 1mg/ml solution (so 2.5 mg = 2.5 ml). There is also a 10mg/ml oral drops preparation (so 5 mg is 1/2 ml). 

Make sure you check the strength of the solution.

Carbon Monoxide 2021

Carbon Monoxide

Carbon monoxide (can be referred to by its chemical symbol CO) 

 In a typical year, nearly 400 Americans die from carbon monoxide poisoning; this number might end up higher than normal due to the horrendous storms in Texas last week.

 Health officials reported that 450 carbon monoxide-related calls have been made statewide since Feb. 11th. Sadly quite a few of these cases were fatal. More people need to be aware of the risks! 

 How many of you own a carbon monoxide alarm? If you do, good for you. Make sure that it is in good working order. 

The units do not last forever. In some of the older units, batteries need to be changed annually (at least) and some units suggest that you vacuum the cover monthly to remove accumulated dust.

 If you are one of the many who do not yet own one, please remedy that immediately. 

It has been the law since January, 2013, with few exceptions. 

 Homes with a fireplace, attached garage, or any gas appliances are at higher risk, but there are many different factors that can cause an elevated level. 

A friend of mine is a lawyer who was involved in a heartbreaking case where a guest at a Bay Area hotel sustained long term health impairment from an exposure. 

The victim’s room was above the hotel pool and a faulty boiler used to heat the pool vented carbon monoxide into his room. When he didn't show up for dinner, his friends found him unresponsive. 

It was a very alert physician in the emergency room who figured out the cause. It was only at that point that the hotel was evacuated.

 This is not an isolated incident. As a result, my lawyer friend got in the habit of taking a portable detector along with him anytime he traveled! 

 Because heaters and fireplaces are often involved, exposure is usually higher during the winter months. In situations such as the one in Texas, people were trying to get warm anyway they could, and it cost lives. 

Outdoor appliances, such as grills, and even generators, need to be properly vented and should not be used indoors. 

If you have a generator as part of your safety plan (not a bad idea for earthquake or fire related power outages), it is essential to make sure that it is properly ventilated. 

 Carbon monoxide is a colorless, odorless and tasteless poison gas that can be fatal when inhaled. CO binds to hemoglobin with much greater affinity than oxygen, forming carboxyhemoglobin (COHb). It is hundreds of times more efficient than oxygen at attaching to the cells, so even small amounts can deprive our bodies of vital oxygen. 

In severe cases, for folks who survive an exposure, it can cause irreversible brain damage by starving the brain of oxygen. 

 Normally if someone is deprived of oxygen they may look pale or cyanotic (bluish); in the case of CO poisoning, the color will remain nice and pink. 

A standard pulse oximeter may not be an accurate indicator of where or not there is a problem. If carbon monoxide exposure is suspected, a specific blood test should be done to check the carboxyhemoglobin level. 

 One of our local ER docs who allowed me to pick his brain added that one of the tricky things about CO poisoning is that the symptoms are very vague and nonspecific. 

A faster than normal heart rate (tachycardia) is the only really reliable physical exam finding.

 Mild exposure might cause slight headache, nausea, vomiting and fatigue. 

This can easily be mistaken for flu or viral syndrome. 

Medium exposure symptoms would be a throbbing headache, drowsiness, confusion and a rapid heart rate.

 Extreme exposure will lead to unconsciousness, seizures, and cardio-respiratory failure that usually is fatal. The effects of exposure can vary greatly from person to person depending on age, overall health, and the concentration and length of exposure. 

Young children and pets are thought to be especially vulnerable. 

Pregnant women should also be especially careful because the fetus can be seriously impacted. 

 A carbon monoxide alarm is similar to a smoke detector because it monitors the air in your home and sounds a loud alarm to alert you of trouble. 

However, the way you respond to a CO alarm is very different from a smoke detector. 

When a smoke detector goes off, it is pretty easy to judge the level of danger. You can see or smell the smoke. 

On the other hand, because CO is completely undetectable to your senses, you are dependent on the alarm to let you know there is a problem.

 If the alarm sounds: 

 Operate the test/reset button 

Call 911 

Immediately move to fresh air (make sure that everyone in the household is accounted for.) 

Do not go back in until you have the ‘all clear’ from the emergency responders. 

 Concentrations of CO between 1 and 30 ppm can often occur in normal, everyday conditions. See the chart below for CO levels and corresponding symptoms. 

 If your unit is coming to the end of its life it may give off multiple chirps to notify you that you need to replace the device or change the batteries. 

Newer alarms might be good for as long as 10 years. The one that we have has a digital display that will signal when it is time to replace it. 

 My first experience with a Carbon Monoxide alarm was back in 2007. I was at my family home in Pittsburgh and my dad had died several days earlier. 

My sisters and I were all staying at the house when on that cold November night, we were woken up by a shrill alarm. 

We frankly had no idea what it was. 

After searching around a bit we found that it was the carbon monoxide detector going off. 

We weren’t sure of the correct action plan, but to play it safe we called 911 and huddled outside on the front porch until the firemen arrived. 

They went through the house with all of the monitors and everything seemed safe. 

Our best guess was that it was my physicist dad on the other side trying to figure out how things worked. 

I kid you not, the very next night the smoke detector went off for no apparent reason. 

Radios and lights were turning on and off. 

In our family, we just shrugged. That is going to be my next book. 

 After that encounter, I educated myself about carbon monoxide alarms.

 Several years ago when my daughter Alana was still living in Michigan, her CO alarm went off and she knew enough to get outside and call 911 immediately. 

After the fact she recounted her conversation with the fireman who had responded: 

 “I am worried about my cats, can you help get them out?” 

“What do they look like? 

“They are CATS, they are furry, have 4 feet and tails!” 

 Happily the kitties were all safely brought out of the apartment. The best guess for what set off the alarm was something faulty with the air conditioning system. 

It went off several times with no clear source identified, which prompted her to move to a different apartment. 

 You may not think that your home is at risk, but there is NO downside for investing in an alarm (plus you are complying with the law.)

 They are inexpensive.

 If you are renting and there is not a unit in your apartment, call your landlord immediately and get that remedied. 

In January of 2017, in the Bay area, there was the tragic instance of a young couple and their pets all found dead with no obvious cause. It turned out that it was CO exposure from a malfunctioning 3D printer. A functioning alarm would have saved their lives. Don’t mess around with this. Please make sure you are protected.

Heavy Metals in Baby Food

If you have listened to any news these past couple of weeks, you have likely heard the story about the findings of unsafe levels of toxins in baby foods. 

What’s it all about? 

 Due to pollution, soil where the foods are grown can be contaminated with heavy metals.

 If you are a science nerd, the ones most commonly identified as an issue are lead, chromium, arsenic, zinc, cadmium, copper, mercury and nickel. 

These metals usually accumulate as a result of emissions from industrial areas, leaded gasoline and paints, some fertilizers, manures, sewage and pesticides to name just a few of the culprits. 

Even though we are no longer using leaded gasoline or lead based paints the damage has been done.

 Most metals don’t undergo degradation so they stay in the ground or water for a long, long time. Pollution in the air or water makes its way into the soil or into our rivers and oceans. 

When these toxins end up in the water, we can see this impact by measuring the levels found in the fish that we eat. 

 When they end up in the soil, they can be absorbed by food. 

Some foods are more susceptible than others. 

 At least we have started to make some changes here in this country. For example, we no longer use leaded gasoline and some industrial regulations have been put into place. 

The fact is that many of our regulations are too little too late. 

Even if our home grown foods were perfectly safe, which they aren't, many products are imported from countries who are not even beginning to enact any effective regulation. 

Trying to feed our children and ourselves clean food is stressful! 

 Knowing that we have issues with some of these contaminants isn’t new. 

Many people already limit certain fish due to mercury. 

We have been educated about the dangerous impact lead exposure can have on our children. 

We routinely get our kids tested to make sure the lead levels aren’t elevated. 

 Arsenic wasn’t something that most of us were paying attention to at all until the elevated arsenic levels in organic brown rice syrup created a media sensation several years ago. 

But it appears that even though concerns about unsafe levels were identified, current studies clearly indicate that not enough was being done. 

 To make things worse, many of the brands listed in these allegations are the ones that parents have counted on for generations to provide safe quality products. 

It is very frustrating that even with the changes that have been implemented, it is still evident that they were not enough. 

At the very least, customers should have been informed that mitigating these concerns was still a work in progress.

 I think it is perfectly reasonable to feel angry and betrayed. 

Go ahead; get good and mad. But then let it out and take a deep breath and release it. 

It is not helpful for you to hold in all that negative energy. 

Turn it into action. 

You can choose to no longer give these companies your business. 

Done! 

 What I wish you wouldn’t feel is guilt. 

Assuming your children have consumed some of these products, I am guessing that you made the best choices that you could based on the information that you had. 

We don’t know what we don’t know and we can’t manage the past, so as hard as it might be, please forgive yourself. 

 I think that it is actually very beneficial that this information is surfacing so that we can make healthier choices moving forward. 

See if you can take any anxiety that you are feeling and channel it into a resolve to take positive action.

 What choices can you make now that you have this information? 

 Alas, while going organic can minimize pesticide exposure it doesn’t have much impact on the heavy metals. 

 Pay attention to the biggest culprits. Rice cereal is one of the biggest offenders. Brown rice has some nutritional advantages but white rice is the safer option. 

The heavy metals absorbed into the food from soil are going to impact the surface of the food the most. White rice is processed to remove that outer bran layer. 

If you are cooking your own rice, start with a little more water than called for and then do an extra rinse. This can help decrease potential toxins significantly. 

Rice has nutritional benefits and by no means needs to be completely removed from your diet. 

As I have been saying in my solid foods class for years, some amount of rice cereal is fine, I just wouldn’t give it daily. 

Variety is beneficial. 

Be a label reader - organic rice syrup is an ingredient found in many snacks. 

 Sweet potatoes and carrots are two popular veggies that have been found to absorb the highest amounts of the heavy metals. They still have some worthy nutrition, I certainly think there is room for them in a healthy diet. 

Just like the rice, the outer part is going to be the place that has absorbed the highest level of the metals. Deep peeling can help a lot. 

 Fruit juices are also on the list. This one is easy. No kid really needs to be drinking juice. That being said, of course, the occasional bit of juice is not something to stress over. 

 Certain nutrients may offer protection. 

Antioxidants can help prevent absorption of toxins. 

It has been well documented that lead doesn’t absorb as well if a diet is high in iron and vitamin C. 

This is true for the other heavy metals as well. 

 Making sure that you give your kids adequate fluids is great for flushing out the system. 

 Variety is important. 

Make sure you switch things up and offer a large assortment of foods, rather than eating the same thing over and over.

 In conclusion, I don’t know of many adults who got through their childhood without partaking of these same products, and we all seem to have survived. Having some exposure to these heavy metals is not ideal, but at a mild to moderate level it is absolutely not something I want you to panic about. We can’t live in a bubble (although during covid, some of you might dispute this.) As with all things, simply do the best you can. If you like more data on this subject, check out this article written by my colleague, the wonderful Dr. Ted from Oath.

Covid/ One year later

It was a year ago that I was doing my first post about COVID. Always with an ear out for items in the news that could cause worry for my patients, I was on alert. Over the years it was not unusual for a virus to circulate that made the news. Measles outbreaks, West Nile, Ebola, Zika, even one called enterovirus D-68 that most of you probably don’t even remember (that one was a cousin to Polio and caused some paralysis). These were terrifying, but in terms of actual threat to our Bay Area families, were soon enough in the rear view mirror.

If I ever claim to have some psychic abilities, that ESP was nowhere to be found when it came to covid. At the very least, I would have bought extra toilet paper. My initial covid post from last year warned families to be prepared in the unlikely event that we might need to do the unthinkable and quarantine for a couple of weeks. Wow, what a difference a year makes.

So many of us had plans to travel, tickets to shows, weddings and events on our calendars. It was unfathomable that everything would be put on hold, but 2020 put us in uncharted territory

It is fair to say that we have found ourselves in a brand new landscape.

• The horrors of the shocking numbers of cases, deaths and chronic consequences.
• The staggering economic hardships of so many people who have lost jobs and livelihoods 
• Frightening number of people who maintain that the virus is a hoax...WTF!
• The isolation of people who are living alone and the sadness of family and friends who are not able to be together.

Sigh.

For anyone reading this, congratulations on making it through a very difficult year. For all of the difficulties and sadness some moments of light have floated through.

Zoom...who had even heard of it? Yes we can all get zoom fatigue, but I have had routine zoom sessions with friends and family near and far. Now I gather once a month virtually with my 98 year old uncle and cousins. More and more extended family members join in the call and it is lovely. We fill our screens with old family photos and take advantage of uncle Melvin’s remarkably sharp memory while he identifies the people in the pictures and regales us with tales.

Working at home in your pajama bottoms and bare feet.

Your pets are thrilled to have you around all day.

Many people have taken up new hobbies. The tap dancing classes that I took from a friend only lasted for several weeks, but I have been playing piano more than I have in years. My son-in-law Adam has perfected his sourdough bread!

Flu numbers are unusually low for this time of year. Pediatrician’s offices are seeing way less of common colds and viruses. No doubt this is in part thanks to the social distancing, masks and hand washing.

So what’s next?

The promise of vaccination is already here for many, and within the next several months for many more. It will no doubt take some time to get everyone protected but at least there is some hope in sight.

While we are making progress, this is the proverbial two steps forward, one step backwards. Alas, as promising as the vaccine is, covid is a wily virus and new strains are popping up. Some of those newer and more contagious strains have recently been identified in the Bay Area. Until there is herd immunity, even with the vaccination, wise people will continue to mask up and continue with social distancing until the public health experts spread the message that we can get back to normal. We simply can not afford to get quarantine fatigue.

Here are some of the quarantine related blog posts that I have done this year:

https://nursejudynvp.blogspot.com/2020/03/managing-quarantine.html

https://nursejudynvp.blogspot.com/2020/03/assessing-our-priorities-in-this-time.html

https://nursejudynvp.blogspot.com/2020/04/tips-for-dealing-with-too-much.html

https://nursejudynvp.blogspot.com/2020/04/finding-humor-in-this-time-of-quarantine.html

https://nursejudynvp.blogspot.com/2020/06/stop-feeling-fuilty-for-finding-moments.html

https://nursejudynvp.blogspot.com/2020/06/decisions-about-how-to-ease-out-of.html

https://nursejudynvp.blogspot.com/2020/07/talking-to-your-kids-about-germs.html

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