Preferred Pediatrics

Flu Update

2009-10-07T09:03:00.000-07:00

My previous statement that this flu season was going to be challenging was an understatement.

We have been informed by the supplier of out injectable seasonal flu vaccine that they are suspending delivery of this vaccine, at the request of the government, to maximize delivery of H1N1 (swine) flu vaccine.

Due to this we have had to reschedule our late October flu clinics and suspended new appointments for injectable seasonal flu vaccine. The supplier estimated delivery of the vaccine the second week in Novermber which should still give time for vaccination before the December to February seasonal flu season.

We do have seasonal Nasal vaccine available and this will be used preferentially for children 2 yrs and above since infants and young toddlers can ONLY receive the injectable vaccine.

We have applied for H1N1 vaccine and should receive doses from the Ohio Department of Health in the next 2-4 weeks. The data on the vaccine to date shows that it is as well tolerated as seasonal flu vaccine so that if your child has received and tolerated seasonal flu vaccine they should tolerate H1N1 equally well.

Woman who are pregnant, Family members with an infant below 6 months in the house, Children with underlying medical problems such as Asthma, Heart conditions, Diabetes or children with suppressed immune systems are at highest risk for severe disease and should CERTAINLY get the vaccine.

Even healthy children are having a more difficult season due to H1N1 with over 60 deaths reported to date, more than is typically seen with a seasonal flu season. I do plan on having my 5 and 7 year old vaccinated and I will be getting the vaccines (seasonal and H1N1) due to my exposure.

Until resumption of seasonal flu vaccine delivery and distribution of the H1N1 vaccine there are limited options for vaccination. Patients with Caresource or Ohio Medicaid insurance should contact the Cuyahoga Department of Health. Families with other insurance may also contact Cuyahoga County DOH but may not be scheduled depending on availability of vaccine. Walgreens does have some limited availability but only for adolescents above 14yrs. CVS minute clinic has not vaccine available.

Up to date information can be accessed at cdc.gov and odh.ohio.gov or by calling your local health department or the state flu line at 1 866 800 1404

Hope this helps.

Dr. V

Flu vaccine and Flu season

2009-08-26T07:26:00.000-07:00

This Influenza season is gearing up to be a very complicated one. As you have seen there have been numerous stories about H1N1 (swine) Flu addressing everything from its transmission to treatment to prevention. More about H1N1 in a moment.

Seasonal flu vaccine, both nasal spray and injection, should be available in mid-September and we have already scheduled flu clinics in the office from late September through November. Patients may also get vaccinated for flu at regularly scheduled well visits, sick visits or by calling and setting up a nurse appointment. As usual the office will send out an email with all dates and indications for those recommended to receive the vaccine.

While we encourage those recommended to receive their seasonal flu vaccine this will NOT protect against H1N1 (swine) flu.

There is currently a vaccine under trial to prevent infection with H1N1 influenza. Estimates are for the vaccine to be available in mid-October to November. Just released recommendations for receiving the vaccine are 1: Pregnant Women 2: Household contacts of children aged less than 6 mo during the flu season 3: Medical Personnel 4: Infants and children aged 6 mo to 18yrs 5: Persons with high risk medical conditions.

We don't yet know how effective the vaccine will be, what its side effects will be or how much of the vaccine will be available. As these questions are answered we will send out an email.

In the meantime continue to encourage your children to wash their hands frequently, keep them away from school if ill, keep them away from other ill children and call the office should they have the sudden onset of high fever, chills and malaise.

Dr. V

H1N1 Flu Update

2009-04-30T16:01:00.000-07:00

It seems to us that folks are overreacting just a bit to the new flu strain. We suggest calm. Please keep in mind that 36,000 Americans die from the flu every year. Yet we don't close schools all winter or avoid public transportation or walk around with masks on. There is NO evidence that this new flu strain is any more serious than other flu strains. In this case, different doesn't mean worse. It just means...different. New flu strains appear all the time. The H1N1 strain is simply a part of this process.
Stay tuned for more as we learn more. I'm going to the mall.

Swine Flu Outbreak

2009-04-27T08:42:00.000-07:00

I am sure you have been reading online and seeing television stories about the current "swine flu" outbreak that began in Mexico and now is affecting the United States and Europe. This morning brought a report that a case has been reported in Elyria, just west of us. So far, all cases in the U.S. have been in people with contact in Mexico.
We would like to reassure our families and suggest remaining calm. While "swine flu" sounds scary and makes for great headlines, the fact is that the number of reported cases in the U.S. is still small and those affected have had mild courses of the illness.
By way of review, swine flu is a strain of influenza that comes about by influenza viruses from pigs and humans combining. The current swine flu also contains some elements from the strain found in birds. This combination happens all the time. It is only when the combination results in a strain very different from human strains that rapid spread can occur. It does NOT mean that the illness is more severe than standard influenza.
The symptoms are the same as those for standard flu: high fever, severe cough, muscle aches, sore throat, and headache. This is NOT a "stomach flu" with vomiting and diarrhea. If you have minor runny nose, congestion, and mild cough you do NOT have the swine flu. The incubation period is about 48 hours, meaning symptoms appear within 48 hours of exposure. The illness usually begins suddenly and lasts about 7-10 days.
Prevention is the key. Please continue to use the same sanitary precautions we recommend during cold and flu season all winter

WASH HANDS!!
Avoid close contact with people with obvious respiratory symptoms
Have your children change clothes after school

The influenza vaccine (flu shot or FluMist) that your child received last fall does NOT protect against this new strain. If your child or any close family member develops the symptoms described above, please contact our office, as treatments are available to limit the severity and duration of the illness.

It's Cold and Flu Season!!

2009-01-15T12:34:00.001-08:00

Well, it's January and it's cold. That must mean that lots of kids have runny noses, coughs, and fevers. Cold and flu season can be tough on kids and parents. The truth is, there is really no way to avoid it. The average child gets 8-12 viral illnesses each year and these tend to be clustered in the winter months. Having said that, here are a few tips for making the best of it:

Wash hands. We can't say it enough. It makes a huge difference. Frequent hand washing and use of hand sanitizer will cut down on virus transmission in families and in school. Send a small bottle to school with your child and encourage him/her to use it!
Wipe down grocery carts and other common items in stores and malls before using them. There are viruses all over them.
Use zinc. Zinc lozenges and nasal swabs have been shown to decrease the duration and severity of the common cold in adults. Although the data is not there for children, our experience is that it does work. The downside is that they have to be used 5-6 times per day and started at the first sign of cold symptoms. Zicam and Cold-Eeze are common brand names for zinc products and are available in the cold remedy aisle.
Avoid cough and cold medications. They don't work. They cause side effects. Enough said.
Get enough sleep. Inadequate sleep weakens your immune system. Go to bed.
Exercise. Exercise decreases the likelihood of getting colds.

When to call:

Cold symptoms lasting more than 14 consecutive days.
Fever lasting more than 5 days.
Poor urine output.
Fever and sore throat together. Could be strep.

More Vaccine Information

2008-11-04T09:36:00.000-08:00

A few items in the national and local papers about vaccines in the past week.

The Today Show on NBC ran a report on a new book looking at the history of autism and its relationship to vaccines. The author discusses the numerous studies showing no causal relationship between development of autism and vaccination status. The book also takes a hard look at some of the alternative medical treatments for autism and their potential side effects. The report is available at todayshow.msnbc.msn.com/id/27440647/ Take a look if your interested.

Also out this week is a study looking at the proposed link between the measles vaccine and autism and how they may be related. It's very technical but the study found that children with intestinal issues with and without autism had no evidence of persistent measles infection or gut inflammation. The article is available at dx.plos.org/10.1371/journal.pon.0003140

(boy I wish the addresses were a bit simpler, cut and paste if you want)

Lastly, and in the opposite vain, the Lakewood Sun Post from 10-30-08 ran a letter from Rachel Lipovec from Chardon. The letter accuses vaccines of being dangerous, ineffective and immoral for a variety of reasons. Ms. Lipovec's suggestion for good health is good diet, exercise and avoiding toxins.

While I agree that diet, exercise and limiting exposure to hazardous materials are all good ideas, none will stop a child from developing meningitis, ear infections or even the common cold. Vaccines remain the most effective way of preventing serious, fatal disease in infants and children and Preferred Pediatrics remains committed to using them. The data have over and again shown them to be effective and safe with limited side effects. There is no evidence linking them to developmental delay or autism.

Get your children vaccinated, it's important.

Dr. V

Daily Dose of Reading Read-A-Thon!

2008-09-25T09:54:00.000-07:00

Our office partners with Daily Dose of Reading (DDR) to promote reading with children. Daily Dose of Reading is a local nonprofit organization that works with pediatric practices to promote literacy and a love of reading. Thirteen pediatric practices, the Free Medical Clinic of Greater Cleveland and two Momsfirst sites of the Cleveland Health Department currently collaborate with the organization (and new sites are being added). DDR gives them training, written materials, children's books, and programming so health care providers can work with families to help make reading part of their daily routines. DDR services are provided at no charge to families or practices. This year DDR is hosting a Readathon as its annual fundraiser.

Interested participants (anyone from birth to 18) are asked to find sponsors for the Readathon. From October 26th to November 1st readers will read as much as they can, then collect the money they've earned on behalf of DDR. Readathon participants are invited to attend the Readathon Reception on Sunday, November 9th to collect prizes and enjoy refreshments. All participants earn a goody bag and top readers and fundraisers in their age group will receive a grand prize.

Visit www.dailydoseofreading.org (look at the Readathon section on the left hand side) to learn more. Be sure to register online by October 26th! You may also call (216)291-9424 x151 for more information about Daily Dose of Reading or the Readathon. Thanks for your support of this local organization!

Time for Flu Vaccine!

2008-09-05T10:08:00.000-07:00

It's that time of year again! We have our flu vaccine in stock and available. Flu vaccine is recommended for ALL CHILDREN AND TEENS over 6 months of age. Every year we seem to have problems with vaccine supply. So far, so good this year but we can't guarantee that we will be able to order more when our current supply runs out. Please call soon and get your kids protected!

Dr. Vogelgesang Appointed to State-Wide Immunization Post

2008-08-13T07:39:00.000-07:00

Congratulations to our own Dr. V! He has been appointed Director of the "Maximizing Office-Based Immunization" (MOBI) Program. This program is a partnership between the Ohio Department of Health, county health departments, and the Ohio chapter of the American Academy of Pediatrics. The program is designed to assist pediatric and family practice offices in increasing their immunization rates. Vaccine specialists visit offices participating in the program and audit charts for vaccine information, then report on their findings and provide education and suggestions on increasing immunization rates. As MOBI Director, Dr. Vogelgesang will be responsible for overseeing training of the vaccine specialists, monitoring office audits, providing appropriate educational materials, and serving as a resource for physicians seeking information about vaccines and vaccine delivery. Congratulations Dr. V!

Dr. Vogelgesang in the News

2008-06-28T06:37:00.000-07:00

Dr. V is published on the Cuyahoga County Board of Health web site this month. He was asked to write an article for parents about poison safety. Check it out at:

http://www.ccbh.net/ccbh/export/sites/default/CCBH/pdf/Lead/GET_THAT_OUT_OF_YOUR_MOUTH.pdf

Schedule Physicals Now

2008-06-28T06:31:00.000-07:00

Don't forget to schedule your child's physical now for fall sports. It happens every year in August: we get frantic calls from parents whose children need a physical to participate in sports or school. We cannot accommodate everyone in a 2 week period in August, so please schedule now.

Why We Dread the Phrase "He's Burning Up!"

2008-05-21T10:52:00.000-07:00

Ah, fever. The number one concern of parents everywhere. How in the world one sign of illness became such a cause of anxiety I have no idea. I suspect it was because, long ago, a fever was often a sign of a bacterial infection and without immunizations and antibiotics, death often accompanied such infections. But now, in the 21st century, that is not the case. Immunization has eliminated many of the serious bacterial infections so most fevers are from common viruses. Still, the anxiety remains for parents. What to do?
Well first, please take a deep breath. Realize, first and foremost, that FEVERS ARE NOT DANGEROUS. A fever is a sign. No more. No less. It is a sign that a child's body is dealing with some sort of problem. That problem is almost always a viral illness such as a "cold" or a stomach flu. The fever will not cause brain damage or damage of any other kind. As a parent, please consider your child as a whole person, not a number on a thermometer. If your child has a fever, look at other things: is he/she drinking fluids well? is he/she alert and talking? when the fever is down, is he/she playful? If so, your child is almost certainly fine. If not, then there is a problem, regardless of whether there is a fever or not. If your child is unresponsive or not "acting right", then give us a call.
The exception to the above guideline is children under 2 months old. In this age group, a temperature is more often a sign of a serious infection and there is often no other sign, so please give us a call.
So what is a fever? Well, we generally consider any temperature under 100F to be normal. At 100F or higher, we consider that a fever. These numbers reflect a rectal or oral temperature. Temperatures taken under the arm will tend to be a degree lower.
Should you treat a fever? Well, that depends, again, on how your child seems. If he/she is acting fine, then treatment is not necessary. If he/she seems cranky or uncomfortable, then by all means give some medicine to treat the fever. Dosing is available on our web site at http://www.preferredpediatrics.net/articles.aspx?category_id=42.
Remember that the medicine will take 30-45 minutes to take effect.
When should you call us? We generally recommend that if your child has had a fever for 3 days, then it's time to give us a call. That, of course, is assuming the child is otherwise doing well, as described above.
I cannot begin to tell you how many calls we get from parents about fever. It is easily half of all the calls we get after hours. In addition, many parents run to the emergency room because of the fever. This usually results in long waits, blood work, needles, x-rays, and other costly, painful items. And it's unnecessary because FEVERS ARE NOT DANGEROUS. Please don't fear the thermometer. And don't fear the fever. It's no different than a cough or runny nose or diarrhea. It's a sign. No more. No less.
Did I mention that FEVERS ARE NOT DANGEROUS?

The Television-It's Your Enemy as a Parent

2008-05-07T08:17:00.000-07:00

Television is bad. There is no other, kinder way to put it. Watching television is linked to a host of problems in children and teens. Young people who watch more television are more likely to be overweight, perform poorly in school, have behavior problems, eat more junk food, and exercise less. In addition, those watching more television have shorter attention spans than those who watch less. So, there is really very little upside to the television, other than it's "easy". So please, please, please turn it off. And for goodness' sake, please keep the television out of your kids' rooms. Studies show that youth with televisions in their bedrooms watch far more than those without. There is really, truly, no good reason for a child or teen to have a bedroom television. Really. I'm serious. Stop. Please! Read a book. Go for a walk. Play a game. Anything! One hour in front of the television should be the daily limit. Enforce it. Your kids will thank you in the long run.

2008-04-30T11:28:00.000-07:00

Are ADHD medications safe?
The American Heart Association (AHA) last week released new guidelines regarding heart screening for children and teens taking stimulant medications for attention deficit/hyperactivity disorder. The recommendations suggest all those taking such medications have a risk screening for family history of heart problems and an EKG.
Stimulant medications are extremely effective in treating ADHD and have been used safely for decades. There is, however, a VERY SMALL risk of sudden death when these medications are given to a person who ALREADY HAS a heart problem. Please note that the medications do not CAUSE heart problems in otherwise healthy people.
It is our view, and one shared by the American Academy of Pediatrics, that the AHA recommendations are too aggressive. We agree that screening for a family history of heart problems is important. This is something we do each time we see a new patient and then annually beginning at age 10. However, obtaining an EKG on each person receiving stimulants will produce a large number of tests read as abnormal despite being done on a normal person. This will then result in further testing and a lot of worry for parents and patients before it is ultimately found that everything is fine.
So, if your child is taking medications for ADHD, please don't worry. The medicines are very safe. But let us know if you discover a history of heart problems (other than heart attacks in older folks) in your family. If you are still concerned, give us a call.

Doctor, Do Vaccines Cause Autism?

2008-04-17T13:02:00.000-07:00

We may as well kick off the blog with a biggie. We have been fielding this question a lot lately because the alleged vaccine-autism connection has been in the news for the last couple of weeks.
You have a choice:
The short answer: NO. Stop reading now.
The long answer:
No, vaccines do not cause autism. Autism is a neurological disorder affecting a child's ability to learn, socialize, and interact with the world around him/her. Autism is becoming more common. This is due in part to better diagnosis on our part but there is also a real increase in cases and we do not understand why. We also do not understand what causes autism. There is likely an interaction between genetics and the environment that predisposes one to autism. The genetic predisposition is clear from studies of twins and siblings. If one has autism, the twin or sibling is at increased risk.
But that's not the whole story. What are the environmental factors? Is it something that happens before birth? During birth? During infancy? Later? We just don't know.
But we do know that it's not the vaccines. There have been several very large, very well done scientific studies that have shown absolutely no relationship between autism and vaccines. They show no difference in autism rates between immunized and non-immunized populations. They show no decrease in autism in populations that stop immunizing. They show no rise in autism rates when immunization is resumed. There is just no relationship.
Lately, much has been made of the "thimerosal connection". Thimerosal is a chemical preservative that was used for decades to help stabilize vaccines so they would have a longer shelf life. It happens to contain ethyl mercury. Because people understand mercury as being toxic, this led to a belief that the thimerosal was "causing" autism in children receiving vaccines. However, there is a huge difference between ethyl mercury and methyl mercury. Ethyl mercury has not been shown to have toxic effects. I liken the difference to oxygen: two atoms of oxygen put together give you the oxygen we need to breathe and live. But three atoms put together gives you ozone, which is deadly. Same oxygen. Big difference. Having said all that, how do we know that thimerosal isn't causing the autism problem? Well, thimerosal was removed from all vaccines (except for some flu vaccines) about five years ago. Have autism rates dropped? Nope. Still rising.
Finally, you may have read recently that the U.S. Vaccine Court found a relationship between autism and vaccines. This is not really true. The Vaccine Court is the body that awards damages to people who have been injured by vaccines. The family of an autistic child filed a claim based on their assertion that vaccines contributed to the autism in their daughter. The Vaccine Court did, in fact, support their claim. However, the important detail is this: this child has an underlying, complex, metabolic problem, making her body more susceptible to stress. The child received several vaccines and developed a fever. The fever was the stress that worsened her metabolic problem, causing brain injury. However, ANY stress that caused fever, etc. would have produced the same effect. Had she gotten the flu, or pneumonia, or an ear infection, the result may have been the same. It wasn't the vaccine, it was the stress combined with this child's very rare metabolic disease that caused the problem.
Autism is a serious problem and we need to get serious about finding answers. But the more time, money, and effort we spend debunking the autism-vaccine "connection", the less we spend trying to figure out what is really going on.

Welcome!

2008-04-17T07:46:00.000-07:00

Hello to our practice families. This is Dr. Stephens. Dr. V and I created this blog to help keep you updated on health happenings and happenings at Preferred Pediatrics. It's easier than sending email and it won't clog up your inboxes! I will probably be doing most of the posting, since I am the designated office "computer geek". Our goal with this blog is to comment on health issues that you may see in the paper, online, or on TV. The issues may include pediatric health issues, health care delivery issues, or information regarding the operation of our office. Please use a newsreader to subscribe to the RSS feed for this blog so you will know when we post new information. Feel free to comment on these posts as often as you like and let us know what you think about this method of communication.
--Dr. Stephens