Lasers, Hypospadias, Blogs – PediaCast 150

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Topics

  • Fragile X Treatment
  • Vitamin A Fortified Corn
  • Mental Number Lines
  • Handheld Laser Pointers
  • Basketball-Related Head Injuries
  • Children’s Exposure to Sex in the Media
  • Hypospadias
  • Around The Net (Great pediatric & parenting sites and blogs)

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Transcription

Announcer: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.

[Music]

Announcer: Welcome to PediaCast, a pediatric podcast for parents. And now direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone. And welcome to PediaCast. See I promised I'd be back and here we are. It's PediaCast episode 150 for Monday, September 20th, 2010. And we're calling this one "Lasers, Hypospadias, and Blogs….

0:01:02.5

Of course we have a lots, lots more than just those three things. Before we get started though, I just want to mention that autumn is really kicking off now. We are almost to October and I have to tell you this is my favorite time of the year. If I have to pick a favorite month, it would be October. I mean college footballs get into full swing. We're going to be pass all the pre-conference play and being an Ohio State Buck Eye fans, sat at number two in the country right now, it feels pretty good. I'll tell you what else feels really good is cooling off here in Florida. So we are coming to you from Orlando, Florida, despite being Buck Eye fans. And it's been a hot summer in a large portion of the continental United States. But down here in Florida it has been particularly hot and humid and we've only lived down here a couple of years.

0:02:01.8

And last summer was hot and this summer was hot and we've had vacation down here in the summer before. So we know that Florida gets hot and humid. But it just seems like it lasted longer and was a little more extreme this year than in the past. But it's cooling off as it is elsewhere and so it's starting to feel pretty good to go outside and do some stuff. Also this the time of the year that Starbuck's brings out their Pumpkin Spiced Latte, kind to love that. Warm apple cider, powdered donuts, candy corn and if you're down here around the Walt Disney World Resort, they have the magic kingdom Mickey's not so scary Halloween party and the not so scary parade, those are favorites. I mean, they're not the in your face scary stuff, it's more of the fun fall harvest kind of thing. But it's a great time and of course it's so expensive, we can't go.

0:02:59.9

Just because you live by Disney, it doesn't mean that they let you in free. So it's a special treat even living next door to Mickey Mouse, it's a special treat when you can get over there for one of their Halloween parties. But it's a lot of fun if you never done it and you have a little vacation budget to do it, definitely worth coming down for Mickey's not so scary Halloween party. I didn't even get paid any promotional money for that. That's because it's coming from my heart not from the pocketbook. And pretty soon here we'll be carving pumpkins. So like I said, fall is in full swing and I'm real happy about that. I do miss the changing leaves and the sweat shirt weather. Because if you live down here in Florida, I mean it cools off and you can go outside and do stuff that it's not jean and sweat shirt weather, yet, and won't be for a while.
All right, let's move on. What are we going to talk about today on PediaCast. We have a full roster of topics for you.

0:04:00.4

In the News Parents Can Use segment, we're going to talk about Fragile X Treatment. If you know someone who has Fragile X or you have kids who have Fragile X, it is a very frustrating disorder. But there does appear a little bit of hope on the horizon with a new treatment drug. We will talk about that coming up. Also Vitamin A fortified corn, not sure how you feel about bio-engineering. But they are making corn that is fortified with Vitamin A in a sort of natural way, so we'll talk about that. Also mental number lines hand held laser pointers and the danger of those. Also basketball related head injuries and children's exposure to sex in the media. And after that we're going to do an In Depth Segment. What's an In Depth Segment? Well, what we do is we take a listener's question and this was actually, since we restarted the program, we've had several listener's questions. But this was the first one and it was a good one and so we putting that on the air and we'll actually going to wrap that into a In Depth Segment.

0:05:06.6

So we're going to talk about hypospadias. The who, what, when, where, how and why all that really in depth look at the disorder or the birth defect. So ifyou don't know what hypospadias is, stay tuned for that. And of course we'll do it in a way that you can understand. No big science or medical terms here. And then finally, we're going to wrap things up with a new segment that I'm going to call Around The Net. And this is something that we're going to do periodically. It's certainly not going to be a weekly thing. But once every four to six weeks or so. We're just going to take a look around the net and find out at what sorts of pediatric and parenting information sites are out there, blogs from pediatricians, just general information sites, where can you get great information besides PediaCast cause you know that's only going to take an hour of your week and you may have some more free time to dig up some more information about parenting and pediatrics.

0:06:04.9

So we'll take you on a little tour of what we find in the net during our around the net segment.
All right, if you have a question or a comment for PediaCast, it's really easy to get a hold of us, just go to pediacast.org and click on the Contact Link, you can also email pediacast@gmail.com or call the voiceline at 347-404-KIDS, that;s 347-404-5437. Also, I want to remind you that the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org. And with all that mind, we will be back with News Parents Can Use right after this short break.

0:07:02.7

[Music]

All right, our News Parents Can Use is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website. You can find them online at medicalnewstoday.com.
One of the antibiotics, most commonly prescribed nutria adolescent acne can increase attention span, improve communication and decrease anxiety in patients with Fragile X syndrome.

0:07:59.4

The most common inherited cause of mental impairment. That's according to new survey study let by researchers at the University of California, Davis Mind Institute. The study examined parental observation of their children's responses domino cycling. While the study did not scientifically examined the efficacy of treating patients with the drug, researchers said the study results are extremely promising and will lead to a placebo controlled clinical trial of treating Fragile X children with minocycline that's funded by the National Fragile X Foundation. This investigation was published in the September 2010 issue of the American Journal of Intellectual and Developmental Disabilities. In the study, parents reported after being treated for an average of 3 months with minocycline, their children showed prolong retention, improvements in language and reduced anxiety. This preliminary survey demonstrated improvements in participants. However a control clinical trial is still needed to compare the efficacy of treating patients with minocycline to treating with a placebo, said Dr. RandI Hagerman,

0:09:02.3

Fragile X and Endowed Chair and Medical Director of the UC Davis Mind Institute and one of the world's leading experts on Fragile X syndrome. Fragile X syndrome is a genetic disorder that results from a defect on the X chromosomes. It's estimated to affect 1 in 3,600 males and 1 in 4,000 females. 1/3 of all children with Fragile X syndrome developed autism and approximately 5% of children with an autism spectrum disorder have Fragile X. The condition causes a range of disabilities from learning disorders to mild to severe intellectual impairment, behavioral problems and emotional issues. It's also associated with certain physical characteristics including prominent ears and flexible finger joints. The symptoms are typically more severe in boys than in girls. Minocycline is one of the most commonly prescribed medications for adolescents acne and it's been in use since it's introduction in the 1960's. The drug has been found to have neuro protective qualities and in animal models improve neuro degenerative diseases like Parkinson's and Huntington's.

0:10:04.9

Interested that used in human patients with Fragile X surge after a 2009 study found at Minocycline improved cognition in mice, genetically engineered to have Fragile X. For this parental survey study, the investigators prescribed Minocycline to patients at the Fragile X research and treatment center at the UC Davis Mind Institute. Other participants were treated elsewhere by their primary care physicians. The study included a total of 50 participant including 7 females and 43 males. These children took the drug for periods ranging from two weeks to 20months with doses ranging from 25 to 200 mg per day. So let me just break in and say here really quick, this obviously is not a well-designed clinical study. They basically are just taking a whole bunch of kids who were on Minocycline, who also have Fragile X syndrome and they weren't really tweaking the doses to find out what the optimum dosing range would be and they're also not saying how long you need to be treated with this.

0:11:04.9

So it's just a survey to see kids with Fragile X, who happen to be on Minocycline, did you noticed an improvement with their cognition and behavior and most parents said yes there was a difference. In fact 50% of the parents said their children's attention spans improved, 44% said their children showed improvements in their use of language, 44% said their children social communication improved and 30% said their children's anxiety levels decreased. Unfortunately many children experienced mild side effect with the drugs such as upset stomach and researchers still worry that tooth discoloration which is common to individuals using tetracycline might be a long term problem. Despite this minor concerns, the study findings prompted the National Fragile X Foundation to fund a two year $100,000 pilot study of the use of Minocycline in people with Fragile X. The study is examining the efficacy of using the antibiotic to treat children between the ages of 4 and 16.

0:12:02.9

The National Fragile X Foundation is honored to support a research project that has the potential to bring significant improvement in a relatively short period of time to individuals with Fragile X syndrome. Those are the words of Executive Director Robert Miller. He goes on to say, "We know families are also excited about the possibility, a gold at the National Fragile X Foundation is to move research forward that translates scientific breakthroughs into near terms treatments and this study has the potential to do just that. So we'll keep our ears at the ground here at PediaCast and as more information becomes more available on the upcoming clinical trial, we will be sure to pass that news on to you.
OK, moving on to corn.

0:13:00.1

A new Iowa state university said he has found that corn bio-engineered to contain increased levels of beta carotene as a good source of Vitamin A. The discovery gives added support to the promise of bio fortified corn being developed through conventional plant breeding as an effective tool to combat Vitamin A deficiency in developing countries. The human body normally converts beta carotene into vitamin A but researchers found that beta carotene in the engineered corn was converted into Vitamin A at a higher rate than they predicted for corn and higher than the conversion rate in other vegetables such as spinach and carrots. Wendy White, an Iowa State University Associate Professor of Food Science and Human Nutrition, led the six-week study. The results validate the promise of so called "Orange Maze…, that will soon be distributed to Sub-Saharan Africa in an effort to combat Vitamin A deficiency. According to 2009 World Health Organization estimate, Vitamin A is deficient in more than half of the world's countries with Africa and South East Asia having the highest deficiencies.

0:14:05.9

Medical researchers have reported Vitamin A deficiency to be one of the most serious causes of malnutrition in developing countries and can cause blindness for immune system function and sometime premature death particularly in young children. The effort to bio-fortified corn with beta carotene is being led by harvest plus a global research initiative directed in part by Washington DC based international food policy research institute. Professor White reports bio-fortification is a revolutionary approach to combatting micro-nutrient malnutrition in developing countries and it has the potential to be self-sustaining. The seeds are bred to be naturally high in key micronutrients such as Vitamin A, Zinc and Iron. These seeds are ultimately distributed to poor farmers in developing countries. Resulting crops are not only used for their nutritional value but also as a source for more seeds which farmers can share with their local community.

0:14:58.2

She says this study answer major feasibility concern for the bio-fortification program because plant breeders were quickly successful in ramping up the beta carotene content in the corn. But the question was, would it be available to be absorbed and utilized by people. What we've shown is beta carotene is bio available to be converted into Vitamin A in the body much more so when we previously expected. The study was posted online this month by the American Journal of Clinical Nutrition. So what sort of study did they do? Well researchers had six healthy female subject between the ages of 18 and 30 consumed 250 gram portion of maze porridge, three times at two weeks intervals. Each subject consumed the beta carotene bio-fortified orange maze porridge as well as two white maze controlled porridges. Both samples were then drawn after they ate each porridge to determine the amount of Vitamin A absorbed in the blood.

0:15:56.0

White says the study's findings provide an important step in the process of making bio fortified corn available to the people who desperately need Vitamin A in their diets. Our test subjects are mostly graduate students based in the US who were screened for excellent health, meaning the study was conducted under ideal conditions. The next step White say is to take the bio fortified corn and field test it on those who need it most. White reports harvest plus has begun to do this by conducting a pilot program in Zambia aimed at feeding the beta carotene bio fortified orange maze to young children in an effort to boost their Vitamin A intake. This program launched after being the first recipient of a bio fortification research grant funded by the Bill and Melinda Gates Foundation. So, I think it's interesting to have them eat the maze porridge three different times, one is with the bio fortified and then twice which is the control regular one and the bio fortified one did increased their Vitamin A levels in a perishable amounts. So, it's an interesting study.

0:17:02.5

All right, let's move on from corn to numbers. As children in western cultures grow, they learned to place numbers in a mental number line with smaller numbers to the left and spaced further apart than the larger numbers that are on the right. Then the number line changes to become more linear with small and large numbers the same distance apart. Children whose number lines have made this change are better are remembering numbers according to a study published in the journal, Psychological Science. Remembering numbers is an important life skill and a world full of numbers, including social security numbers, telephone numbers, addresses, temperature, locker combinations and passwords. For this study, Clarissa Thompson of the University of Oklahoma and Robert Seagler of Carnege Melon University looked at how children's memory for numbers relates to the way they represent that numbers in their heads. Young children's knowledge sometimes seem impressive because they can count, 1 2 3 4 5 6 7 8 9 10 but often they just learned by wrote memory.

0:18:01.0

Their counting doesn't have much to do with their understanding of how big the numbers really are say Thompson but eventually these words get associated with the size of the numbers. Children normally start out with logarithmic number line which has more space between smaller numbers and crunches the larger number together up at the top and eventually they progress to a linear number line where all the numbers are equal from each other. In one experiment, each child was given a stack of blank number lines with 0 written below the left and 20 written below the right end. Then the children heard a series of number from 1 to 19 and had to mark on each number line where they thought that number belonged. Then the experimenter told a story that included a few numbers. After the story, investigators asked each child to name four cartoon characters in an effort to throw off their memory a bit. Finally, the experimenter asked each child questions about the story like how many forks did Coleen washed?

0:18:58.0

Children with a more linear number line were better at remembering the numbers in the story. In three experiments, Thompson and Seagler found that the more linear the child's number line was, the better the child was at remembering the numbers. And this was true for preschoolers for numbers from 1 to 20 and for elementary school children for number from 1 to 1000. We really do live in a world of numbers say Thompson. Some we only need do approximate, and others we really do need to remember exactly. Ability to estimate the size of numbers influences the ability to remember the numbers exactly. So what does that mean for you moms and dads, well, if you have a child in the preschool or elementary school age, it's not a bad idea to draw a line and have them practice putting numbers on it and teaching them that all the numbers from 1 to 20 or from 1 to 100 or if you're really industrious, from 1 to 1000, should be equally apart and not all scrunched together one end to the other and the ability to do that will help them to memorize numbers.

0:20:03.5

All right, let's move from numbers to lasers. A 15 year old boy recently ordered a strong hand held laser device online because he wanted to pop balloons from a distance burn holes into paper cards and melt through her sister's shoes. According to a letter published in New England Journal of Medicine, the fun stopped when the boy used the laser in front of a mirror. It's one of those images you get in your mind and you just want to yell out to this image of this boy and say no, don't do it. We'll he apparently wanted to create a laser show so faced the mirror zapped the laser beams in several directions, unfortunately some of the beams hit his eyes and his vision in both eyes blurred immediately and then he didn't tell his parents for fear of punishment and simply hoped the vision problems would go away. Well guess what, they didn't. Two weeks and his eye sights problem continued so the boy finally told his parents who sought the help of an ophthalmologist.

0:20:59.8

Kind of sad too that it took two weeks for the parent to figure out that their kid had an eyesight problem. By this time the boy's eyesight had deteriorated so badly in his left eye that he couldn't count fingers on a hand unless the hand is within three feet of his face. As it turns out the eye doctor found a dense sub retinal hemorrhage on the boys left eye and several round scars in the pigmented epithelium of his right eye. The clinician diagnosed this as bilateral retinal laser injury. Four months later the boy's eyesight have improved a little bit, significant problems and permanent scarring remained. Used to be that laser devices is sold to the public had a maximum power of 5 milowatts which is not considered harmful for human eyesight. More powerful lasers, once strong enough to damage the eyes were reserved for trained professionals in the medical, industrial and military fields. The hand held laser device that this boy purchased on the internet had a power of 150 milowatts, which is 70 times more powerful than the safety threshold.

0:22:00.1

And more powerful lasers, as powerful as 700 millowatts can be bought by anyone on the internet. The government restrictions are in placed by they are not enforced and online sales and international shipping continue. What's more advertisements for these dangerous lasers are often build them as "laser pointers… like the harmless one used by teachers and many powerful laser look identical to the safe ones. Another common tactic is to package a powerful laser inside a toy sword and call it a light saber. You can imagine teen agers find this fascinating despite the potential for blindness and other serious injury. The letter to the New England Journal of Medicine asked how a child using a so called toy laser device and the kids around him are supposed to tell a harmless laser from a dangerous one. And the author concludes that if something isn't done about this problem many more kids will suffer serious eye injuries in the future.
All right let's move on to basketball, a new study conducted by researchers at the center for injury and policy at the Research Institute in Nationwide Children's Hospital, our bandwidth sponsor, examined basketball related head injuries in the emergency departments among children and adolescents between the ages and 5 and 19 from 1997 to 2007.

0:23:15.3

According to the study more than 4 million in basketball related injuries were treated in emergency departments during the 11 year study. Well the number of injuries decreased 22% over the course of the study. The average number remained high with over 375 thousand injuries reported each year. Data from the study which was released online September 13th and will appear on the October 2010 issue of Pediatrics, revealed that traumatic brain injuries which carries significant risk increased 70% over the study period despite the over all downward trend in basketball injuries. So if your kids are getting hurt playing basketball but more of them are having head injuries. We found a dramatic increase in the number of basketball related traumatic brain injuries over the 11 years study period said the study co-author Dr. Laure McKenzie, in addition the proportion of traumatic brain injuries doubled for boys and tripled for girls during this time.

0:24:08.3

Many athletes do not recognize the symptoms of concussion or do not report them to coaches and trainers. Educating athletes, coaches and parents to recognize and to report suspected concussions is vital to managing them effectively and helping to prevent future injuries. You know, I didn't think about as I was actually preparing this new article. But as I'm going through it here, it just struck me, did the number of head injuries really increased over the study period or more people just reporting them and having them diagnosed for seeking help in the emergency department because there is more in the media about the risks associated with head injury. I suspect that maybe part of it. The study also reported frequency rates for other common basketball related injuries, sprains and strains to the lower extremities, 30%, specifically to the ankle, 24%, fractures or dislocation to the upper extremities 15% and specifically the fingers 8%.

0:25:05.5

Adolescents age 15 to 19 years or more likely than younger athletes to have strains and sprains and cuts as well. Children age 5 to 10 years are more likely to be diagnosed with a traumatic brain injury than athletes aged 11 to 19 years. Boys are more likely to sustain cuts, fractures and dislocations while traumatic brain injuries and knee injuries were more common among the girls. Basketball is a very popular sport and we want to encourage children to continue playing while also reducing the risk of injury said Dr. McKenzie who is also a Faculty Member of the Ohio State University, College of Medicine. There are some precautions such as having young children used age appropriate basketballs which may decrease the rate of concussions and finger related injuries. This is the first national study of basketball related injuries for school aged children and adolescents treated in US emergency departments. Data for the study was collected from the National Electronic Injury Surveillance System which is operated by the US Consumer Product Safety Commission.

0:26:01.4

The surveillance system provides information on consumer product related, sports related and recreational related injuries treated in hospital emergency departments across the country.
And finally in our News Segment, sex in the media. Pediatricians, parents and media companies need to be more cognizant of the sexual material that children and teens are exposed to through television, music, the internet and other media, that's according to a new policy statement from the American Academy of Pediatrics. Sex related media exposure may be a contributing cause of the US teen pregnancy rate, topping that of other western countries. It may also play a role in the fact that nearly 25% of all US teenagers have a sexually transmitted disease. Let me just say that again, 25% of all US teens have an STD.

0:26:52.0

Dr. Victor Strossberger, a Professor of Pediatrics at the University of New Mexico, School of Medicine and the lead author of this statement said "The media represents arguably the leading sex educator in America today…, he added "we do such a poor job of educating kids about sex in sex education classes in school and parents are notoriously shy about talking to kids about sex so the media picks up the slack. According to Strausberger 70% of teen shows contain sexual content and less than 10% of that content involves anyone classify as being responsible content. Strausberger said there is no mention of contracting diseases or the need to wait to have sex until later. The policy statement offers several recommendations for pediatricians, parents and the media. Physicians should ask two media related questions during every visit with their patients. One, how much entertainment screen time per day does the child engage in and two, is there a TV or internet connection in his or her bedroom. In addition, parent should monitor their children's use of social networking websites and use story lines from shows and movies as teaching tools to talk to kids about sex.

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And if you like to read the entire policy statement from the American Academy of Pediatrics, check out our Show Notes at pediacast.org and we'll have a link to the full text of the statement waiting for you there.
All right, that concludes our News Parents Can Use, we will be back with an in depth answer to a listener question. But I have to warn you, the listener question involves the male genitalia. And we're going to talk about hypospadias which is a birth defect of the male genitalia, so if you are listening to this in a car or you have it out loud in you have young kids who are listening we are going to be using certain anatomical terms correctly but that could bring up some discussion or your kids asking questions. So I'm just warning you now that there will be some, I don't want to say explicit language cause we are going to use the correct terms for body parts, but you may just want to be sensitive to that. So, we're going to have a little musical interlude.

0:28:58.1

You may, if now is not the appropriate time for you to listen to this segment you may just want to fast forward to the next musical interlude and that will alert you that we're going to have our Around the Net segment. But of course when it is a more appropriate time, come on back because we're going to have some interesting information for you about hypospadias.
All right, so we are going to take a break and we'll be back right after this.

[Music]

OK. We are back with our In Depth Segment where we are going to talk about hypospadias.

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Last warning, we are going to be using some anatomically appropriate terms which you may want to be sensitive to if you have young kids listening.
All right, this question comes from Shannon from Ottawa, Canada. And Shannon says, "Hi, Dr. Mike. As a new mom, I've really enjoyed your podcast and I'm very happy to see you began adding new episodes. The reason I am writing to you is that my son is diagnosed with hypospadias soon after birth and after some awkward conversations with my brother and father, found out that it seems to be genetic. It has been recommended that it be corrected sooner rather than later and I have mixed feelings as neither my father or brother had theirs fixed and they say they have no regrets. I was wondering how often you see this in your practice and maybe you would like to educate your listeners in what seems to be a common problem that is not normally discussed. Thanks for taking your time to read this and for being so awesome. This is from Shannon.

0:30:57.0

All right, let's talk about hypospadias, what is it? Well the simple answer in boys, hypospadias is the condition where the opening of the urethra which is the tube that travels from the bladder to the penis to the outside world, the opening of the urethra is located somewhere along the underside of the penis rather than at the tip. Severity and ease of repair vary depending on the location of the opening. So in mild cases, which are the more common ones, the opening is near the head of the penis but underneath it instead of at the tip. Less commonly, the opening is mid shaft or at the base of the penis and rare but also the most difficult to repair, the opening is in or beneath the scrotum, where the testicle are. All right, let's talk about epidemiology. That's just a fancy way of saying who gets it and how common is it. OK, you're going to love this, 100% of people with hypospadias are boys. 0% are girls.

0:32:00.0

How common is it? Well, it is the most common birth defects of the male genitalia. It's second only to undescended testicles. Incidence varies widely from country to country. It's been reported as low as 1 in 4,000 boys to a high of 1 in every 125 boys which actually is what it is the United States, 1 in every 125 boys in the United States has or is born with some form of hypospadias. So in the US, it's very common. Now, it's also been increasing it seems. According to population surveys in the 1970's, the incidence was reported as 1 in every 250 boys and in the 1990's, incidence was reported as 1 in every 125 boys. So, why the increase? I mean why would they increase double in the span of 20 years. Well, genetic and environmental factors are possible.

0:33:01.3

But would that really cause it to double in 20 years, probably not. Mild cases of hypospadias which again make up the vast majority are probably just better identified today compared to 20 years ago. I don't have any science behind this or study to back me up. But I think it may sense. And really Shannon's family is a good example of this. Adult men in the family likely have mild hypospadias. I say that because the moderate and severe types make it difficult, if it's not fixed, to procreate. And since Shannon's around, her father who has it obviously was able to conceive a child. So I'm assuming it's a mild form of hypospadias. So adult men in the family likely have the mild form. And they chose not to have it repaired and they've done well. They can likely aim pretty well into a toilet when they pee and as I've said they have successfully procreated. They are medically sophisticated.

0:33:58.6

They probably see their doctors regularly and they know they have hypospadias and have chosen to let it be but they still know the name of the condition they have, they just don't talk about it when they're around the water cooler or at a family get together. But if they were surveyed, they know they have hypospadias. They know that's the term for what they have. But 20 years ago or more, what this men have known they have a medical condition, and name for it. Maybe they thought all men have a hole on the other underside of the head rather than at the tip of the penis or maybe they knew they were different, they just didn't knew what name to put to it. They didn't want to talk about it. They have good aim when they pee. They could procreate, so why bring it up with their doctors and I think back then doctors were less likely to look in certain places unless the patient have a complaint they vocalize. So is the incidence really increasing or are men becoming more medically sophisticated better identifying normal from not normal and associating a name with their condition.

0:34:59.4

That probably has something to do with the seemingly increased in incidence especially when you see a doubling of incidence over the last 20 years. Now, how does this happen? No, I'm not saying that genetics and environmental factor aren't also involved. I'm just saying, is it really enough to double the number, maybe it is. So how does this happen in the first place? Well, the most common occurrence is actually what we calls sporadic. This just means that it happens and during the development and we really don't know why. There is no family history, there is no identifiable environmental condition to hang or had on it's just happens. No, should there be some reason, we just don't really know what that reason is. Now, having said that, it does run in some families, as in Shannon's case. This is not the most common way it occurs but we do sometimes see it and when it does happens it's associated with a parasintric inversion of chromosomes 16. Now, what does that mean, well it means in these families there is a genetic cause.

0:36:00.1

And we'll leave it at that for our purposes. There are also environmental and chemical agents that my play a roll. Certain steroids and hormones are responsible for the formation of the male genitalia. So during formation, any chemical that interferes with this process could cause normal development to a rest. In other words, the tube could stop growing before it reaches the tip of the penis. And some chemicals thought the cause of disruption in that process are thalates DDT and polychlorinatedbifenals. Now these are hypothetical association at present. No animal trials have been conducted to see if exposure to this really does cause an increase incidence of hypospadias. However, there are anecdotal reports which suggests that workers and hair dressing salons exposed to high concentrations of hair spray which contain thalates have doubled the risk of having boys with hypospadias, interesting. All right, so what symptoms go along with hypospadias.

0:36:59.7

Well, I looted the two of them, inability to aim while peeing standing up. In fact the opening is often irregular and not conducive to a nice stream but rather results to an uncontrollable spray. The other involves procreation. If the opening is not on the tip, semen may not properly be deposited into the vagina leading to difficulty with conception. Now again, these are problems that are less severe and less of a concern with mild cases of hypospadias which are the most common types of hypospadias that we see. Now obviously in Shannon's family they have not been severe enough for the men to seek treatment. But the potential is there. I should also bring up cosmetic factors. That may also be an issue down the road too. There are some other associated symptoms as well. Often there is a downward curve of the penis called cordy, and this are caused by bands of fiberous tissue connecting the base of the penis to the urethral opening.

0:37:59.6

And this curvature of the penis also makes it difficult to urinate in a standing position and that curvature is worsen during an erection which again interferes with conception. In fact it could be so bad that proper penetration is not even possible and this can happen even with mild cases of hypospadias from time to time. And until the penis is full grown, you know man size, may not know how severe that it could potentially become. So if you have a baby with mild hypospadias, the opening is close to the tip but still on the underside, there is a potential even if you have family members who have not had this problem, there is a potential to develop cordy as the baby grows becomes a teenager becomes an adult man which could cause a curvature of the penis that makes intercourse and conception very difficult if not impossible.

0:39:00.9

Now, since it's much easier to fix this condition in an infant size penis than a full grown man size one, with less surgery time, quicker recovery time and no work lost to worry about, in my mind it's a good reason to get the condition corrected in infancy even in mild cases because there could still be issues with the curvature creating cordy down the road. Now again in Shannon's case, the men have no problem aiming your aim I assume and no problem with penetration and conception. But does that guarantee that Shannon's son will also not have these problems if his hypospadias is mild, no it does not. Does it make it less likely who have those problems, I think it makes it less likely. I mean, you've got two in the family who followed the same path. It's likely that Shannon's kid will also follow that same pattern and not have the problems. But is it guaranteed, no.

0:39:59.0

Less likely it's still possible. And surgery and recovery time in infant is much easier and faster generally than in an adult. Plus the surgery is performed thousands and thousands and thousands of time every year on babies, not so much with adults. So you also have surgeons who are more skilled at correcting baby hypospadias than you do correcting adult hypospadias. So that' something else to keep in mind. What about associated birth defects. Well, hypospadias most commonly occurs as an isolated birth defect. But it is sometime associated with other problems. 10% of kids with hypospadias will have an undescended testicle and 10% will have an inguinal hernia. Less than 10% will have an enlarge prostrate utricle. This is a blind pouch coming off of the urethra in the vicinity of the prostate gland. If it's too large it can collect and hold urine which can cause increased urinary tract infections pseudo incontinence where urine is being held in that little sac that drips out.

0:41:02.0

And it can also cause kidney stone formation. Although in this case there are no kidney stones they're urethral stones. So less than 10% have that problem.
OK. Let's move on to medical decision making. So your child has hypospadias, what do you do? Well the only real treatment is reconstructive surgery. So the decision really is whether to correct or not to correct. And that decision is pretty easy in my mind if you have a mid-shaft defect which is one at the base of the penis or if it's in or under the scrotum. So if you have the more medium to severe forms of hypospadias which are the less common ones, in my mind there is no real issue here. It should be corrected. Unfortunately, those are the ones that are most difficult to repair and sometimes require multiple surgeries and they may also result in other cosmetic issues but the primary goal is to make urination and procreation easier and more successful not to make everything to look good.

0:41:59.6

So you have to keep that in mind in the medium to severe forms of hypospadias. Mild cases on the other hand usually are quick easy one procedure surgeries, usually. They have a near normal cosmetic outcome. But those cases are also the ones least likely to really have a medical need for the surgery as in the case of Shannon's family. So what am I saying here, do you treat it or do you not treat. Well, that's your decision. The decision that you and your family have to make with your personal doctors counsel. I can't and don't want to make that decision for you. But I can tell you what I would do if it were my kid. Personally, I'd have it fix. I think the risk of fixing it is smaller than the potential benefit that you are going to get. But again that's my idea and I certainly wouldn't fought you for coming with a different decision based on your family's experience with the condition and your expectations.
All right, let's move on, we are going to take another quick break and we are going to be back with a new segment called Around The Net. And we are going to do it right after this.

0:42:59.3

[Music]

We are back on PediaCast with a brand new segment called Around The Net. Now as I mentioned in the introduction, this is a new segment for us. We're not going to do it every week like our news and listener type stuffs that we do. But we are going to fit in kind of in place of our Research Round Up once a month or so. We're going to take a look at pediatric and parenting resources that are available in the internet. To see what kind of topics they've been covering lately. What sort of things you can find and we'll take a look at general educational sites, blogs, podcasts, Facebook groups, Twitter peeps and twits, YouTube channels, basically if it's on the internet and it's aimed at parents and worth your time we'll consider including it in this segment.

0:44:13.7

Also if you know of a resource that we aren't covering, send me a note, pediacast@gmail.com or go to pediacast.org and use the Contact Link or you can call in on our voice line as well. So again if there is something out there that I don't know about, let me know.
All right. So let's stop talking about it and actually get on to doing it. Also I should mention too, we are going to cover a lot of different sites briefly and some of them a little bit more depth. You don't have to memorize any of these sites, we're going to have links to every one of these sites in our Show Notes. So if you hear about something that sounds interesting to you, just go to pediacast.org, click on Show Notes and look for the Show Notes episode 150 and we'll have links to all these sites for you.

0:45:06.3

OK. The first one is the pediatric super site and it is just at it's sounds. It is a pediatric super site with tons of pediatric medical information. Now, the main audience is pediatric professionals. But there are lots of interesting article for parents too and most of them are written in a way parents can understand, especially if you have a little working knowledge of medicine and biology. If you have a high school education, maybe a little college with some biology, you're going to be able to understand and if there's word you don't understand, Google them. It's a lot easier these days than it used to be. So it is more aimed at pediatric professionals but if you want to be an educated parent and you're interested in more of the science stuff, check them out. They're at www.pediatricsupersite.com.

0:46:01.2

OK, so what are some of the recent articles, well, they've been talking here recently about pertussis, lime disease, H1N1, flu associated pneumonia, hand washing and ear infection treatment. Those are all recent articles on the Pediatric Super Site. So check that one out.
OK, another one is the Nationwide Children's Hospital Health Information Library. Now, disclaimer, Nationwide Children's is our bandwidth sponsor, but they're also an incredible pediatric health institute. One of the top five largest pediatric hospitals in the country and also a really rapidly developing research institute associated with the hospital and the whole thing is affiliated with the Ohio State University, College of Medicine. And they have a large library of medical and parenting information. And the intended audience for this site is moms and dads. It's going to be an easier to understand resource than the Pediatric Super Site but that means it's also a little more watered down.

0:47:01.4

For many of you, it's a good thing but for pediatric professionals, that won't be as helpful. Of course, they also have resources for pediatric professionals that were not mentioning here. But there health information library really is aimed more at parents. It's available at nationwidechildren.org and the link to get you to the health information library for parents is in our Show Notes so that you can bypass their main page and just get right to the library. It's divided into three segments. One segment for parents and it has practical parenting advice, information and news. There's another segment that's for kids and that includes a homework, health, games, and information for children. And then there's a whole teenage section that has answers, advice and basically just straight talk for teens. You can also sign up Health-e Hands which is a free electronic newsletter that is just full of parenting advice and pediatric information that just comes to your email inbox on a regular basis so you can sign up. Again they call it Health-e Hands.

0:48:09.1

OK. Let's move on. Dr. Greene. Now this is another general parenting/pediatric information website really aims moms and dads. So again pediatric professionals may find this one a bit lacking but it's really comprehensive site that Dr. Greene has put together. It's drgreene.com. And it includes health and parenting educational materials. He has blogs. They're actually community forums where you can get answers fro pediatric professionals namely Dr. Greene and colleagues and other parents as well. They also include product reviews on their site. So you can check them out, drgreene.com.
And then another good on is Kids Health, it's kidshealth.org. And this comes from Nomorse. Now Nomorse is a large pediatric health system.

0:49:02.9

They run the Alfred Dupont Hospital for Children in Wilmington Delaware. They're building a brand new pediatric hospital and health campus here in Orlando, Florida that's set to open in 2012. And they also have multi-specialty clinics in several locations in Delaware, New Jersey, Pennsylvania and Florida. Now their Kid's Health site, again kidshealth.org is aimed at parents that has general health information, questions and answers, really a broad spectrum of information including positive parenting, behavioral topics, first aid and safety, growth and development.. It's really a nice organized and easy to find the information that you want. And like Nationwide Children's site, they have special section for children, really aimed at kids and another segment of the website that's aimed at teenagers. Their latest article "Packing Healthy School Lunches…. So they have news articles on the topics that are relevant depending what time of the year it is and what's going on around in terms if there are any epidemics , pandemics.

0:50:05.6

During H1N1 flu season, they have something. So, right now it's back to school and packing healthy school lunches. And again that's from Nomorse. And it is kidshealth.org.
OK. Another good one, well just for general information is the Mail Clinic. Now the Mail Clinic, when I think of the Mail Clinic, I think of adult medicine. But hey have a really well done, information for kids, infant and toddlers, children, tweens, teens, it's all divided up into age groups. It's not as fancy or flashy as the other sites. And it doesn't have the breath of parenting topics that the other sites have. But what they do have, they do really, really well. And what they have mostly is detailed of it, detailed information. But still in a way that parents can understand about disease processes. So to get to that, you go mailclinic.com.

0:51:01.0

And it's kind of buried where you find their pediatric information. So just go to pediacast.org, to the Show Notes, and we'll have a link right to where you need to get. It's called the Healthy Living segment of the Mail Clinic. Big website. And from that launch page, you can get into infant, toddler health, children's health and tween and teen health. And basically what they do is they take a disease and they'll tell you symptoms, causes, risk factors, complications, testing and diagnosis, treatment options, prevention. I mean, so what it lacks in breath of information and flashiness, it more than makes up for with a depth that you can really dive into but still understand. So you want to check that one out if you're interested. Especially if you're looking up a particular disease process and what you can do, let's say you want to find out more about hypospadias or you want to find out more about ear infections, whatever, eczema, asthma. Just do a Google search for asthma in Mail Clinic and I think they'll probably take it pretty quickly to the page that I am talking about.

0:52:02.8

It really just goes down into in depth. Still, not as much depth as a pediatric professional who wants to use the information to better their practice and just to see what the current trends are in treatment. Not quite to that level of depth. But for parents it's a level of depth much deeper you are going to get from any other site that I found on the internet.
All right, we are going to move now from general pediatric sites to pediatric/parenting blogs. And what I've done is come up with a selection of blogs. Most of them done by pediatricians. So it's basically like me doing PediaCast except instead of doing a podcast, they're doing it as a writer in a form of a blog. And there are several of these. They are just outstanding. And one of my favorites is called the Seattle Momma Doc. And this is Dr. Wendy Sue from Seattle Children's.

0:52:58.7

She is a pediatrician and mother. Her blog is equal amounts of parenting and medical advice. And it's from someone in the trenches with young kids at home. And some of her recent posts , "Spoonful of Bacteria for Baby…, which is an article on probiotics. "Please and Thank You's…, "Making Promises…, they're actually her advises not to make promises especially if you are promising your kids they're not going to get a shot when they go to the doctor's office. And I remember when I was in private practice, during my 10 years of that, that would happen a lot, almost daily. Kids would come in, I don't know what parents are thinking. It's like the babies, 12 month, 15 month check-up, OK, that's a bad example isn't it. Yeah, 12 and 15 months old don't really care about parents promises. They don't understand the concept, I'm sorry. OK, let me backtrack. OK, so you have a three year old and there is a new immunization on the horizon or it's the time of the year to get your flu vaccines and the parent says, had the promised the kids, "no shots, I promise you are not going to get a shot… or the pre-kindergarten visit, "no, you are not going to get a shot…, you need shots.

0:54:14.6

You need shots before kindergarten. And even if it's not before kindergarten, and you're thinking, "no, my kid doesn't need a shot…, you don't know what's out there. You don't know what's new. You don't know what catch up stuff need or additional boosters. So don't promise your kids that they are not going to get a shot when they go to the doctor. And here's the thing, I couldn't believe how many parents would actually, OK, they promised their kid that they're not going to get a shot. So now, one or two things is going to happen. They just bought themselves another trip. Because they're going to make good in their promise, they're going to do the well check-up and they're going to come back for a shot only visit in a couple of weeks. Well, you've just caused yourself a lot of time and grief or you're going to renegade on your promise and go into, well mommy didn't know and the doctor knows best.

0:55:02.9

I'm not so certain that's right thing either. So in the end don't make promises to your kids, You're not getting a shot if you take him to the office especially for a well check-up. All right, that was really down the road. I didn't to take, I'm sorry about that. Because I still want to talk about Seattle Momma Doc because my favorite blog post from her was about moving day. I actually loved it so much that I wanted to present it to you as an example of some of the things that pediatricians/moms write about. So this is really a good combination of medicine and parenting and very well written. And so I wanted to really just present you with this blog post. But then I thought if I just present it and give you some of the quotes from it and provide a link, that's not really as meaningful.

0:56:00.2

So then I had this idea, maybe I will get permission from Dr. Wendy Sue to read it on here so you can actually hear it. And then my brain, the gears got turn in and I thought, no, I shouldn't read it, we have to get Dr. Wendy Sue to read it So that she could really do the full effect of what her blog post was trying to communicate with parents. So, Dr. Wendy Sue is nice enough to actually record her voice reading her blog post and she did an outstanding job. So without further a due, let's listen to Dr. Wendy Sue, Seattle Momma Doc from Seattle Children's Hospital talking about moving day.

Dr. Wendy Sue : Thanks Dr. Patrick for having me here on PediaCast. This is Dr. Wendy Sue Swanson with seattlemommadoc.seattlechildren.work. This is about post about moving which I've called the most dangerous day of the week.

0:56:58.9

It's called Moving Day, double take. We moved in today. Yup, we moved in 10 months ago. Crazy or stupid, you decide. I'm just turning from a late night in clinic, the boys are in their spaces while the boxes is terrored amidst the palpable tired. But the night still swells with possibility. I can see the stars from the backyard. And the bare walls blended with the smell of cardboard boxes. You can feel I just turned the page in a new hard covered book. Moving, I'll be at chaotic and uniquely stressful. I can feel like hope, optimism prevails tonight. But I'm still thinking of the last time around. Here's my moving day post from last year. Read about our terrible misfortune and improper planning, learn from our mistakes especially if you are about to do a double moving double take two. My story of nine stitches, two parents who feels as deflated flat and small as the bottom of your worn shoe and you're really three year old boy and one orange popsicle.

0:57:56.7

This is about our mistakes and the dangers of the events. That's all in moving day in my world. October 31st, 2009. Let's go back in time. History is supposed to be one of our most strange instructors. Circuit 2003. I took care of a three year old girl in the ER when I was an intern. My first year as a physician while training in pediatrics after medical school. In medical training, a certain patient have stick out. Jump off the exam room pages of a hundred patients you can see them on this time. I know someone will stay with me forever. Often because of the lesson the patient teaches you or with children they would think it's rediculous charm. Ours is because I'm a mistaken at care or because of some serious satisfaction the true joy in being able to help or because I came up with a proper diagnosis swiftly and without any invasive testing. Or because of what they call your fellow doctor taught me during the course of caring for them. The stories that stay with me in medicine are diverse and holy unpredictable. There's no formula. Like so many things in life, it's about chance, timing, and fate.

0:58:57.7

Sometimes the children are really sick, sometimes not sick at all. Sometime I remember them because they were the first or only patient I was able to care for with a particular diagnosis. The three year old from that summer day early in my pediatric training got long term the top of my long term memory storage, not because she was sick, not because I did much to help her, and not because I made any mistakes, it was this. Number one, her story, number two, her unique, beautiful French name, number three, the peeked terified look on her mother's face. Number one, her story, and the reason she was there, her family was moving that day and she was a toddler, while packing she got into some pill bottles, they were out of that locked cabin in easy reach sitting in an open cardboard moving box. Her mom found her putting various pills in her mouth and act, called 911 and was directed to go straight to the ER. The reason this is relevant today is that we moved last week, I was thinking about her constantly trying to do well in the phase of a lesson she taught me.

1:00:00.4

Two boys under the age of three of my life caught up in the winds of a moves and a myths of a busy life while launching a new blog and seeing patients in clinic, it terrified me, as it turns out, It should have. Number two, her name, it's been my number one girl name ever since. I've shared it only with my best friend from college and my husband both endorsive, trouble is I had two boys I'll tell you the name but I can't, both never to maintain patient confidentiallity and protect my favorite girl name, and trust me it's darling. Three, the look on that mother's face. A collage of fear, dread, guilt, stress, anxt, tear, it was memorable and until last weekend I don't think I really undrestood. The punch line We spent Saturday night in the ER Children's and I got an undesirable anatomy tutorial of the deep muscles in my first born's hands.

1:00:57.9

A very skilled and very nice to see doctors and nurses stitched them up after making sure his hands still worked. We failed him during our move as it turns out, our ultimate task keeping the boys safe when it's cue. And my lessons from that dear three year old girl back in 2003 didn't carry me as far as I wanted. F a little boy his story, one week to the day we moved in and F is in nearly three year old, bestfriend run downstairs to play in a matter of minute before the adults made their way down the stairs F had apparently fallen open handed on to the edges of a furnice sculpture. Blood was gushing my dear boy screeaming in pain. I quickly realized he'd sustained a deep three inch laciration, a cut, Moment of terror we head straight to the ER a misserable reality. He was stitched up and put back together fully again, but it was agonal in way. The thing is all the medicines were transfered, cleaning supplies could away hammers, scissors, nails, tacks open stairways and toxins were accounted for.

1:02:00.0

We put the last collapsed box out the door I breath a huge sigh of relief well Literally we done it the house was done exept we've left that filter for the the furnice line out on the basement floor drying after being cleaned. Like so many children that I've cared for who've sustained an injury it's not what you're thinking about that putskids in dangers, it's what you're not thinking about. Work from my poor execution just by good intention help your friends with their move. Thank you, this is Dr. Wendy Sue Swanson Seattle Momma Doc, with Seattle Children's Hospital.

Dr. Mike Patrick: All right, Isn't that great? So if you want to see more from Dr. Wendy Sue, just head over to Seattle Momma Doc, the website is seattlemommadoc.seattlechildrens.org and of course we'll have a link to it in the show notes at pediacast.org. Also she goes on to talk about tips on a safe and low stress move including pointers for before you move, why you move and after you're in.

1:03:05.1

So be sure to check her, especially if you have a move planned or you know someone who is planning to move, check the rest of the article with her pointers and again that's at seattlemommadoc.seattlechildrens.org. So thanks again Wendy Sue for playing along, it was fabulous having you here in PediaCast and maybe sometime soon we can actually have you on here live and we can discuss some things. All right, next Dr. Tanya, or maybe it's Tanya. I always have trouble with pronouncing names when I'm at work too and when I see kids I pronounce it one way one time and then you see a couple of kids and you pronounce it correctly and then you have some positive reinforcement. So the third kid, you pronounce like you did the other two and then suddenly they change it up on you. Mia, Maya, you know, this kind of things, so. Tenya, Tanya, having little trouble with it. But anyway, I can spell it, it's D R T A N Y A.com.

1:04:03.0

And Dr. Tanya, she is a pediatrician mother and best -selling author from California. Her book "Mommy Calls…, Dr. Tanya answers parents top 101 questions about babies and toddlers. Several best-seller list after its release last fall. Her side is a collection of low written articles answers the questions submitted by parent and links to pediatric and parenting related news stories. Recent topic she has included, include milk, tooth brushing tips, eczema, family dinners and temper tantrums. So, it's drtanya.com/blog and we'll have a link to it in our Show Notes. All right another one is Dr. Gwen Is In and she's at pediatricsnow.com/blog.

1:04:58.5

It's another pediatrician/ mother. She's from Massachusetts. Her site is a virtual online magazine that's build as "one pediatrician moms, two cents on child health parenting pop culture and everything in between…. And really she just has oodles of information and articles. She also does a podcast on blog talk radio which you can connect to through her website. And again we'll have a link to that in the Show Notes. Dr. Jennifer Schu, she is at parentingsense.blogspot.com. She's a pediatrician and an author at Atlanta, Georgia. She's the author of "Heading Home with your Newborn…, "Food Fights…, and "Baby and Child Health…. She maintains a blog aimed at sensible parenting and healthful living. And is a content creator for CNN.com. Recent topics include contact lenses, the risk in egg recall, girls as young as seven starting puberty, kicking the caffeine habit and flying with crying babies. And again you can find out more information from her and read some her article at parentingsons.blogspot.com. That's Dr. Jennifer Schu

1:06:04.8

Dr. Nabangs, pediatric blog. She's a pediatrician and mother at Scottsdale, Arizona. She describes herself as a pediatrician, a wife, a mother of four active boys. A friend, a cook, a teacher, a student for life and now a blogger. Her posts have a science based flavor. And recent ones include bed bugs, salmonella, imperforate anus, puberty, UV light exposure, immunizations and peri-orbital and orbital cellulitis. If you like our Research Round Up, than our In Depth segments, where we really explore the science of medicine yet still in a way none medical people can understand. So in other words if you're an arm chair pediatrician at heart, be sure to check out Dr. Nabangs blog. Again drnabong.blogspot.com and of course again we'll have a link to that in the Show Notes at pediacast.org.

1:07:00.7

All right, and a couple, these are none pediatrician ones. But I'm throwing them in because I find them pretty interesting especially the second one. It is a good one it is littlekidsblog.com, spelled in a crazy way. Just go to pediacast.org and click on the Show Notes to get the link. It's the little kids, infant and pediatric massage blog. So, not a pediatrician blog but it's interesting information that will appeal to a large number of you. Topics are as just the name suggest, infant and pediatric massage. It's put together by Tina Allan, she is a certified pediatric Massage Master Teacher. So if you're interested in that look for the link in our Show Notes. And then finally, I love this one, briandeer.com, this guy is really interesting. It's not limited to pediatric topics, OK.

1:08:03.7

He's a medical investigative reporter in the United Kingdom. So you're going to find some information on his site that you're not going to find in anywhere else. And he does not shy away from controversial subjects. So you're going to find articles on exposing the truth about MMR and autism, follow the money. DTP shots and brain damage. Research rod, love sickness, burger bugs, Vioxx, slum lords, killer apes, it's not all medicine. It's really more of a science investigative reporter with a heavy leaning on medical topics some of which are pediatric. But definitely interesting really well researched, worth a look, absolutely worth a look. So again, you can find the site briandeer.com. If you have trouble finding that or spelling, just go to pediacast.org. In fact all of these sites that we mentioned are available in our Show Notes at pediacast.org.

1:09:00.0

OK, we are running ten minutes late on our desired to have an hour long show here, but hey, it's a podcast, so we can do that.
We are going to return and wrap everything up into a nice little package right after this.

[Music]

All right we are back to wrap things up. First of all we always do thank you and I really want to thank Nationwide Children's Hospital for being a supporter and our band width sponsor of PediaCast. They've been with us, it's going on three years now.

1:09:59.1

So, three years, we just want to thank Nationwide Children's Hospital in Columbus Ohio. Vlad at Vlad Studio for providing the artwork for our website and also for the pictures that we used to represent PediaCast on the podcast. Medical News Today for helping us out with the new department, Wizard Media. Of course, my lovely family, wife, and kids and listener's like you, who have stuck with us. We really appreciate that. Reminders, if you have never done a review on iTunes, iTunes reviews are very helpful. They don't take long. Just go to, open up iTunes, go to the iTunes store, click on podcast, click on kids and family, slide down, find PediaCast, put in your two cents with a review on our program. It's a free show, OK. You just got over an hour of very well researched, up to date pediatric information, all I ask for in return is you have never done a review on iTunes, please just take five minutes out of your buy schedule to do that, it will be wonderful.

1:11:03.9

We are back in the swing of things.& We got two shows out in a row not more much a week apart so we have plans of more shows in the future hopefully lots of exciting news and other people are going to participate in this show in various ways which is going to make it better, more unique, chalk full of information all coming your way as we progress down the road and develop the show into something bigger and better than it currently is.& So that's all things to come, we really appreciate all of you sticking with us during our sabbatical.& We will be back and until that time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids, so long everybody.

[Music]

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