Infant Formula Recall, Flu Vaccine, and Celiac Disease – PediaCast 010
- Infant Formula Recall
- Drug Studies: Are Kids Getting a Fair Shake?
- Overdoses in a Neonatal ICU
- Flu Vaccine Recommendations
- Effects of Passive Smoke Exposure
- Celiac Disease
- Spinach and E. Coli Infection
- Wimpy Kids
Announcer: This is Pediacast, episode 10 for the week of September 25th, 2006.
Hello Moms, Dads, Grand Moms, Grand Pas, Aunts, Uncles and anyone else who looks
Welcome to this week's episode of Pediacast, the Pediatric Podcast for Parents.
And now, direct from Birdhouse studios here's your host, Dr. Mike Patrick Jr.
Dr. Mike Patrick: Hello everyone! And welcome to this week's episode of Pediacast, the Pediatric Podcast for parents. This is Dr. Mike Patrick Jr. coming to you from Birdhouse studio, and as usual we have another show packed with information for moms and dads can.
This week is episode 10 and our topics this week include and infant formula recall, drug studies, are children getting a fair shake, overdoses in the neonatal intensive care unit, flu vaccine recommendations, effects of passive smoke exposure, celiac disease, spinach and the E. Coli infections that have been sweeping the country and then we will wrap things up with the discussion of wimpy kids.
Now don't forget here at Pediacast, we'd love to hear from you so if there's a question or topic you would like us to address on the program, you can reach us through the contact page on our website. Simply go to www.pediascribe.com/podcast and click on the contact link. You can also email us at firstname.lastname@example.org. Or use our voicemail system to leave comments and questions by calling 347-404-KIDS.
Okay as we get started let me remind you that the information presented in Pediacast should not be taken as substitution for the advice of your child's doctor. No radio program or podcast can offer patient specific information. We don't try to do that and you shouldn't ask us to.
The final word on diagnoses and treatment must come from a doctor who can obtain a face to face interview and hands on physical examination of your child. What we can and will do is discuss generic child health, parent and family issues which do not necessarily pertain to your child or family-specific situation.
Okay now that we've made the lawyers happy, we'll move along with the program.
Now I have to say I'm a little bit embarrassed about this first topic — the infant formula recall. I got a letter yesterday. Now I first heard about this particular recall on a podcast a week ago, and yesterday I got the official notification from the drug company.
Isn't it nice to know that they are notifying the pediatricians in a quick fashion? The letter I got was from Ross Products Division of Abbot Laboratories and it says, "Dear Healthcare Professional, Abbot's Ross Products Division is initiating a voluntary recall of the above-mentioned three lots of liquid ready to feed infant formula produce and one lot of hospital discharge kits. These products were shipped from our plant between May of 2006 and September of 2006. This recall does not apply to any other Similac products with different lot numbers, and does not apply to powder or any other form of Similac products.
These products are being recalled because some bottles from these lots may not contain as much vitamin C as indicated on the label. Abbot discovered this problem as a result of consumer complaints for an unusually dark formula color. This problem is due to an isolated bottle defect which has been corrected by the third-party supplier of the bottles. Please immediately check our inventory for these products, the liquid ready-to-feed product. The lot number is located on the back of the plastic bottle. The hospital discharge kit lot number is located on the back of the bare tag attached to the kit."
Okay for the specific lot numbers, I'm not going to read them here because if you're savvy enough to be listening to a podcast, then I think you're probably able to go to the website.
It's basically www.similac.com and then they have a link on that page.
We can get all the information for those specific lot numbers that are involved and also information for how you can get a hold to Ross to get those formula bottles changed out for free with different bottles of formula.
We'll also have a link in the show notes so that you can get there very easily.
Again, that's real quick move in there Ross. You know, let the pediatricians know a week after it goes out in a podcast media.
Okay let's go ahead and move on to our first real segment here. On the latest episode of 101 Uses for Baby Wipes, Dennis Gray brought up a recent report on pediatric drug research.
Now the report suggests that studies are being on children but the results aren't being published and aren't reaching the doctors who need to know about them which are us, pediatricians.
So, let's listen to what Dennis had to say.
Dennis Gray: Little med research done on children.
Dennis Gray: This is by Lindsey Tanner, AP medical writer:
Finding out how prescription drugs affect children isn't easy, even for pediatricians, a new study says.
That's because very little research on children and drugs is published in medical journals that help guide doctors on treatment. The result is that some prescribe the wrong dose or use drugs that could be harmful to kids.
"Ironically, some of the times, when drugs do work in children, they're still not getting published, according to Dr. Danny Benjamin, associate professor at Duke University who led this study, and also works for the US Food and Drug Administration.
He said an FDA program meant to encourage drug companies to test how drugs affect children has led to hundreds of studies. The problem is that about half the time, the results don't get published in peer-reviewed medical journals, mainly because researchers and sponsors don't submit them for publication, according to Benjamin.
Drug companies that conduct or sponsor pediatric research are motivated mostly to get their products on the market not to tend to the public health concerns, according to Benjamin.
Also, parents often are reluctant to let their children participate in studies.
(You're not kidding!) So the research often involves many institutions with a few children at each location, which complicates compiling data and submitting them for publication, Benjamin said.
Examples the authors cited include unpublished data suggesting that an anesthesia drug might increase children's risk of death when used for sedation.
Also, unpublished data has suggested that some steroid creams used for skin rashes in adults could cause a hormone imbalance in children.
"People slather this on children, particularly babies," said study co-author Dr.
Dianne Murphy, director of the FDA's office of pediatric therapeutics.
In both cases, precautions are listed on the drug label but not in much detail.
They also appear on the FDA's Web site, but that's not where doctors usually look for such information, the researchers said.
"We've just got to get the data out to people who are caring for children," according to Benjamin Dr. Peter Lurie of the watchdog organization Public Citizen's Health Research
Group said drug companies and academics need to push harder to publish.
"It really is like the tree falling in the woods. The study is of no use whatsoever if it never reaches the practicing physician," according to Lurie.
Scott Lassman of Pharmaceutical Research and Manufacturers of America, an industry trade group, said drug companies shouldn't be faulted.
While he agreed publication in a peer-reviewed journal is the gold standard for getting information out, companies often present data at medical conferences and or post them in an online industry database.
Okay, you know, in this age of prescription drugs being advertised on TV and every other media venue, spam included, how can this be?
How can it be that the doctors don't know these if this stuff works for kids?
Why is the data not reaching the pediatricians? Now if a drug is found in clinical studies to be effective for kids, you'll know. The drug companies will be yelling from on high, telling every pediatrician about it and pass them out samples.
I think the real problem here is liability. Sure. Remember Vioxx? The drug companies get into enough trouble when an elderly patient dies and it's suspected that the drug caused their death.
Now if a kid was being treated and complications arose imagine what would happen to the drug company. And that's why the information isn't being given out. Drug companies are scared to disseminate the information to pediatricians.
Yeah, we should ask Dr. Mike. Dr. Mike of Pediacast, are you listening? Send me some feedback. Would you please?
Dr. Mike Patrick: [Laughs] Alright. Thanks for asking, Dennis. I would love to talk about this. First, let me say you know the author of this news report which was Lindsey Tanner from the Associated Press, she states, "Very little research on children and drugs is published in medical journals that help guide doctors on treatment. The result is that some prescribe the wrong dose or use drugs that could be harmful to kids."
Well that's very exciting, isn't it? It makes you think that all these doctors out there are prescribing the wrong dose and harming children. You'll notice she uses the word some and I think that's interesting when she says that "some and I think that's interesting when she said that, "Some doctors are doing this…" What's her definition of "some"? Is she talking about a handful of doctors a roomful, a convention hall-full of them?
You know, she doesn't back up her claim with any figures, or any quotes from any researchers who are suggesting that doctors are prescribing wrong drugs or using wrong doses because of a lack of publication. You know she simply makes this assertion on her own which is a nice example of irresponsible journalism.
Well let's take a look at Ms. Tanner's sources. You'll notice that her primary sources, two people that she quotes right there at the beginning of the article, they come from the Food and Drug Administration and if you carefully look at the history of the pediatric drug studies, it reveals the bias of her sources.
Here's the history: Prior to year 2004, the FDA and the American Academy of
Pediatrics pushed for drug companies to include children in the initial studies of any new drug which the drug company felt would eventually be used in kids. The pharmaceutical companies resisted this policy because of the added expense of doing pediatric research and the difficulty in getting parents to agree to allow their children to participate in clinical drug studies, which I'm sure you can understand.
Now in 2004, Congress passed the Pediatric Research Equity Act, and President Bush signed it into law. And this law basically mandated with the FDA and the AAP had been requesting.
So, now if a drug company didn't include children in their initial studies, they basically shut themselves out from ever pursuing a pediatric indication in the future. Well the drug companies want to keep their options open in any new drug that they develop. So since 2004, there's been an explosion of new drug trials involving children.
Children were involved in the studies, even if the drug company is only seeking an adult indication. That way if they decide to pursue a pediatric indication down the road, then their ducks are in order. Well the next question becomes, why don't the drug company seek a pediatric indication right from the get-go? Well there are several reasons for that.
First, pediatric approval usually takes longer. If the drug company gets adult approval first without a pediatric indication tagged on on they'll get an answer faster and can start selling the product sooner.
Now this may seem like they are shutting out kids from the benefit of the medicine but actually the opposite is true. Look at it this way. If they wait on an adult and pediatric indication, nobody including kids gets the medicine until the entire approval process goes through. If they seek adult indication first, the product goes on the market sooner and it's available everyone including kids. Now, how can this be?
Well FDA approval means any doctor can prescribe the drug for any patient. Adult vs. pediatric indication only means the FDA endorses that use, not that it's prohibited one way or the other. So doctors can still go off label and use adult drugs in kids. And it happens all of the time. A good example of this is albuterol. Now albuterol is only approved by the FDA only for those ages 12 and over. That's the only indication it has. Yet it's used in asthma and wheezing and it's so universally accepted in kids that if a pediatrician did not use albuterol for a wheezing baby, even a tiny premature one, you'd probably get sued for malpractice, and Albuterol doesn't have an official Pediatric indication, yet it's used as the standard of care.
No another reason drug companies are hesitant hold out for a pediatric indication is because there's not much profit to be made in marketing these new medicines to pediatricians. Now let's look at why that would be. You know new drugs are expensive and insurance companies are going to include them on their formulary right away. If they do include them, you can bet it will be with the highest co-pay, which for many plans is going to be on up in the $50- to $60-range for a one-month supply.
Now, parents tend to be young adults with modest incomes. They don't want to pay more money if a cheaper drug that is known to be safe in kids because it's been used successfully for many years is available. And pediatricians feel more comfortable using cheaper entrenched drugs as long as they appear to be working. You know it's tough for drug companies to change the prescribing habits of pediatricians if the gold standard treatment is cheaper and works well. Now drug companies have a financial interest in getting drugs out as soon as they can.
Unfortunately, the way the FDA works, profit is delayed if a pediatric indication is pursued. This may seem greedy but keep in mind, the money to develop new drugs doesn't grow on trees. It comes from the sales of established medication. And the sooner a drug is released the sooner it'll make a profit which can be used to develop more drugs.
Now why is the FDA slower to approve a pediatric indication? Well this is where the liability business comes into play. Drug companies and the government have little liability if they do their job correctly, even for pediatric drugs. If a company does proper studies and the FDA reviews their studies according to their internal rules and approves the medicine, then really there's little room for liability. However if short cuts were made and approval occurs prematurely or if a patient is hurt because of the fact that they rushed it through or if an established medicine is shown to have a newly found harmful effect, then the drug company and FDA do nothing to address the situation and warn consumers then there's a huge liability.
So the FDA wants to make sure that all the i's are dotted and t's are crossed before they approve a pediatric drug and this takes time. And because it's because difficult to include children in the initial studies, due to increased cost and lack of volunteers many of the pediatric studies that are done are just inadequate. The FDA makes the drug companies repeat them with larger numbers of children which delays the package even more.
Now the FDA actually — they hate all this, and that's the reason why these guys that are interviewed and quoted in this article are so upset about this. Keep in mind, the goal of this legislation was to have more drug companies pursue pediatric indications right from the beginning. Well the drug companies have no financial incentive to do this for the reasons I've outlined. Yet they still do the studies to keep their options open. But they don't want to do expensive studies so basically the results are half-assed trials. You know, they're just lip service which angers the FDA because it's not what they had in mind.
And so the FDA is not exactly an unbiased source for Ms. Tanner's article. So, why aren't these studies published? Well, it's because they're bad studies. Look, they are only being done to meet a requirement. They aren't submitted to peer-reviewed journals because most of them would not be accepted.
The numbers of participants are too low, and often the results are not significant. Now the FDA complains about the dangers of slathering a steroid cream on babies say it could cause hormone imbalance in children. Well what they don't tell you is whether the hormone imbalance that results is dangerous. They don't tell you how many babies were included in that particular study and they don't tell you if the results are statistically significant.
They don't tell you because it was probably a poorly done study and which is why
it wasn't submitted for publication. You'll also notice Ms. Tanner interviewed the editor-in-chief of JAMA who complained that few pediatric studies were submitted to JAMA for consideration. Well JAMA is the publication for American Medical Association.
For those who don't know it, pediatricians generally have no love for the AMA.
Few are members. Most of us only belong to the American Academy of Pediatrics which has a long-running medical feud with the AMA.
A better source to ask is probably the editor-in-chief Pediatrics, the research journal of the American Academy of Pediatrics. Tons of pediatric studies are submitted and published every month by that journal as well as other pediatric-specific publications but Ms. Tanner, you know, she didn't want to ask the people who actually publish pediatric research.
So how does all this affect your local pediatrician? Is your doctor less knowledgeable because these studies aren't published?
You know, really he's not affected at all. Let me explain. As a pediatrician, I am not going to prescribe your child a medicine unless it's something I feel comfortable using in my own child.
That's the litmus test for me.
And since there are many tried and true drugs out there that have been used in children for a long time and work well on the vast majority of kids I stick with those. Which is why the drug company see little profit in pediatrics.
Now are there more difficult cases who don't respond to the entrenched medicines? Sure. But more often than not, those were the kids being referred to a specialist because of their failure to respond.
The specialist tends to be more knowledgeable about the new drugs in their field, because, you know they don't have as many to keep track of, even ones that have been approved for a pediatric indication. They're upon those too. Of course I see what medicines specialists use on kids. You know, I refer the patients to them, and if I start to see something used over and over and over by a specialist that I trust, then I start to use and slowly become more comfortable with it.
Sure I listen to drug reps and read the literature and those of you who listen to Pediacast on a regular basis know I pay attention to research because we talk about it all the time. Still there's a difference between reading about a drug and seeing it work in patients who are not finding relief in the traditional therapies.
And so when you see a drug that is being prescribed by the specialist and you see it working, that's when I start to feel comfortable in terms of using it.
Now one other interesting note with all this. The Pediatric Research Equity Act expires in 2007, must be renewed by Congress if it's to continue and you can expect the FDA and the
American Academy of Pediatrics to lobby hard on one side and the pharmaceutical companies are going to fight hard on the other. So it will be an interesting debate.
Earlier this month, NICUN, which is the Neonatal Intensive Care Unite Nurses at Methodist Hospital in Indianapolis and they were obtaining Hep-Lock to flush IV catheters.
Now Hep-Lock is a dilute blood thinner that keeps these catheters from clogging off and the drug cabinet is a locked machine that requires employee ID patient medical record number, and basically the nurses remove bottles Hep-Lock from this drug machine and use them to flush some IVs.
Now the problem began with a pharmacy tech who is stocking this machine and she put the wrong heparin bottles in the cabinet. So instead of a dilute Hep-Lock, she stocked it with a regular heparin, which is a thousand times stronger than the regular bottles of heparin that were supposed to be in that drug cabinet. Now the regular bottles of heparin do look different than that usual Hep-Lock, the more dilute form bottles. They have a dark blue label instead of a light blue label. Well the nurses flushed the catheters of six infants with this wrong heparin. So it was basically the heparin that was a thousand times stronger and this caused the infants to basically lose their ability to clot their blood normally.
And as a result of that three of the infants died because of this overdose. And probably what happened is they had strokes. That's usually what happens when you are unable to clot and you bleed. Now the official response from Methodist Hospital spokesman John Mills was this.
He said: "We are all saddened this news and our hearts are with his family and all of the families that have been affected."
And Sam Odle, the president and CEO Methodist Hospital added, "We are acutely aware that nothing can quickly compensate these families for their loss. The hospital will no longer stock highly concentrated heparin products, a minimum of two nurses must validate any dose of heparin in the neonatal ICU and the pediatric ICU, and the staff members involved in the incident were receiving counseling and they are also taking time off until they feel comfortable returning back to work. And the hospital would also promise to pay for counseling for the involved families and they'll provide restitution they say for all six families as well."
You know my first thought about all of this is just absolute horror for these families. And then I looked at it from the pharmacists' and the nursing staff's point of view I mean they just must feel terrible this happened, I mean obviously there's no excuse for it happening, it's an awful mistake but you put yourself in their shoes it just must have feel absolutely terrible. And then I think about what the babies went through, you know, dying from a massive stroke, and then the three that survived, are they going to fully recover? They may have had strokes and they just didn't die from it, but are they going to be neurologically normal the rest of their lives that's really hard to say.
And you know of course then you think about the medical-legal fallout and the nightmare that you know would ensue for basically everyone involved. You know and it doesn't matter that the hospital has said that they're going to give them appropriate restitution. You know the lawyers are going to get involved, and basically it's just going to be a terrible tragedy all round for everybody involved.
You know it's easy for those of us involved in the day to day operations of the medical system to forget we're dealing with other people's lives. You know our actions have a lasting effect on family units and even the most routine tasks can turn unexpectedly deadly and tragic when we fail to give them proper attention.
Should the pharmacy tech have double checked the bottles to make sure she was putting the right ones in that machine? Yes, of course. Should the nurses have double checked the heparin bottles to make sure it was the right one? Yeah, of course. Have the best doctors and nurses in the best hospitals ever failed to double check a dose or a medicine or the chart or the patient-identification tag? Yeah it happens.
You know it's a normal part of the human experience to make mistakes now and then because of a momentary lapse and the carelessness. Every person in every job has done it from to time. The difference in medicine is that when this lapse of judgment occurs, people's lives can be forever altered. Now those of us in the medical field need to remember this.
You know we need to slow down and pay attention. Those of you outside the medical field, you have to remember, doctors and nurses and pharmacy techs are people too. They sometimes make mistakes and are very very sorry for them, but few in the medical field have a pattern of repeatedly making mistakes or recurrently having lapses in judgment. Those few who do should get out of the medical field. They have no business in it.
The path that this case will follow is predictable. You know the families are going to get lawyers regardless of any promised restitution from the hospital. The lawyers will sue anyone who has an insurance policy that will pay. The insurance companies will settle out of court because no jury in their right mind will side with the medical system in this case and the lawyers and family will walk away with a sizable chump of change.
Now don't get me wrong. I'm not saying the families doesn't deserve compensation. I believe they do. And who's going to look after families in their compensation bid. Well it's going to be the lawyers. And from the lawyers' perspective they really are providing the families a service by making sure they get what they deserve.
So we go from the medical system looking after these families to the legal system taking care of them, and as a doctor, I just hate that. I absolutely hate it, yet I do see the value of the lawyers in this case representing families in this kind of situation just as lawyers see the value of good doctors taking care of their own loved ones in their time of need.
Okay we're going to talk briefly about flu recommendations this year. This comes from the Infectious Diseases in Children Journal September 2006, Philip Brunell MD. Millions will be affected this season by flu and substantial hours of lost work and decreased productivity will occur and thousands will die from the flu this year.
Young children are among the most severely affected by influenza and common complications for kids include bronchiolitis and wheezing, croup, ear infections, pneumonia, febrile seizures and little newborn babies apnea where they stop breathing can happen with the flu too.
Now children are responsible for a large part of influenza spread. Children shed more of the flu virus from their upper respiratory track and shed it for a longer time. They're also in close contact with other kids and day care and school and then they're in close contact with their families.
And then when they have this close contact, you know they often practice poor hygiene, they're rubbing and picking their noses, they're touching doorknobs, they're coughing without covering their hands, they're not washing their hands very well.
So they're just sort of like a reservoir for the flu, you know, and they travel around from house to house, spreading it to everyone. So routine influenza vaccination is now recommended for all children age 6 months to 5 years.
That's the official recommendation this year and those in contact with children
birth age 5, especially if you are in contact with those under 6 months you can't have a shot yet, and that will include parents, teachers, babysitters, healthcare workers.
Vaccinations should begin in October — or late September is fine too — to ensure protection prior to the onset of flu season. Children younger than 9 who have not previously had flu vaccine need two doses, and these doses should be at least 4 weeks apart for the injection and then if you're getting the flu mist, which is the nasal spray one, the two doses should be 6 weeks apart.
What about kids who should have had two flu immunizations the previous year but who only had one because they didn't go in to get their second one or the doctor ran out. If they had their shot early in the previous flu season then they only have one of them this year.
If they had their shot in the spring, then they should go ahead and try to get two doses this year. Now what type of flu vaccines are out there?
Well there's one that is the injection then you know with a needle and that's basically a killed flu virus. This is the form recommended for all children 6 months of age up to the age of 5. It should also be used for children with a history of chronic lung disease such as asthma. Because it's a killed virus there's no chance that you can get flu from this vaccine.
Now, flu-like symptoms like low fever, body aches, fatigue — those are common for a couple of days but it's not the flu infection that you are getting. It's simply the byproduct of your immune system gearing up. And that really is much better than the high fever, cough, fatigue for a week or more with true influenza, not to mention the potential complications of wheezing and pneumonia and ear infections that you get with the true flu. 9So if the flu shot gets you down for a couple of days, don't blame the flu shot. It's you immune system doing that.
And now the other type of flu vaccine is the nasal spray. Now this is a live virus but it's made to be less potent. It's only approved for 5 years of age and older in kids and this may change in the coming years as the makers have filed their request with the FDA to approve or actually to get its indication down to the age of 12 months.
It should not be used for people with history of lung disease such as asthma. So this live viral nasal spray vaccine, it actually offers three advantages. Number 1, you get a better immune system response because it's a live virus. So the body realizes it's a live virus, and you get a better immune response to it so it's going to protect you a little bit better. You also get better protection because it stimulates your first line of defense which is the type of antibodies that are present in the nasal secretion. So your body's going to be fighting that flu virus off right from the beginning as it enters the respiratory tract, whereas with the shot form, the type of antibodies that are made actually attack the flu virus in the bloodstream. So you get a little bit of a better first line of response, and then of course with the nasal spray there's less pain and better compliance with the kids coming in to get their second dose.
It's going to be a lot less belly aching like "I got to go and get another one, no!" So if it's just a nasal spray usually, you know, it's not too big of a deal as opposed to the needle.
I do want to say a word about thimerosal. Thimerosal is a mercury-containing preservative that’s used to prolong the life of multi-dose vials This is only really an issue with the injectable flu vaccine. The nasal spray flu mist does not contain any thimerosal because all of those come as single-serve doses.
Now most injectable flu on the market also comes in single-serve doses and do not have the thimerosal in them. There are some multi-dose vials still out there on the market have the mercury-containing preservative in it. If you are concerned about mercury in your child's vaccine, it's just best to get the shots early before your doctor runs out with the preservative-free vaccines. If there's no choice and your child's older, and you really want him to get a flu vaccine and they have to get the one that contains thimerosal, they you're just going to have to decide if the benefit of the vaccine outweighs any risk from the mercury preservative and you can talk to your doctor about that.
This is my personal viewpoint on this. Now I'm just talking about how it would feel as with my own kids. I think the benefit of the flu vaccine outweighs any risk that may be associated with the tiny presence of a mercury-based preservative. So I'm sure a lot of parents out there, they would disagree with that, and you have that right to disagree. I'm just saying that if it were my children, and they weren't tiny babies, and they had the choice between no-flu shot and one that had a little bit of a mercury-based preservative in it, I'd be fine with that.
Okay moving on along with Pediacast this week, we're going to talk a little bit about passive smoking.
Now passive smoking simply means exposure to lit tobacco products of other people. Passive smoking involves two types exposures. You have second hand smoke, and this is the smoke exhaled by the smoker, and then you have sidestream smoke and this is the smoke coming directly off the burning end of the tobacco product.
Now most passive smoke that we non-smokers inhale is the sidestream smoke. Now the problem with that is that the sidestream smoke does not pass through a filter. So it contains two to three times more harmful chemicals than that smoke inhaled by the smoker. So if you are in an enclosed room with many smokers for one hour, you're exposure to these harmful chemicals is the same as if you had smoke 10 or more cigarettes, because of the fact that you're breathing the smoke and it's bypassing the filter. Now the harmful chemicals in the sidestream smoke directly damage the lining of the upper and lower respiratory tracks.
They cause swelling and allergic reactions and decrease the body's natural defenses against invading organisms. These chemicals are directly responsible for many childhood conditions and this includes pneumonia, asthma attacks, allergy symptoms, runny nose, sore throats, itchy watery eyes, cough, viral infections such as cold flu, bronchiolitis, wheezing, bronchitis, croup, all of these things. It's also associated with ear infections and sinus infections and increased incidence of SIDS or crib death, in homes where there is significant smoke exposure. Now some people say, you now, "Doctor, you're just blaming all these stuff on cigarette smoking. There's no way it happens." But it is true. It really does. The way this mostly works is through the allergic reaction and then the damage that happens to the cells and the airway. And what happens is as you're making a lot more mucus in response to these harmful chemicals being breathed in, and the usual little hair cells that line that passages in the upper airway, they have little hairs on them that basically move secretions away from the middle ear and away from the sinuses and up away from the lungs.
And that's just to keep mouth bacteria in the mouth. So if they start to migrate up toward the middle ear, up into the sinus or down in to the lungs then these bacteria are basically going to get pushed back up to the mouth from these little hair cells. Now the smoke actually damages these hair cells so they don't work as well. So now it's easier for mouth bacteria to get up into the middle ear space up into the sinuses or down into the lungs.
And the other thing is if you're having an allergic reaction to this smoke, which most people do, you make a lot more mucus, which you know, that's why smokers have a cough. Now this mucus, normally it's there to try to trap things and then you can cough and get it out but if those little hair cells aren't working, it's a little easier for that mucus now to go up into the middle ear space, up into the sinuses, down into the lungs and that can actually carry bacteria with it, plus it can also block those openings to the middle ear space to the sinuses and to the lungs.
So then what happens is mouth bacteria that do make it into the ears, the sinuses and the lungs get trapped there because they are not able to get back to the mouth because now this mucus is blocking the way. So this is how smoking can lead to pneumonia. It can lead to ear infections, sinus infections all these things. So there really is an association there. Now how can you protect your child. Well the best thing you can do is to stop smoking and to encourage others who live in your house to give smoking as well. Not only will your children be healthier, but you'll be healthier as well with less risks of cancer, high blood pressure, heart disease and the like. You are also more likely to live longer which means spending more time with your those you love including your children and your grandchildren.
But how do you stop? That's the million dollar question. Well ask your doctor for medical help in the form of gum, pills, patches, all those things. Support groups are often helpful as well and I would encourage you to check out Quitnet, it's www.quitnet.com.
We'll have a link to it in the show notes. And this site offers medical advice, forum boards, online support groups, education materials and a comprehensive directory of local stop-smoking programs in your area. Quitnet has been online since 1995. The idea for it originated with Dr. Nathan Cobb, a physician at a smoking-cessation clinic in Boston, and its services have been expanded greatly since the year 2000 and it’s currently sponsored by the Boston University School of Public Health. And again for more information, www.quitnet.com and look for it in the show notes.
Now other ways to protect your children, you know, one will be to smoke outside.
That way the harmful sidestream smoke could go up to 30,000 feet instead of lingering in your house.
And don't kid yourself into just smoking in one room. Smoke is a gas. It travels freely through cracks and under doors and the air intake of your furnace or air-condition will suck it in redistribute it.
Keep in mind that smoke and chemicals will linger on your clothes as well and come back into the house with you so if your child suffers from allergies, asthma or chronic ear or sinus infections, your smoking may be to blame even if you smoke outside. Also never smoke in the car. You know the chemicals are trapped in an even smaller space and your child's exposure will be extensive, even when you roll down the window, sidestream smoke exposure in the car is significant for other occupants in the vehicle.
Also, ways to avoid other exposures for your kids. Don't use babysitters who smoke, avoid places of dining and recreation that lack a true smoke-free zone. Avoid prolong visits with relatives who smoke in the house. You know one issue I frequently encounter is young parents who have to live with a parent or relative who insist on smoking in their house and these parents are reluctant to say something about the situation because they are the guest, and that does show gratitude and respect for the part of the parent but as your child only advocate, parents, even young ones, have a responsibility to look after the health and well being of their children.
So step up to the plate. Confront these situations and offer fair solutions and if you don't get anywhere with your request, seriously consider alternate living arrangements.
Okay, celiac disease. Have you heard about it? Have you ever heard about the celiac disease? If not, let this be a little bit of a lesson for you because it's actually more common out there than a lot of people realize and there's probably a lot of people out there who have a mild form of celiac disease and don't even know it. What is it? Well, it's a genetic disease that is caused by an inherited allergic sensitivity to wheat protein and more specifically it's the wheat protein gluten that's the problem and if we're going to get even more specific, it's the gliadin fraction of the gluten protein that's the specific culprit.
Now, because of this allergic sensitivity, when a person with this disease ingests wheat protein, the body makes an allergic response which results in chronic intestinal inflammation. The antibodies made to fight the gluten protein cross-react with the person's own intestinal tissue so the body basically is attacking itself and this puts you into the category of the auto-immune diseases. It occurs in about 1 of every 200 people in North America and Europe, and women are more affected than men.
Now the sensitivity can present anytime between the ages of 6 months and 85 years of age, and peaks of onset occur during infancy and then again during young adulthood. It's usually not seen under the age of 6 months because of a gluten-free diet until regular solids are introduced. They often follow a family pattern. So if the family pattern is for it to show up in infancy, that's usually where you are going to see it.
And if the family pattern is more of a young adulthood or even an older adulthood onset, that's probably the type that you'd be looking at. Now what are the symptoms for this. Well, if it starts in the infants, you usually see chronic diarrhea, failure to thrive, fat malabsorption leading to greasy stools, wasting of muscles, bloated abdomen, and unhappy disposition, and explosive foul-smelling stools and they can have some vomiting with it as well.
Those set of symptoms is pretty obvious and also really make you open your eyes and you think, "Wow, this is not right." So in the infant onset of it, it's more likely to get picked up and diagnosed. The symptoms for later onset disease, so we're talking about older children and young adults and then some older adults as well, you're going to have a recurrent abdominal pain, constipation, mixed in with some mild or even intermittent diarrhea and then you can have some weight loss and a lot of times short stature.
And in addition to this, you can have some extra intestinal forms. Now and this is an autoimmune disease so basically other tissues are being attacked by these antibodies that were created because of the gluten exposure and specific symptoms really depend on which tissues are targeted and again this often follows a family pattern. Some common examples, the musculoskeletal system can become involved, so you can see short stature, muscle wasting, rickets, osteoporosis and arthritis.
The dental system can become affected so you can have severe enamel disruption and lots of cavities. The skin can be affected so you have itchy blisters and hives. Mouth ulcers are possible. With the reproductive system you can see the late puberty and fertility, spontaneous abortion in young women. The blood system, you can have anemia, easy bruising, easy bleeding. The hepatic system which is the liver, you get inflammation of the liver which is hepatitis and the pancreas can be affected, so you can have pancreatitis with it.
And the central nervous system, the brain and spinal cord can become affected as well so you can have epilepsy, seizures, depression, dementia, schizophrenia, migraines, ataxia, which is the inability to walk, severe behavioral changes and irritability. Well I sound like one of those drug company ads on TV, you know, where they tell you all the bad things that can happen if you didn't [laughs] take their drug.
All these things are pretty rare with this so if you have a strange set of symptoms that's just not explained by anything else, you may want to think about celiac disease. Now autoimmune diseases do tend to run in groups so if a person has another autoimmune disorder, or if the autoimmune disorders run in your family, then you do have an increased risk of developing celiac disease. And again an autoimmune disorder is just your body's antibodies which are supposed to be protecting you against foreign substances. They are basically attacking yourself.
And lupus, some thyroid diseases. It's thought that type 1 diabetes probably has the autoimmune component where the body is attacking the pancreas so it's not making insulin.
Inflammatory bowel diseases and cystic fibrosis — all of these things are thought to have an autoimmune component to them.
So if those things run in your family, then you are going to be a little bit at higher-risk to develop celiac disease.
Now diagnosis really starts with a suspicion based on a set of symptoms and your family history. Diagnosis is often delayed because there are more common diseases that can cause the same set of GI symptoms, including infections, which can cause chronic diarrhea, things like giardia, rotavirus, different parasites. Lactose intolerance can also cause a similar set of symptoms and you want to listen to episode number 9, for more information on lactose intolerance. Also milk and soy protein allergies can result in these same types of problems in the GI tract as well. There are several blood tests that measure the level of these antibodies that are attacking yourself and that the body is making in response to that gluten exposure.
And a referral to a GI specialist, if not already done, is really the next step.
And then the GI specialist, once you have a presumptive diagnosis based on the blood work usually does an intestinal wall biopsy to confirm the diagnosis. Now so what do you do about it if you find out that you do have a celiac disease?
Well you have to do a long gluten-free diet that's basically life-long. Within two weeks of beginning the gluten-free diet, 70% of people report improvement of the symptoms but it may take up six months for symptoms to go away completely. And this is a result of the damage that's done by the chronic attack of the immune system and the persistent inflammation. Those who have extra-intestinal forms of it where you have different parts of the body being attacked, they have more long-term problems that never go away and it really depends on the amount of damage and the organ systems in question.
Sometimes the gluten-free diet alone is not enough to stop the body from attacking itself and these cases, steroids and other immune-suppressing drugs might need to be used.
For more information about celiac disease and the specifics of a gluten-free diet, you can try the official site of the Celiac Disease Foundation which is at www.celiac.org, and another excellent resource which has been on the web since 1995 is Celiac.com and you can find that — what do you think – www.celiac.com. And of course, we'll include those links in the show notes.
So celiac disease, you know, to some of you it may sound a pretty foreign, but when you consider that it occurs in about 1 in every 200 Americans, it actually is a common disease; it's just not one that we think of very often and a lot of doctors don't think of it off the top of their head either. So if those symptoms I mentioned, the chronic diarrhea, recurrent abdominal pain, mixed in with some constipation and weight loss and you know they're testing this and that and nothing's coming up. If they haven't thought about celiac disease, you might want to mention that to them.
Alright, what is going on with spinach and E. coli? Well there's been 173 recent cases of E. coli infection in 25 states and the source appears to be fresh spinach from three counties in California, Salinas Valley. The Food and Drug Administration has asked people not to eat fresh raw spinach until further notice and groceries across America have removed the product from their shelves. So far, 92 people have been hospitalized. A woman in Wisconsin has died from the disease and two other deaths — a child in Idaho and elderly woman in Maryland are thought likely to be from the same source but their cases are still undergoing investigation.
Now this E. coli business. First you have to differentiate, we are not talking about run-off-the-mill E. coli here. You know we all have E. coli growing in our intestinal tract. It's a normal bacteria to find there, and it's also the bacteria most commonly involved in urinary tract infections in kids and adults and that's because you know it's coming from the poop, and those bacteria or what go up into the bladder and then you get your urinary tract infection. So this is a normal bacteria that's part of our lives that usually does not cause much problem. Now the issue is that a specific strain of E. coli which is called E. coli O157:H7 is the real culprit here. So these infections that we are talking about are not normal E. coli that is found in all of us.
This particular E. coli is O157:H7. Now this particular strain of E. coli, it makes a toxin that damages several types of cells in the body. Now infection with E. coli O157:H7, it occurs easily with contact in as little as 10 to 100 bacteria are all that are thought needed to cause infection.
Sources include humans who have the bacteria in their intestinal track, and they can have symptoms from it or they can just be a carrier, and not actually have disease. It also grows in the guts of cattle, sheep, pigs, goats, poultry and deer and again they can be symptomatic with it or they can just be a carrier and shed it in their poop. Any contact with human or animal stool containing this particular strain of E. coli can result in infection and trace amounts of that contact are enough, because remember it only takes 10 to 100 bacteria to cause infection.
So how do you get it? Well poor hygiene by food handlers and farm workers may contaminate food. Also the animal slaughtering process results in contamination of the meat with a little bit of stool. I know you don't like to think about that but it's true and that's one reason why you have to cook your meat thoroughly. Beef is the most common meat transmitter and it should be cooked until there's no red and juices run clear to avoid an infection.
This is the official party line: have I ever ordered a steak medium? Hmm yeah, because my father-in-law order it medium rare all the time. But you know you're taking that risk but you know, there's risk in life. And every time you get in the car, you take a risk that you're going to be in a car accident. I mean you buckle up to protect yourself as best you can but you know you don't say, "I'm not going to get in the car because I might get in a wreck and die." So in any case, you know you can go overboard with these things a little bit too. You just have to know what the risks are.
Now, most doctors are going to say you have to cook your meat all the way through until the juice runs clear. You know I'm not telling you not to do that, I'm just saying, you know, some people do it some people don't.
Most people don't get E. coli — you know, something to think about. Okay you can also get this from milk and dairy products, again, because it's in the intestinal tract of the cow so you only want to use milk and dairy products that are pasteurized.
Wash your hands every time you use the toilet or change your child's diaper in case you or the child is a carrier to avoid spread to others through your hands. Also wash your hands before food preparation and wash kitchen utensils and surfaces after handling raw meat to avoid contamination. Also be sure your drinking water is free from bacteria because if your drinking water has E. coli O157:H7 in it, it’s going to be a bad situation. But it's unlikely that it's going to be there. But it's possible.
Okay so what happens if you get this particular bacteria? Why go to all these trouble to avoid infection with this thing. Well, E. coli O157:H7 has the potential to cause life-threatening disease and in many cases it causes no symptoms and the people are just a carrier, or sometimes it just causes brief, mild diarrhea and it goes away. The problem is, it's kind of like a time bomb — well I shouldn't say time bomb because you know a time is going to go off. Ah what do I want to say? Like a jack in the box. No that's bad too. [Laughs]
That might have been subliminal. I'm sorry all you folks out there in California. Forget I said that. There's just no way to predict, you know, who's going to have this and then have a life threatening disease from it.
Because it is possible and you just don't know exactly when it going to happen.
So what happens if you are one of the unlucky ones? Well, this particular type of E. Coli can cause severe bloody diarrhea, high fever and dehydration and then the worst case scenario is that it results in something called hemolytic-uremic syndrome or HUS.
Now HUS is a very bad thing. The toxin that is made by the E. Coli O157:H7 causes red blood cells to break apart and that can lead to severe life-threatening anemia and it also causes kidney failure and seizures along with it too. Now HUS is more common in young children, the elderly, and those with impaired immune systems and this is probably because the E. Coli can reproduce in high numbers in those individuals because their immune system is not strong.
And if it's a strain that can make that toxin and it can reproduce and make a lot of bacteria which then make a lot this toxin, you have to watch out. Now in children, as long as you recognized the condition then give them supportive care right away like in the Pediatric Intensive Care Unit. 85% of them do recover with supportive care but the cost is great. You know, with long hospitalizations in the ICU and high medical bills, but the mortality rate in kids can be as high as 15%. So HUS is definitely bad news and you want to avoid infection with E. Coli O157:H7 because there's that tiny chance you can get hemolytic-uremic syndrome from it and that's definitely not something that you want.
Now a final word on this. There is suspicion that field workers in California were responsible for this transmission. You know the question becomes, were these illegal farm workers?
Could these have been prevented with better worker regulation? Now we are talking about the high cost of produce in the United States if we disallow illegal workers. But, you know what price are we going to pay for this incident? You know, when you look at all these folks who had to be hospitalized and the deaths and the possible lawsuits, you know, in this case, the growers are going to lose money because they can't sell any more spinach. The grocers and dining establishments are going to lose money because they have to throw out all the spinach that they have and they're are not going to be able to sell more spinach and of course then the medical and legal expenses of course are just going to pile high with this thing.
You know of course, those paying the highest price are the ones who have forever lost a loved one because of our unwillingness to address this important issue. So I don't know, I think we need to make a decision. Are illegal workers, are we going to provide for them so that they're not spreading this kind thing to us, or are we going to somehow try to legalize these kind of workers or let Americans do it?
So that's a political debate and I know this is a medical show, but sometimes these things intertwine with one another. Jack in the box. I can't believe I said that.
Okay are we raising wimpy kids? You know the brain storm [laughs] — this particular segment came from my wife. She sent me an email — now how many husbands and wife out there communicate by email? We do that a lot. She sent me an email and said, "You might find this article interesting." And it was one of those things when I first read it I thought I was going to agree with it, but then as I read it, I decided that I didn't quite agree with it. I'm sure you've been in that position before.
The article basically comes from Psychology Today, it's an article entitled, "A Nation of Wimps" and I am going to have a link in the show notes to the original article so if you are interested, you can click on that and take a look for yourself and make your own decision.
According to this article, many of today's parents are hyperprotective compared to a generation ago. And examples that this article cites is that we provide constant supervision rather than let kids basically roam the neighborhood. You know we make sure they're wearing helmets and other protective gear, playground equipment isn't as high as it used to be and we use shock-absorbing materials below the slides and swings and monkey bars. We use germ-killing hand gel like crazy. We help children with each and every school problem that comes their way and some parents even pursue and get a diagnosis of a learning disorder even for straight A students so they can take their SAT exams in an untimed environment.
And the latest of these, a soft learning disorder is labeled difficulty with gestalt thinking, which means having difficulty seeing the big picture. And apparently that is enough to buy you an untimed SAT exam and the colleges aren't privy to those who take a timed exam versus those who get a complete untimed test.
Now child psychologist, Dr. David Elkind, who is a professor at Tufts University, he says that kids need to feel badly sometimes and we learn through experience, and we learn through bad experiences. Through failure, we learn to cope. That's what he says. Now according to the article, psychological distress on college campuses is rampant with anxiety and depression on the rise and Steve Hyman, Provost of Harvard University says the psychological problems are interfering with the core mission of the University.
Alright, so anxiety and depression are on the rise in college campuses and we've known that for quite some time.
University of Michigan Depressions Center estimates that 15% of college students nationwide are suffering from depression. Now this article also talks about drug and alcohol use on college campuses. It claims that data's on the rise and that there's been record increase in binge drinking with students often stuporous in class if they get there at all.
Professor John Portmann, professor of religious studies at the University of Virginia, says that "every fall, parents that drop off their well-groomed freshmen and within two or three days, many have consumed a dangerous amount of alcohol and place themselves in harm's way. These kids have been controlled for so long, they just go crazy."
Now according to the article also, parents are calling professors, and administrators to complain about C grades, pointing out that these scores will make it difficult for their children to have a shot at graduate school. In many colleges, this has resulted in grade inflation.
Lawrence Summers publicly ridiculed the value of graduating with honors when he took over the job of Harvard's presidency in 2001 because he said 94% of the college seniors were set to graduate with honors. So you know, they don't really mean anything. Professor Portmann, remember the guy from the University of Virginia, he says the parents are to blame because in an early age, they read their children the old Dr. Seuss book "All the Places You'll Go." They decorate their cars with bumper stickers proclaiming their child's honor roll status and they grow to expect their children to be the smartest, fastest, and most charming people in the universe. He goes on to say, if these parents can't get the children to prove it on their own, they will turn to the doctors to make their kids into the people that parents want to believe their kids are.
And there's a lot more that this article goes on to say, and again, check the show notes out and click on the link to it. Let me add my two cents to all this. You know, this is basically a rant by the psychologists in the university, academic community as they try to place blame for the erosion of academic pursuits in America.
What these folks need to do is stop trying to place the blame on parents and look at their own shortcomings. First, it is silly to blame parents for wanting to keep their children away from illness, pain and injury. You know, it's the academic world that pushes for seatbelt use and bicycle helmets, and playground safety. I mean all these studies and recommendations come from large children's hospitals associated with university programs.
So when parents listen to these studies, and try to protect children from injury, then they are suddenly blamed by these same academic characters for wrapping their children in a blanket of protection. Give me a break! Then they'll complain that parents are doing everything they can do well in standardized tests, grade, athletic performance and the like, but who developed a system of standardized tests and athletic and academic scholarships? The educational system developed these measuring sticks, not the parents. If the universities would stop putting so much emphasis on test scores, high school grades, GPAs and athletic performance, there wouldn't be a need for parents to get the most they can out of the system.
And since the system caves into the demands of these meddling parents, students whose parents do not interfere get left in the dust. They don't get the scholarships and financial aid they rightly deserve, because they're passed over in favor of the children whose parents are strongly advocating for the rights of their children. Plus, by positively reinforcing meddling behavior, the universities are making it a requirement for parents to become outspoken advocates of their kids.
Some would question the right of parents to get involved with their child's college life. You know the article suggests that college students are supposed to be adults taking care of themselves but that today's students don't need their parents to look after them. But if college kids are such grownups, why does mom and dad's income play such an important role in financial aid decisions? And if parents are expected such high tuition rates, don't they have the right to make sure, the product they are paying for treats their children fairly? You know, I'll let you read the article for yourself and come to your own conclusion.
You know, I read it, and my personal feeling is that the academic world is as much to blame as the parents are. And another thing. The assertion that there's more drinking and depression and anxiety in colleges today, I think is just absurd. You know I think back to my college days, when there are supposedly less drugs and alcohol? There wasn't less of it back then. The universities were just ignoring it. But the media and lawsuits have brought drinking and drugs to the forefront of the news and the schools are finally being forced to deal with these issues.
And as for anxiety and depression, is that really on the rise? Or are we just recognizing it more, diagnosing it more, and treating it more. You know, I think we're simply better at identifying these kids. Where did the push come from to address young adults with anxiety and depression and treat them appropriately? From the academic world! And again, they turn it around and try to blame the parents for it. Anyway, read the article for yourself and come up to your own conclusions. But you know, please don't feel bad for making your kids wear a helmet when they ride a bicycle. Don't feel bad about insisting they play on safe equipment and if you feel your kids aren't being treated fairly in grade school or high school or college, don't be embarrassed to speak up.
Now you can count on the other parents speaking up and since universities have made a president listening to the concerns of parents and acting on them, not only do you have to right to speak up, the actions of the institutions by changing grades and making exceptions time and time again have affirmed that it's exactly what you should do. So again, check out the link and it will be waiting for you there in the show notes.
Well folks, we are the one-hour mark here, and that wraps up this week's edition of Pediacast. Thanks for tuning in. Don't forget, if there's a topic you'd like to hear no the program, drop us a line on the contact page, you can find it at www.pediascribe.com/podcast.
You can also email us at email@example.com, or leave a voicemail at 347-404-KIDS. As always, we appreciate your support, if you like Pediacast, be sure to tell your friends and family about the program. And if you have time to leave us feedback in the iTunes Music Store or Podcast Pickle, we would appreciate it.
Other parents do read those comments and use them to base their selections and the more parents we have involved and asking questions, the better we can address the issues most important to today's family.
So until next week, this is Dr. Mike Patrick Jr. saying stay smart, stay healthy, and stay involved with your kids. So long everybody!