Bedwetting, Head Lice, and Discount Prescriptions – PediaCast 015
- Surviving The Applewhites
- Rainfall, Television, and Autism
- Pigs Blamed in E. Coli Outbreak
- WalMart Offers $4 Prescriptions
- Immunization Feedback
- Toxic Mold
- Head Lice Comments
- Croup and Steroids: Oral Administration or Shot?
Announcer 1: You're listening to the Trypod Network. What's on?
Announcer 2: This is PediaCast, episode 15 for the week of October 30th 2006.
Announcer 3: Hello moms, dads, grandmoms, grandpas, aunts, uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from BirdHouse Studios, here is your host, Dr. Mike Patrick Jr.
Dr. Mike Patrick: Hello, everyone and welcome to this week's edition of PediaCast, a pediatric podcast for parents. This is Dr. Mike coming to you from BirdHouse Studio. I'd like to welcome everyone to episode 15 of the program. This week we're going to be discussing some things from the news including rainfall, television and autism, a new study that came out. We'll talk about it briefly because I'm about autism doubt here. No disrespect for folks who are dealing with autism at home, but we've been talking about it a lot lately and I just need to move on for a little while, if you know what I mean. But we'll touch-base on the news report because it is pertinent.
Also pigs now are blamed in the E. coli outbreak. Wal-mart offering $4 prescriptions and then we're going to answer some listener questions regarding bedwetting, toxic mold and then I have some comments about head lice that will be coming up in a little bit.
And then we're also going to discuss research on croup in terms of steroids and do you give them orally or with a shot, which one is better? So a quick little research study on that and I promise you it's quick because after last week's it got kind of deep into the science of the whole immunization thing and I just don't have the energy for it tonight.
So I'm keeping things light for episode 15. In fact, I usually don't start recording this late, but tonight's the night when the clocks go back so I figured I got an extra hour to sleep. So it's like midnight and I'm a bit punchy and the Ohio State Buckeyes won 44 to zip against the Minnesota Golden Gophers. My daughter and I were at the game that's why I'm a little hoarse in the voice, but I digress in a big way.
Sigh. So anyway you'll notice that PediaCast is now part of the Trypod Network and I'm very excited about this affiliation. And I'd like to say a special word of thanks to Kristin over at Manic Mommies, Charlie at Israelisms and Len from Jawbone Radio for helping bringing me on board.
If you haven't heard of Trypod before, definitely go and check out the network. It's about 20 or so really fantastic podcast, just a phenomenal group of folks. Check them out at www.trypodnetwork.com and the try is with a Y. There'll be a link at the website.
Speaking of the website, definitely check it if you haven't already. It's redesigned, so new colors, new graphics, a whole new look to it and also a new way to get there as well. Of course all the old links still work, but if you're going for the first time, try pediacast.org, that's pediacast.o-r-g.
Why not pediacast.com? Well because I wasn't organized enough to think about looking up before I named the podcast to see if I actually could do pediacast.com, but I like the name. Of course someone has it registered and parked and now that I'm part of Trypod I'll probably never get it. But I'm OK with pediacast.org, just org. It's a medical podcast, organs, right? Lungs, hearts, kidneys.
OK. I told you I was a little punchy. Sigh. Also I just want to remind everyone that if there's a topic that you would like us to discuss on PediaCast, all you have to do is let us know. You can go to the Contact page at pediacast.org, OK? Or you can call the voice line at 347-404-KIDS, 347-404-K-I-D-S or you can email me at firstname.lastname@example.org that will work, too.
Today was a fun day. I told you that my daughter and I went to the Ohio State Buckeye game and it was wonderful that they won. I have to say though that the interesting thing is that it was cold and we knew we were going to have to sit outside in the cold for many hours, so I thought it'd be a good day to break out the flannel lined jeans.
I don't know how many dads out there have a pair of flannel lined jeans, but let me tell you they are great. They're comfortable, they're warm. You really can't go wrong with them, but I do have one little problem with them. I have a couple of pairs of them and this new pair that I got, actually last winter and I think we ordered them from LOB or Lance or something like that; and when I got them the flannel inside is pink.
I don't know if this is like someone's idea of a joke at the company. I mean, they're men's jeans. Now I know, I know there are guys who wear pink all the time. I'm just not one of them. And every time that I put these pants on and I haven't worn them in a while and this is the first time this season, but when I put them on I see this pink lined flannel and I'm kind of embarrassed. It's like I close my eyes when I put them on because I don't want to know that there's pink in there.
And of course and this crazy but it sort of goes through your mind, if I end up in the emergency room and there's a trauma and they're cutting my pants off, they're going to find pink flannel under there. It's bothersome. But they're warm and they're very comfortable so I wear them. OK. See? I told you I was punchy tonight.
All right. Another reason that I'm like this is because it's been a crazy week, I just want to say that. My son is in the world premiere stage production of Surviving the Applewhites, which is a novel by Stephanie Tolan. It's a fantastic. It was a Newbery Honor book in 2003.
The newspaper here in Columbus, the Columbus Dispatch, gave it fantastic review which they don't often do for theater productions in the city, but they really gave it a great review. They called my son adorable, so how bad of a review can it be when they call your son adorable? And as a proud dad, I'm going to put a link in the Show Notes to the actual review in the Columbus Dispatch and just look for the little boy that was adorable, Nick Patrick, that's in there.
This is how crazy this week has been. I guess it was Wednesday, we have the final tech rehearsal. So the author is there, they have to go through all of the lighting and sound cues and make sure that everything is on track for opening night, which was Thursday night. And they wanted a little bit of an audience there so they could get an idea of where people are going to laugh, where they need to pause the lines, that kind of thing. So it was really important that all the family members of the cast were there and they also rounded up some people from other areas. The place was about half-full with people watching as they did this tech rehearsal.
This is a busy time of the year in our office and things were just crazy the last couple of weeks in terms of the amount of kids we're seeing with viruses and ear infections and it's just the winter rushes starting up and it wears you down. But it also means that I'm getting home a little bit later.
Fortunately, in our office practice we have an on-call doctor who basically is there until about nine or ten o'clock at night during the winter time. I'm in a group with there's six of us all together, so the five others can at least get home at a decent hour because the person who's on-call is the one who is actually going to be there seeing kids into the evening hours.
So it was made clear to me at home that I had to be home by six o'clock because six o'clock is when the family was pulling out of the driveway to get to the theater and that was that. So I looked at my schedule and it look like I'd be able to get done at work in time to be home at six o'clock. Well as it turns out, I cut it kind of close. And in cutting it close, I mean we're talking like pulling in to the driveway at six o'clock.
It's not like I was lollygagging around. I wasn't eating bonbons with my feet up on a desk somewhere. I was busy seeing sick kids, right? These are little guys with ear infections and things. My wife is surely going to understand. So I gave her a phone call on my way home, "I'm coming home. I'm going to be there. I'll be there at six o'clock." And she says, "You're going to get out of your car and get in my car." And I could tell by the tone of her voice she wasn't really happy about it.
She wasn't quite as upset as the wife on Grey's Anatomy of the doctor in charge. I'm so bad with names! You know who I'm talking about if you watch Grey's Anatomy. It wasn't like his wife. But in any case, I hadn't eaten dinner and my wife said, "I'll have dinner; I'll bring your dinner and you can eat it in the car as we're heading to the theater." I thought that was great. So I'm late, my wife understands, I'm sans sick kids, this is fantastic. She understands, we're going to be OK. I mean she sounds a little snippy about it, but I think we're going to be OK.
So I pull in to the driveway and sure enough she's in her car, kids are in the backseat, her car's idling. It's like hey, bastard, get in here! So I get in the car and she has dinner waiting for me. It is a plate with Salisbury steak, mashed potatoes and gravy and peas with a fork! And I'm supposed to eat this as on the passenger in a car on the interstate. I held up the plate as we're going by semi-trucks and she's like put the plate down on your lap. So that's the kind of week that it's been.
We're going to go right on into our news segment here. First, this whole business that television and rainfall related to autism, you've probably heard about this. It's been all over the news and everybody is reporting this like it's medical research. But look folks, this is not medical research. This is a management professor at Cornell University. He tried to get a medical research team to look into this but nobody took him seriously.
So Dr. Michael Waldman assembled a team of researchers, himself, to look in to the association between rainfall, T.V. viewing and autism. And he basically found that the more it rains the more TV kids watch and then their chances for having autism increase. And then as TV viewing by kids has increased over the years the number of autistic kids being diagnosed has also increased.
So he's saying that basically, since the more it rains the more you watch TV the higher your chances of autism are and the fact that over the years as kids watch more TV the number of kids that we're seeing with autism has increased, so this must be one of the reasons.
Well, Cornell University should just be ashamed and embarrassed about this. This is nothing but getting your name out there. That's it. Who is Dr. Michael Waldman? Now he's got his name out there. Here's his little 20 minutes of fame. That's all that this is. Increased rain equals increased TV viewing, does anybody question this? Is this something that we need to research?
And TV viewing and autism, why couldn't it be that autistic kids are watching more TV? Or is it the TV watching making the kids autistic? Plus, autism we know begins in early child development, usually between one and two years of age is when the very first symptoms of it begin. Are these kids watching TV as infants? It just doesn't make any sense at all.
And just because, again, as we've talked about here many times before, just because two things are temporarily related that does not prove cause and effect that there definitely is a room for things to happen at the same time. And it could very well be that autistic kids are just more likely to be set down in front of the TV because it keeps them entertained, they stay out of trouble, they don't really want to interact well with the rest of the family anyway and all of these things.
And I'll say this one more time as well, I do not believe personally, which is what PediaCast is all about, me being able to tell you my personal opinions, I do not believe we're seeing more autism. Five to ten years ago, we said these kids had learning problems, developmental delay, mental retardation. I've been personally seen kids in a clinical setting for over 10 years now and we're not seeing more of these kids, we're just calling it by a different name. It's now under the name autism. There's not more of them. We're seeing the same kids; we're just calling it something different.
But you know there are those out there with agendas, including the agenda of getting your name in the media, and they'll figure out a way to get moms and dads to believe that we're seeing more autism. And then they'll go on to tell you exactly what it is that's causing the autism and it just so happens that the something they tell you is causing it is something they have a problem with, whether it's immunizations or TV viewing habits or something in the environment. It's just another example of a parental terrorist group, which now includes an academic department at Cornell University, just trying to scare you with bad research and ill-conceived conclusions.
Ahhh… Boy! Right off the bat this week. Somebody has to get me started.
All right. Pig is blamed for the spinach E. coli outbreak. Wild pigs are the likely culprit behind the E. coli spinach outbreak that swept the country a few weeks ago. You recall the outbreak left over 200 people sick and resulted in three deaths. Well, genetic tests found the exact strain of the E. coli bacteria in the gut of a wild boar that was found dead at a Salina's area ranch in California and this comes after investigators announced two weeks ago that that same strain was found in nearby cattle manure.
Health officials think the wild boar spread the E. coli bacteria from the cow pasture to the spinach field, which is less than a mile away. Genetic tests also found the same strain of E. coli in a creek downstream from the spinach field as well as in four additional cows grazing in a nearby pasture. Officials added that wild pigs have been known to romp around the cow pasture, smash fences leading to the spinach fields and they move up and down the creek, thus, explaining the distribution of contamination.
By the way, no new cases of E. coli disease have been reported since September 25th, so the FDA Center for Food Safety and Applied Nutrition have declared the outbreak is over.
Asked if the public should feel confident about eating spinach again, Jack Gezewich of the FDA said, "We have no evidence to suggest people should not be eating spinach from other places – except from these four ranches and they're no longer producing spinach this season."
All right people. Can we do something about the pigs? Come on! Over 200 cases of deadly E. coli because wild pigs are running around your property? I mean, the spinach farmers knew about these pigs, right? I mean, they're trampling fences, they're running around their cow pastures, they're moving up and down this creek, apparently. See? Farmers in the Midwest put up with this kind of non-sense. That's why they have dogs and guns.
Sigh. That's why you don't see E. coli outbreaks coming from corn fields and soy beans.
All right. Wal-Mart offering $4 prescription medications in 12 states. Wal-Mart and Sam's Club pharmacies are offering 314 generic drugs for $4 for a 30-day supply. So that's less than the $10 to $30 copay for many generic prescription medications leading folks to be paying for their drugs out of pocket rather than using their insurance plan.
Target stores pledged to match Wal-Mart's offer and K-Mart reminded its customers that 90-day supplies of select generics only costs $15 at their pharmacies. Now here's my favorite part about the story, the Walgreen Company announced that it will not match competitors’ discounts. Walgreen criticized the move by Wal-Mart saying the $4 list only covers about 5% of all generic medicines available.
Well I saw the list, folks. Our pharmacist, Rob, who is at Wal-Mart and Wal-Mart is not paying me any promotional money here, but it's kind of neat because our local Wal-Mart, we live in a small town outside of a big city and even though it's Wal-Mart Rob is just as great. He's our pharmacist and he's the kind of guy you go in there to get a gallon of milk, you pass by the pharmacy, you wave to him. It's kind of neat. And he showed me the list of the medicines that are included on this $4 prescription deal and there's a lot of them. I was surely impressed with the list and there's a lot of them that we use on a fairly regular basis.
Now the statement on Walgreen's website says, "Once consumers learned the fine print of Wal-Mart's program, they'll realize Walgreen offers the best value for pharmacy patients with its convenient locations, close-in parking and unique pharmacy services." Great PR, Walgreen. I mean, who's handling your public relations work? You may want to find another agency. I don't know, that just doesn't cut up for me.
All right. Well that concludes our news segment this week and we're going to get in to some listener comments and questions, right after this.
OK. It is time for comments and questions. We're going to reach in the mailbag here and talk about what is on your mind and I'd really like to see much, much, much more of this because last week is a prime example of me being left out there to come up with content on my own.
I don't know. People who create things, you're your own worst critic, if you know what I mean. And I listened to last week's program and I just had to roll my eyes and think it's so complicated. Sigh. Again, that's the punchiness coming out. Sorry.
All right. So Ian writes regarding last week's episode # 14 – Immunizations, Mercury, Autism, Guillian-Barre. Ian says, "Wonderful program! Congratulations on your thorough work to disabuse the fanatics of their delusions. My only critique, although I share your harsh sentiment towards the parental terrorist groups, is that your goal to persuade (I'm sorry. I'm botching up your email, Ian. I'm really sorry.) He says his only critique, although I share your harsh sentiment toward the parental terrorist groups, is that your goal to persuade unbelievers may need a more constructive tone to use when engaging them."
Yeah. OK. I guess I was a bit harsh. I said some things last week that I would never say in my office. For instance, I have never ever, ever, ever used the term parental terrorist group in the office and probably never will. But Ian, this isn't the office and honestly, my goal here is not to convince anyone to change their mind. Really, it's not. My goal here is to give you the facts, let you know my opinion, however harsh that opinion may be and then let parents make up their own mind.
I'll be honest; in the office I am very constructive. I'm really not all that forceful about my personal opinion and any of the listeners out there who are also my patients because there are several of those as well, they'll tell you that I am not very forceful in my opinions in the office. Come on, guys. Write in and support me on this one, will you?
But this is not my office practice and if I had to behave on PediaCast like I am expected to behave in the office, this wouldn't be any fun. You know what I mean? So in the office I'm the professional and I'm going to give you both sides. I'm going to tell you what my opinion is, but not be terribly forceful about it and sort of be supportive and direct you to making the right decisions, but not criticizing you and making you feel bad if you don't happen to agree with me. And I think that's just part of being a professional and respecting the people that you're serving.
But on PediaCast folks, this is me. And the things that come out of my mouth are going to pretty much be what I'm thinking and you can bet that there are going to be a lot of doctors out there, these are the same thoughts that are running through the back of their minds. They just don't have the vehicle to express them. And I know that because I work with other doctors and I went to school with other doctors, I trained with other doctors. I know what they talk about and I'm not afraid to tell you.
Thanks for your comments, Ian.
Maria. She says, "Excellent webcast!" It's a podcast, Maria! It's a podcast! I say that and Maria, no offense to you, really. There's a debate in the podcasting world right now about whether we need to change the name from podcast to netcast if you go with the Leo Laporte school of thought to webcast. I look at it this way, I have PCs, although I do have Mac ENVI, but anyway, they're podcast. Let's just call them podcast. I like the name.
Anyway, she says, "Excellent podcast! (or webcast, talking about last week) It was so informative and easy to understand. I always wondered what was behind the anti-vaccination vigilantes. I have four children; one is diagnosed with SID and another with autism. It is challenging daily and I would rather have them alive and challenging rather that dead because of a virus or disease that could have been prevented by a vaccination."
And I agree completely with you, Maria, and thanks for your comments.
Also I got an email from Dr. Rich Sagall and he does the Pediatrics for Parents podcast. If you haven't heard that one yet, I suggest you check it out. He has a good one. He says, "I listened to your latest podcast and I found the discussion on vaccines and vaccination very interesting. My feeling is similar to yours except I am not OK with parents who decide not to vaccinate their children. I believe they are putting their children at an unnecessary risk. A question, are you OK with parents who believe their children are at a greater risk of injury when restrained in a safety seat? I believe the evidence is just as compelling for vaccinating as it is for safety seat use. You should also mention the concept of herd immunity, in a way; the children who are not immunized are riding on the backs of those who are immunized."
Well thanks, Dr. Rich, for writing in. I really appreciate it and I'm glad that you're listening to the program as I also listen to yours. And you make a great point regarding herd immunity and I did completely fail to mention it. Shame on me!
Herd immunity is basically the concept that if you immunize a population, you are going to reduce the incidents that that disease is out there because there is no host for the disease to live in. There's not a reservoir of the disease. So if you have a population that's all vaccinated against measles, the measles doesn't have anywhere to live. So that means that children who aren't vaccinated who live in that community they are getting protection by the fact that all the other kids are being immunized so there's not going to be a reservoir of measles.
Now the problem with this is that if there are some risks associated with vaccine and in particular, we're talking about things like allergic reactions, I mean, true risks that are documented that we know are there but are very small in terms of their occurrence. But you're putting your kid at risk to get immunized to protect the kids whose parents don't want them to get immunized and that's really not fair.
That's something that I didn't explain last time, this whole concept of herd immunity, like we're a big herd. And thanks, Dr. Rich, for bringing that up because I do think it's an important point. Now, with regard to you're not being OK with parents deciding against vaccinating their children, see, folks, didn't I tell you? I said most pediatricians aren't going to be OK with this.
And here's where I am with that, saying I feel it's OK was not really what I meant. I'm not back tracking on this. What I meant is that when parents refuse vaccines and I mentioned this on the blog at one point not too long ago, it does bother me. It makes me feel like a failure because I really strongly believe that the benefit of vaccines far outweighs the risk. And I do my best to make a great case for them without resorting to calling moms and dads parental terrorists in the exam room. I really try to make a good case for them and honestly, after we have the discussion most parents do agree to have them or they'll agree to go home and talk about it and then they come back and they do get them.
A few don't. They sign a waiver that's basically saying that they're disagreeing with what I'm recommending. And when I say I'm OK with that, I guess what I mean is I don't ask them to leave the practice. I don't agree with their decision, I make that clear. But I don't ask them to leave and often they do because you've put so much time into explaining it to them and then you make them to sign this form and it comes across as not being very supportive, but I don't kick them out of the practice. But I do understand your point, Dr. Rich and I certainly appreciate your comments, I really do. Great program. And again, it's Pediatrics for Parents podcast. He also has a wonderful newsletter that he puts out as well.
OK, moving on. This one comes from Lyn, she says, "I have just recently found and subscribed to your podcasts and wanted to let you know that I have found these to be most informative and relevant. You had asked about topics of interest from your subscribers, so I thought I'd throw out my questions. I have an eight-year old daughter who is diagnosed with ADHD three years ago. She has taken Strattera for two plus years. I wanted to know if this drug, because of its similarity to anti-depressants, could cause suicidal tendencies in children. Also, could you address nighttime enuresis if you haven't already? Thank you so much and best wishes for your continued success."
Well thank you, Lyn, I appreciate the comments. With Strattera, boy, there is a hot topic for you! I'm actually going to hold off on answering this one for the time being only because I have a contact at Lilly Pharmaceuticals who is working on attempting to secure me an interview with one of their Strattera experts and I will pose that question to the Lilly representative. So stay tune to an upcoming episode and we will get to that question eventually.
But the nighttime enuresis or bedwetting, I do want to talk about that a little bit. Bedwetting, first of all, is very common. I have a bedwetting discussion in the office weekly, sometimes daily. Millions of kids are bedwetters and you definitely worry more when there's a daytime and nighttime incontinence both. There are some things that could make them wet their pants during the day as well as at night. And so I am only discussing here kids who solely have accidents at nighttime. So they're dry during the day. That's what I'm talking about.
I think all of these kids; you should bring it up with your doctor. We check their urine; make sure there's no sugar, no protein, no blood, all that sort of thing. And in the end, most of these kids have a completely normal physical examination and a completely normal urinalysis and usually have a family history of other bedwetters in the family. And these kids tend to have sort of a smallish bladder and also they tend to be deep, relaxed sleepers. And you know the kind I'm talking about. A tornado could go through the neighborhood and they're still asleep in bed, even though everyone else in the family is awake.
And we do know that bedwetting does tend to run in families. The usual things apply in terms of dealing with it and most of these, by the time that people come to the office to see me because of bedwetting, these are things that they've already tried at home, but I'll mention it.
You want to limit the amount of caffeine intake. Caffeine is a diuretic, which means it makes you make more urine, so you want to limit that. You should limit drinks after dinner to just a few sips; you don't want to drink a 16-ounce glass of water before you go to bed if you're a bedwetter. I mean, this is obvious stuff.
In terms of some strategies to deal with this, in the end often times these things don't work very well or they just work temporarily and then you're sort of back to the problem again. And the best way to know exactly how long the whole bedwetting thing is going to last is usually to look at the family pattern. It may take some digging to find out what the family pattern is because people don't like to talk about these kinds of things. You can understand that. But you may have to pry it out.
And if the family pattern is for the bedwetting to go away at 10 to 12 years of age that's probably when it's going to go away. And in some families, it's the middle teenage years before it disappears. But almost always by 14 or 15 years of age it's going away and sometimes much earlier. Again, I just sort of look at the family pattern.
Now one method that I have found to have some mixed results and as a pediatrician you try some things, you get feedback from parents; this isn't necessarily one that you'll find in the parenting books, but it is one that I find works to some degree and that is, of course you have him go to the bathroom right before they go to bed and then you set an alarm clock for yourself, now this is not a permanent solution; but let's say you set the alarm for one o'clock in the morning and you get up and go in and wake your child up and have him go to the bathroom.
For some kids you're going to be able to do this. Other kids, they're such deep sleepers it is impossible to get them to wake up and go to the bathroom. But if you have a kid who will wake up and go to the bathroom, what you may be able to do is to get up at one or two in the morning and have him go and then they may be dry the next morning.
Now if you go in and they've already wet the bed then I'd do it a little bit earlier the next night and if they can't go or they go again in the middle of the night, then I'll try making it a little bit later that you do this. Again, this is not going to work for everybody. But I do find occasionally that it will work, then what happens is if you do that every night for about two weeks, eventually, sort of with the biorhythyms in the body, a lot of these kids will start getting up around that time on their own and go to the bathroom, like their body just gets used to getting up at two in the morning. And so they're paying more attention to those signals on the subconscious level.
But again, what generally happens with this in my experience with talking to a lot of families who have done this successfully, is that then the kids will get up and go to the bathroom and the bedwetting will get better or maybe even go away completely, but then within a couple of months usually they're back at it again. And then you're getting up and helping them to get up and whether it's worth it or not is really another question. And I think it really depends on the motivation of the family and how much you really want to get this taken care of.
But if you got a kid who's a really deep sleeper and you absolutely cannot wake him up in the middle of the night or you have trouble getting back to sleep, then it's not a practical solution for you because now as the parent you're not getting enough rest, then it's probably not worthwhile to even try that. But I wanted to mention it because I do have some families in my practice who have done that with some success, maybe not quite a bit a success but a little success.
The next thing that you can use are these monitors. Again, these kids are such deep sleepers, these monitors have a little probe and the first sign of moisture this alarm shrieks and the idea is as soon as a drip of urine comes out, the alarm goes off, they wake up, they hold it and then they go to the bathroom.
In practical use though, a lot of times regardless of the claims of the companies who make them, do this miracle things, usually the monitor wakes up everybody else in the house. These kids are such deep sleepers, the alarm goes off, mom and dad and brother and sister come running in the bedroom because it sounds like there's a herd of cows running down the hall and they go in and the kid is still sleeping and just wet the bed. For some kids they work, but a lot of times they don't.
There are medications that you can use to help with bedwetting. I tend not to like to use those. One of them is Imipramine, which really its purpose is a tricyclic antidepressant, and it can have potential effects on the heart, usually that's in over dose amounts, but there is the potential of side effects with it. I don't know. When I practice medicine I always think if my kid had this problem, what would I do and I try not to do things to your children that I wouldn't do to my own. I don't know. I just wouldn't feel comfortable giving my own kids Imipramine for bedwetting. That doesn't mean it's not right or not proper. I just don't like to do it.
Another option is DDAVP. This is a hormone that your body makes and this one I have mix feelings about. I do have some kids on DDAVP. There are some children who naturally don't make a lot of DDAVP and so if you give them this medicine as a hormone, it may help the bedwetting to go away because you're replacing something that they're a bit deficient in. And what this hormone does is it just helps the kidneys hang on to water so you don't make as much urine.
The problem with it is that if you have a kid who is making a normal amount of DDAVP and they're just bedwetting because they have the smallest bladder and they are really deep sleeper and when they sleep deeply their whole body relaxes and their bladder valve opens and the pee comes out and they don't have a natural deficiency in this DDAVP and you give them DDAVP there is the potential, it's remote, it's a small chance, but there is the potential that they'll have too much DDAVP, their body will hang on to too much water and over a period of time that can lead to hyponatremia, which is a decreased sodium level.
So that if you're hanging on to water and not making the right amount of urine, you basically start to dilute out the sodium in your blood because you're hanging on to this extra fluid and then the relative amount of sodium in the blood can decrease so that you end up with hyponatremia. And if that gets severe enough, you can actually have seizures.
And I have seen kids have seizures on DDAVP for bedwetting before. Now you have to understand a little bit about my background, after my residency I did a year of pediatric emergency medicine fellowship. And you see some things in the emergency department, especially at a big children's hospital, that they're not common but when you them it affects the way you practice medicine. And really not just in medicine, really in all of our lives, our experiences sort of color the way that we practice.
So even if you see something just two or three times, if it's something that is pretty severe, like a kid having a seizure because you're treating him for bedwetting and the seizure was so bad they ended up in the intensive care unit, you think twice about doing it.
In some families, the bedwetting is just so distressing that they are willing to take that risk and you make it clear that DDAVP has this potential, it's extremely unlikely and you document it in the chart that you explained it and it still can be used for bedwetting.
But again, it's one of those things that I don't feel as comfortable with it. I'm not sure I would give it to my own kids. However, as long as parents understand the risk, they understand why you're using it, how you're using it and that sort of thing, sort of full disclosure, then you try it out and if it improves their life and they understand the risk and accept them then you go with it.
Now you would think, couldn't you just measure the DDAVP amount in the kid's blood and if they have a deficiency use it and if they don't not? Can't really do that. DDAVP is a pretty short acting hormone that gets released in sort of cycles or pulses and so a blood level of it is really not going to be helpful.
So what it boils down to? As I've said, the wake up method that we talked about usually doesn't work that well. There's a select number of kids it's going to help, but most of the time it doesn't. The monitors, there's a select number of kids it's going to work for, most of them it's not. The medications, I'm not all that comfortable with them. They can have potential side effects. Sigh. We use them occasionally.
In the end, I think the best thing is not to get too crazed about this. Make sure there's a plastic mattress cover. You can buy the Chux pads that go under their hips, they're smooth on one side and really absorbent on the other, that's going to help protect the sheets.
More and more they're making these pull-ups and absorbent underwear that are getting thinner and thinner and more practical all the time. This is something that as long as the physical exams are normal, the urines are normal, they're not having accidents during the day, they're sort of following the family pattern in terms of the age at which this is happening, it's probably best just not to get too excited about it and just sort of let them do their thing in terms of the bedwetting. Your doctor should definitely be involved with the ongoing evaluation and coming up with your treatment plan, but in the end, a lot of these kids, you're just going to have to wait for it to go away on its own.
Now on the website this week, I am putting a couple of links to some resources for you. One is the Bedwetting Store. You got to love the Internet, right? It's a place where you can look for these alarms, the pull-ups and absorbent underwear. They have a mall in stock there.
And then one of the absorbent underwear brands is called GoodNites GoodMorning and they have a GoodNites GoodMorning Club. Now again, this is from a company that makes these things. They want to advertise them; they want to sell them to you. But I was clicking through their site and they did have some good resources for parents who have kids who are bedwetters. So I'd encourage you to go to their site as well. And both of those sites, the Bedwetting Store and the GoodNites GoodMorning Club, we'll have links of them up on the Show Notes.
OK, moving on to our next email from a listener, this one comes from Angie. Angie says, "I just found out about your podcast and I'm listening to my fourth episode right now. I'm hooked! I'm a stay-at-home mother of three children – eight months, two year and four years – and hopefully we'll have many more. So I'm sure your podcast will come in handy to me throughout the years. Thank you. Questions for your podcast, what effects could toxic mold in the home have on young children and children not yet born? And what are the symptoms of a lasting problem from the mold? Are there any tests that should be done when young children are exposed to the mold? In our case, we had a water leak in the ceiling of the children's room for about two weeks due to a broken air conditioner. Toxic mold was found, we were evacuated, room contents were sanitized and mold was removed and we moved. I was only told "toxic mold". I didn't receive the report from the mold removal company, I asked for it but the landlord never sent it. Symptoms during the time included headache, runny noses and bloody noses and they stopped when we left. Does that mean we are clear or should we have tests done?"
OK. First, your experience, Angie, I mentioned this last week when we were talking about mercury, it sounds, when I read this I just think Monsters, Inc., you know? When the kid patrol comes running and they are like shaving him and tearing off the clothes, shaving him, hosing him down, everybody gets so crazed about this stuff.
As always, I have to say, again, because of the legal climate in our country and liability with having a medical podcast, anyone, if you're concerned about your child's health it's always best to see your doctor so he/she can take a look and listen because that's really important.
But here's my take on the mold situation, first, if you're exposed to mold spores, the first thing that you're going to see are allergic-type symptoms. Basically, breathing in the mold spores creates an immune response. So your immune system kicks in, says hey, these things aren't supposed to be here; you start making mucus to trap these particles and the mucus gives you a runny nose, you get more mucus inside the sinuses that causes the headaches and occasional nose bleed can happen, too, because these are kids who have runny noses and they're blowing their nose, they're rubbing their nose, they're picking their nose; kids are prone to do that when they have a runny nose and at other times as well.
So bloody noses are pretty common when you have the whole allergy, runny nose kind of symptoms going on along together. And as long as the bloody nose stops pretty easily and it's not terribly frequent, it's not anything to get too concerned about.
Now once the mold is cleaned appropriately and of course in your case you moved to a mold-free location, well hopefully, the new place is mold-free, and if the allergic-type symptoms go away and there's no recurrence of any kind of symptoms and there are no new symptoms at all, I think it's very likely that there'll be no long-term effects.
These allergic-type reactions when you're exposed to mold spores can become more severe in some people and especially people who have sort of hyper-active immune systems. And these would be folks who have asthma, eczema and in these cases, the immune system really revs up in response to this mold being there and then that could result in wheezing and difficulty breathing, which always requires a prompt medical attention and not in the form of podcast. I'm talking like in the emergency room or urgent care or at your doctor's office right away.
The mold does have the possibility of causing a very severe allergic-type reaction which wheezing and difficulty breathing, but once the mold is not there anymore and you're not wheezing, it's unlikely that you're going to start to have those kind of breathing problems down the road, unless you'd become reexposed in the future.
In rare cases and this is especially true for young infants, the elderly, those with compromised immune systems, there is the potential for the mold spores to get into the lungs and start growing and resulting in possible pneumonia, what we call pneumonitis where you get inflammation in the lungs, especially the coverings of the lungs on the outside rather than inside the bronchial tubes; and also just sort of chronic lung problems, in general.
And there's also the remote possibility of the mold spores going into the blood stream and causing sepsis and can lead to infection of organs and bone and cause all kinds of terrible things. Now again, this is rare. You probably and I've used this analogy before, if you're exposed to these kinds of molds, you probably have more chance of being in a fatal car accident than having this happen to you even if you continue to live with the mold. But we wear our seatbelts when you get in the car, just in case. And the mold should be dealt with appropriately, just in case, because there is that small chance that something bad could happen because of it.
So I think your first best place to get help with the mold problems or for anybody out there really is your local health department. They can test the mold that's there. They can provide you information on how to clean it up appropriately. I would avoid these molds clean up companies as long as you possibly can. They tend to give you a picture of exaggerated risk that can lead to costly and often unnecessary clean up.
If you have the health department take a look and they give you ideas on how to clean up and then if the easiest way to manage that clean up is through one these companies then fine. But if you find some mold in your house, I don't think the first place I would call is these clean up companies because you can bet there is going to be a big bill just trying to get over that.
In any case, if you have wheezing, difficulty breathing, fever, persistent runny nose, headaches, persistent nose bleeds, nose bleeds that you can stop very easily, it doesn't matter if you have mold exposure or not. If you have any of those things go see your doctor. If you had these symptoms and you saw your doctor and you're now symptom-free and you no longer have contact with the mold, then I think it's extremely unlikely that you'll have any new or long-lasting problems related to the exposure.
But still, if you're worried, see your doctor. He might roll his eyes and say, everything looks and sounds fine. But what do you care if he rolls his eyes? If it's peace of mind you're after then there's nothing wrong with making an appointment to get some.
OK, moving on. I hope that answered your question, Angie. I can't tell you, in your case, exactly what to do. I'm just saying that if your kids don't have any symptoms and you're not around the mold anymore, things are probably going to be just fine. But if they get a cough, runny nose, congestion, have fever, any problems go see your doctor.
All right. You know, I have to tell you and I'll get to the exact reason for this here in just a minute, which is an interesting story in itself, but basically, I was listening last night to Manic Mommies and again, I'll get in to why I listen to this show in a few minutes. But Erin from Manic Mommies basically had the story and the gist of it in a quick nutshell, basically, she had some friends who were having a Halloween party, they had some relatives who are coming from out of town and these relatives used to live in the area and these were mutual friends so they were going to stay overnight at the friend's house after the party.
Well the hostess of the party, her daughter, the day before the party comes home from school with head lice. So Erin was in a bit of a quandary, do we go to the party, do we not go to the party, that kind of thing. On the one hand, the party sounded like it's a traditional event and their close friends. But on the other hand, it's the day after there's lice in the house. So what would you do? Well Erin decided not to go to the party.
I just wanted to put in my two cents; I'm with you on that one, Erin. I wouldn't have gone either. And if I were the one having the party, I don't know, I probably would have cancelled it or postponed it or rescheduled it or bribed someone else to host it, something along those lines.
Technically, if you use lice shampoo and you do laundry and you perfectly follow all of the head lice guidelines that we talked about in episode four of PediaCast, then really even 24 hours later I think it's unlikely that it's going to spread. But, and this is big but (oh, that didn't sound good, did it?), if you don't wash the hair well, again, I'm punchy, it's well after midnight, if you don't wash the hair well or the lice is resistant to the shampoo that you're using, which sometimes happens, or you leave some live lice in the house somewhere because you didn't do a perfect job with the clean up, then there is a good chance it could spread the next day.
And if it spreads to my kids at the party or it spreads to me, well then now I have to deal with that clean up in my kids and in my house and so I'm with you on that one, Erin. I wouldn't have gone to the party and I talked to my wife, Karen, and she wouldn't have gone either.
Now OK, what's the deal with Manic Mommies? It's a great program by the way, for any of you out there who haven't heard them, they're one of those great podcasts I told you about over the Trypod Network and Kristin was very helpful in terms of helping me understand what Trypod was all about and getting me onboard over there.
Of course, all the moms out there just love Erin and Kristin. I have some folks at my office also who listen to their show and everyone I've ever talked to just has nothing but good things to say about them. But I suspect that there are probably plenty of dads out there listening to them as well and they're just not going to admit it.
The crazy thing about their show is this, listening to Manic Mommies is like looking in to a window in my wife's head. It's like I don't really need to know what's in there. I don't necessarily want to know what's in there but I can't keep myself from looking. It's like looking in to a window in my wife's head! That's exactly what it is.
Now listening to their show has had some side effects on me and one example of this is tonight, my daughter and I get home from the football game and my son is in another production, he had two play performances today with Surviving the Applewhites and my wife ushered for one of those productions. So I get home from the football game and there's a note on the kitchen table that says, "Mike, please put the laundry, the towels in the dryer."
OK. Easy enough, right? So I go downstairs, move the towels from the washing machine to the dryer, well, you open the drier, there's a whole load of clothes in the dryer, right? I mean, you got to put those clothes in a basket to get the towels from the washer to the dryer. You know what I'm saying?
Sigh. Before Manic Mommies, I probably would have put the clothes from the dryer in the basket and left them in front of the dryer and then played darts with my daughter. But I'm looking at this basket of unfolded dry clothes that I took out of the dryer and you know, I don't know why, but in my mind, I'm just thinking Steve, which is Kristin's husband on Manic Mommies, has to do his own laundry now and has to do their son's laundry and has to clean half the rooms in his house and has to fold all his laundry that he's doing and this is going through my mind and I'm thinking I'm being guilted into folding these clothes. And you know what? I folded the clothes. So dads, head over to Manic Mommies at your own risk. But they really are worth giving a listen to.
All right. I think it's time to move on before I dig myself into a much deeper hole. We're going to talk about a research study. It's very brief, I promise. I'm not in the mood to get into the science of it too much tonight. So we'll get in to a research study, right after this.
All right. We're back and we are running kind of short on time because of my punchiness tonight. I've not been able to stay on topic very well and I apologize for that. This is a quick research study, it's an interesting one. Basically, this is comparing oral steroid versus a shot of steroid in the treatment of mild to moderate croup. And this is from the August 2006 issue of Pediatric Emergency Care.
What they did, this is at the Schneider Children's Hospital Center in Tel Aviv, Israel, they looked at 52 children who were between the ages of six months and six years of age who had mild to moderate croup. And they randomized them into two groups, so group one had a steroid shot and group two had steroid medicine by mouth.
Now the patients in both groups showed a significant reduction in croup symptoms and there was no statistically significant difference between the two groups at four hours after their dose. There was also no difference between the two groups with regard to hospital admission rate, time for overall resolution of their symptoms or how long it took for the croup to go away completely. The need for additional treatments was not different between the two groups and the number of return visit to the emergency room, also there was no difference between the two groups.
So according to this study, a nice, simple one from mild to moderate croup, there's really no advantage to giving a shot of steroid instead of oral steroid. There is this notion that a shot is stronger than oral medicine and this is just another study to sort of debunk that myth. And I have always, in kids with croup, for quite some time, I think it goes back to when I was a fellow in pediatric emergency medicine, in the emergency department there was a study going on at that time, which I'm not sure if it actually got published or not, because there is some competition to get these things published.
But I remember the department of pediatrics where I trained had done sort of a mini study along these same lines and basically, had found the same results. So I've always been of the oral steroids are fine, whereas, some people who trained in other programs it's kind of drilled into them oh, do the shot, it's stronger. But I think this sort of study shows you that it really doesn't matter.
One exception to that is if you have a kid who's doing a lot of vomiting and you're afraid they're not going to hold the oral steroid down, then doing a shot of the steroid may be better, in my opinion in that particular situation. Also another reason to do an oral instead of the shot is because when you give them a shot they're going to get really upset and of course the croup always gets worse when they get upset. The other thing, too, is that the shot of steroid is only going to last about 12 hours or so and then in a lot of kids that's all that they need. But at least with the oral steroid you can send them home with some and they can do a few more doses as well to help keep away the inflammation in the throat.
By the way, I also want to mention we usually only use steroids in croup if they have really bad airway issues, if they have strider, which is that high-pitched noise when they breathe in. If it's just a barky cough and they're not really in any distress, you're probably better off not doing the steroid because remember croup is caused by a virus and steroids do decrease your immune system's ability to fight off the virus, so you're really not helping your body out in terms of getting better.
So you don't want to demand the steroid if your kid has croup. We usually only do it, again, if it's a moderate croup. I guess the study looked at mild croup, too. I'm not sure I'd use a steroid in really mild croup, but again, that's a difference of opinion.
And again, this talk in PediaCast, it's talk. It's just things that are going through my mind, what we deal within the office every day, what parents deal with. Again, if your kid has croup and you're worried about him, go see your doctor.
Well folks, that wraps up episode 15 of PediaCast. Our first podcast with our affiliation with the Trypod Network. So I'd like to thank all my regular listeners for joining us this week. Also welcome to all the newcomers out there. Thanks for giving us a chance and I hope you enjoyed the program.
I would also like to thank Vlad, I'm going to mutilate his last name here, I think, it's Vlad Gerasimov or something like that. We'll just call him Vlad. He's a Russian guy who is just a fantastic artist and he has graciously allowed me to display some of his artwork on the website. His site is vladstudio.com and I encourage you to go to his website and take a look.
And of course, go to pediacast.org if you want to see some of his artwork. You can send his pictures as E-cards, you can also buy posters of the artwork. It's very playful-type of art. I think you'd like it. So just go to pediacast.org, take a look and then click on the artwork by Vlad link if you want to go see some of his other things.
So I will remind you once again that we have a redesigned website at pediacast.org. Also, you can link there to our blog, we try to add something new to that a couple of times a week. And of course, your comments in the ongoing comments (That's what I'm trying to say. I'm sorry, it's late.) Anyway, the blog is available for you at the website.
Also if you haven't signed up yet for our newsletter, you can do that, too, at pediacast.org. There's also a listener survey and of course the important thing is to spread the word about PediaCast because the more listeners we have the more variety of questions we'll get and when we do these things, a lot of times I'll get the questions, we'll answer them and you think oh yeah, I did wonder about that, I just didn't think about asking about it.
So hopefully, we'll increase our audience and be able to answer more questions and get more comments from everybody who is out there. So make sure you spread the word, let your friends and families know about PediaCast. And also if you have time and would like to write us a review in iTunes, that would be appreciated as well.
And if you have something you'd like for us to address here on the program, just go to pediacast.org, click on the Contact page. You can also leave a voice message at 347-404-KIDS, that's 347-404-K-I-D-S. That's our Skype line or you can email me at email@example.com.
So until next time, this is Dr. Mike Patrick saying stay safe, stay healthy and stay involved with your kids. So long everybody!