Expired Medication, Epidurals, and Asthma – PediaCast 073
- Listener Comment (Thinking Inside the Box)
- Expired Medication
- Epidurals and Breast Feeding
- Asthma Questions
- Lead Poisoning
- PediaCast 41: Thinking Inside the Box
- Using Expired Medications: A Murky Issue
- Drug Expiration Dates: How They Benefit the Pharmaceutical Companies
- Lead Information from the National Safety Council
- Christmas Cards for the Hip Family (cardmychristmas.com)
- PediaScribe: Bloggy Giveaway (Christmas Cards)
Announcer 1: This is PediaCast.
Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital, For every child, for every reason.
Katie: Welcome to PediaCast. A pediatric podcast for parents, the Listener Edition. And now, direct from BirdHouse Studios, here is your host, Dr. Mike.
Dr. Mike Patrick: Hi everyone and welcome to PediaCast, it is Episode 73 for Wednesday, October 31st 2007. So I guess, I'd better wish everyone a happy Halloween.
I'll tell you from a weather outside standpoint, this is in the holidays and, you know with Thanksgiving coming and Fall, this is really one of my favorite times of the year and of course college football factors into that a little bit.
But, you know apple cider, powdered doughnuts and today, at our house, Karen and the kids, while I was at work, carved pumpkins. And the cool thing about carving pumpkins is the by-product is pumpkin seeds. Now I don't know if you've ever done this before but, if you clean off the seeds, put a little oil on. OK, it's not the most healthy, but you know, it's a snack folks. You don't do it everyday. And then you salt them, and bake them in the oven. When I got home from work, the house just smelled like baked pumpkin seeds, it was just terrific and of course it's a nice little salty snack, high in fiber too I might add.
But don't give them to the little kids, you know, who might choke on them. That's the medical disclaimer.
Does Christmas season really have to start tomorrow? The department stores are going to be putting out the Christmas trees.
The only thing I do want to mention is, as much as I sort of hate rushing it, it's not too early to think about Christmas cards, and Karen has a blog give away over at Pediascribe, where there is a company that makes Christmas cards, and they're really pretty cool.
Actually we'll have a link in the show notes for you but, if you go over to Pediascribe or go to the show notes at Pediacast.org and click on the link that will take you to this blog contest over at Pediascribe.
They're basically giving out a free set of these homemade Christmas cards and I say homemade but, they're really much nicer than, you know, someone just getting out, you know, Printastic and making something. They're really nice, you want to give them a look-see and again there's a chance to win a set of them which will take care of you for Christmas. So, you might want to check that out.
Coming up in the show we have our Listener Edition so we're going to have some, well at least, one listener comment. Those are always juicy.
Also, we're going to talk about expired medication, is it safe to use or not and how long after it expires should you keep it around.
Epidurals and breastfeeding for those brand new moms.
Some asthma questions and then we have a topic on lead poisoning that we're going to cover.
Don't forget if there's a topic that you would like us to discuss, all you have to do is go to pediacast.org and click on the Contact link, you can also email me at email@example.com or call the voice line at 347-404-KIDS.
And with that in mind, we'll be back with your questions, at least some answers to your questions and your questions, I guess we got to ask the question before we can give you the answer and it's all coming right after this.
I am all alone on Stickam today, so if you have not had chance to check this out, it's Stickam.com and basically, you look for user PediaCast and we're on in the evenings and when we actually put together the show, I shouldn't say we, it's like I have a split personality or something cause it's pretty much just me.
But when I'm putting this thing together, I do it live with a little video camera so you can listen and watch on Stickam and then there is a way that message back and forth so after the show, we can chat for a little bit. So come join us some time and like I said, I'm all alone tonight everyone must be busy. But it is at Stickam.com.
It's seven o'clock right now Eastern Time, and I think I've said before that I have toyed with the idea of moving it and record it a bit later, that's probably a better time for most people. Stay tuned for more information on that.
OK, first up in our Listener's segment is Heidi from New Holland, Pennsylvania. Heidi says, "Hi Dr. Mike I've been listening like crazy ever since I found PediaCast a couple of months ago. I am already to Episode 41 and I learned so much from each episode. As an example, today I received a sample in the mail of the Next Step formula marketed for the nine to 24 month old. I did not even have to ponder over what this was all about since you educated me so well in a previous episode. As the first time mom of a nine month old, it felt great to be well informed on this new formula without even doing any research on my own. Main reason I am writing is to congratulate you on a fabulous Episode number 41, I know you felt like you were ranting in your discussion of medical decision making but it was so refreshing to hear someone attack this issue head-on and cluing the public as to how medical professionals must make complex decisions on a daily basis. You also challenged all doctors to rise to the task of remaining current within their fields and to have true scientific basis for the recommendations they are making. I for one was inspired. I am a fourth year Optometry student in school at stress to go to the literature but, I know that there are things we are taught that reflect the opinions of our instructors and not necessarily reliable and valid scientific research. I planned to look further into everything that I am recommending as an Optometrist so that my patients are getting the best eye care possible and so that I can feel confident in my recommendations to my patients. Thank you so much for all you do, Heidi in New Holland."
Well, thanks for the nice comments Heidi, and I hope you don't change your mind about me or the show when you get to the episodes where I rant a bit about kids with lazy eye or amblyopia and how they should see a Pediatric Ophthalmologist rather than an optometrist.
And for those of you scratching your heads wondering what this Episode 41 is all about, I'll put a link in the show notes so you can find it easily. It was called Thinking Inside the Box and really, it served as a foundation for interpreting medical research and I did rant, more than just a bit in that episode but, you know honestly, I have no regrets about that.
So check it out if we've peeked to your curiosity which I hope we have.
Ok, this next one comes from Jody in Needham, Massachusetts and Jody says, "Hi Dr. Mike, thanks for a great show. I like your new format. A topic for you; expired topical ointments cream and medications. My husband has always used expired over the counter medicine, sometimes a year passed the expiration date, I always toss the medication a month after the expiration date regardless of it being ingested or topical. Recently, I was at my mother's house and needed something for my 18 month old daughter's cut, my mother pulled out topical ointments that dated back to 1995. Her opinion was the same as my husband's, they were fine to use. Please help, what is your rule of thumb when using expired topical medications for toddlers and kids. I am firm about not using any expired ingested medicines for my daughter. Thanks again, Jody."
Well obviously from a liability stand-point, the party line for most doctors, pharmacist, drug companies, is going to be, don't use expired drugs and better yet, get them out of your house. Just throw them away but, those who know me well understand I can't just leave it at that. I’d rather take a more practical and balanced approach.
So I scoured my resources looking for a good discussion on this topic and actually, I did find a couple of them that seem to come from very good resources and made some sense.
Now, the first one I will admit is a little bit outdated and let me be upfront with that. Their discussion is a smart one and I do think that their basic ideas still applies today.
Ok so, where did I find it and where can you find it?
Well, It's in a 1998, see it's not quite as old as that topical ointment that Jody was talking about. It's a 1998 newsletter called Helping Hands, and it's a publication of the National Healthcare for the Homeless Council and on page three of the newsletter and I do have a link to the news letter's PDF in the show notes, but on page three is an article by Dr. Karen Holman, who is the medical director of Healing Hands Healthcare Services in Oklahoma City, at least she was in 1998 and also by Dr. Stacy Abby who was a professor at the St. Louis College of Pharmacy and also again in 1998.
But I did see this as a very reliable source and their article is called Using Expired Medications: A Murky Issue. And when you think about it, expired medication maybe a real issue for free clinics that rely on donations of medicine. The position that they take on this makes sense to me and obviously in the article itself they're addressing health care professionals but, I think moms and dads can take home something from their discussion as well.
Now, I'm going to present their entire article here and again there will be a link in the show notes so you can see it for yourself but, I do want to give you a sampling of what they have to say.
This is directly from the article. Just a sample; The expiration date reﬂects the time it takes under normal storage conditions for the product’s potency to fall below a clinically acceptable limit. The expiration date applies to unopened medication and is usually two to ﬁve years past the date of production. Except for reports of tetracycline degradation resulting in Fanconi syndrome, no serious reactions have been linked to outdated medications. There is a signiﬁcant concern however, with loss of pharmacologic activity over time. The loss of potency is further inﬂuenced by storage conditions such as light, moisture and oxygen exposure.
A review in the Medical Letter estimates that unopened medication will retain 70-80% potency for 10 years or longer. Drugs in opened containers probably retain 70-80% of potency for one-to two years beyond expiration date. With eye drops or ophthalmic drugs (excuse me, I have the tongue trips tonight), with ophthalmic drugs, the limiting factor is stability of the preservative, not the drug itself, and consequently, multi-dose ophthalmic solutions for the eye, generally should not be used beyond the expiration date.
Sometimes the potential risks outweigh the beneﬁt of using certain medications – for example, narrow therapeutic index drugs or drugs that with any percentage of efficacy loss may result in serious repercussions and they give examples of that. What they basically mean is that if you need a certain level of a drug in your blood in order to protect you from something dangerous, then you definitely do not want to use expired medicine in case it has lost some of its potency. And examples of that are going to be oral contraceptives (makes sense), Anticonvulsants (Anti-seizure drugs, OK, also makes sense), Nitroglycerin; a heart and blood pressure pills, blood thinners like Coumadin, and Thyroid medications.
So, I mean if you have a serious medical disorder and your body is relying on a medicine. It's probably not one you want to use after the expiration date.
Now, another party that's sort of interested in the real shelf-life of medicine is the military and in the mid-1980's, the Air Force in conjunction with the Food and Drug Administration, carried out a testing program on stock-piled medicine, to see how long the medicine remained safe and effective, and the results of their studies confirmed that most medicines remained safe and effective long passed the expiration date. So, why do the drug companies set short expiration dates maybe shorter than they need to?
Well I'm sure you can think of several reasons, mostly to do with liability and profit. I also have a link in the show notes to an article that discusses that aspect as well.
So, what's my advice? I guess I have to stick to the party line for my official reply, throw out expired medicine and don't use them. But, this is one case where I might not practice exactly what I preach and I'll leave it at that.
OK, listener number three, this is Cristina from Calgary, Alberta in Canada, "Hi, Dr. Mike. I'm expecting my first child very soon and listen to your podcast as a way to prepare myself for the challenges that may come my way. I have a question that you probably don't get asked as part of your practice but, I thought you might be willing to address it as something that affects your future patients. I have heard that drugs from epidurals can cross the placenta and this could affect the baby's sucking reflex and be detrimental to breastfeeding. My brother-in-law who is a veterinarian tells me that the drugs only affect the fluid in the spine and cannot be transferred to the baby. I know that there are some women who get to the point where they really need help in labor but, I want to make an informed decision because breastfeeding is very important to me. Which information is correct? Thank you for the time you take and I'm sure I will have many more questions once my little one arrives."
Well first, let's talk about what exactly is an epidural. Those of you who have had one, yeah you probably know what it is but there's going to be a lot of dads out there who may not know exactly and you know, some of moms out there too who might just have been sort of out of it and the whole thing was you know, a blur and might not remember.
Basically, an epidural is kind of like a reverse spinal tap. So, a needle goes into the spinal canal in the lower back but, instead of taking out spinal fluid, basically medicine is going to be inserted into the spinal fluid and that numbs the nerves that go to the groin region in the legs. So basically, it just numbs the area where the pain is going to be when the baby comes out. Kind of like a numbing shot before stitches. Just basically keeps the sensory nerves from firing off signals to the brain, telling the brain, "Hey we got some pain down here".
Now, the medicines that they use are typically a Lidocaine-type medicine, so this is like the numbing shot before stitches. And then also a relaxant-type medicine, an example that's often use is Fentanyl which is an opiate or narcotic medication, and again it's just there to help mom help relax a little bit.
Now, both of these medicines on their own do cross the blood brain barrier. Lidocaine if it gets in the bloodstream and goes up in the brain, can cause initial excitement of the central nervous, like tremor, anxiety, blurred vision, ringing in the ears, dizziness, and even seizure followed by a central nervous system depressions such as drowsiness, respiratory depression, and apnea. So Lidocaine and Lidocaine-type medicines, numbing medicines can cross the blood brain barrier and have effects on the brain.
Now Fentanyl obviously crosses the blood brain barrier and goes into the brain and that causes central nervous system depression and that's frequently used along with other drugs and conscious sedation, and surgical anesthesia is a part of that.
Epidural medicines definitely have the potential to not only cause problems with newborn suckling, but can also cause lots of other problems too, some of them life threatening such as, apnea and respiratory arrest.
Now having said that, our epidural's a bad idea. Well, you have the potential you know, to die every time we get in a car or an airplane yet we still do it because the benefit clearly outweighs the risk and I think a similar observation can be made here.
Very small doses of the medicine are used, little makes it to the rest of mom's body where then it is uniformly distributed and a tiny amount might make it to the baby's body through the placenta and then into the baby's brain it's going to be a minuscule amount.
But, what if mom gets too much, you know what if her liver is not working quite as well as another mom's and the regular dose; a lot more gets by it and so because the liver is kind of your anti-toxin machine, taking stuff out of the bloodstream that shouldn't be there. So what if this particular mom's liver doesn't do a very good job of that, so more of these medicines make their way to the baby, what if mom's small, and you know, the anesthesiologist gives her a little bit of bigger dose, you know what if a bolus of the medication gets into the bloodstream and goes to the baby's body.
I mean there's risk, there's a possibility that these medicines are going to have some depression, CNS, Central Nervous Depression on the baby which can interfere with their breathing and suckling but, it's a small risk, a tiny one. And if the baby does have Central Nervous Depression, you're certainly in the right place because hopefully there's a Newborn Intensive Care Unit right down the hallway.
So, I think the benefit that moms get from helping them relax, from helping with pain control, for making the whole experience of having a baby a more pleasant one , I think the benefit outweighs the risk, that's my personal opinion.
Now, if this interferes with suckling, so be it. Babies are smart; I’m not a big fan or believer of this concept of nipple confusion. It's not like babies are little machines that, you know, you put something in their mouth and they can't figure anything else out. It's just kind of silly if you ask me. If they don't suck really well the first time around, it's not a big deal.
Now the Leleychi Liggers, OK, close your ears, I'm not saying breastfeeding's not important, it is. But, relieving mom's pain and anxiety is also important and breastfeeding still can work even if the baby has bottle now and then or has a bottle in the beginning, it's not going to be the sort of thing. I can't tell you, we have been doing this in practice going on 10 years now and I can't think of a time that the baby stopped breastfeeding or couldn't breastfeed because they had a bottle. Might it make it a little bit more difficult? Well sure but let me tell you, it's just the beginning of parental difficulty. OK, it's a good lesson for what, the next 20 years plus of your life is going to be.
But, certainly it can still work and I do think easing mom's anxiety and pain is important. It's important for the dad too. That mom's anxiety and pain be controlled or tempered a little bit.
OK, let's move on.
Christy in Boston, Massachusetts says, "Hi Dr. Mike, first I'd like to say how much I love your show. I started listening when I received my first iPod last Christmas and now I’m a regular listener and a true fan. I tell other parents with young children about what a great service you provide and I thank you for your time and enthusiasm. My question is related to asthma. My three year old son has been diagnosed with asthma, although it may be on the young side for a label, having a mother, uncle, and grandmother with childhood asthma, it's not surprising. His asthma flares up primarily when he has a cold, and a cold always goes to his chest and sometimes if he's done too much physical exercise such as running around. My question has two parts, asthma medication and related diseases. Since he had his first asthma episode at around 10 months of age, my son has been prescribed Pulmicort once a day, as well as Albuterol, and Saline both delivered through a nebulizer when he is wheezing. At his three-year check-up his pediatrician also prescribed an Albuterol Sulfate Inhaler to be given through a child's aero chamber. My question is this, is one method more effective and/or more potent in providing the medication, in other words nebulizer versus aero chamber and inhaler and also how does Pulmicort work in comparison to Albuterol and are there any known long-term side effects with these medications? Last winter his pediatrician put him on daily preventative Pulmicort. My second question is regarding asthma-related diseases, for instance my son is one of those children who also has eczema, eczema flare ups, and food allergies to tree nuts and peanuts. Why do asthma, eczema and allergies seem to be connected in many children and adults? Thank you for your time, I know that many parents have children who deal daily with asthma and welcome further education. Thanks Dr. Mike"
Well thank you Christy for this question because it's an important one and I don't think that I have addressed this specifically in PediaCast and shame on me because, asthma is very common and these are the kind of questions that I get in the office very, very frequently.
So first let's discuss nebulizer versus a metered dose inhaler with a spacer or an aero chamber attached to it. Those of you who have kids with asthma, you know what we're talking about.
But, for those of you who do not, have not shared the joy of childhood asthma, a nebulizer is basically a machine that blows out air through a nozzle and you hook up two being to it and then a mask, and there's a little medicine cup, some medicine goes in there and then when you turn the machine on, the air aerosolizes the medicine so a mist of this medicine comes out and the patient breathes it in.
An inhaler gives you the medicine, you know, you push down on it, you get a jet of propellant and the medication goes into the mouth and then you take a deep breath at the same time that you push so that this medicine gets down into the lungs.
Now, an aero chamber is just a plastic tube that connects to the metered dose inhaler and it's good for kids because then you can do a puff of the inhaler and that medicine is now in that chamber, aerosolized briefly and then the kids can blow out and suck a big deep breath in and get that medicine down into their lungs. So you don't have to coordinate pushing down on the inhaler at the same time that you take a big deep breath in at the exact same time to get the medicine down into your lungs.
Is one better than the other? You know, it just depends on how well your child does with these.
You know the nebulizer, a lot of the medicine escapes out the side of the mask and the tidal volume of your lungs, how much air that you can actually get into your lungs is to some degree going to determine how much of the medicine gets down there.
So if you have a kid who doesn't want the mask on and they're fighting or they're not taking big deep breaths while the treatment is going on and a lot of it is escaping, they may not get quite as much medicine as they might with an inhaler and the aero chamber because more of the medicine is going to stay in the chamber and then they are going to be able to get that down into the lungs. So they probably get a little more medicine with the inhaler and the chamber, in my opinion.
On the other hand, doing the inhaler with the chamber takes a little bit more coordination and purpose whereas the nebulizer is much more passive and all I have to do is sit there and try to remember to take deep breaths.
It's one of those things if you have both try them because you can take ten different kids and five of them do better with the nebulizer and five of them do better with the inhaler and the aero chamber so, really it's going to depend on the kid. If you notice his asthma gets a lot better when we use one versus the other. I know I'm taking the wishy-washy approach or the wishy-washy line on this but I don't think that there's a one answer that's best for everyone.
For the young kids I do stick with the nebulizer for the most part and the older kids with the inhalers. What's the age cut-off? Again, it depends on the kid and how responsible and how coordinated they are in that sort of thing.
OK let's talk about the different medicines. This is really important. Basically the two kinds of medicines that we used to treat asthma, well there's really more than two but, the ones that you're talking about Pulmicort and Albuterol.
Pulmicort is a steroid medicine and Albuterol is what we call a bronchodilator. You got to understand what is going on with asthma to understand how these things work.
With asthma you basically have inflammation in the lining of the air tubes and because of this inflammation, the diameter of the air tube, in other words how the width of the area where the air can flow, is going to be constricted because the tissues of that breathing tube are boggy and swollen and impinging on the inner diameter. So basically think of a clogged pipe.
The wheezing that you hear is because of the resistance in the airways of the air rushing by all the swollen inflamed tissue in the lining of the air tubes. So how can you fix wheezing while you have to increase the diameter of the air tubes so that there's more room for air to flow through them.
And the two main ways to do that, one is to reduce the inflammation and the other is to make the diameter bigger by helping the air tube muscle to relax and open up a little bit more.
To decrease the inflammation we use steroid medication and acutely if you want to reduce the inflammation because they're having a bad attack, it's not something that you can do very quickly. It takes some time to reduce the inflammation but that's why we use Prednisone and oral steroids and specially if you have allergic triggers during certain times of the year or all year long, then you want to sort of chronically everyday have a steroid that is reducing inflammation to help prevent wheezing and that's when the inhaled steroids like Pulmicort come in to play.
In the immediate time period in order to help with severe wheezing, you want a bronchodilator because that's going to be an immediate effect. You can't get rid of inflammation immediately but you can make the airway diameter bigger by dilating or relaxing the smooth muscle in the airway and we use a bronchodilator to do that and Albuterol is an example of a bronchodilator.
So the inhaled steroids they are more of a prevention effort and the inhaled Albuterol is more of a treatment effort.
So when you have bad asthma you want to prevent recurrences of what we call acute exacerbations of the asthma and you want to ease current exacerbations of wheezing. So the Pulmicort or steroid is to prevent, the Albuterol or bronchodilator is to treat.
Now, you can also use steroids to treat but usually those are going to be either through an IV or by mouth not the inhaled-type steroid.
And this is important because if you have a kid with asthma and they are wheezing and you give them a breathing treatment with Pulmicort, thinking that's going to make them better, you're mistaken. It's not, it takes days on being Pulmicort before it's really at its maximum effect whereas Albuterol is the rescue medicine and so that's the one you want to have on-hand or if they’re actually having a wheezing episode.
OK, in terms of long-term side effects. Again you have to look at it; well what's the long-term side effects of not controlling your asthma. I mean, yeah there's a long-term side effects.
Albuterol, you know, it's not really a long-term effects with Albuterol. I don't think there's really much there. There are some short-term side effects with Albuterol such as anxiety, increased heart rate, it can increase your blood pressure, those kind of things.
And in the steroid medicines, there’re probably are some long-term effects but they're not any worst than the long-term effects of uncontrolled asthma.
So they talk about steroids, you know using them too much does it affect children's growth, does it affect your immune system, maybe to some degree it does but, certainly untreated asthma can kill you and untreated asthma can cause you not to grow as well.
The benefit of these drugs certainly, certainly outweighs any risk of short or long-term side effects from them. In my opinion.
OK and then finally what's the relationship of asthma, eczema and allergic rhinitis?
You know, they are the same disease. It just depends on where the problem is as to what we call it.
So all of these diseases are immune system mediated. Basically, your body is saying, "Hey something's here that shouldn't be, we're going to attack it and get rid of it." And that thing is what we call the antigen and whether that's viral particles or whether it's molds or dust mites or whatever your triggers are, then that's what your immune system is going after.
And what the immune system does is it causes inflammation, why? Because you're increasing blood flow to the tissue so that white blood cells can get there to fight whatever it is that the body doesn't want to be there anymore.
And there's chemical mediators involved in the process too and you know, if you get injured, you get inflammation and in this case the body thinks it's injured and so it sends the white blood cells in to clean up antibodies, histamines, leukotrienes, you know all these chemicals and it causes this inflammation.
Now the level of this whole reaction determines what the symptoms are. So if it's in the upper airway that this process is going on then we call it allergic rhinitis, if it's in the lower area then that inflammation causes wheezing, we call it asthma and if it's happening in the skin then we get eczema which is you know the dry skin and it can have inflammation involved with it too.
So really, the relationship is it’s just sort of the same disease. It just depends on what level this inflammation immune system reaction is occurring that determines where the symptoms are and then that determines what we call it.
So hope it helps you understand that a little bit better.
OK, moving on to our final question.
This one comes from Heather in Kettering, Ohio and Heather says, "Hi Dr. Mike. I wanted to say thank you very much for your great podcasts. My husband and I listen to them on the one hour trip from Dayton to Columbus when we go to visit the in-laws"
Which you know when you're going from Dayton to Columbus, I would imagine you take Interstate 70 and Route 42 where all the truck stops are. I live about a mile from there, so next time you go by wave out your window.
With all the toy recalls, Heather asks, "I was wondering if you could address parents' concerns about elevated lead levels in children. My 12 month old was tested at his well-baby check-up at nine months and his blood lead level was slightly elevated. Our pediatrician said she'd do a recheck at 18 months. Is this something that I should be worried about? We did have some of the recalled toys but they were my older son's trains but, my older son won't let the little guy near them so I'm pretty sure that isn't it. What are some other environmental factors that would cause an elevated lead level, what effects could having an elevated lead level have on the development of a baby? Thanks Dr. Mike and Go Bucks!"
Alright Heather, I am all for that.
So let's talk about lead, how high is too high?
We don't know for sure and it's probably somewhat individual specific.
In general a small amount of lead in your body is normal, you know, it's one of those trace elements you have. I mean you have a normal amount of iron, you have a normal amount of calcium, you have a normal amount of magnesium, and you have a normal amount of lead. So usually, you don't have a lead of zero and most of the labs will report like, it's less than two and that just lets you know that, that's a normal lead level.
Now, we traditionally call ten and higher lead poisoning although, now there are some evidence that lower elevations of lead, you know, in the six to eight range. Those may have an effect as well although this kind of research is tough because, of the kids who are more likely to be exposed to lead, are they also, somewhat predispositioned to having lower IQs anyway. And I'm not trying to be judgmental here, I'm just being realistic.
The kids who are in older houses with chipped paint where the upkeep is not so great or the kids who aren't being watched as closely, they have their fingers in paint flakes, window sills, and then things are going in their mouth and they're not being as well supervised.
Is that sort of environment more likely to be in a lower socio-economic climate, and in my opinion, I think it is.
And so these kids, who tend to have the higher lead levels, also tend to have lower performance, lower IQ’s, and so it's hard in doing a research project to take out that factor in this whole business.
There are some studies that show lower amounts of increase lead can cause developmental issues, but again it's hard to say. Is it the lead doing that or is there some confounding factor?
And of course when they do research studies they try to make the lead the only variable but that's a very, very difficult thing to do.
Now, the way that we handle this basically, is if you have a lead that's elevated, you recheck it basically every three or four months until the lead level has come back down to where you want it and if it's not going down or if it's really high, then you make sure that someone from the health department or an independent agency is inspecting the home to find any sources of lead.
I'm not sure if what your pediatrician means by slightly elevated since you didn't give me a number in your question but I'm guessing that it's somewhere between eight and fourteen probably tittering that borderline normal.
And so for those kids you need to just check it every three months and if it's going up instead of down, and lead is one of those things that does not rise quickly and then also does not fall quickly. Once it's high, it's high for a while. So this is something that you check every three or four months. Now if it's really high, you know, then you can have acute problems so when we see leads that are up 18, 20. I've seen leads up in the forties before.
Generally, we refer those kids to a lead clinic for a more thorough whole body examination and then also a strategy to get the lead out of the body. And then there's this technique called Chelation where kids can get medication through an IV to help get the lead out quicker, but those are going to be for the extreme, really high cases.
Now, in terms of lead exposure, we worry about homes that were built before 1978 because the standards in home building before 1978 allowed a lot more lead in paints and building supplies. Chipping paint obviously is one thing we really worry about cause kids would get that paint dust on their fingers and then it can absorb through the skin or they lick their fingers and it can get in the mouth.
And then you got to think about old things that you have in the house that even if you live in a brand new house, I remember, I had a family one time, the house itself was fairly new house but they had a piano bench that was very old and had this lacquer that ended up having lead in it and in hindsight, we figured out that the kid liked to crawl over to the piano bench and gnaw on the leg of the piano bench and that's where they were getting exposed to the lead.
Also old phone line insulation used to have lead and I know in our area, about 20 years ago they replaced all the old phone lines and I had a guy tell me who worked on this project that, when they did that the insulation on the old phone lines just crumbled and fell to the ground. So along the roadways, and highways, and around parks, there was a lot of this basically telephone line insulation dust that could be carried into homes, you know, out in the environment that way so that's another potential exposure area. And then of course, toys from China because of using lead-based materials and paints.
I will say that when I started in pediatric practice, right from my training, we always check lead levels 9 to 12 months of age and then right around two years of age and back when I was a resident in the first few years of my practice, we saw elevated lead levels all the time and I have to say I see much, much, much, much fewer and less cases of elevated lead than I used to. I still checked at 9 to12 months and again at two years for pretty much everybody. Oh and again before kindergarten at age five. So pretty much everybody gets those checks whether you live in a brand new house or an old house. I just check everybody. Because again, just ‘cause you live in a new house doesn't mean that you're not exposed to it through toys and furniture and those kind of things.
And we just don't see, at least me personally, I don't see nearly as much in the way of elevated lead as I used to.
Used to be we are calling people about elevated lead or referring them to the Health Department. I mean, literally, I would say, five to ten kids a week and now it's maybe once a month.
I mean really it's a lot less than it used to be and I think that the community clean-up efforts really have a lot to do with that.
In terms of other effects of lead poisoning, you know there's lots of them. I'm going to direct you to a lead information sheet that is really well done. It's an excellent resource; it's from the National Safety Council. It's a trustworthy source, it's very complete, and I would encourage you if you're interested in lead poisoning and its effects and how you get in contact with lead and all that. We'll have a link of course in the show notes.
All right we're running way over which I usually do often on the listener-answer, listener ones. See the news ones and the research ones, I stay on topic a little bit better, in the interview ones too but, these listener ones tend to go over. I better get a break and we will be back to wrap up the show right after this.
And thanks go out to Nationwide Children's Hospital for providing the bandwidth for our program, Vlad over at Vladstudio.com for providing the artwork.
Thanks to all of you for joining us, don't forget to check out the Pediascribe blog. Karen is doing the Bloggy Giveaway, it's a part of a huge, in the huge event in the blogosphere to give stuff away and she's going to be giving away Christmas cards for the Hip Family they’re called, they're really cool Christmas cards and she's giving away a complete set of those cards at Pediascribe the blog.
If you go to the show notes at pediacast.org, there will be links to both the Christmas cards for the Hip Family site and the contest post on Pediascribe. So check that out.
Also, the PediaCast Shop is open up; we have t-shirts to help you spread the word about PediaCast.
Reviews in iTunes are always so helpful as is a nice word of mouth, plug with your friends and family.
The plan for tomorrow is a Research Edition and hopefully that will go well and we’ll get that out, I have not started it yet.
So if there's not a show tomorrow, you know why but, hopefully there will be. I'll get right on it.
My wife and daughter at play rehearsal, my son's playing The Wii at the moment and I'll probably got to go spend some father-son time and then I'll get back on and getting some research stuff together.
So, until tomorrow or perhaps the next day. This is Dr. Mike saying, "Stay safe, stay healthy, and stay involved with your kids."
So long everybody.