Announcer 1: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For Every Child, For Every Reason.
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Announcer 2: Welcome to PediaCast a pediatric podcast for parents. And now direct from Summer Land Studio, here is your host Dr. Mike.
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Dr.Mike: Hello everyone and welcome to PediaCast, a pediatric podcast for moms and dads. It is Episode 139 and it is Friday, December 11th 2008.
Appendicitis, Flu Shots, and Drinking Water. Of course those are just three of the topics that we're going to be discussing, 'cause you have to come up with three for the title. But as always we're going to cover lots and lots more for you.
I hope everyone had a wonderful Thanksgiving. I'm still kind of pinching myself that we live in Florida now. I will say this, I'm not complaining when it's 60 degrees here like the Floridian Natives. My daughter and I went back to Ohio for the Ohio State – Michigan game and we sat in the stadium 28 degrees during the game and my daughter who was really hesitant about moving, she's a 14 year old teenager, it's tough moving when you're that age.
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We home school bt it's still tough because she had lots of friends in the theater world, she does a lot of acting stuff and then our church youth group. And so it's tough moving to a new State and she was really hesitant to move. But as we sat at the Ohio State – Michigan game in 28 degree weather she looked at me and said, "When are we going back to Florida?" She announced in typical teenage fashion that as soon as she turned 18, she's moving back to Ohio but now she says she might give it a few years.
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All right. So welcome to the show. Those of you who sort of follow along our blogs as well as the program itself, our house – the house that we're building is coming along. We're in a rental now which means I am in a make shift studio in our bedroom. Never fear though, the new house will have a brandnew studio and we'll get back to interviews and Karen will return. We'll be able to do the duelling shows with rants and raves and we're saving up some of those. That's all going to be coming up.
We're shooting for February on that. So it'll probably be around February or so when we're in the new house and the new studio and I think things will go better.
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You may have noticed though, that even though I'm in a make shift studio, the audio quality is still fantastic, if I do say so myself. It's not my doing really, I have to get props to Carlos at the Apple Store at the Florida mall for pointing me in the right direction of an amazing product, they are not a sponsor of the show, although maybe they should be. Apogee makes a little sound processor called the Duet and that combined with my Neumann condenser microphone I think is really for a home studio is just outstanding.
And this Apogee Duet, it's a little on the pricey side, but I'll tell you, compared to what I had before, this little baby rocks. It really does a nice job with the audio. So if there're any fellow podcaster out there, save up your money, they're about $500 and of course that doesn't come out of my family money, it's really sponsorship money that has allowed me to do this.
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But the Apogee Duet is just an amazing product. And I think that combined with my condenser microphone means, hopefully no post production manipulation.
OK. So enough with the technical stuff.
Moving on to family. Do any of you out there do the Christmas movies as a family?
It's kind of a tradition at our house. Once we hit Thanksgiving, for the next few weeks we go through all the Christmas movies. So far this year we've watched Home Alone and Christmas with the Kranks, Both of the Santa Clause; Santa Clause and Santa Clause 2, didn't hit number 3 yet. As I remember seeing that in the movie theater it wasn't quite as good as the first two but we've watched those and we still need to get White Christmas in there; that's one of my all-time favorites. I love White Christmas with Bing Crosby and Danny Kaye; it's a great Christmas movie.
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What Christmas movies do you guy watch as a family? And if you don't, maybe you should. Family movie nights are kind of a fun thing. You're not communicating, but you're laughing together and sharing memories especially if you do it year after year. So that's just kind of sharing with you one of the things that we always do and look forward to this time of the year.
There's so many great Christmas movies out there, from the old classics to the brand new ones.
Also, I want to say look for us on Facebook. We do have a PediaCast group on Facebook now and I am on Facebook, if you look up Dr.Mike, you'll find me on Facebook. So that's another way that we can communicate. Then the Facebook group PediaCast, hopefully we can get some good conversations going, so check that out as well.
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All right. So what are we going to talk about today?
I mentioned as we started the show, we're going to talk about Appendicitis, Flu Shots, and Drinking Water but of course there's much more than that. There's a new crib monitor out that uses radar, actually it's not out, it's being developed but it should be out soon.
We're also going to talk a little bit about Constipation, some Holiday Safety Tips for Christmas and New Year's, and Vaccine Cost; the cost of vaccines. We're going to discuss that.
Also the Cry it Out method, we've got another comment. I won't dwell on that, we've covered it from head to toe, probably more so than we need to. But I did get one more comment about it that I wanted to share with you.
And then as I mentioned we're going to talk about Appendicitis, Flu Shots, and Drinking Water recommendations. And I'm not talking about drinking water using 'drinking' as an adjective; this is actually the verb 'drinking.' How much water do you need to drink; that's what we're going to talk about with that. And that's coming up a little bit later on in the show.
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Don't forget if there's a topic that you would like to discuss or if you have a question or a comment, that's fine too or if you have a new story to point us to, we would appreciate that. And it's really easy to get a hold of me, just go to Pediacast.org and click on the Contact link. You can also e-mail pediacast@gmail.com. If you do that, be sure to let us know where you're from. That's always interesting. And then you can also call the voice line at 347-404-KIDS which translates into 5437.
Don't forget the information presented in every single episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands on physical examination.
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Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at Pediacast.org.
And with all that in mind, we will be back with News Parents Can Use right after the short break.
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Our News Parents Can Use s brought to you in conjunction with news partner Medical News Today, the largest independent health and medical website. You can visit them online at Medicanewstoday.com.
Radar – the technology that tracks enemy bombers and hurricanes is now being employed to detect another danger: when babies stop breathing.
In a high-tech twist on the remote devices that allow parents to listen or watch their baby from afar, University of Florida engineering researchers have built a prototype baby monitor that focuses on a baby's breathing. If his or her chest stops moving, the crib-mounted monitor detects the problem and sends an alarm to a portable unit kept by the parents.
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"It's a step beyond just watching the baby through a video link or hearing it cry," said Dr. Lin, a University of Florida professor of Electrical and Computer Engineering and the principal investigator of the Doppler radar technology used in the monitor.
A paper on the system, which works by using Doppler radar to remotely scan the in-and-out movement of the baby's chest due to respiration, will appear in the February issue of IEEE Microwave Magazine.
Parents buy millions of baby monitors each year in the U.S., but most transmit only sounds or video images of the baby – both are useful, but only if a parent is listening or watching. Some recently available monitors also monitor babies' movements and breathing, but Lin said he is not aware of any on the market that use wireless technology.
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University of Florida engineering students helped designed the monitor.
The students did the work as part of the College of Engineering's Integrated Product and Process Design Program, which allows senior-level undergraduates to participate in yearlong design projects of new products or processes. The student team's goal: to use Lin's radar technology, the first developed three years ago and under continuous refinement since, in a useful product with the potential to be licensed to a company.
The students produced a small-book-sized device that attaches to the crib just like a standard monitor. They also designed a remote station with red, blue, green and yellow lights, which indicate the status of the baby's vital signs; it also indicates the battery life of the station and confirming the station's wireless connection to the crib monitor. The station emits a loud alarm and flashes a red light when the monitor detects that the baby's breathing activity has fallen below a preset threshold, or that he or she has stopped breathing.
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Future versions could also detect heartbeat, using a higher frequency signal.
"It's the same Doppler radar that police use to catch speeders, but in our case, we don't measure constant speed, but rather back-and-forth motion – sort of like vibration," Lin said. "That's the fundamental principle of this technology."
The crib's monitor signals are very low power and not harmful to the baby or parents, Lin added. While a standard cell phone emits about one watt of power, the Doppler radar emits just one ten-thousandth of a watt of power.
Tom Weller, associate dean for research at the University of South Florida College of Engineering said, "The baby monitor is a good example of how research and education can come together in a useful product.
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"This miniaturization monitor is an example of solid microwave engineering coupled with great innovation, and something with the potential for a very broad societal impact," said Weller. "It is especially noteworthy that Dr. Lin transferred his research output into the very capable hands of creative undergraduate students."
Dr. Lin is also pursuing other applications for his technology. His best-realized idea so far: a search-and-rescue robot equipped with the Doppler system to determine the presence of living people in structures damaged by earthquakes or explosions. Lin said the system, so far tested in a small working prototype robot, could complement robotic video systems because it requires less power to operate and has greater range. The robot was developed by student Gabriel Reyes as his research project in the University Scholars Program.
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"Or the military could use it to find enemy soldiers," Lin said, noting that the Doppler radar easily penetrates walls or other structural components.
Lin has also reduced the size of the electronics in his system so that they fit on a fruit fly-sized microchip, potentially enabling the remote monitor to be used even in cell phones. That could turn the phones into portable life-sign detectors useful, for example, for friends and family who wish to keep tabs on elderly relatives living alone.
Lin, who has based his dissertation on the research, was awarded a graduate fellowship from the IEEE Microwave Theory and Techniques Society for his work.
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And moving from Doppler radar to a more traditional pediatric topic, Constipation.
New research conducted at Nationwide Children's Hospital, shows the burden of illness in children suffering from constipation, and the costs associated with this condition, are roughly of the same magnitude as those for asthma and attention deficit-hyperactivity disorder or ADHD.
These findings are a result of a study involving gastroenterologists and researchers at Nationwide Children's to estimate the health care utilization and cost for children with constipation in the United States. The study, available online at PubMed.gov, is slated for publication in The Journal of Pediatrics in early 2009.
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Using a nationally representative survey, clinicians and researchers analyzed data of children under 18 years of age who were diagnosed with constipation or prescribed a laxative over two-consecutive years (2003 and 2004).
Results showed that children with constipation used more health services than children without the condition, amounting to an additional cost of $3.9 billion each year for children with constipation. Despite this amplified cost impact and its prevalence during childhood, constipation has not received the amount of attention in public health campaigns that similarly occur with asthma and ADHD.
"Despite being considered by many a relatively benign condition, childhood constipation has been shown to be associated with a significantly decreased quality of life," said the study's author, Dr. Carlo Di Lorenzo, chief of Gastroenterology and Nutrition at Nationwide Children's and a faculty member at The Ohio State University College of Medicine. "The day-to-day struggle caused by constipation can often be emotionally devastating, and can also have an impact on the overall health and well-being of affected children and their families."
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Researchers and clinicians hope that health care utilization and cost estimates revealed in this study can boost awareness of childhood constipation, awareness that could result in earlier treatment.
In many cases, constipation in children can be prevented or corrected through dietary and behavioral changes. Parents should talk to their children about their bathroom habits and make sure they are having a bowel movement at least every other day. For mild cases of constipation, prune or apple juice, high-fiber cereal, or over-the-counter softeners or laxatives made for children may help. And if the problem persists, parents should seek the advice of a medical professional.
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I have to pause here just to say that in my own experience, constipation is a huge issue. In private practice we see tons and tons of kids with constipation problems. It's funny because it's not one of those things that parents talk about, you know when you're at a play group or after church or you're out to dinner with friends; you talk about a kid's asthma, you talk about their ADHD, but you kind of steer away from constipation. So I think it gets this impression out there that not a lot of kids have it, like you're the only one fighting this problem. But let me tell you, it is really, really common. And there's just tons and tons of kids out there on medications like Miralax or really trying to do dietary manipulation.
Also if you were listening to that new story and you heard me say 'oral' health, that was supposed to be overall health. So if you thought, "Wait a minute, what does constipation have to do with oral health?" Yeah, I read that wrong. Sorry. It's a free program, what do you expect? [Laughs]
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Let's see, let's move on.
The holidays are an exciting and busy time of year as parents race to finish shopping, decorating and baking. As the number of days left in the calendar year wind down, be sure to allow plenty of time in your hectic schedule for playtime with your child and sharing holiday traditions as a family (like the movies). Nationwide Children's Hospital reminds parents to keep alert to various holiday dangers.
Holiday visits to homes of family and friends can be fun for children but they also may be potentially unsafe. Remember others' homes may not be "childproof." So keep an eye out for breakable items, medications, uncovered electrical outlets and other potential dangers within your child's reach. Also, your childproof home might become more dangerous for a few hours, if a visitor leaves her purse and its contents in easy reach of children. There is a potential danger when a guest leaves medicine, an alcoholic beverage or cigarettes within reach.
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Avoid the temptation to wait until the next day to clean up after a holiday party. Just one or two ounces of alcohol left in the bottom of a glass can be fatal to a curious, early-rising toddler, and bits of food left on plates can be choking hazards or even cause food poisoning.
Plants typically used for holiday decorating include holly, mistletoe, evergreens and poinsettias can be poisonous depending on the quantities ingested. Eating holly berries, mistletoe berries or evergreens can make children sick with nausea, vomiting, diarrhea or skin rash, and higher doses can be even more dangerous. Poinsettias are minimally toxic but can cause an upset stomach if ingested in large amounts. Keep dangerous holiday plants out of a child's reach. Pick up fallen leaves and needles, and wrap mistletoe in netting to protect children from fallen berries.
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Perfume, cologne, wine and electronics with batteries make great gifts for adults but are dangerous if swallowed by children. So never leave gifts within their reach.
You might easily forget about little dangers such as the tiny batteries used in cameras, calculators and other popular gifts, but these "button" batteries can cause serious health problems for children if they're swallowed. Store all batteries in a safe place. If a child accidentally swallows a small battery, the first step is to call your local poison center, unless your child is choking on the battery or having trouble breathing in which case you should contact your local emergency medical services immediately and perform basic first aid yourself. And if you have a kid at home, you should know how to do that. Classes are available at your local Red Cross.
Also as a reminder, in the United States you can reach your local poison control center simply by calling 1-800-222-1222.
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Holiday baking is a tradition in many families, but young chefs also need careful supervision. Turn pot handles away from the front of the stove so they won't tip, and remind children that cookie sheets are hot when they come out of the oven.
Ornaments, tinsel and other decorations fascinate children but they too can be hazardous. Many are choking hazards, and broken ornaments can cause painful cuts.
Lights and candles are fire hazards. If you use electric lights, look for frayed or exposed wires, make sure no wires are pinched by furniture and no cords run under rugs. Don't use the same extension cord for more than three strands of light and turn all lights off before going to bed. When lighting candles, remove flammable materials from the area and never leave a candle burning unattended. The liquid in bubble lights and oil lamps canalso cause death if ingested by a child. So immediately throw away a bubble light if it is cracked or broken.
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Instructions for new toys should always be read to make sure toys are appropriate for your child's age and abilities. Some toys may pose a choking hazard to children younger than 3 years. Toys that are too advanced or too simple can be misused and lead to injuries. Protect young eyes by avoiding toys that shoot objects into the air.
Don't underestimate the importance of a toy's size. Parents can determine if a toy or toy part is a choking hazard for children younger than 3 years of age by placing it in a small parts test device available at many children's toy stores and through mail order companies. Because small balls or ball-shaped toys pose an even more serious choking hazard, these should pass the more rigorous test of not being able to pass through a toilet paper tube that is 1 ¾ inches in diameter. A child's doctor also can provide advice about what kinds of toys are appropriate if parents are unsure.
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Adolescents also can be injured by toys. Avoid gifts such as hobby kits and chemistry sets for children younger than 12 years of age and always supervise children ages 12 to 15. Toys with arrows or darts should have blunt tips made from rubber or flexible plastic.
Your attention is the best holiday gift you can give your child. Involve children in holiday preparation as much as possible.
Sitters, baby sitters that is, should be selected carefully when children can't tag along to holiday parties. Be sure your babysitter knows whom to call in an emergency including the numbers where you, fire and police departments, and the local poison control center, and your child's doctor and other trusted adults can be reached.
And to check whether the gifts whether the gifts you are giving or receiving have been recalled, remember to visit Recalls.gov and we will have a link to that in the show notes.
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And finally, the costs that health care providers are charged and reimbursed for childhood vaccines vary widely, and the high cost of some immunizations is leading to significant financial strain for some physicians, according to a pair of new studies from the University of Michigan Health System.
The findings suggest that many physicians appear to be paying too much and receiving too little reimbursement, but they can use this new data to help improve both areas, the researchers say.
"Physicians need to be better business people, and negotiate better prices and payments," says lead author Dr. Gary L. Freed, chief of the Division of General Pediatrics and director of the Child Health Evaluation and Research Unit at the U of M Health System's Mott Children's Hospital. Freed is the immediate past chair of the U.S. Department of Health and Human Services' National Vaccine Advisory Committee.
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With vaccines for children enrolled in Medicaid funded by the public sector through the federal Vaccines for Children Program, prices are negotiated annually with vaccine manufacturers by the Centers for Disease Control and Prevention. But the data from the new studies support the belief that costs and reimbursements are widely variable in private practices.
"Until now, nobody knew what anyone was paying," Freed notes. "This information will change the way in which physicians negotiate prices." The studies appear in the December issue of the journal Pediatrics.
The studies found that the price-per-dose of one brand of hepatitis B vaccine, for example, ranged from $4.26 to $13.06 at different medical practices. Reimbursements of the MMR (measles, mumps and rubella) vaccine ranged from $16.77 in some practices to $59.02 in other practices. Many physicians in the survey expressed dissatisfaction with the price and reimbursement levels of vaccines.
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"The good news for physicians is that they can join purchasing cooperatives in which they band together to get a better rate as a group than they would as individuals," Freed says. Additionally, physicians who are paying more for vaccines can follow the lead of their peers and have negotiated prompt-pay discounts and volume discounts.
11% of the physicians in the survey indicated that they have considered no longer providing vaccines to privately insured children and 50% reported delaying the purchase of some vaccines for financial reasons and experienced a decline in profit margins from immunizations. While the study did not specifically look at the effect on costs to patients, Freed notes that most of the vaccines are not associated with out-of-pocket expenses for insured families or for those on Medicaid.
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By the way, special thanks go out to Tony in Minnesota for sending that story along. Remember if you have a story, a news story that you think we can use here on PediaCast, just send a link to pediacast@gmail.com or use the Contact page at Pediacast.org.
And that wraps up our News Parents Can Use. We'll be back to answer your questions, right after this.
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Caller 1: Hi, Dr. Mike. Wow, congratulations on your move whatever State you're in with that. It's an exciting time for you and your family and I've really enjoyed hearing about it in the podcast. My name is Sidney Roberts and I'm calling from Ashland Virginia, basically to say thank you and thank you to PediaCast and also have a couple of questions here too. But I've been a listener for more than a year and a half. And I just had to tell you the confidence that you have instilled in me relating to pediatrics. Really helped me navigate the medical issues with my two children this past summer. And it's just so empowering to be able to go through a situation like this with the knowledge that I had from your podcast, so thank you so much.
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And basically my almost three year old daughter had appendicitis in August. That was right around the time when you were, was on I think with your longest title in the summer. Just reviewing you a little bit here Dr. Mike. We actually had her diagnostics pretty early and after the appendectomy she was in the hospital for about six days, because it hadn't ruptured, it was gangrenous and therefore they treated it like a rupture. So now that ordeal is all over and we've had a follow up with a pediatric surgeon. She's completely back to her wonderful self after two to three weeks recovery.
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And I'm just wondering, is there any truth to two rumors that I've heard, one is from my husband's aunt who claims that on their side of the family that they have faulty appendixes. There are three cases of appendicitis among my husband's uncles and aunts and grandmother.
And then number two, is it true that appendicitis could have been caused by something she ate? I know that sounds really crazy, but I thought it's something that you might be able to address. So thank you again, Dr. Mike for PediaCast. I really enjoy it and thanks so much for all the information and your good humor delivery too. I really appreciate it. Thanks. Bye-bye.
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Dr. Mike: OK. Thanks to Sidney from Ashland Virginia for sending our first question in to the Skype line. And again don't forget you can call the Skype line too if you have a question that you would like us to discuss on the program. And the phone number for that is 347-404-KIDS. Had a brain freeze there.
OK. So we're going to talk here about appendicitis. Sidney wants to know, does it run in families? Is there sort of a 'faulty' appendix that you can inherit? And also could appendicitis be caused by something that she ate?
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Let's talk about the appendix first. The appendix is a blind pouch, which means it's a tube with only one opening and it arises from the cecum; the cecum being the first portion of the large intestine. So it's in the part of the intestine that's near the junction of the small and large intestine. So if you are moving through the intestine, which I know you wouldn't really want to be doing, but if you were moving through the small intestine and you pass through the junction of the small intestine into the large intestine, right in that area, a blind pouch – kind of like a cave, is going to arise from the large intestine and that's the appendix.
Now the appendicitis begins when the opening to the tube becomes obstructed. There are lots of things that can cause this obstruction; if you have an enlarged lymph node in the area, so lymphadenitis – enlarged lymph node can cause it if you have an intestinal illness and that lymph node gets enlarged or if you have some types of cancers that could cause large lymph nodes. Those could potentially cause obstruction of the appendix.
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Foreign bodies that have been swallowed could do it, trauma; so clots and scar tissue, this one's kind of gross but, intestinal worms could do it, constipation can do it – so you could have what we call fecal stasis or poop that's not moving and that could cause a chronic obstruction of the appendix. Fecaliths, which is when the stool has been there for so long – you start to get calcification in the stool and you get stones in the stool called fecaliths and those can fill up the appendix and or obstruct the opening to the appendix.
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Basically the first part of this whole process of appendicitis is when the tube, that blind pouch that is the appendix, when the opening from the intestine becomes obstructed. And then what happens? The intestinal walls make lots of mucus and over time with chronic obstruction of the appendix, mucus from the intestinal wall begins to fill the appendix and it has nowhere to go.
Why does the intestinal wall make mucus? It's to protect, it's to keep things slippery, it's just part of the intestinal tract is to make some mucus. And again if the appendix is obstructed, then over time the mucusal layer inside of the wall of the intestine that makes up the inside of the appendix makes this mucus but it can't escape from the appendix because of the obstruction and it has nowhere to go.
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So then the appendix bulges and puts pressure on its own blood supply and because of that, the intestinal wall dies from lack of oxygen and these results in inflammation and pain and eventually rupture occurs. Now once rupture occurs then bacteria that normally live inside the intestine can spill out, cause what we call peritonitis which is an infection of the lining of the inside of the inside of the abdominal cavity – this can result and then the bacteria getting into the blood stream and causing sepsis and eventually death.
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So what's the treatment when you have this whole thing happen?
Well it's to remove the appendix and to remove it as soon as possible to avoid the perforation, rupture, peritonitis, sepsis, death continuum. So you got to get the appendix out.
Also antibiotics are used especially if there has been perforation and of course expectant management because you may need to support the blood pressure of the person if sepsis from the perforation arises.
So it's a very serious cascade of events. And once the appendix becomes obstructed, it rapidly leads to this whole sequence of events
0:32:11.6
So the question becomes does it run in families?
It can, but it's not likely a defective appendix that is the problem. It really depends on the ideology of that particular appendicitis. In other words, what caused the obstruction?
Well we do know that fecal stasis and constipation runs in families, so you get decreased transit times with low fiber diets and that can cause the poop to sort of back up. So these folks who have fecal stasis and constipation which runs in families can be more prone to obstruction of the appendix. So appendicitis may be a bit more likely in those families.
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Also lymphadenitis, you could have a family trait that puts lymph nodes closer to the opening. Also if there are certain cancers that run in families that can lead to lymphadenitis, you could get it at that way I suppose.
So it's not really a faulty appendix, but if you look at the mechanism by which appendicitis arises, it is possible that there are some family traits that could make it more likely for appendicitis to happen in those individuals.
Foreign bodies, trauma, worms as an ideology would not necessarily run in families.
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Can certain foods do it? Which was Sidney's other question.
Well, certain foods – not really. Unless you're talking about in general, so I mean if you had low fiber diets that result in constipation then, fecal stasis and obstruction can happen that way. But there's not really a food group per se that can make this happen. You know food is liquid slurry by the time it gets to the appendix. If it's not, then maybe it wasn't digestible in which case maybe it's a foreign body which is a different thing altogether and a thing that can indeed cause appendicitis.
So I hope that asnwers your question, Sydney. Thanks for writing in.
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We're going to move from a question to a comment and this one comes from Jessie in Murray Utah. Jessie says, "Dr. Mike, I am new iPods and podcast but have already listened to a number of your shows. I find them to be very well balanced, informative, and of course entertaining too. So good job. I also just recently visited your daughter's blog as you recommended, you must be proud she's a great girl." Thanks, she is. "I just listened to one of your podcast from September; I don't remember the number of it. You read a comment from a listener that was concerned about his four week old that would cry uncontrollably till 2:00 AM and he wanted to know if it was OK to let the babe cry to sleep. Your answer was awesome. However, I believe you might have left out one very important factor which I will cover in the following, way too long blurb on my passionate feelings toward positive parenting. When my son Kai was born, being that I was already a very poor sleeper taking up to two hours to quiet my brain enough to be able to fall asleep, this as you could imagine became very problematic when the baby had to nurse every four hours. So, I was desperate for a solution."
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"My brother recommended I read the book On Becoming Baby Wise by Gary Ezzo, I did so and begin to implement his philosophies right away. Although he did have some very good points that I still use today, he said you should let babies cry to sleep as soon you get them home and that every time they see you during that time, simply reinforces their crying, so be tough. I did this, but it was tough, tough, tough. He would be crying in his crib and I would be in a lump on the floor outside his door crying at the same time He was a very overly active mentally and physically baby and he still is today. No one can keep up with the kid, he hasn't liked to sleep from day one, his eyes are wide open in every picture we have of him at the hospital since the day he was born (or even in the hospital the day he was born.) So in one regard this was good, he learned how to put himself to sleep. The benefit was good. However, looking back I would say the cost was a little too great and I do believe it created a little too much bed time anxiety for him and myself."
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"Kai continued to grow and amazed the doctors and everyone else around him with his extraordinary abilities in just about everything which meant that I was going crazy trying to figure out how to keep up with him. He c ould unscrew a toy airplane with a little electric drill meant for a three to five year old two weeks after he got it for his first birthday." You might want to go back there, and read the safety news article on toy safety. [Laughs]
0:37:00.7
"He could speak full eight to twelve word sentences and an intelligent conversation with an adult at 18 months of age and he was stubborn enough to kick the three wheels out of the bathtub. During the course of his first two years, I read an entire library of parenting books searching for help with my brilliant, sweet, terrible two year old terror. One author and his concept of positive parenting has stuck with me though through all the rest for every problem, not just sleep issues and I'll mention it in a minute. Fast forward two years and I had my beautiful daughter, Taia and discovered that you can train a child from the day they come home from the hospital without being the you-must-cry-yourself-to-sleep so you can learn to go to sleep on your own nazzi. That Dr. Mike is the part I think you missed."
"You said start letting them cry themselves to sleep at around four months, I am saying sure, that sounds good. But why make it hard on yourself by spoiling them rotten up until then? Bottom line is two things; one, the basic is this, the first week or so are total adjustment time. Not a lot of rules apply but you are slowly trying to establish boundaries with the little one from day one. Instead of nursing the baby asleep, establish a sleep-feed-awake time, sleep-feed-awake pattern – that way the infant does not make the connection between feeding and falling asleep."
0:38:23.2
"And I must give credit where it is due and mention that this one comes from Garry Ezzo's book. But if that's not your 'bagga chips,' you can still make the training work without it but whatever you do, don't plug the baby in every time it whimpers, but I digress that's another blurb. So nurse your babies, snuggle them, play with them, love them, at bed time sing them songs, rock them, 'snozzle;' morph of the words snuggle and nozzle created by my boy who's now three. And yes he did notice that we were doing both and morphed the words on his own. Yes, he is still a little over active. So snozzle them all you want, get them to the point they can hardly open their eyes for all I care. But when you lay them down, even when they are teeny-tiny do so while they are still at least somewhat awake. Doing this will slowly teach them to put themselves to sleep, although you will still have to let them cry it out a little. But it's much less because you never let it get out of hand in the first place."
0:39:19.3
"So my advice to that gentleman; all parents and even yourself Dr. Mike, please get the book The Power of Positive Parenting by Dr. Glenn Latham. It's a workbook like a college textbook-type format and read the chapter on Fuzzy Babies and then you can read the rest of the book later because it all rocks. Fantastic stuff from potty training and thumb sucking to hate talk and dealing with teenagers. You can shape behavior even of your infant simply by positively rewarding good behaviors and ignoring the bad ones. If I could shout out one thing from the mountain tops, it would be to tell parents especially those who overuse coercive parenting to read Dr. Latham's book."
0:40:03.6
"He will explain how to use positive reinforcement as your primary tool after all as he quotes in his book, 'Research has shown that the most effective way to reduce problem behavior in children is to strengthen desirable behavior through positive reinforcement rather than trying to weaken undesirable using adversive or negative processes. From what I have listened to in your podcast, it sounds like you probably already used a lot of what he advocates and would be a big fan of his work. So while this did become very long, it's something that just has been life changing for us and I want so much for other parents to be able to feel as good about a parenting style as I do about Dr. Latham's and thus my own. I want them to uplift their children, not degrade them from the time they are born till well, forever. I guess this parenting stuff never really ends. Does it? I love your podcast. Hope you have time to read this and keep it up."
0:40:56.1
OK. So thanks for the comments, Jessie. And I will put a link in the show notes to The Power of Positive Parenting by Glenn Latham at Amazon.com and I promise you, there're no kickbacks in the link, it's just a link. There's no like I get a percentage or anything.
And the reason that I read this whole thing Jessie is because this was really heartfelt and good observations and comments and critiques and the whole thing was really well done, Jessie. I appreciate you writing in and I'm sure there're some parents out there who are going to run out and grab this book and hopefully it will change your life like it changed yours.
I might have to get on the podcast here some time. If anybody knows him out there, Glenn Latham, put him in touch with me, that'd be great.
0:41:41.9
OK. Let's move on. Jennifer in Cabot Arkansas. Jennifer says, "In light of flu season and the flu shot, I have a question for you. We regularly get our flu shots every year. We have done so since my first daughter was born and old enough, she had severe RSV as a seven month old and now has asthma so I know the importance of her getting the flu shot. My question is about here and a possible reaction to the shot. She received her first shot split into two doses in 2003 at age 16 months. The next two shots in 2004 and 2005 were fine. But after getting her shot in 2006, she started vomiting; she vomited again after her shot in 2007 and yet again after her shot this year. The vomiting starts about 12 hours after the shot and lasts for about eight to twelve hours. I remember last year calling her pediatrician and asking if this could be a side effect or a reaction to the shot and the doctor said no. Is our luck so bad that every year she is healthy when we go and gets the shot only to win the stomach bug door price each year for the past three years? I know it's entirely possible, but I was curious as to your opinion. Could this be a reaction to the shot? Should she still get the shot next year? Thanks so much, Dr. Mike."
0:42:54.8
It's a great question, Jennifer. Vomiting following the flu shot three years in a row. It starts about 12 hours after receiving the shot, last for eight to twelve hours and then it's gone. So why?
Well could it be a GI illness? I mean could it be a stomach virus and just a coincidence that this has happened three years in a row? Could it be that it was caught in the waiting room? Although a 12 hour incubation is sort of on the short side for intestinal virus. I mean most GI viruses; it's going to take a full day or two before you would start to have symptoms from it. And most of them also last longer than eight to twelve hours and usually then have some associated some diarrhea which you did not mention.
0:43:40.9
It really does not to me, sound like a GI illness. I think that the incubation's too short, to have been caught in the waiting room anyway when you went in for the flu shot. Also it seems to me that it's sort of on the short side in terms of duration and the fact that there's not any diarrhea along with it, also makes you sort of suspect that maybe it's not an intestinal virus.
So is it caused by the flu vaccine?
I think that it's possible. Not really as an allergy to a vaccine component cause you don't have rash or hives. But I think it's probably part of the immune response to the vaccine. So when you get the vaccine, the body thinks you have the flu and inflammatory mediators can cause nausea and vomiting. Sort of the same sort of thing that causes fever after you get a shot. The body thinks you're sick.
0:44:37.8
That's the whole point here – is you're fooling your body into thinking it has the flu. It forms an immune response which makes you build antibodies so that when the real flu comes along, you can fight it very quickly. But in the process of creating this immune response, you can have a fever and you can have some nausea and vomiting along with it. And this is why some people say, "Every time I get a flu shot, I get the flu." You don't really get the flu, you are just experiencing your body's immune system at work. You don't really have the flu. You're just experiencing those side effects of the immune system. And that's why a lot of people say the flu shot makes them sick. Others have headache, they can have fever, they can get some nasal congestion, some joint or muscle ache. But again, it's not the flu it's your immune system at work.
0:45:27.2
And while it's a nuisance, a few hours of vomiting that goes away quickly is better than a solid week of fever followed by a solid week of dealing with pneumonia. So to me, it sounds like this is a result of the flu vaccine. But it's not really an allergy, it's not the flu. It's just your body at work. And I still think your best bet is to get it every year, especially given your child's history of underlying respiratory disease including their asthma.
So thanks for writing in Jennifer. I appreciate it. Again, just the immune system at work.
0:46:02.6
OK. Let's move on to our final question. This one comes from Daniel all the way from Indonesia. And Daniel says, "I've been reading about how the recommended amount of water to drink is half your body weight in pounds converted to ounces. So a hypothetical 190 pound man would need to drink 95 ounces of water each day. So my series of questions is this; Do you agree with this recommendation? Is it true for children as well? If my kids ages four and two are drinking milk instead of water, how much water should they be drinking? Thanks for the show. I really enjoy hearing sound medical advice over here on the other side of the world where sound medical advice is rare."
0:46:48.4
Well thanks Daniel for the compliment and for writing in. Gosh we reached Indonesia. That's just crazy to think. I'm sitting here in my bedroom at a rental house outside of Orlando Florida talking on a little microphone; OK it's a big microphone 'cause I'm a geek. But anyway, and you're hearing me in Indonesia. I don't know it's just craziness.
So let's talk about water intake.
There's lots of recommendations out there and they're all based on good research from reputable sources. But the crazy thing is, the recommendations you get vary greatly So coming up with the right answer for you Daniel is difficult.
0:47:24.5
Let's start with what's the benefit of water?
Water makes up 60% of our total body weight and every system in our body depends on it. I mean water is needed to deliver nutrients to cells because it's a major component of blood, it's needed needed to eliminate cellular wastes and toxins, it provides a moist environment for our eyes and upper respiratory system, and the amount of water in our blood largely affects our blood pressure. So it's important.
We also lose water everyday through urine, sweat, tears, through the respiratory system, through chemical reactions and evaporation, so we have to replace what we lose. Otherwise our bodily systems can't operate to their full capacity and efficiency and we become dehydrated.
0:48:08.7
Too much loss can lead to low blood pressure; it can lead to death, so we need to replace what we lose. Now the problem in coming up with a standard recommendation is that not everyone loses the same amount of water. So to come up with a formula like half your body weight in pounds converted to ounces or the old eight ounce glasses a day or 64 ounces of water, those really don't work because we don't all lose the same amount of water.
Many factors determine our water loss; including diet, diuretics such as caffeine and alcohol make you lose more water, the climate where you live and work and play, sweating and evaporative loss makes a difference – so people who live in South Florida are going to sweat a little bit in a different way than people who live in Alaska unless you either bundle up and incite sweating. But my point is that we all sweat a little bit differently and have different amounts of evaporative water loss.
0:49:06.7
Also our amount of activity differs from person to person which has an effect on respiratory loss through breathing, when you breath out water vapor comes out, that's why you can see your breath in cold weather. So the amount of respiratory loss through evaporation is going to differ depending on your activity level and the amount of activity level in your body also is related to what kind of chemical reactions are happening in your body and you can get water loss that way too.
So there's a difference in water loss between an accountant in Des Moines and a construction worker in Miami Florida, right? There's difference in the amount of water loss between these two people. And then if one drinks a lot of caffeine or has a lot of alcohol at night, that's going to make a lot of difference too.
0:49:54.4
So you get the point, this is not an easy thing to quantify. So recommendations in the past have sort of aimed at overshooting the need; flood the body with water, the kidneys will get rid of the extra and life is good. But what if your kidneys are compromised or you have normal kidneys but you have greater intake than even they can handle?
If you get too much water, this can dilute the electrolytes in your body which can cause seizures and heart arrhythmias, it can increase blood pressure and stress the heart. So you don't want too little water but you don't want too much water either. You want the right amount, but the right amount is so greatly different from person to person. So in the end, numerical formulas aren't that helpful.
0:50:41.1
The best recommendation that I've heard and it's one that can apply equally to adults, teenagers, children, and toddlers and it applies equally to men and women, boys and girls and it goes like this:
You should drink enough water so that you rarely feel thirsty and you produce a colorless or slightly yellow urine several times a day.
If you feel thirsty, you aren't getting enough water.
Rather than waiting until you are thirsty to drink, you should increase your water consumption so that you never feel thirsty.
And if your urine is medium or dark yellow, or you aren't urinating several times a day, then you need to drink more water. And you don't want to overdo that so you don't want to be having to urinate every hour and it's completely clear. That would indicate, you're getting a little too much water.
0:51:32.9
So I think listening to your body, drinking to prevent yourself from getting thirsty and drinking so that you pee a few times a day and when you do pee it is clear to light yellow in color. That is a good gauge of how much water your body needs.
OK. So we figured out how to get the right amount. The next question is what counts? Does it have to be plain water?
No it doesn't. Your body is very good at extracting water. For example milk is mostly water with some fats, proteins, and sugars added in but the base is water and that water counts. So you want to give your kids enough fluids so that they aren't thirsty that they make a clear or light colored urine and they produce urine several times a day but not necessarily every hour.
0:52:22.8
What about babies and young toddlers? How do you know if they're thirsty? How do you know the color of their urine when it's soaked into a diaper?
Well you can still how often they urinate and five to six times a day or in a 24 hour period is a nice number. You can also make sure they're healthy, they're growing well, they're not over weight, they're not underweight. These are all good clues that you are providing the right amount of fluid which translates into the right amount of water, since water is a major component of milk and juices.
I've never been a numbers guy on fluids and nutrition. So whether it's water intake or the amount of milk or juice, or the amount of calories, or the number of jars of baby food, what's way more important than the number is the kid and this too holds true for babies, toddlers, and children, and teenagers.
0:53:11.4
The most important indicator that your child is getting the right amount of water and other fluids and food and calories is to ask yourself;
Are they urinating often?
Are they healthy?
Are they weight and height or length appropriate?
And is their BMI or Body Mass Index on target?
And these are questions you should discuss with your doctor during well check-ups. If the answers to these questions are yes, then I think you're in good shape. If any answers are no, then you may need to re-evaluate fluids and calories, food and drink. And that's an evaluation that should be made in consultation with your child's doctor.
So I hope that helps Daniel and thanks for the question.
0:53:46.5
All right we are going to wrap things up and I will be back to do the outro as we call it in the biz, like it is a biz.
Hey, the sun's come out. I'm looking out the studio window and even in Florida we do have some cloudy days and this morning was just all rain and clouds. And as I'm looking out, which by the way it is beautiful, even though I'm in the bedroom, we have kind of an alcove here and sort of a bay window with three windows surrounding me and you see the backs of the houses but it's beautiful. The new studio is going to be beautiful as well. So, excited about that. Right now the sun has come out, it's a sunny day so can't go wrong with that.
All right. We will be back and we will wrap up the show right after this.
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0:55:08.6
OK. As always thanks go out to Nationwide Children's Hospital for providing the bandwidth for our show today. We do appreciate them so much.
Vlad at Vladstudio.com who provides the artwork for the website and the feed.
Also Medical News Today for helping us out for the news department and of course thanks to listeners like you and a big thank you to my family for giving me the time to put this crazy show together.
Pediascribe, that's my wife's blog. There are lots of posts to choose from because she was a part of Nablopomo which is the National Blog Posting Month where bloggers from all over the world did a post-a-day. And the one that I'm going to highlight though is called 28 Down 2 To Go which is basically house pictures. It's consuming us after all, this house building thing.
0:56:02.2
The title by the way refers to the number of posts for the month and not the house, it's not 28 down 2 to go on the house but on the number of posts that she had done. But the post itself is on the house pictures. So I thought you'd be interested what is consuming our lives when I'm not working or doing PediaCast.
And also, feel free to explore the other posts at Pediascribe as well, there's a plethora of them to choose from because of Nablopomo.
0:56:30.5
Also on Baggachips.com, that's my 14 year old daughter's blog. She has a review of the Twilight movie. Boy, Twilight – that thing is just really consuming folks, isn't it? Just like the house. I think Twilight is consuming my daughter just like the house is consuming my wife and I. Although Twilight's kind of consuming my wife too. So if you want to read a review of the Twilight movie compared to the book, 'cause my daughter has read all of those as well, you can check that out at Baggachips.com. Well have links in the show notes to all these things which you can find at Pediacast.org.
0:57:08.8
Some reminders for you, the PediaCast shop is open. We have t-shirts and duffle bags and the like. Hey, they make great Christmas gifts and talking points too. So check out the PediaCast shop and again there's a link to that in the show notes at Pediacast.org.
If you have not done an iTunes review, boy those have really slowed down. It takes 30 seconds to write a review. If you picked up on PediaCast because of our reviews in iTunes, I would simply ask that you please pass it on and put a quick review in there. It's really appreciated. We always have an influx into the audience after Christmas because I suspect it's because people get iPods for Christmas and then they're looking through iTunes, they find PediaCast and it's because of all the great reviews from you folks that they give us a try.
0:57:59.1
We also have a Poster page at the website. You can download those and hang them up all over the place to help s spill the audience and we have a listener survey. It's also really quick like a 30 second survey to just help us with demographics of the audience. So if you have not taken the time to do that, that also is available in the sidebar there at Pediacast.org.
Don't forget about the Skype line. I would like to get another entire Skype show together. So if you've asked a question, even if you've already written in and your question has not been answered, try calling the Skype line and asking there. 347-404-KIDS, 347-404-5437 and you may just get bumped up through the front of the line because we get so many more questions by e-mail and through the contact page as compared to the Skype line. And I would really like to get another Skype show together.
0:58:53.3
As I mentioned before too, we'll do another Rant and Rave show. So if you have some comments that you have recently submitted and we have not talked about them, although I did go ahead and do the Cry It Out Method one 'cause I wanted to get that information too. 'Cause that book by the way; The Power of Positve parenting, that would also make a good Christmas gift for any new parents that you may know or get a Christmas gift for yourself, nothing wrong with that long as it's not huge and no one else is getting it for you.
So anyway I wanted to get that out. But I do have some other rants and raves and we're going to save them up for our first Rant and Rave show where we bring Karen in and do the duelling husband and wife team-type show. And that will be coming up probably in February or so after we get moved in to the new studio.
0:59:40.1
All right. So until next time and I'm not sure when that next time's going to be with Christmas coming up here. We may try to squeeze one more show in before Christmas or it may be afterwards. So we'll just have to wait and see on how timing goes.
So until next time, whenever that is, it won't be too long. This Dr. Mike saying, "Stay safe, stay healthy, stay involved with your kids and Merry Christmas and Happy New Year everyone incase I don't talk to you before then." So long everybody.
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