Swine Flu, CPR, Breastfeeding and Alcohol – PediaCast 148


  • swine flu update
  • tamiflu controversy
  • urine test for appendicitis
  • children learning CPR
  • community-acquired MRSA
  • body temperature
  • breast-feeding and alcohol consumption
  • dry drowning



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


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

Dr. Mike Patrick:  Hello, everyone.  And welcome to PediaCast.  It is episode 148 for Monday, August 3rd, 2009. And it is a real live turning point for the show.


In fact this is PediaCast 2.0, cause we're going to change things quite a bit.  We're calling this one "Swine Flu…, lots of update on swine flu for you.  CPR and breastfeeding and alcohol.  I actually have several questions regarding alcohol use during breastfeeding.  So I figure it's to quit avoiding the topic and talk about it.  OK. So PediaCast 2.0,  what is this all about?  Well, there's several differences that we are starting with today's  program.  First, we have a new co-host and this is in response actually to the number one show request over the past several months.  And the new host is, wait for it, my lovely wife, Karen.  OK.  So why is Karen going to make a great co-host of this program.


Several factors, number one, she is a pediatric nurse by training and has experienced both the hospital setting and an intensive care unit setting and in a private doctors office setting.  She's an experienced mom.  She's been through the infant years, the toddler years, the childhood years and we're currently dealing with the teen age years, right?

Karen :   Yeah.  Well, dealing.  That's the subjective kind of word.  How well are we dealing, I'm not sure.

Dr. Mike Patrick:  Another important thing is motivation.  Because as a lot of you know, it's been a few weeks since we had a podcast.  We are committed though to the weekly shows here again for a while.  Hopefully for a long time.

Karen :  So you have me nagging you , "come on, come on, we got to record, we got to record….  

Dr. Mike Patrick: When are we going to have another show, again exactly.

Karen :  Come on, my fans need me.

Dr. Mike Patrick:  And I think most importantly, when I just talk, I don't know, sometimes it seems a little boring.  

Karen :   I don't listen when you talk.  So, just kidding.  I always listen, always exactly.


Dr. Mike Patrick:  There is definitely going to be a fun factor here I think.  All right, we will continue of course to answer all of your medical questions, but feel free now to throw in some parenting questions our way as well. And details on how you can get your questions into our hands is coming up.  But first let's give a warm PediaCast to our new weekly co-host, Karen.

Karen :   Clapping for myself that I will be very humble.

Dr. Mike Patrick:  OK.  Well, you know that's okay.  Humility goes out the door at least in the introduction when we get to the News segment and the Listener segment.  Then we'll talk a little bit more about humility.

Karen :  OK, or not.

Dr. Mike Patrick: Or not. Yeah.  OK. So it's, I'll tell you what, in fact your first official duty as co host is going to be, well let's wait for the interludemusic to finish here.  


OK.  You're first official duty is going to be to let everyone know some other changes in the show.  Not only are you the new co-host, but there's actually some changes too.  

Karen :  Yes, apparently we're breaking the show now into three segments, instead of the normal two.  We are going to have the News Parents Can Use segment.  Just like before.  But it's going to be a little more conversational.  It's a you and I chatting about the news and it's not going to be you reading the news story.  Not that I didn't hang on every word, I did.  But it will be a little more fun to chatting about it, a little more natural.  

Dr. Mike Patrick:  The disadvantage of that is more work.  But you know you guys…

Karen :   NOt for me. So anyway ,

Dr. Mike Patrick:  No, but seriously, the audience out there, they're worth it.  If they're worth it so we'll put a little bit more into the news department and we'll have more stories, less in depth probably, but more discussion.  

Karen :   That's right.

Dr. Mike Patrick:  OK.  

Karen :   And if there is a news story that particularly interests you and you wanted submit a question to ask further about it, that's up to you.  


So, then we can go into a little more depth as in the Listener's segment.  Just as before it's going to be Dr. Mike, primarily answering your medical questions ,

Dr. Mike Patrick:  And you can just call me Mike. We've been married a long time, thats OK.

Karen :   Long enough.  Withy Mike answering the medical questions ,

Dr. Mike Patrick:  And Karen will primarily be answering the parenting questions, but of course, both of us will chime in along the way.  

Karen :   Pretty much me which is the snarky comments, but that's OK.  

Dr. Mike Patrick:  I will learn from you, and when you answer the parenting questions, then I can put my snarky comments right back.  

Karen :   There you go. And then there's the third segment, we're going to rotate through several options.  One is that you have heard of before, but there not going to be in every week, like the Research Round Up, some interviews with parenting experts, pediatric specialists, authors,  whatever opportunity pops up for us.  And then a focus segment where we will be talking about a certain topic or disease or go really into depth.  So, three segments, the third one is going to kind of mix up now and then.  So ,


Dr. Mike Patrick:  This week, we are going to do a Research Segment and it's actually an interesting study regarding CPR and kids as young as 9 years old can they learn effective CPR that could actually save someone, so that will be coming up on our Research round Up today. So we're really excited to bring you this new format and again you can expect shows to hopefully be weekly and still for each episode to last about an hour.  But we're going to pack them with more fun and content.  And since the show is  free on your end, you can't beat the cost of admission, right?

Karen :   That's right.

Dr. Mike Patrick:  Especially if we are going to put more into it ,

Karen :   And I'll email you guys  also popcorn and candies, so you can enjoy that.  Just send me your email address along  and I'll email that out to you.  

Dr. Mike Patrick:  How do you email?  OK.

Karen :   We can try, I'll give it a try.  

Dr. Mike Patrick:  OK.  Well you get back to me next week and then tell me how that worked out for you.

Karen :  OK.


Dr. Mike Patrick:  OK.  One other item before we get started, and I didn't mean to leave you hanging with this one.  But our last show was early June and I said "Oh, in our next show, I will let you know how this went….  And then didn't have a show for a while.  So you may have forgotten.  But Nick and I, Nick is my 12 year old, our, sorry. He's our ,

Karen :   I actually did give birth to him, right there.  

Dr. Mike Patrick:  Our 12 year old son.  And we did a preteen get away which was a little bit embarrassing from the dad's point of view.  It's basically a weekend where you talk about sex, peer pressure,  purity, these kind of things.  But it really was fantastic, we had a great time and it really one of those memories that you sort of park in the back of your mind and remember forever.  So Nick and I basically went to a hotel for the weekend ,

Karen :   Not just any hotel.  You went to the Coronata Springs, does that ring?

Dr. Mike Patrick:  Well, we live by Disney World ,


Karen :   Right ,

Dr. Mike Patrick:  So Disney is right around the corner and Coronata Springs is one of the modern resorts. So we went and in a nice room ,

Karen :  Right ,

Dr. Mike Patrick:  Then we go to the pool ,

Karen :   And then you get there and bumped up to the beach club.

Dr. Mike Patrick:  Yeah, that's great.  Because the beach club pool is, I mean, wonderful.  Those of you who have been there knows what I'm talking about.  Huge pool, sand on the bottom, slides all over the place.

Karen :   All free form not like a rectangular ,

Dr. Mike Patrick:  Lazy river , So we thought we're just going to be in a regular resort and we got bumped up and so that was a nice surprise.  No extra cost, just were able to do that.  

Karen :   I think they call that Disney Magic.

Dr. Mike Patrick:  I think you're right.

Karen :   It's pixie dust.

Dr. Mike Patrick:  So we ended up, I think in a previous show I had talked about focus on the family.  They have a series called Preparing Adolescence.  And we actually went with a different company this time.  It was from Family Life.  And the program was called Passport to Purity, done by Dennis and Barbara Rainey.  So ,


Karen :   Their whole company is just so impressive that you can find all their resources at familylife.com.  they have things you can buy and books and this Passport to Purity program.  They also have these articles about family and marriage and kids and all that stuff.  They put on this thing called Weekend to Remember.  Mike and I went to one of those in June also, hosted at a Disney hotel, so it was convenient.  And that was just a wonderful time to kind of remember why we got married and what was it all about.

Dr. Mike Patrick:  Right, yeah.  So, really it was fantastic.  And we were so impressed with the program that we thought we would go with their preteen getaway.  So any parents out there if you thought about this, I think it's wonderful idea.  And you have to catch your kids ideally before mom and dad aren't cool anymore. You know like once you hit those teen age years where they roll their eyes and "Oh, I got to spend a weekend with you… ,

Karen :   And talk about embarrassing things…


Dr. Mike Patrick:  Yeah ,

Karen :   I might have already learned from the kids in my class, you know that ,

Dr. Mike Patrick:   See, you might want to catch them before that.   But it's never too late.

Karen :   Right.

Dr. Mike Patrick: But anyway, it was really fantastic program.  If you liked to learn more either the Focus on the Family one or the Family Life one, we'll have links in the Show Notes for your so you can check out those programs.  It's basically a workbook and series of CD's that you listen to.  And really it's not so didactic that Nick did not get bored, it was really interesting.  

Karen :   That's what I loved.  That's what I loved about this one over the Focus on the Family one, because Katie and I did that one over a few years ago and it was really good, I got a lot of it, these things I wish I know had known about when I was 11

Dr. Mike Patrick: Right.

Karen :   But the Passport to Purity one seemed to pull in more hands on projects, you have to gather the supplies and do things to really visualize the concept.  So I think that kind of broke up the listening to the CD's and writing in the work book.  

Dr. Mike Patrick:  Yeah, it's all definitely.  And the projects were fun and easy to do.  They give you lists of supplies you needed to take to do the projects.


Karen :   Right.

Dr. Mike Patrick: It was really a great time.  Again if you are interested in doing that in the Show Notes, we'll have links for you both on the Focus on the Family site and the Family Life site as well.  OK.  So let go ahead, we're already 10 minutes into this program, so we really better get moving.  What are we going to talk about, in the news segment, we're going to talk about swine flu.  We have some updated information for you.  Also we're going to talk about Tamiflu and a new urine test for appendicitis, well the potential for one anyway.  Research segment, we're going to talk about children learn CPR and then we'll answer your questions about community acquired MRSA or methicillin resistant staphylococous aureus.  Body temperature, breast feeding and alcohol consumption and then dry drowning.  So that's all coming up.  And don't forget if there is a topic that you would like us to talk about or if you have a question or a link to a news story, just gives us a holler, pediacast.org and click on the Contact Link.  


You can also e-mail us, pediacast@gmail.com or call the voice line at 347-404-KIDS and we'll have that up as long as Skype stays alive.  Apparently there's rumor that they may have to shut down their operations because of some problems.  Apparently they sold their proprietary software to NBC Universal maybe, no.  Well, there some issue that Skype may have to shut down.  Which will make it hard to do interviews.

Karen :   Which I don't think the film companies would mind much  since ,

Dr. Mike Patrick:  No.  But we will find an alternative.

Karen :    Yes, somehow.

Dr. Mike Patrick:  OK. Before we move on, don't forget the information presented in every episode of PediaCast is for general educational purposes only.  We do not diagnose medical conditions  or formulate treatment plans for specific individuals.  If there is a concern that you have about your child's health, make sure to call your doctor and arrange a face to face interview and hands on physical examination.  Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.  And with that in mind we will be back with News Parents Can Use right after this break.  



Dr. Mike Patrick:  All right, our News Parents Can Use is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website.  You can visit them online at medicalnewstoday.com.  
All right, first up is our swine flu update.

Karen :   Yehey.  It's a bad thing though.


Dr. Mike Patrick:   Yeah, I know.  But people have been writing asking lots of general questions about swine flu.  So, what's new?  Well, there is a vaccine that is in the making to help protect the population against the swine flu also known as the H1N1 or novel H1N1 meaning this new novel, new H1N1 flu strain.  And this vaccine being developed by Sanofi Aventis, they are a big vaccine manufacturer.  It's not quite available yet.  But the federal government wanted a plan on who gets it first.  So there is not a big rush. You want some kind policy who is going to get this vaccine.

Karen :   The most at risk people will get it first.

Dr. Mike Patrick:  Yeah, exactly.  And the advisory committee on immunization practices which is part of the CDC recently, in fact last week met and identified who should be the first people to get it.  They really narrow things down.  More than half of the US population is in the target group.  The committee says what, who should get this?


Karen :  Pregnant women should get it.

Dr. Mike Patrick:  And actually in our area there was actually a death of pregnant women, she give birth who have swine flu and she had pneumonia I believe and passed away.  Yeah, definitely, pregnant women ,

Karen :   And health care workers because they're exposed to a lot.

Dr. Mike Patrick:  And I already had been exposed to it a lot, going to knock on wood, you know I haven't ,

Karen :   That's from Ikea, is it really wood?  I'm not sure.

Dr. Mike Patrick:  It's pressed wood. So, health workers ,

Karen :   Caregivers of children under the age of 6 months, so you don't spread it to those babies.

Dr. Mike Patrick:  Yup.

Karen :   Healthy children and young adults ages 6 months to 24 years.  And those people under 65 who have chronic underlying medical conditions.

Dr. Mike Patrick:  Right, so if you take all those groups, that actually ends up being half of the US population.

Karen :   Wow.


Dr. Mike Patrick:  So half of the US population should be in the first round of folks who get this.  Interestingly, you may be asking yourself, we said those under 65, you know you usually think of flu shots are being important for the elderly and for young kids.  So why weren't anyone over the age of 65 included in this first round up?  It's kind of interesting that seems that the older population of Americans have pretty good immunity against this H1N1 virus because a similar flu virus that went around back in the day.  

Karen :   What day?

Dr. Mike Patrick:  Way back, back when people who were 65 and older were around and we weren't.

Karen :   I see.

Dr. Mike Patrick:  So they were exposed to a flu virus that was very similar to this one.  So, as a rule, generally speaking those 65 and older have pretty good immunity against this.

Karen :   Well that makes sense.

Dr. Mike Patrick:  Because of past exposures.  OK.  So, here's now where things get a little dicey.  The US government has contracted with the vaccine manufacturer to buy around 200 million doses of H1N1 vaccine.


Now to two dose series, because if you aren't protected against this new flu virus, you've never been exposed to it.  You've never had immunization against it before, so you need 2 doses of the vaccine.  So if they bought 200 million doses, that's enough for ,

Karen :   100 million people.  

Dr. Mike Patrick:  Right. Exactly, simple math, 100 million people.  So let's keep doing math here.  If the current US population  is over 300 million, and they recommend that half the population get the vaccine in the first round.  So they're saying that 150 million people should get this vaccine in round 1, but they only ordered enough for 100 million people.

Karen :   That's bad math.  They think 150 million people should get it and the first 100 million in line can have it, and then the 50 million, sorry about your luck.


Dr. Mike Patrick:  Yeah, and that's the first round, and they call it the first round.  Like there is going to be a second round.

Karen :   Right, right.  Well, they're just hoping that some people die off so there will be less they have to vaccine, I think.

Dr. Mike Patrick:  I don't know, I don't get that, OK.

Karen :   And really does that surprise you?  I mean it's the government doing this.

Dr. Mike Patrick: You're right, you're right.  And to make matters worse, apparently they expect that only 120 million of those doses, so enough for 60 million people will be delivered and ready to give by mid-October.  Now please if you're from the CDC don't email me and say I'm citing panic, I'm just reporting the facts.

Karen :   Right, right.

Dr. Mike Patrick:  You know, people can draw their own conclusions.

Karen :   I know I've drawn mine.  

Dr. Mike Patrick:  So , That's not pretty.  There's probably going to be shortages cause they didn't order enough to cover all the people that they recommend for it.

Karen :  Right. Now I have a question, do you think Pres. Obama will get vaccinated against the swine flu, H1N1?


Dr. Mike Patrick:  Absolutely.

Karen :   But wait, he is not a pregnant woman, that I know of.  

Dr. Mike Patrick:  Right.

Karen :  He is not a health care worker, he isn't a care giver for children  under the age of 6 months.

Dr. Mike Patrick:  True.  

Karen :   And he doesn't fit in the category  of healthy children and young adult ages 6 months to 24 years and those under 65 with chronic underlying medical conditions.  So why can he get it?

Dr. Mike Patrick:  Well, I think in fine print, at the bottom of their recommendations, they said and the leader of the Free World.

Karen :   Oh,  I didn't catch that. I need to get bifocals.  I didn't see that in the fine print.

Dr. Mike Patrick:  All right.  Now, OK.  Now, I'm going to get a little controversial  here ,

Karen :   No.

Dr. Mike Patrick: I think this might be a little foreshadowing of what life will be like with the looming proposition of federally controlled health care. Let's recommend half of the population get a vaccine.  In fact, say it's so important these people get it, that these are the first ones we should give it to, and then let's order enough for maybe half of them.

Karen :   Yeah. Do you think people are really going to line up for it though?


Dr. Mike Patrick:  Yeah, I think so.

Karen :   You think so?

Dr. Mike Patrick:  Yeah, I do.  

Karen :   OK.

Dr. Mike Patrick:  Usually people, nah, I don't want to get a flu shot but there is a lot of fear which is probably not warranted by in large. It is a more virulent strain of the flu than we usually see and infects lung tissue a little bit better than other strains of the flu.  But the media has hyped it up and there have been some deaths of young healthy adults in the United States.

Karen :   Right, right.

Dr. Mike Patrick:  So I think that yeah people should get it.  Now, this also, this is interesting, this is from the Government's Accountability Office, the GAO, and they released a report to congress last week and they said "the Federal government is not prepared for a potential outbreak of swine flu this fall….  Furthermore, they say, "federal agencies haven't addressed nearly half of the 24 recommendations that they made to congress last month".  


And during that house homeland security committee meeting last week, the government's H1N1 preparation came under fire with Bernice Steinhardt, Director of Strategic Issues at the GAO, he criticized the government for the lack of clear leadership in responding to this influenza pandemic, and he said the feds response is outdated and he pointed out significant response gaps at the federal state and local levels including the need for more hospital space and the resources in some parts of the country.  In response to this criticisms and concerns, Congressman Bill Pascrell Jr.,  a democrat from New Jersey proposed that the committee require the Department of Health and Human Services to answer the GAO's questions doggone it and their concerns and do it within three months.  

Karen :   Three months.

Dr. Mike Patrick:  And the motion met with approval by unanimous consent.  So, let's do the math again.  Three months is November.  So how much of this flu is going to be circulating by then?


Karen :   Hang on, let me count.  A lot.  

Dr. Mike Patrick:  Yeah, a lot.  And the reason is because it's usually when schools get started, that's when these viral infections  really get cranked up.  And so we started putting kids in room together again, in small rooms, close together.  And they start passing the germs and passed it on to their family.  And so there is going to be a ton of flu out there in November.  So right about the time when we need recommendations put into place, they're just going to reconvene by that time and say " OK. We're doing what we should be doing….  All right,  and these are the folks we want to run health care in this country.  I mean really? Really Gus?  Is that such a great idea? Exactly.  

Karen :   No, it's not.  But I do have a good idea.

Dr. Mike Patrick:  OK.

Karen :   I think you and I, we  should have a baby, seriously.  I mean, I don't fit into any of those categories there.  But if I can get myself pregnant ,

Dr. Mike Patrick:  No, you're right.  Because I fit in cause I'm a health care worker ,


Karen :   You're a health care worker.

Dr. Mike Patrick:  The kids both fit in

Karen :   Yeah, and I'm like left out.  So I could possibly be the only person in this family that dies from the swine flu because I won't be able to get the vaccine.  But if I can get pregnant, I can get the swine flu shot.

Dr. Mike Patrick:  There is got to be another way.

Karen :   You think.

Dr. Mike Patrick:  There's got to be.  

Karen :   Well maybe somehow I can get in the fine print with Obama ,

Dr. Mike Patrick:  We'll work on that.

Karen :   OK. First in line Obama, second in line, the co-host of PediaCast.

Dr. Mike Patrick:  That's in the even finer print.  All right, Tamiflu causing sickness and nightmares ,

Karen :   P.S. , just so that the listeners don't start spreading rumors, I'm not pregnant, so, there you go.

Dr. Mike Patrick:  Right, and you don't really want to get pregnant Kate ,

Karen :   No, no.  We just got a new a new cat, that's enough responsibility for him right now.

Dr. Mike Patrick:  I don't think cat owners are in the swine flu first dose group, OK.


Karen :   OK.   On to Tamiflu.

Dr. Mike Patrick:  Yeah, this comes out of the United Kingdom. Doctors in the UK are saying that more than half of children taking the drug Tamiflu experienced side effects such as nausea and nightmares.  An estimated 150 thousand people with flu like symptoms were prescribed with Tamiflu in the United Kingdom last week.  There a swine flu website/hotline. So if you have flu like symptoms, you can just call the hotline and get Tamiflu.

Karen :   Well, it's kind of like when we are in college.  It didn't matter what your symptoms were.  You could go in with a runny nose or stomach ache or broken arm, and they'd give you Sudafed.

Dr. Mike Patrick:  Right.

Karen :   You know, it didn't matter , Now Tamiflu instead of Sudafed, it's Tamiflu.  It will cure anything that ails you, just call the number, no liability there.

Dr. Mike Patrick:  Well, again, this is another fine example of nationalized health care which the UK has. It's sounds great.  Let's set up a 1800 number and if you have flu like symptoms, you can call and get it.  the only problem with that, is there is going to be a significant number of people who have flu like symptoms, one of the symptoms is sore throat who have streph throat ,


Karen :   Right.

Dr. Mike Patrick:  They'd get their Tamiflu, they don't treat their streph and they end up in a few weeks with rheumatic fever.

Karen :   Right, right.  

Dr. Mike Patrick:  So, I mean, you don't want to mess around with streph and you really need to see your doctor to distinguish, OK, you got flu like symptoms but is it just the flu or is there something else in them.

Karen :   Or if they have flu like symptoms that have already progress to pneumonia and they're just getting the Tamiflu and ,

Dr. Mike Patrick:  Exactly.  Bad, it's bad.  

Karen :   Viability.

Dr. Mike Patrick:  Now, if there really were people dying right and left of swine flu, I could understand it.  And if the medical system was totally overwhelmed, but to just have a 1800 number to call to get the medicine is just, I don't know, OK.

Karen :   Think of the money they are saving now not having to pay doctors to see all these people and all.

Dr. Mike Patrick:  Yeah, but Tamiflu is expensive.  OK, I digress.  The doctors apparently say that 85 children attending four different schools in the UK were given Tamiflu as a precaution after being exposed to classmates who have the flu.


Karen :   OK. I have a question, having heard Research Round Ups in the past, 85, that's not a very big number is it?  

Dr. Mike Patrick:  No, it's not really.  And the other thing is if you want to find out what side effects Tamiflu has on these kids, they're kids who have been exposed to the flu, right?

Karen :   Right.

Dr. Mike Patrick:  And so some of them may have gotten the flu and you're partially treating something that they already have and you just don't know it.  And we'll get into why that is important here in a second.  So 45 of the 85 kids experienced side effects.  So over half of them, 29% had nausea, 29% had stomach cramps, 20% had neuro psychiatric side effects, and that was defined as inability to think clearly, behaving strangely and having nightmares.  And 12% had problems sleeping.

Karen :   Problems sleeping not related to nightmares?  Cause they would think if you are having nightmares you'd have problem sleeping.  This is a whole separate thing?


Dr. Mike Patrick:  Yeah, I think so.  But see, if you want to really know the side effects of Tamiflu, you have to take healthy kids ,

Karen :  Right.  Just how many of these kids had the symptoms before they had Tamiflu, like nausea and stomach cramps.  Maybe they were constipated when they got put on Tamiflu or behaving strangely?  I think you need a something a little bit more objective than that.  Cause if anyone ask me, "Does your 12 year old son behaves strangely?….  Yeah, but is that because he is having a side effect from some medication or is it just because he is a twelve year old boy.  

Dr. Mike Patrick:    Right, right.

Karen :   12 year old boys talk strangely.

Dr. Mike Patrick:  So the news says all Tamiflu causes these things.  But we are looking at 85 kids who were exposed to the flu.  Now in Japan, so now let's move on to Japan here for a second.

Karen :   OK.

Dr. Mike Patrick:  Health officials there have recommended against prescribing Tamiflu to teenagers over fears that it causes a rise in these neuro psychiatric events.  So in Japan they are so concern about the inability to think clearly, the nightmares and the strange behaviors, they're saying, let the kids have the flu ,


Karen :   And possibly die.  

Dr. Mike Patrick:  It's possible.  It's low risk.

Karen :   It's a little risk but ,

Dr. Mike Patrick:  But it's there.

Karen :   Right.

Dr. Mike Patrick:  Yeah, yeah.

Karen :   Would you rather die or have a nightmare?

Dr. Mike Patrick:  And doctors in Japan say that about 20% of adults reported side effects of either nausea or vomiting after taking Tamiflu.  OK, so I do want to make some important observations regarding all these.  First, as I've said before, these are not clinical trials.  So they did not take healthy kids and give them Tamiflu and see what happens.  These are folks who either have flu like symptoms in Japan or they are exposed to the flu and have a very good chance of catching the flu before they are given the Tamiflu.  So let's see what are the symptoms of the flu? With the big three, it's going to be fever, nasal congestion or cough and sore throat.  But according to the CDC, and just so you don't I'm just making this up, there's a link in the Show Notes for you.  According to the CDC, substantial numbers of people with the flu report having abdominal pain, nausea and vomiting.  


And according to an article in The New York Times, and again, so you don't think I'm making this up.  There's a link for you in the Show Notes, according to an article in The New York Times, swine flu and seasonal flu as well often results in neurological complications including even seizures.  The flu can cause seizures and it can cause other neurological complications.  So I ask you, did these kids and the adults in Japan really have side effects from the Tamiflu or were they having symptoms of the flu?  What you think?

Karen :   Yeah.  It's hard to tell and it's a crazy study and I do the air quotes here.  

Dr. Mike Patrick:  Yeah, exactly.  Well it's possible  that the Tamiflu is to blame. I'll give you that.  But it's also possible it's the flu virus causing the problems and the problems still would have occurred and perhaps even had been worse without the Tamiflu.  So, why would the United Kingdom and Japan use the media to scare people and to not taking Tamiflu?  Why would they do that?  


Karen :   I have a sneaking suspicion you're  going to diss on the whole national health care system here.

Dr. Mike Patrick:  Yeah, yeah.

Karen :   And get some hate mail in the process.

Dr. Mike Patrick:  Yeah, probably.  But no, the United Kingdom and Japan both have nationalized health care plans.  So that means that they have to pay for Tamiflu if a doctor prescribes it and they and they want to keep their cost down, I don't know.  Well the other argument would be why are they having this hotline in the UK that people can just call and get Tamiflu.  So I guess that would , Don't write me email, OK.  That's the refute to that one.  But there was a time in Canada a few years ago that they used some really shady research to suggest that Adderall, the medicine for ADHD which is expensive, shouldn't be used because of heart problems.  And they stopped letting doctors prescribed it and they have to go back prescribing old fashion Ritalin and then they finally came around and said yeah, that was crummy research.  


Karen :   Don't say funny.  

Dr. Mike Patrick:  OK fine, we'll pay for it. All right. So anyway,  I guess the question ended up people are going to ask if Tamiflu could cause a problem, what's my opinion on this.  Cause a lot of people I know, hey Dr. Mike, what do you think?  I think ultimate thing is what I do for my own kids.  If they have flu like symptoms, I'd put them on Tamiflu, personally.

Karen :   Oh yeah , Yes, I rather they have a nightmare than die.  

Dr. Mike Patrick:  Yeah, exactly. OK.  All right, let's move on, we do have some non-swine flu news here.  This is an interesting one.  And I kind of indulging myself.  And this will probably be a little bit more interesting to people in the health care field especially fellow physicians, I thought this was interesting.  Appendicitis is the most common childhood surgical emergency diagnosis and it can of course be challenging to diagnose appendicitis.  Even with the use of lab work and radiologic procedures such as CAT Scans and ultrasounds, appendicitis often leads to unnecessary surgery in kids who didn't really  have appendicitis and that still happens in about 30% of cases.


So about 30% of the time in kid that has appendectomy, the problem was not really appendicitis.  It's constipation which is the leading reason behind it.  And then also if you missed appendicitis and the appendix ruptures, a serious complication can occur when that happens and that actually happens in 30 to 45 percent of cases of appendicitis.  So, 30% of the people who have their appendix out didn't really have appendicitis and 30 to 45 percent who have their appendix out, it actually ruptured before they were diagnosed with it.  So it's still a challenge ,

Karen :   Yeah, but how long did they wait at home?  I mean you just can't say,…Oh, because it took so long to figure out what it was….  Maybe they wait at home and endure it for a while and walked in with it ruptured.


Dr. Mike Patrick:  Right.  But there's probably still a few of them that did see a doctor and didn't get the right diagnosis.  You know, if you are constipated and it really was their appendix.

Karen :   That's right.  I call it practicing medicine.

Dr. Mike Patrick:  OK. Well, moving on researchers had Boston Children's Hospital are looking at a simple urine test to aid in the diagnosis. They have found seven different bio markers that are consistently seen in the urine of kids who have true appendicitis and that aren't in the urine when they don't have appendicitis.  And the best of these markers appears to be a protein called Leucine-Rich Alpha 2 Glycoprotein which the body seems to produce only in response to inflammation in the appendix.

Karen :  By the way, write that one down cause it's going to be in the final exams.

Dr. MIke & Karen :   Leucine-Rich Alpha 2 Glycoprotein.

Dr. Mike Patrick:  Yes.  This protein marker has a coat area under the curve value of 0.197.


Karen :   No.  No, sorry 0.97.

Dr. Mike Patrick:  What did I say?

Karen :   0.197.

Dr. Mike Patrick:  See, that's why you're the co-host.  To keep me honest.  Cause the statisticians out there like that's not very good.  

Karen :   Right, I do the urine test.

Dr. Mike Patrick:  So the area under the curve is 0.97.  What that means is that it has near perfect sensitivity and near perfect specificity.  Meaning that there's almost no false negatives and almost no false positives.  So investigators are now trying to develop a reliable and easy way to test for this protein in hospital laboratories, right now testing is cumbersome because it requires a mass spectrometer and those are not available in most clinical labs.  So they went and develop a rapid clinical test such as a urine dipstick that could be used in hospitals and doctors' offices. The researchers also were on their findings were limited to children with appendicitis and they say further studies are needed to see if this urine bio marker would be a reliable indicator of appendicitis in adults.  So we'll keep a close eye on this one folks.  I mean a rapid urine screen for appendicitis at your doctor's office would be a fantastic tool.


Karen :   But they would cost money and under the National Health Care System that would be frowned upon.

Dr. Mike Patrick: OK.  Now you're getting a little too cynical even for me. Because the cost of unnecessary  surgeries is even higher.

Karen :   Right. True.

Dr. Mike Patrick:  So, this really have the potential  to save many kids from unnecessary surgery and it has the potential to aid an earlier diagnosis of appendicitis thereby preventing appendix rupture and subsequent complications and it has the potential to reduce radiation exposure.  Because all of these kids wont need CAST Scans.

Karen :   A little story here, when I was a freshman in high school, before I met you, it was finals week to be exact and I had appendicitis. Belly pain, fever, vomiting and that sort of thing.  And seriously, a doctor looked me over, pushed on my belly, think he ran a CBC and said, " Yup, it's appendicitis….


And went in, took out my appendix that was just starting to rupture. So it was like some 23 years ago.  Back when doctors could be trusted to make decisions based on clinical findings.  They didn't have to rely on CBC and CAT Scan and a urine test and all these things.  My surgical report that I actually read said my appendix was starting to rupture so I'm glad I didn't have to wait around to have all these test on and have the results analyzed and all that stuff.  So, the whole thing could have burst while I was laying there waiting.  

Dr. Mike Patrick:  Yup, yup.

Karen :   And that's not good.

Dr. Mike Patrick:  No, it's not.  But you know, that though, you had an experience back then there was still a third of kids who did get their appendix out and it was fine.  

Karen :  Do you have a link for that research?

Dr. Mike Patrick:  No.

Karen :   That says back 23 years ago?

Dr. Mike Patrick:  I learned it in medical school.

Karen :   Oh, did you. OK. Fine.  Trumped.

Dr. Mike Patrick:  So I'm going to say kudos to the researchers who are looking into this.  And we wish them God speed in finishing their investigation and producing a usable desk.


Karen :   Dude, did you just used the term "God speed…?

Dr. Mike Patrick:  Well, you know, we live by NASA now.  And I don't know, God speed just reminds me of astronauts.

Karen :   Which then all boils back down to urine test for appendicitis.

Dr. Mike Patrick:  No, it's , Well OK, never mind.  Do we really need a co-host?

Karen :   First week and I'm fired.

Dr. Mike Patrick:  No.  All right.  Let's take a break and we'll be back and we'll actually going to have our Research Round Up.  We're going to talk about CPR in nine year olds right after this




Dr. Mike Patrick:  OK.  We are back and we are going to do a Research Round Up here for you.  Kids as young as nine, can and should learn  CPR.  This comes out of the Medical University of Vienna in Austria and was study completed by Dr. Frtiz Stertdz and colleagues and was published by in the journal, Critical Care, July 2009 edition.  Now, the question before the researchers, can young children as young as age nine learn to perform effective CPR and could they retain this knowledge several months after learning it.  OK, so what did they do?  This was a prospective study, so they recruited 147 children.  The average of the children was about 13 years old and the youngest in the group were 9 year olds.  


And these 147 kids underwent 6 hours of CPR and life support training.  And the six hours of training included learning how to properly position a life dummy, Resusci Anne, to evaluate vital signs and to perform effective CPR.  They also learn to effectively activate the emergency response system.  They learned how to deploy an automatic external defibrillator or AED.  And they learned how to perform effective CPR.  So they learned to do all these things and they waited for four months and then the researchers assessed each child's life support knowledge and their ability to perform each of these five tasks on a hands on skills lab again four months after they actually had the class.  They also noted each child's age, gender, weight, height, and body mass index or BMI and looked for patterns between these variables in the   outcomes of their knowledge and skills assessment.  


OK, so what did they find?  The results are that all the children, every single child scored 80% or higher when tested on their life support knowledge and their ability to perform the skills that they learned in class.  And that knowledge and skills included again proper positioning, activating the emergency response system, obtaining vital signs, using an AED and performing CPR.  So, 80%, all the children scored at least an 80% when they were tested on their knowledge and their skills.  But then the next question was, was the CPR that they were performing effective?  86% performed effective chest compressions with correct depth of compressions and the correct number of compressions per minute and 69% of them performed effective rescue breaths with correct positioning of the airway and an effective volume of air delivered.  


Now how did age, gender, height, weight and BMI effect this outcomes? Well in terms of knowledge, there was no significant association.  So the youngest and the smallest of the kids did just as well as the oldest and the biggest of the kids and the boys and the girls did equally well in terms of their knowledge and knowing what to do.  But then in terms of how effective was the CPR, where there was no association with sex or age, so the nine year olds all the way up to 13 and higher, all did it effectively, I mean, there was no difference by age and there was no difference by sex, male or female either.  However,  there was a difference when you look at their height, weight, and BMI regardless of their age.  So the depth of compression and correct volume of air delivered was significantly linked to a child's weight, height and BMI.  So the bigger kids did it more effectively.  But the younger kids who were smaller still knew all the right ways to do it, it just that because they were smaller, they weren't able to physically do it.


Karen :   Right.  That makes sense.  It's hard to get the correct volume of air into an adult when you're a child breathing out. Your lungs can only hold a certain volume of air.  

Dr. Mike Patrick:  Right. So it's the physical limitation.  But even the nine year olds who were small knew what to do.

Karen :   And I guess if I'm laying there dying I'd rather have a small nine year old at least attempt to save my life than ,

Dr. Mike Patrick:  Or the nine year old can tell the adult what to do.  Like this is what you're supposed to be doing.

Karen :   Cause kids love to tell adults what to do, it will be perfect.

Dr. Mike Patrick:  So the authors conclude that students as young as nine years are able to successfully and effectively learn basic life support skills including AED or automated external defibrillator deployment, correct recovery positioning and activation of the emergency response system.

Karen :   That may be the only thing, I mean putting an AED in the hands of a nine year old.  


Dr. Mike Patrick:  What if they had a class and learn how to do it and knew this was serious business.

Karen :   These are the kind of kids that take magnifying glasses and fry ants on the sidewalk.  You know what I mean, you get an electronic or electric type thing on the hands of a nine year old

Dr. Mike Patrick:   But they're also the kids that can program the VCR.  Well, OK, people don't have VCR's.   Well they were the kind that could program the VCR let me tell you.

Karen :   That's right.  Back in the day.

Dr. Mike Patrick:  As an adult, physical strength may limit depth of chest compression and ventilation volumes but skill retention is good, again this is what the authors are saying.  Because BMI and not age was significantly correlated to depth of compression, it will indicate that a well-built nine year old child would be just as capable as an older child at performing CPR ,

Karen :   And yet, we want to keep our kids thin and trim and have them play outdoors and not sit around and play video games and get obese.  But here if they're a little overweight, they'd be so much better at CPR.

Dr. Mike Patrick:  That's a good point.


Karen :   Going to fatten them up.

Dr. Mike Patrick:  The authors also say that given the excellent performance by the students evaluated in the study, the data support the concept that CPR training can be taught and learned by school children and that CPR education can be implemented effectively in primary schools at all levels.  And even at physical strength, even though physical strengths may limit CPR effectiveness, cognitive skills are not dependent on age or size and with periodic retraining, children performance would likely improve over time.  So this is an interesting study that suggest kids as young as nine can learn CPR.  So my questions to parents out there, does your child school teach CPR?  I didn't learn it in school.

Karen :   What about medical school?  Did you learn it there?

Dr. Mike Patrick:  We're talking grade school.  Yes, I learned CPR in medical school.

Karen :   I actually learned it in high school, in that local fire station.  But I was kind of weird like that.  I did things in high school that most people thought weren't typical at my age.

Dr. Mike Patrick:  But you did a lot of babysitting.


Karen :   I did do a lot of babysitting.

Dr. Mike Patrick:  So you are being responsible learning to do CPR so you'd be able to do it as a  baby sitter if you have to.

Karen :   Yeah, I don't know if that was my motivation.  I think my motivation was just getting to go to the firehouse and seeing the stuff there and hey cool, I can learn CPR.

Dr. Mike Patrick:  I think this is a good idea.  I think schools should implement CPR training at a young age.  They should start teaching it.

Karen :   I mean for us, we really should have our kids learn CPR because my cholesterol level right now is wavering somewhere between critically high and complete and utter cloggings.  So it would really be a good thing to teach our kids CPR.

Dr. Mike Patrick:  Yeah, you're right.

Karen :   My own personal safety.  

Dr. Mike Patrick:  And you know, they really don't know it, do they?  Katie did.

Karen :   Katie did.

Dr. Mike Patrick:  Katie did a babysitting class that included ,. And I like the fact that they included AED deployment. Cause I can see it now, OK.  Guys falls over, old guy, I was calling him old guy ,

Karen :   OK. It's more likely.


Dr. Mike Patrick:  Yeah, falls over, grown-ups are all gawking, ten year old Bobby yells for someone to call 911, checks the guys vitals, gets him in proper position, perform CPR, yells for someone to breakout the nearby AED, places it correctly, turns on the machine, tells everyone to stand back, the machine shocks the guy, and he lives.  I mean that's awesome.  

Karen :   That is awesome.   But why does it have to be Bobby?  How come you couldn't pick a girl name there?  I mean the research showed that the girls did just as well as the boys.

Dr. Mike Patrick:  That's why I have a co-host.  There's a woman.  I picked a woman for a co-host.

Karen :   Cause you picked a woman for a spouse.

Dr. Mike Patrick:  All right.  And if we don't  , You know the reason that your cholesterol may be wavering so high though, we went and took a trip to, it's kind of fun living in Florida because there's some really cool one tank trips you can take.  So we went down to Sanibel Island Captiva in ate at the Bubble Room.

Karen :   Thanks to Emily, Mike's cousin who was at Fort Myers.  She heard we were coming down there for a little visit. She said, "Oh, you got to go to the Bubble Room….  And like, four hours later there we were put down.


Dr. Mike Patrick:  Yeah, the appetizer, they make their own potato chips.

Karen :   They're called Moons Over Caroliners, something crazy.

Dr. Mike Patrick:  Yeah.  Homemade potato chips

Karen :   Homemade potato chips.  As if that's not fatty enough.

Dr. Mike Patrick:  And then cheese ,

Karen :   Oh yeah, if that's not fatty enough,
Dr. Mike Patrick:  Bacon bits.

Karen :   OK.  Let's dip it in some sour cream.

Dr. Mike Patrick:  Oh, man.  They were good.

Karen :   Oh, they were so good.  Clean that thing.   When do you want to go back?  After we teach the kids CPR.

Dr. Mike Patrick:  Yeah, that's the time.  All right, let's take another break and we'll be back and we'll answer your questions right after this.




Dr. Mike Patrick:  OK.  All of our questions are medically related this week.  So I have to answer all of them.  

Karen :   That's okay.

Dr. Mike Patrick:  But seriously folks, send in some parenting questions and that takes a little stress off of me.  So what we're going to do here is Karen is going to read the questions and I'll respond.  

Karen :   OK.  This is from Elizabeth in Cedar Park, Texas.  And she writes, "Dr. Mike, my 11 year old son was recently diagnosed with community acquired MRSA abscesses in his groin and rear end.  They required surgical drainage and I have to say that the research that we did on MRSA was very scary.  My question is in regards to your latest podcast… which could have been months ago. "Where you reported on research that showed the effectiveness of bleach on surface areas to kill MRSA.  Other than the strong antibiotics and antibiotic ointments.  Are there any other homeopathic options to treating MRSA infections".


"We've been told that there's  no way to tell where my son got MRSA or if one of us in the household maybe carriers short of undergoing testing.  And I would like some options in case one of us developed a hard to treat infection.  Thank you very much for all the information that you provide in PediaCast.  I've been listening for a little over a month and I've listened to almost a year of podcast….  Wow that's a lot.

Dr. Mike Patrick:  That's dedication.

Karen :   Like 24/7,"Sincerely, Elizabeth….

Dr. Mike Patrick:  OK. Elizabeth, I have to be kind of nice to you because you listened to my voice for a month, like over lots of shows over a month's period of time.  But why are you searching for a homeopathic remedy?  I can understand that for a less serious thing, but MRSA is a bacterial pathogen and you want to kill it.  You want to kill this bacteria, why do you want to kill it?  Because it's an invasive organism.


It starts on the skin and creates an abscess, it can then move to the blood and cause sepsis.  It can move to spinal fluid and cause meningitis or the bone and cause osteomyelitis.  So this is a bacteria you want to kill.  And what must you use to kill it?  Well the obvious answer is you use whatever it takes.  And it doesn't really matter what you call it, if you have something you call a homeopathic agent that's going to kill it, fine.  But more than likely, you're going to need an antibiotic to kill it, cause those are designed to kill bacteria.  So,  I'm going to recommend to you a homeopathic remedy, no.  Is your doctor going to recommend one, no.  Why?  Because we want you to get better.  We don't want the bacteria to spread and risk it killing you, we want to use something proven to kill the bacteria in question and I personally don't know of any homeopathic agent that would do this.  And I don't think your doctor knows one either.  If you want to try one, that's your prerogative, but it just doesn't sound like a very good idea to me.


Now the question is why is MRSA scary?  I mean, why do you have to use more powerful antibiotics as Elizabeth put it.  Well it's scary because it's resistant to many antibiotics and we fear it could become resistant to the antibiotics we have left to treat it which means it could go unchecked and cause lots more disease and death.  Now does this mean that it is a stronger organism or that it requires a stronger antibiotic, not really.  No one antibiotic is really stronger than another.  They just work by different mechanisms of actions, that' all.  There really is no strength factor here.  Let me give you an example,  amoxicillin works by inhibiting a bacteria's ability to make a cell wall and that causes the bacteria to die.  Now, some bacteria make a substance that makes the amoxicillin not work and it's called beta lactamase.  So, what we do now is we add in chemical to the amoxicillin that makes the beta lactamase  that the bacteria makes not work.  So now the amoxicillin part of it can work.  


And this combination drug is called Augmentin.  So Augmentin has amoxicillin in it.  It really just works same way as amoxicillin does but it's quote stronger because it has this other agent that makes the chemical that the bacteria is making not make the amoxicillin not work.  

Karen :   That's a lot of double negative.

Dr. Mike Patrick:  I know.

Karen :   But I understand.  Hopefully your listeners will too.

Dr. Mike Patrick:  So, it just adds a second layer of mechanism.  It's not really stronger.  So why then the Augmentin stop working, well because the bacteria mutates and it makes a cell wall in a different way, a way that is no longer bothered by any of the penicillin antibiotics, which amoxicillin and Augmentin are a part of.  So what now?  Well, we find a different way to disrupt cell wall formation and these are the syphilis poring group, Keflax, Omnicef,  Suprex and others.


But bacteria again can mutate and make cell wall and yet different ways and bypass the disruption that's caused by the syphilis poring antibiotics.  What about Zithromax and the erythromycin group?  Well they work by shutting down production of certain proteins inside the bacteria, but what if the bacteria mutates and doesn't need those proteins in question, well then it develops resistance.  Or what if the bacteria mutates in such a way the antibiotic no longer enters the cell, where the antibiotic immediately gets pumped out of the cell, then the antibiotic stops working and we have resistance.  What about the Sopho group of antibiotics, their clindamycin, vencomycin, will they all work by different mechanism and they still kill many strains of MRSA that are out there but does that make this antibiotics stronger, no. They just work by a mechanism that happens to kill the bacteria.  That doesn't make them stronger.  It just makes them different.  And this is important.  Why am I going into this.  It's important because people get this fear like, "Oh, we have to use stronger and stronger antibiotics making it seem like these antibiotics are evil, like these are the strong antibiotics.  


Like they're something different and more powerful about them or that that bacteria is more powerful.  And it's not really about power, it's just different.  So, this is important because the terms stronger antibiotic gives the impression the drug is somehow more evil but that's not really the case.  It just works by disrupting some process that the bacteria needs in a different way.  So if you have some homeopathic agent that will do the same thing, go for it.  But I think it's unlikely that you're going to be successful in finding that.  Now from this discussion, I hope you can see why inappropriate use of antibiotics is bad.  Bacteria are pretty simple creatures.  Their genetic code can mutate easily without killing the organism.  And if you exposed them to antibiotics that killed the herd, there is going to be one or two with life saving mutations.  They reproduce and now you have a resistant herd of bacteria that's no longer sensitive to a specific antibiotic and sort of just a natural selection.


I'm not saying I believe in evolution and made human beings, I'm just saying if you look at a simple level, the antibiotics is going to kill most of the bacteria but there is going to be one or two that have mutated so that they are able to live even in the presence of the antibiotic and that what makes them resistant.  So it's not a good idea to treat with antibiotics when a disease is caused by a virus because you're just making resistant strains of bacteria.  So what can you do to prevent MRSA? It often lives on the nose, so you can talk to your doctor about it using a topical antibiotic for everyone in the house up inside their nose for a few days to kill the dormant MRSA that happens to be living in you.  And then once you have MRSA, don't wait for it to become a huge abscess that requires surgical draining.  I mean if your child has red firm skin lesions, have someone look at it pretty quickly and don't wait for it to get out of control.


All right, I think we beat that one as far as we can go.  So let's move on.

Karen :  This is from Carmen in Saskatoon, Saskatchewan, Canada, love that.  

Dr. Mike Patrick:  Far away.

Karen :   Far away, where it's cold.

Dr. Mike Patrick:  Carmen from far away where it's cold.

Karen :   "Dear, Dr. Mike.  I notice that my three year old son's body temperature will increase to fever levels after a hot bath or playing outside in heat.  Usually it will increase to 38.1 to 38.2 degrees Celsius after being outside but has gone as high as 38.5 to 38.7 after a bath.  I'm concerned about this increase in temperature because my son has epilepsy and has had seizures due to this temperature increases.  Can you explain to me how body temperature works, why the body allow the temperature to increase to this levels instead of regulating it better and tell me if this is normal for body temperature to increase like this".


" What is the normal body temperature range and what temperature is considered a fever.  I, of course, am going to ask his doctor about it too but wonder what you have to say about it.  Thanks….

Dr. Mike Patrick:  All right.  Well the rest of the world are using Celsius, silly Americans need to do some conversion here.  So 38.1 is equal , This is the range you are talking about after playing outside, 38.1 to 38.2.  That's 100.6 to 100.8, and then after a hot bath, you are talking about 38.5 to 38.7, that's 101.3 to 101.7.  So after playing outside, your child's body temperature is 100.6 to 100.8 and after a hot bath it's 101.3 to 101.7.  Those temperatures don't really surprise me if you take the temperature immediately after they've been playing or immediately after they get out of the bath tub.  


Because play generates heat, so that increases the core body temperature and soaking in a hot bath is going to transfer heat and that's also going to increase your core body temperature.  Now your body has mechanisms to dissipate heat, skin vasodilation occurs and basically what happens with this is your skin acts like a radiator.  The blood vessel in the skin dilate and you sweat so that heat can be transferred from the blood vessel to the skin and then as the sweat evaporates, the heat is transferred to the surrounding environment.  That process though is not immediate, it works very quickly once the heat source is removed but it's not instantaneous.  So you do have a little cool down period there.  Now how fast does it happen.  Well it depends on the ambient conditions and the person's body.  But I'll say 30 minutes is a good guess for most people.  So as long as the heat source is removed.  So you stop playing or you get out of the bath tub, and the ambient conditions are favorable, it's regular room temperature, then your body temperature is going to return to normal pretty quickly, definitely I'd say within 30 minutes or so.


And if the temperature does not return to normal, then you worry about over exposure, heat stroke, infections, maybe they really do have a fever, metabolic problems, central nervous issues.  But I suspect, Carmen, that your child's temperature is back to normal within 30 minutes or so.  And if it's not, then I would definitely talk to your doctor about that.  Now,  let's a little bit about the epilepsy component of this.  We aren't talking febrile seizures here. We've covered those in details during past episodes and if you are interested in learning more about febrile seizures, I'd encourage you go to  PediaCast episode number 72 and we'll have a link on the Show Notes for you so it's easy for you to find.  Just a recap of febrile seizures.  They likely result from a rapid change in body temperature.  And children  with genetic predisposition to having this happen, they're short lived, they're not dangerous and  their most common or simple form and they are not related to epilepsy.


So this is a different issue altogether.  Now the question before us now is this fever cause seizures in epileptics and if so does fever from physical activity and bathing causes seizures.  In other words, is fever from activity and from a hot bath somehow different than fever from illness.  And this is not an easy question to answer.  But epilepsy is not one uniform illness.  It's really a diverse group of disorders whose common feature is recurrent seizures.  And different forms of epilepsy have different triggers.  So for some people flashing lights may incite seizures and some kids with epilepsy but not others.  Drugs such as antihistamines  may lower the seizure threshold and can result in seizures in some kids, but not others.  And fever may be associated with more seizures that some epileptics, but not in others.  


So in your case Carmen, you have noticed a correlation between seizure and fever in your child's form of epilepsy.  But here's the next question, is it really the fevers fault that causes the seizures in your epileptic child or is there a common underlying issue that can cause fever and lower the seizure threshold meaning make it more likely for your child to have a seizure, but what do I mean by this.  Well, infection leads to inflammation.  The immune system is revved up and lots of body chemicals are involved in this process.  This are the chemicals that result in fever when you are sick.  When you have an infection.  And in some of this kids, the same chemicals that your body is making, that can cause fever also lower the seizure threshold, other words make it easier for your body to have a seizure.  Now is this a case of fever causing a seizure, no.  It's a little different.  The underlying chemicals involved in the inflammation are causing the fever and lowering the seizure threshold.  


So there's a difference and an important difference because these chemicals are not in play when fever is cause from physical activity and hot baths.  So fever from infections is different than fever from  internal exertion or external sources such as a hot bath.  So, Carmen, the question you really have to ask yourself is this, when your child in the past has had a fever and a seizure together, was your child sick?  If so, that's not surprising and in the future your doctor will likely advise Tylenol or Motrin to keep fevers and inflammation, especially Motrin, down during illness in order to prevent a recurrence of the seizure, because by using Motrin, you decrease some of the inflammatory  chemicals and processes in the body so that may help to prevent the seizure from happening.  But that doesn't of course mean that you should constantly take your child's temperature when they aren't  sick, cause that's not really helpful and probably just annoying your child.


But if your child had fever and a seizure and was not sick in the past, but they were physically active or taking a hot bath, and that's when they had their seizure, then you might have a reason to worry about this.  So a lot of this in deciding whether it's something to worry about as to look at past history because things patterns seem to copy themselves over and over.  So in that case, which I imagined is not the scenario that you are facing, Carmen, then you may want to avoid certain prolong physical activity where they can over heat and you may want them to avoid prolong hot baths if in fact they've had seizures in the past with fevers that were not associated with illness.  But of course talk to you doctor about this because of course we are about explanations and education here at PediaCast and not specific medical advice as you know.

Karen :   You've covered that one pretty well.  I have nothing to say.

Dr. Mike Patrick:  OK.

Karen :   You said, I'm not going to the dead horse, so, I'm not into dead horse feeding either.


Dr. Mike Patrick:  OK.

Karen :   OK.  Next question is about breast feeding and alcohol.  It's from Sarah in Phoenix, Arizona, where it's warm.  " Hello.  I know in recent shows you have discussed a certain aspect of breastfeeding however, I haven't come across an answer to my question.  On occasion my fiancé wants me to enjoy glass of wine with him at night, however since I breast feed, I'm worried it will go through my to my breast milk.  So my question is how much alcohol actually filters into the breast milk? Do we need to pump after a glass of wine?  If so, do we need to pump immediately after drinking the glass or 30 minutes later.  I seemed to be a bit confused about this aspect of breastfeeding, please help.  Thanks, Sarah….

Dr. Mike Patrick:  OK.  Well, let's talk first about why do you not want your baby to have alcohol?  It seems obvious, now let's think about it.  It's a CNS or central nervous system depressant.  It can cause drowsiness which is not always a bad thing in babies  especially when colic hits.  


But it is also causes respiratory depression which can then lead to apnea which can lead to death.  So this is an important question, you really don't want your kid, your baby to get a lot of alcohol in their breast milk because it can decrease their drive to breath.  So it's an important question, how much alcohol gets into breast milk, how long does it stay there and what's the safe exposure level for your baby?  So let's tackle this questions one at a time.  We're talking here about ethanol, that's the type of alcohol that's in social  drinks and ethanol easily enters breast milk and in fact it enters so easily whatever your blood alcohol level is your breast milk alcohol level is going to be the same.  So, it completely diffuses into breast milk.  But the good news is it also leaves breast milk just as easily as it goes in.  So as your blood alcohol returns to normal, the amount of alcohol in your breast milk is also going to return back down to zero.


So as it turns out, ethanol remains in equilibrium or ethanol in the breast milk remains in equilibrium with the ethanol that's in the blood.  So as ethanol is cleared from the blood it's also cleared from the breast milk.  So because of that there is no reason to pump and discard after drinking.  How long does it take to clear the ethanol from the blood and from the breast milk.  Well, the rule of thumb is two hours for a single alcoholic beverage and a single serving is defined as 12 oz. of beer, 5 oz. of wine, or ½ oz. of 80 proof liquor.  So it's basically one beer, one small glass of wine, or one shot of 80 proof liquor.  And so for each of those, it's two hours is how long it's going to take for it to clear.  And each additional serving is going to require an additional two hours.  Now, breast feeding mother should limit themselves really to one serving per day, why?


 Well, you want to avoid excess time constraints on your infants feeding schedule.  Too much alcohol actually decreases breast milk production and results in another maternal health issues like poor nutrition and liver damage.  OK. And what about the last of our questions, how much alcohol exposure in breast milk is too much for baby.  I'd say any amount is too much.  Which is why you should wait the full two hours after a single serving and limit yourself to just one serving per day.  So see, it's really easy.  One beer, one small glass of wine or one shot once a day, wait two hours afterward, pretty easy. And usually we don't have such easy answers on PediaCast.  It is not OK to judge how the alcohol is making you feel, because it will take much less , So in other words if you drink and maybe you drink three beers and you think, "Oh, I feel fine, I'm breathing fine, there's not going to be a problem, I've waited a couple of hours, I feel great….


But remember, if you take three drinks, it is going to take six hours for it to clear and it will take much less ethanol to cause respiratory depression in your baby.  So you may feel fine after you done drinking but it doesn't mean your baby will feel fine with that same concentration of alcohol in his or her blood and brain.  So you may feel fine but it could still cause your baby to stop breathing.  Alcohol exposure has also the potential to cause long term developmental issues, how much does that take, well, we really don't know.  And I don't think you want your baby to be the case study that helps us find out, right? So, again to sum up, breast feeding moms should limit themselves to one drink per day, should wait two hours after that single drink to breast feed again, there is no need to pump and discard between drinks in your babies next feeding.  And again the definition is of one single drink, is 12 oz. of beer, 5 oz. of wine or 1.5 oz. of 80 proof liquor.


Karen :   Hold, wait a second, did I miss it in there somewhere.  I might have been actually say Facebooking while you are reading or telling them your answers.  On the off chance that I was, I might have been ,.

Dr. Mike Patrick:  This is what happens when you get a free co-host, OK ,

Karen :   Free? We never talked about free.

Dr. Mike Patrick:  We didn't discussed that.

Karen :   OK.  I want to make sure, did I missed it. You talked about how long it takes to clear a single serving of alcohol from the blood unless from your breast milk, but how fast does it get from your mouth to the breast?  I mean, let's say I'm going to nurse my baby, can I drink the wine while I'm nursing?  

Dr. Mike Patrick:  Do you really need an answer to that?  Bad idea.

Karen :   OK. All right. So as soon as the baby is done, then I can drink my one serving.

Dr. Mike Patrick:  Yeah, yeah. Make sure the baby is in a safe place while you're drinking.

Karen :   I'll give it to you.

Dr. Mike Patrick:  That's why we're not going to have another baby.

Karen :   It makes me sound like a muss giving up alcohol to breastfeed.

Dr. Mike Patrick:  OK.  I hope that helps Sarah, really.  OK, that was supposed to be the final question, but I have one more quickie for you here.


Karen :   Wait a second, you're the one who wrote the script, so you would have known that that wasn't the final question for the whole , That was the last question is just a teaser, die you're so sly.

Dr. Mike Patrick:  Well, you know, I ,

Karen :   Oops, that means it's my turn.  Stephanie from  Hathaway Pines, California says, "Hi, Dr. Mike.  I love your show.  Could you please discuss dry drowning and the symptoms since summer is here and many are turning to the pool to cool off, I thought it will be an appropriate subject.  Thanks and have a great summer. Stephanie".

Dr. Mike Patrick:  OK.  Dry drowning, how can that be a quickie?  Well because I already did it.  And I did it in really great details in PediaCast episode number 133.  So look for the link in the Show Notes, Stephanie and you'll be able to find out all you need on dry drowning.  Again, PediaCast episode 133.  By the way, the search capacity of the website is working now.  


So if you go to pediacast.org, click on the Search Link, you can put basically any term in there and it should bring up what shows we've talked about these different topics.  All right, we are going to take a break and we will be back to wrap up the show right after this.  


Dr. Mike Patrick:  All right, thanks go out to Nationwide Children's Hospital for helping us out with the bandwidth for the program today.  Also Vlad over at Vlad Studio for doing the artwork.  Medical News Today.  Our children, although they really didn't suffer from this one because they're visiting grandparents in Ohio.


Karen :   Like 5 weeks.  I miss those little tykes.

Dr. Mike Patrick:  I know, they're spending a couple of weeks with your parents and a couple of weeks with mine so they are away from us.

Karen :   I know, but they are having tons of fun.  They're going to Canada and they went to the top of the statue of Liberty and they're going to Dave and Buster and eating all the food that we don't have down here like Red Robin and Graters and Donatos and La Rosa's ,

Dr. Mike Patrick:  They went to Ground Zero.

Karen :   They did go to Ground Zero.  That's very, very cool.

Dr. Mike Patrick:  So thanks to them.  OK, maybe we'll just send our love to them.  We'll thank them when they're here and we're ignoring them to do podcast.  And of course thanks to listeners like you, who have persevered in the absence of PediaCast.  And we, our pledge to you is we're back to the weekly programs here.  

Karen :   To send me an email, saying that you miss the show, send them to me cause obviously it doesn't work when you send it to him.  Send them to me and I can nag him. Come on, come on, we got to do a show.

Dr. Mike Patrick:  How do they send them to you? It's still pediacast@gmail.com and I'll forward them all to you?


Karen : No, no.  Just ohiominnie@gmail.com and I just can nag him for you.

Dr. Mike Patrick:  OK.  There you go. All right. There you have it. Don't forget that iTunes reviews are always helpful, especially if you found us through iTunes and you saw all the great reviews that we have there, if you can contribute to the chatter, that will be excellent. Because reviews in iTunes are always very helpful. And we also do have a listener survey that you can get through the website. It doesn't take very long at all.

Karen : And feel free on that one to comment on how much you love having me as the co-host. Cause it sounds like from what Mike said on this episode, my job may be on the line, OK. I may be getting fired after the first time. Make sure you fill out that list of their survey and say how much you love me as the co-host.

Dr. Mike Patrick: As long as your salary continues to be free, we'll keep you around. If you start asking for money, then you may have to go.

Karen : OK.

Dr. Mike Patrick: Because our budget here is really limited.


Karen : And you didn't put it in the reminders, but I added it, I need a new blog name. Because PediaScribe which was great when it was sort of a medical thing. You know, Pedia, about pediatric and kids. And Scirbe that you are writing. But, since I've taken over the blog it's pretty much it's been as far from medical stuff as you can get. You may have noticed recently, my whole topics kind of change. So, I am looking for a new blog name something at least that we can work with when it comes to finding a domain name that's available. So submit those again to ohiominnie@gmail.com and we kind of see what comes in and how we feel about it and what's available domain name, why is in there, maybe a small price if we decide on some version of the name that you submit, so.

Dr. Mike Patrick: Right. So ohiominnie@gmail.com.

Karen : That's right. And as soon as you can do that, it will be great. Just like to get a new word press blog up and running soon.


Dr. Mike Patrick: Yes, yup. We name it before we design it.

Karen : Exactly.

Dr. Mike Patrick: OK. One other item of interest here, today, it is kind of cool that we're starting PediaCast 2.0 with a new co-host, Karen, my wife and today is our 18th wedding anniversary. So some couples go out to dinner, some couples, you know, go on a trip, do something really special, we are recording PediaCast on our 18th wedding anniversary. So, happy anniversary.

Karen : And then you are going to work, Happy anniversary to you.

Dr. Mike Patrick: Right.

Karen : 18 years. Do you think the next 18 is going to be better or worse than the first 18?

Dr. Mike Patrick: I think they're going to be better.

Karen : You think so. It took really 18 years of the a lot of prayer and a marriage conference and well, a lot of wine to figure out the whole marriage thing. I think we're starting to get the hang of it now. Two more slow learners.

Dr. Mike Patrick: What does your dad say, we've been, he says ,


Karen : We've been married 55 years, two of them happy and those weren't consecutive days.

Dr. Mike Patrick: See what mess I got ,

Karen : That's my heritage.

Dr. Mike Patrick: Yeah, OK. All right, that's how dedicated we are to this cause folks. I mean, we are taking time out of our anniversary to record PediaCast for you, so. All right, so we will be back next week and until then this is Dr. Mike ,

Karen : And Karen ,

Dr. Mike Patrick: Saying stay safe, stay healthy, and stay involved with your kids. So long everybody.



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