What's Going Around 2/28/2011

Well, pretty much the same illnesses are around that were on Feb. 14 (click here to link to post).

The good new is, they all seem to have slowed down, at least for now. If you think your child has one of the illnesses discussed in the post, have them seen by their physician.

When Allergies Attack

It’s springtime in Chico. We’ve had dry windy days, the trees and flowers are starting to bloom, and soon the farmers will start tilling the soil. All of that means that allergy season has begun here in the North Valley.

The molds in the soil, pollens and other allergens will soon be kicked up into the air, and from there into our noses and lungs. For those with allergies, a few months of sneezing, itchy and runny nose, itchy and watery eyes that can range from mild discomfort to pure misery are ahead. For those with allergy triggered asthma, a long season of cough and wheezing may be in their near future.

Of course, if you have simple hayfever, you can try one of the over the counter antihistamines. For occasional sneezing or other symptoms while outside, one of the short acting over the counter (OTC) antihistamines may suffice. Some of these are Benadryl (diphenhydramine), Chlortrimetron (chlorpheniramine) and DImetapp (diphenhydramine). There are many others. The main disadvantage of these is that they can be sedating and have to be taken every four to six hours. For more persistent allergies, one of the twenty-four hour non-sedating antihistamines may be a better choice. The two available over the counter are Claritin (loratadine) and Zyrtec (cetirazine). Another of this class, Allegra (fexofenadine), which is only available by prescription now, should be going OTC soon.

Any of these may be combined with a decongestant if you have a lot of stuffiness. Be aware though that some people may have a hard time sleeping if they take a decongestant in the evening.

What about the itchy, watery eyes? There are OTC eyedrops that may be of some help. For occasional use, one of the short acting antihistamine eyedrops may help. These have a “-A” ending. Opcon-A, Opticon-A, Nafcon-A, Vasocon-A, and others fall into this category. These are also occular decongestants, that is, they “get the red out” of your eyes. They are not meant for long term use as they can lead to rebound redness once stopped. There is one pure antihistamine eyedrop that was by prescription only until a few years ago called Zaditor which is available OTC.

Another treatment that can really help, especially after coming inside after being exposed to outside allergens, is the simple sinus rinse. Special bottles for this are available in most pharmacies and grocery stores. They come with, and you can buy, the salt packets you need to dissolve in them before use. You can make your own, however. Mix one part baking soda to two parts non-iodized (pickling) salt. Use 1/8 tsp into 8 oz. warm water for the rinse. The basic idea of these is you squeeze or pour water up one nostril, then it runs out the other one carrying with it the pollens, mold spores and other allergens stuck inside your nose out with it. The inflammation in your nose makes its secretions acidic which makes the inside of you nose feel irritated and sore. The baking soda neutralizes the acid and really soothes your nose as well.

If you can’t get your symptoms under control, they are year round, or they are triggering asthma symptoms, please see your doctor. In addition to histamine, there is another class of body chemicals that can also cause all the typical allergy symptoms called leukotrienes. Some people need a medicine to block these as well. If there is a lot of congestion, nasal anti-inflammatory sprays can be used. There are antihistamine nasal sprays and prescription antihistamine eyedrops available as well, including one that only needs to be used once daily. Your doctor can help you sort your way through this maze of potential treatments.

If symptoms still can’t be controlled or are severe, doing allergy testing may help. If you know what you are allergic to you can try to avoid that allergen. If severe enough, you may even need allergy desensitization therapy (“allergy shots”, etc.) This is something an allergist can help you with.

I hope this gives you some idea of how to deal with those springs sneezes. I wish you a happy and comfortable Chico springtime.

New Tdap Booster School Requirement

A new law has been passed in California (AB354) that requires that all students entering 7th through 12th grades will need proof of a Tdap (tetanus, diphtheria and pertussis) booster shot for school entry starting in the 2011-2012 school year. So, if you have a child age 10 years or older who has not had a Tdap booster or if you are unsure, contact your physician.

Pertussis (whooping cough) is a serious illness. In 2010, California had five times the usual number of pertussis cases than usual. The problem is, that the immunity from the initial vaccine series that children receive before kindergarten wears off by the teenage years. So, the older Td booster was replaced with the newer Tdap several years ago.

Believe me, you do not want your teen to get whooping cough. In teens or adults, it causes enormous, prolonged coughing fits that often go on until the person vomits or passes out. Cases have been documented where people have coughed so hard they have broken ribs or punctured lungs and it goes on for weeks or months. It used to be called the “hundred day cough” for a reason. Plus, once a person has had whooping cough, they may get back into the coughing fits with subsequent colds for one to two years afterwards.

However, this isn’t the real reason for the vaccine. It is to protect the very youngest. Until babies have had their two, four and six month doses of the pertussis vaccine (the DTaP vaccine), plus several weeks to mount a good immune response to the six month dose, they are not completely immune yet. California unfortunately had nine deaths in young infants from whooping cough last year.

Because of this, it is also recommended that all parents or close household contacts of under six month olds be vaccinated as well. Daycare providers for young infants and others who routinely work with very young infants should also get the vaccine. Check with your doctor’s or your child’s pediatrician’s office or go to the health department. Enloe Hospital is offering the vaccine to new mothers before they go home with their newborn. The Enloe Children’s Health Center also has free doses for parents of young infants who are patients there.

This is really important. After the large increase in the number of new cases last year, the numbers may continue to climb if vaccines aren’t given. Please take the time to make sure that your child is safe.

What's Going Around 2/14/2011

Well, the winter cough and cold season is definitely here. The number of sick visits in the office has exploded over the last week.

There is a bad cold going around that is starting out with a bad sore throat at its onset then turning into a bad chesty cough that is lasting for two to three weeks for most people.

There is still a lot of RSV bronchiolitis in the area.

I am still seeing a bit of croup.

Finally, there is Strep. Throat going around as well.

In the News

IRS Rules Breastfeeding Supplies are Tax Deductible - about time!!!

Chico's Technological Marvel

I had the great privilege Tuesday night of helping demonstrate something truly amazing for several of my fellow pediatricians and obstetricians from Enloe Hosptital. That is the North State’s new state of the art training simulation center.

A joint project between Enloe Hospital, Feather RIver Hospital and Chico State’s Nursing program, the Rural Northern California Clinical Simulation Center it is only one of 4 such simulation centers in California. In fact, it is one of only 7 facilities in the world, yes, I said world, to be certified by the Society for Simulation in Healthcare.

The simulation center is a place where medical personnel - physicians, nurses, respiratory therapists, pharmacists, flight care, etc. can practice very realistic emergency scenarios in real time. This allows them to fine tune treatment, teamwork and timing to be better able to handle similar emergencies when they occur in the hospital.

The technology for this is almost unbelievable. There are a number of high tech mannequins ranging from the size of a premature baby all the way up to a full grown adult. Several of them are even wireless with built in electronics and air compressors. The baby mannequin I used for the demo last night breathed, cried, could become jittery, had an audible heart beat, had several pulses throughout the body, could have external monitors put on, IV’s put in and even had blue lights under the skin of the face to mimic low blood oxygen. One of the mannequins even has eyes that open and close and reactive pupils. Several of the mannequins can be programed to speak specific phrases. The mannequin of the mother in labor had separate monitors for both the mother and baby.

These mannequins can be programmed to go through any number of complex reactions including responding to mock medications administered or other interventions. The Enloe Pediatric and OB departments are planning on taking advantage of the facility to better patient care in labor and delivery and post-partum areas.

To send a team for training in a facility like this normally costs several thousand dollars. We are truly blessed to have such a facility available for to us for free here in Chico. I hope the medical communities of Chico, Paradise and all of the surrounding areas take advantage of this marvel!

Hurray for Green Bay

Congratulations to hometown Chico boy Aaron Rodgers and the Green Bay Packers! What an exciting Super Bowl it was Happy

Chico Influenza Update

We have begun to see sporadic cases of influenza (the flu) in Chico the past couple of weeks. I recently posted a detailed post on flu prevention on 1-19-2011. Both influenza A and B have been reported, I know of at least three cases of influenza B that have been seen in our office. I have not heard confirmation as to whether or not the A strain that has been reported is the H1N1 “swine” flu that came through last fall or not.

The main thing to be aware of is that there are anti-viral medictions that can lessen the symptoms and shorten the duration of the flu. This is particularly important for people with high risk conditions who did not get the vaccine this year if they display symptoms of

High fever with back and thigh aches, cough, runny nose, sore throat and possibly vomiting or diarrhea are concerning for possibly be
influenza. If anti-viral treatment is going to work it needs to be started ideally in the first 24 hours after symptoms start. Treatment after 48 hours is unlikely to help at all. Antivirals given to people living in the same household as someone with documented influenza may help prevent them from getting it as well.

So, if you are concerned that you or one of your family members has
influenza, be seen by a physician quickly so that either they can be treated, or at least made more comfortable while it runs its course.

New Meningitis Vaccine Booster Recommendation

Here’s an FYI for parents of teenagers. In the past, children have received a single dose of the meningococcal vaccine, usually at age 11 or 12. This vaccine is to protect them from Neiseria meningitidis, which is the one bacteria that can go directly from person to person as a severe ilife threatening infection around the brain and spinal cord. There have been outbreaks on High School campuses and in college dormitories in the past couple of decades. It is around, there are a handful of cases in Chico each year. If you are not vaccinated and catch the disease, there is a one in three chance you will die and a good chance of brain damage if you survive.

It has become apparent that one dose of the vaccine is not sufficient for lifetime immunity. It is now recommended that all children who have had their first dose get a second, booster, dose at age 16-18. Any teen over age 11 who has not had any doses will need two doses to complete the series. Children with specific immune system disorders can receive the vaccine as early as two years of age.

This is a serious disease. Please make sure your child is fully vaccinated, You may just be saving his life.