Thursday, December 29, 2011

Nurse Judy Classes in January

I will be doing ALL of my classes in January

Solids foods class (this class generally repeats every other month)
January 7th 10:45 am (Saturday morning)
This class is geared for parents of children from 4 months until 15 months. It covers all the aspects of starting solids, nutritional information and tips for picky toddler eaters

Parenting class ( I do this class once or twice a year)
January 11th 7:30 PM ( Wednesday evening)
This class is geared for parents of children over the age of 2 through 7 (although the tips are ageless)
We deal with all sorts of creative problem solving for typical behavior issues, rewards and consequences

Illness class (This class generally repeats every other month)
January 14th 10am ( Saturday morning)
This class is appropriate for all parents
Recognize and learn what are appropriate levels of concern and how to deal with a wide range of illnesses. We will discuss fevers, rashes, coughs and colds, tummy bugs and common viral syndromes

Safety class ( this class generally repeats every other month)
January 25th 7:45 pm ( Wednesday)
This class is appropriate for all parents
Accident prevention and dealing with emergencies. We will cover head injuries, burns, poisonings, pet safety, child proofing, CHOKING RESCUE

Classes are held in the noe valley pediatrics waiting room
$20/per person sliding scale available

Tuesday, December 27, 2011

December 27th 2011

The virus RSV is rampant. All of the kids we have tested for it in the office this week have had positive tests.
RSV stands for respiratory syncytial Virus and is a nasty bug that is most common during the winter months. It causes lots of congestion, a wet wheezy cough and some fever.
If your child is wheezy they should be evaluated. Unfortunately there is no magic for this virus. In some cases we are using the nebulizer to help us open up the little airways. Steam, humidifiers, keeping heads elevated and getting lots of fluids are other tools.
If your child has been diagnosed with RSV we are very interested in their mood and their ability to eat.

We know of several cases of pertussis out there as well.
Pertussis will be more of a dry cough that comes with coughing fits that can last for several minutes. Some can lead to vomiting. Not all of the coughs have the characteristic whooping sound.
Pertussis and RSV are much more of a concern with our youngest patients.

We have had some positive strep throats.
There is still a tummy bug out there with vomiting and diarrhea. This has been usually gone within 48 hours, but the diarrhea will linger if you go back to a normal diet too quickly.

Many of the viruses we are seeing have splotchy rashes as part of the package.

With all the illnesses out there, I actually don't think that the classic influenza has arrived yet. There is still time to get shots if you haven't yet.
Stay well and Happy new year.
We will be closed next Monday
Judy

Monday, December 19, 2011

Monday update December 19th

We are seeing a lot of everything today without any major focus.
The biggest issue is probably the coughing patients. I have quite a few with croupy coughs ( who are mostly doing okay.)
We also have quite a few kids who are wheezing.The nebulizers have been humming along for most of the morning.
If you have a coughing child who has any labored breathing they should be evaluated. It is not the sound of the cough as much as how the respirations look, when figuring out if they need to be seen or not.
We have lots of strep throat out there.
Some random fevers
Some random rashes
For all of you who are planning to travel by plane this holiday, I strongly suggest having tylenol with you on the plane ( and more diapers than you think you will need)
I will check back in if there are any exciting changes.Otherwise Happy and healthy holidays!
Judy

Wednesday, December 14, 2011

December 14th

It is hard to believe it is mid December.
With the upcoming holidays, our office will be closed on Monday December 26 and Monday January 2nd.
As always, if you have questions or concerns after hours please contact the Pediatric Referral group at 387-9293
This week we are seeing lots of fevers, some of them are accompanied by a spotty rash and vomiting.
We are also seeing a short, but relatively nasty virus that has both vomiting and diarrhea.

My next solids foods class with be held Saturday morning January 7th at 10:45 am here in the office
I am also planning on doing one of the "parenting pearls" workshops soon. This group is for parents with kids who are at least two. I will talk about problem solving techniques for all sorts of behavior issues.If you are interested in either class please let me know.
Stay well
Judy

Monday, December 5, 2011

December 5th

We are mostly seeing the basic winter stuff going around, lots of colds and coughs

I am seeing a spotty rash with a mid grade fever going around.
We also have seen some Chicken pox out there. I have 2 confirmed cases and one more that looks suspicious. One of the kids is fully vaccinated, the others are too young.

We have a fairly mild tummy thing runny around. This one has a day of vomiting, with soft stinky stools. One patient did end up in the emergency room for IV hydration.

Stay well
Nurse Judy

Monday, November 28, 2011

November 28th

I hope everyone had a nice Thanksgiving.
There are tons of illnesses floating around out there.

Many of the parent's I spoke to were so apologetic about calling this morning.
Don't be silly, that's what we are here for.

Mostly we are seeing coughs and colds ( some croup)
We are still seeing roseola and sore throats.
The cases of diarrhea seem to be subsiding, but I had a few vomiting kids this morning.
We are also seeing lots of odd mystery rashes.
I do NOT think that the flu is actually here yet, but do get vaccinated if you haven't yet. We still have the vaccine in stock. We do suggest that all patients over the age of 6 months get the protection.
Class updates:
I do have one space left in my Wednesday evening illness class. Email nursejudynvp@yahoo.com if you are interested
I will be doing my next safety class on December 14th at 7:45 pm
Stay well,
Nurse judy

Monday, November 21, 2011

Monday update/ Natural resources in trouble

We are seeing lots of wheezy coughs. The nebulizer has been humming along from many of the rooms here all morning.
I also am seeing some feverish achy kids. It feels viral and I don't know how many days it is lasting yet. It seems to respond well to the fever reducing meds and aside from the high fever the kids don't look too worrisome.
I am still seeing some remnants of that nasty diarrhea bug that was plaguing us earlier this month, but it is definitely on the wane.

Some of you may have heard that Natural resources ( a terrific neighborhood small business) is having a financial crisis.
They need to raise quite a bit of money in order to stay open.
I have offered to do an extra illness class tomorrow evening ( tuesday the 22nd) at 6:30 here in the office waiting room. 100% of the proceeds will go to the natural resource fundraiser.
If you are interested in joining..please email me at nursejudynvp@yahoo.com and put natural resources in the subject line.
RSVP's are required
We will be closed on Thursday and Friday this week.
The after hours clinic will be open to take care of any acute issues that come up.
Happy Thanksgiviing
Judy

Monday, November 14, 2011

new email/monday update 11/14

we do have a new email address nvpeds@gmail.com
Please remember that this is for NOT urgent issues only.
The nurses generally check it several times a day.

This Monday we are seeing Roseola, coughs/ colds/ and sore throats ( most have been negative for strep so far)
Dr Hurd worked in the weekend clinic and she said there were lots of wheezing patients.
The diarrhea is still going around. Most of the patients from 2 weeks ago are finally clearing up. I am speculating that it was simply a nasty virus. Time does seem to fix it. We just need to do gentle diet/ good hydration and good butt care to avoid rashes until they are better. For the youngest and smallest with persistent diarrhea I would want their weight checked if it goes on longer than 5 days.
For all the coughing kids...Teach your kids to cover those coughs whenever possible and do frequent hand washing/purell to stop the spread.
Stay well!
Nurse Judy

Thursday, November 10, 2011

illness class scheduled

I will be doing my next illness class on November 30th at 7:45 pm
You can get full class info at www.nursejudy.net

Tuesday, November 8, 2011

Tuesday November 8th ( election day)

We are having trouble with our office email account. We are working hard to fix it, but for now we do not have a working email. I will likely be launching a new Gmail account later this week and I will post the address. Please remember that email correspondence is for NON urgent matters, None of the " dear Nurse Judy my child is having trouble breathing" stuff please ( and yes I have gotten that).
Illness wise we have been very very busy.
We are still seeing a diarrhea that has taken at least a week to clear. It does seem to be going away with gentle diet and probiotics, but it has been a tough one. The Similac expert care diarrhea formula has been near impossible to find, The rep is trying to help me find where you might get it, I will let you know if we find a stash.
We are seeing lots of sore throats, More often than not they have been strep, so any sore throat with a fever ( that doesn't have lots of congestion along with it) should be checked.
We have seen some roseola cases ( several days of fever...then fever fades and out comes the rash)
Yesterday we also got a positive office test for RSV, which is a nasty virus that causes lots of congestion in head and lungs. Mucous is clear. This virus is very rough on the youngest babies. There is not much to do for it but observe closely, keep heads elevated, use steam and keep the nose clear. I prefer that any child with labored breathing to be evaluated ( One of the Nurse Judy Rules).
The stack of phone calls has been enormous and twice recently I have made non urgent calls after the phones have been turned off and we are "officially closed" Thanks for your patience for the non urgent matters.
Please do call back if you are very worried and have waited longer than two hours for a call to be returned

Go out and vote!!
Nurse Judy

Thursday, November 3, 2011

diarrhea galore

I am adding an extra post this week because I am seeing a large number of patients with diarrhea that has lasted longer than a week. The children seem fairly well otherwise. My typical treatment of BRAT diet, Similac diarrhea formula and probiotics has not worked the magic that it usually does. This has been a stubborn one. We are going to be starting to send some of this poop to the lab to get some answers.
We are also still seeing fevers with a croupy cough.
We are still seeing strep throat.

Good Hand washing please!!!!!
Judy

Tuesday, November 1, 2011

11/1/11

For any of you who are on our nvpedi email contact list...No Noe Valley pediatrics did not have it's suitcase stolen while traveling in Spain. Our account was hacked. Our password is safely changed. We did lose complete list of contacts ( anyone out there that can clue me in as to how to retrieve it, let me know)
In the meanwhile, We are seeing lots of sore throats. Half of them have been positive for strep throat.
There is a fever and cough going around that has lasted for 2-3 days.
There is a bit of diarrhea/vomiting
I hope everyone had a fun Halloween.
Stay well
Nurse Judy

Monday, October 24, 2011

Monday update for October 24th

I have seen a few kids with some vomiting and diarrhea today, I hope this isn't the start of a widespread tummy bug.
We have had several cases of strep throat.
Lots of coughs and colds are making the usual rounds.
I still have hand foot mouth going around. ( Refer to the archives on the right for info on hand foot mouth.)
We are seeing all sorts of odd little rashes.
I have some kids with fevers, but I don't think I am seeing the actual flu yet.
It is worth getting the shot if you haven't yet!

Stay well
Nurse Judy

Tuesday, October 18, 2011

Flu info follow up

We will be holding a flu shot clinic on Saturday morning from 9-12 for patients and parents.
Please check the blog archive ( over on the right) and click for complete flu shot updates and information from October 4th.
Thanks
Judy

Monday, October 17, 2011

Monday October 17th

Today my most frequent complaint is nasty sounding cough.
Many of the kids have a wet cough and others are croupy.

Coughs can sound awful and be fairly benign. Our biggest task is to figure out if it is an Upper airway cough or one that is down in the lungs.
Upper airway coughs can often sound very wet and junky, but the breathing seems okay.
The most important question is " Are the respiration s labored?"
When your child is calm, lift up the shirt and watch them breathe for a bit.
If it seems like the breathing is rapid, with the tummy going in a out and any retractions ( the little hollows at the base of the throat or between the ribs sucking in during inspiration) I would consider that breathing to be labored and I would want to have someone check them out.
If the breathing looks normal I am way less concerned about the cough.
We also still have hand foot mouth going around, but this week the patients have been more unfortunate and have way more mouth sores.
Please check out the earlier post about tips on dealing with this.

We are still seeing all sorts of odd rashes.

If you or your child need the flu shot still, we have our flu shot clinic coming up next Saturday morning!
Stay well and enjoy this lovely weather while it lasts
Nurse Judy

Thursday, October 13, 2011

class update

I have one or 2 spots left in the safety class October 19th at 7:45 pm. If you are interested let me know
I am also going to do my introduction to solid foods class on November 9th ( Wednesday night) if I get a group of at least 4.
email me at nursejudynvp@yahoo.com if you want a spot.

hand foot mouth review

Since we are seeing so much hand foot mouth lately I thought I would do a little review.
Hand foot mouth is a very common illness that most kids get once during childhood. I have seen a few rare patients who don't seem to hold the immunity and have had it more than once, but they are the exception.
I also do see some parents who get it (and are quite miserable)
It is a virus. Time will fix it. Unfortunately there is no magic pill for this one.

I actually like to call it Hand Foot Mouth and Butt, because in my experience kids often get blisters on their Butts as well as on the hands and feet.
Some kids have mild congestion and fevers as part of this.
It is a very variable illness, meaning that one child will not look very sick and another can feel wretched. The lucky ones might simply have a mystery spot on the hand and that is it! Most of them are better within a week.
I have found that the kids with the most mouth involvement are the most miserable. In extreme cases the mouth sores are so awful that they don't want to eat or drink and can have a risk of dehydration. ( watch for decreased energy and urine output)
If your child has a lot of mouth sores, tylenol and or advil are very appropriate for pain relief even if they don't have a fever.
Offer cool creamy and soft foods ( hooray if you have breast milk).
Avoid anything acidic or sharp, like orange juice or tortilla chips.
Smoothies are great. I like an over the counter medication called glyoxide that can be applied by Q-tip to affected areas ( if your child lets you anywhere near them!)

The exposure period for this is usually about 3 days to a week. In other words, if your child was exposed on a Monday...they may start to show symptoms as early as Thursday but if a week goes by without anything happening you are probably out of the woods.
On the other hand, If you child has the illness. They are contagious as long as they still have blisters or a fever and perhaps can shed the virus for a week or 2 after wards.
If your child is happy and eating and has no fever but has a few blisters I would try to keep them away from a new born or someone with a compromised immune system, but it seems excessive to expect you to keep your kids out of daycare if that is the only symptom.
Good hand washing is key to avoiding this.
making sure the shared toys are cleaned frequently.
Bottom line, don't freak out..this is a rite of passage. Call as needed!
Nurse Judy

Monday, October 10, 2011

October 10th 2011

The phones are pretty mellow today, which is a good thing with Dr Schwanke and Dr Hurd both away on vacation this week,
We have heard about lots of mild cases of hand/foot mouth going around. There are always coughs and colds out there. I am also seeing an increase in conjunctivitis.

There are 2 cool websites that I would like to share.
www.healthychildren.org is a pretty nice and balanced site with all sorts of good information about general heath
www.sfkids.org is a great resource for local activities ( many free and inexpensive)

I hope it stays a quiet and reasonable healthy week!
Nurse Judy

Tuesday, October 4, 2011

Flu shot information

We are giving flu shots( and mist) on an appointment basis on Tuesdays, Wednesdays and Thursdays from 10:00 am-11:30 and 2:00pm-4:00pm.
If your child is on the schedule to see one of the doctors they can also get a flu vaccine regardless of the day or time.

If those times are difficult for you, we will be doing a drop in Flu clinic on Saturday October 22nd from 9:00am until noon. This is for patients and parents only. No appointment is necessary.
Parent shots are $35 and we do not bill insurance, so you might be better off at Walgreens. If convenience and cute band-aids are a factor feel free to come here.
Babies under 3 get the pediatric dose of the preservative free vaccine.
Anyone over 2 also has the option of the flu mist ( which is also preservative free)
I have found that kids under 4 often don't cooperate with having something squirted in their nose and the shot is actually easier for them.
Flu mist is a live vaccine and is NOT suggested for patients who have asthma.
We do have limited amounts of the preservative free vaccine for higher risk patients and pregnant women.

Babies who are getting flu shots for the first time will need to get 2 shots in order to achieve immunity.
This is the same vaccine as last year. Last years did seem to be mostly effective. Hopefully they have matched the strain correctly again. The shots are thought to give protection for just about a year. This shot does protect against H1N1.
People with mild colds symptoms are fine to get the shot.
We have seen only mild side effects so far this year. Some folks after the flu mist have complained of several days of snuffles, head ache and dry throat.
Some folks after the shot complain of mild achiness ( especially at the shot site)
Mild egg allergy is NOT a reason to skip the vaccine. Folks with very severe egg allergies may choose to get it in the allergist's office.

If you have further flu shot questions feel free to comment and I will try to get them answered.
Nurse Judy

Monday, October 3, 2011

October 3rd

Last week I was seeing a bunch of preschool age kids with high fevers and and body aches.
Today we are still seeing fevers, but more with the one year old crowd.
There is strep throat going around and well as lots of coughs and some croup.
By far today my biggest complaint was for odd rashes and loads of very irritating bug bites. I have had at least a dozen patients calling with bites that are causing allergic reactions, lots of redness and puffiness at the sites.
I think the warm weather last week may have had something to do with it, but make sure you have screens in the windows and check the bedrooms for spiders or mosquito s.

We DO have the flu shots available. Call on Tuesday, Wednesday or Thursday for same date appointments.
We will be having a flu shot clinic for patients and parents on Saturday morning October 22nd between 9-12 am
We do recommend that all of our patients over the age of 6 months receive the shot.
If this is your child's first year getting the shot, they will need 2 ( a month apart) to achieve true immunity

My next safety class will be held on October 19th ( Wednesday evening) at 7:45 pm.If you are interested, visit www.nursejudy.net to click and reserve a a spot
Be Well,
Nurse Judy

Monday, September 26, 2011

September 26th

There is a mixed bag of stuff out there.
We have had all kinds of rashes.
There is still the hand foot mouth virus about, perhaps some slap cheek and a couple of kids who likely have the chicken pox. They are too young to have had the vaccine. (We generally give the chicken pox vaccine called Varivax at 15 months of age, but it can be given to children as young as a year. )
There are also some calls about a fairly mild tummy bug that isn't lasting for more than a day or two.
We are seeing lots of colds and coughs and ear infections.
There are some fevers out there but I don't think I am seeing the flu yet.
Stay well
Judy

Tuesday, September 20, 2011

update this week

I have quite a few babies ( around the 1 to 2 year old group) with fevers today. The fevers are reasonably high and the kids are all looking pretty well without any other symptoms.
I am suspecting roseola, but will know more in a few days as we watch for a rash to appear.
Any fever lasting over 3 days needs to be seen!
Judy

Monday, September 19, 2011

September 19th/ illness class scheduled

We were extremely busy today with sick kids and the phone call volume was very high.
We do our best triage the charts and call the more serious cases first, but if you are ever worried and feel like you are waiting for a long time for a call back, feel free to call again and ask the front desk to nudge you to the top of our pile.
We are seeing lots of coughs and colds.
We have several cases of Hand/ foot/ mouth
A few kids were having vomiting for a day ( no diarrhea yet)
There were lots of sore throats..strep tests were negative
some of our older kids had pretty high fevers for a day or 2 without any other symptoms showing right now.
We had a 4 year old admitted to the hospital last week with RSV ( a very nasty virus that typically shows up much later in the season)
My illness class is scheduled for this coming Sat morning at 10:45 where we will talk about all of the above...if you are interested in a spot let me know www.nursejudy.net

Stay well, its a nice week coming up...sunscreen and hydration please!!!
Judy

Tuesday, September 6, 2011

September 6th

I hope everyone enjoyed the 3 day weekend.
We have a lot of coughs and colds outs there. Doctor Schwanke thinks that the warm days of Fall lead to increased pollution ( spare the air days) that are contributing to our wheezers.
We also have some kids with body aches and fevers that are lasting about 3-4 days.
I am still seeing a slew of strange rashes.
We have one case of probably chicken pox. The child is too young for vaccination and is just back from Hawaii.

My next scheduled class is the "illness class" on September 24th at 10:45am

stay well
Nurse Judy

Monday, August 29, 2011

August 29th 2011

I am starting to see a glimmer of illnesses coming around.
There is certainly a fever that is lasting for several days.
We are starting to see lots of coughing, and our nebulizers which have been quiet all summer have been going as back ground noise through out the day here, so the kids are starting to wheeze.
We have had several cases of conjunctivitis and still quite a few of odd rashes.
There was one case of hand/foot/mouth in the office today.
Stay well
Nurse Judy

Thursday, August 25, 2011

Flu vaccine is here!/ solid foods class scheduled

We got the first shipment of our pediatric flu vaccine.
Beat the rush and get it early.
We will be scheduling same day appointments on Tuesdays , Wednesdays and Thursdays from 10-11:30 and from 2-4.
Call in the morning to get on the list for that day.
Some years we do end up doing a Saturday morning flu shot clinic.
I will post that info here if and when we schedule that.


I did schedule the solid food intro class for Monday September 5th at 7:30 pm.
This class would be most appropriate for parents with children from 4 months-15 months

The class will discuss all aspects of introducing solids, making the transition to whole milk and table foods, general nutrition, and tips for picky eaters
Email nursejudynvp@yahoo.com to save a spot

Monday, August 22, 2011

August 22nd

Most of our kids are back in school.
It feels So early this year.
There does seem to be a mild cold floating around.
There is still a virus with several days of fever.
A couple of kids have a mild vomiting/ diarrhea bug
but in general the phones are fairly quiet.
We have the flu mist in stock as well as some of the vaccine for people 3 and over.
We have not started getting the flu shots for the younger kids just yet.

We are delighted to have the warm and wonderful Dr Sophia Hurd as a regular part of our practice. She has done some vacation coverage for us in the past, and some of you may have seen her in the Pediatric after hours clinic. She is going to be routinely here on Mondays and Fridays as well as a few extra days here and there.

For those of you waiting for my infant toddler nutrition/ solids food class..It is ready to roll and I will schedule a class in September for sure.
If you want to have me contact you with the details drop me an email at nursejudynvp@yahoo.com
I have one spot left in this Wednesday evenings child safety class,

Stay well
Nurse Judy

Wednesday, August 17, 2011

August 17th

We are seeing a mild virus that has had a fever for 3 or 4 days.
We have had plenty of ear infection.
We still have odd rashes showing up.
Most of our sore throats this week have NOT been strep, although a bad sore throat that does not have associated congestion should be checked.

We will be getting the flu vaccine very shortly.It is recommended that all children over the age of 6 months get protected.
Parents, grandparents and nannies of younger babies should also make sure they get the vaccine.
We never quite know what the flu season has in store for us.
Sometimes it shows up early. Sometimes we don't see it until February. Once in a while the strain will be quite severe and then there is a rush to get vaccinated and the supplies get strained.
We anticipate having enough to take care of the normal demand, but can't guarantee availability late in the season if the demand takes a strong upturn
The Flu vaccine should give protection for the entire season, so plan to get it early to avoid the rush.


I will blog the information about the flu shot clinic hours as soon as things are set.

Stay well.
Nurse judy

Monday, August 8, 2011

August 8th 2011/ nurse judy safety class scheduled

Hard to believe that some of our older kids are heading back to school.
Remember that middle school kids need to show proof of the TDaP vaccine.
We are seeing a lot of fever/ viral illnesses today.
We have lots of kids with sore throats, only one came up positive for strep.
The tummy bug seems to be coming around again and I have had quite a few calls about younger kids with diarrhea.
We are still seeing lots of odd rashes.

My next safety class will be August 24th at 7:45
I plan to start holding a new class on solid foods. This will include starting solids, nutritional needs/ feeding tips for infants and toddlers.
If you would like me to email you when I schedule the first class let me know
Stay well
Nurse Judy

Wednesday, July 27, 2011

July 27th 2011

Not much to report.
Most of our calls this week have been interesting rashes ( which have not turned out to be anything alarming)
I may be seeing some hand foot mouth, but it is a quiet rumbling, not a roar yet.
I have seen some mild fevers.
Otherwise all is quiet on the Noe valley Front.
I will check in next week.
If you have a middle school or high school child, make sure they have had their TDap Booster.
The City has added a 30 day grace period, but after that, if they can't show proof of immunization they will not be allowed in school.
be Well
Nurse Judy

Tuesday, July 19, 2011

Tuesday July 19th

I think I am starting to see a couple of the seasonal viral syndromes that come around a few times a year.
I have one patient who almost surely has slap cheek and several who likely have hand foot mouth.
If you search the blog entries you will find more info about both of these illnesses.
We also have some cases of a tummy bug out there, a few miserable kids with Mono, and some random fevers.
Our new schedule in the office has Dr Hurd working with out on Monday's and Fridays. She is our new acute care doctor. On the days that she works, typically the schedule will start with lots of open appointments so getting in on those days with mild issues should be pretty easy.
Stay well
Nurse Judy

Monday, July 11, 2011

Monday July 11th

For the most part things are fairly mellow.
There are some kids with fevers.
We are seeing plenty of coughs and colds.
The tummies have been quieter finally.
I am still seeing an odd assortment of mystery rashes that have not turned out to be anything of concern.
Stay well
Nurse judy

Thursday, June 30, 2011

Almost July/ illness class scheduled

The office will be closed on July 4th.
Please call the after hours number if you have any concerns during the 3 day weekend.
Please be careful with fireworks!!

It has been reasonably mellow this week with the biggest complaint still being that of a fairly mild tummy bug.

My next illness class will be next Thursday July 7th at 7:45 pm.
This class will answer questions like, " when should I be worried about a fever?"
We will talk about coughs, colds, tummy bugs, rashes etc.
for more info or to RSVP for a spot visit www.nursejudy.net

Stay well
Judy

Monday, June 27, 2011

Monday June 27th

The tummy bug persists. This has been the most prevalent complaint of the day by far.
Most have both vomiting and diarrhea. The kids don't seem too ill.
We have lots of kids with coughs and colds, and a few wheezers.
Plenty of sore throats are out there, but none have shown up as strep throat with the office test.
We are also seeing lots of odd rashes.

Summer is here, make sure your kids stay hydrated, and be wiser than me and make sure you use plenty of sunscreen. ( I got myself a good burn this weekend..ouch)
~Nurse Judy

Monday, June 20, 2011

June 20th

Nice weather and correspondingly quiet on the illness front.
We have seen some various viral illnesses, with congestion and 2 or 3 days of moderate fevers.
I have a few kids with croup.
Lots of rashes!
Lots of traveling families who wish they were home!!!!
Stay well, enjoy the sunshine..lather on the sunscreen!!!!
~nurse Judy

Monday, June 13, 2011

June 13th

Most of my calls this morning involved a tummy bug.
This one does not seem to linger too long and has involved a day or 2 of vomiting, a bit of diarrhea and a low grade fever.
We are now seeing sore throats that test positive for strep and some kids with a viral fever.
We had a child bitten by a squirrel in Golden gate park this weekend. She was feeding them and this squirrel was fairly bold. As a rule, squirrels are not a rabies risk, but having your child hold out food for them should not be encouraged.
Be well
Nurse judy

Thursday, June 9, 2011

Thursday check in/safeyt class schedule

This week I am now seeing a virus that has a high fever, some congestion, some tummy complaint and sore throat.
The throat cultures have been neg.
The fevers have been lasting about 4 days.
It feels very fluish, but we haven't been doing actual flu tests ( and many of the kids who are ill had flu shots)

we are also seeing multiple cases of head lice.
If your little one has been scratching at their heads, consider taking a close look to see if you see any nits or bugs ( how many of you are scratching your head while you read this?)

My next safety class is now scheduled for Wednesday evening June 29th at 7:45pm ( $20 per person)
This is open to any parents, nannies or grandparents. RSVP is required, let me know if you want a spot.
Judy

Monday, June 6, 2011

Monday June 6th

Nothing too exciting in the works today.
We have some kids with a mild tummy bug, plenty of general coughs and colds and some conjunctivitis.
Summer check ups are booking up rapidly, so if you haven't yet, call for any needed appointments!
For mild acute issues this week, Thursday will be our easy day to get in for any issues that have been lingering.
Be well
Judy

Monday, May 23, 2011

May 23rd 2011

We are seeing lots of kids with sore throats. About half of them are positive for strep so far today.
There are plenty of irritatingly long lasting, but mild coughs hanging around.
I did talk to several families today with kids who well may have slap cheek.
There are not nearly as many new cases of diarrhea, but some of my poor patients are still trying to get their tummies back to normal after this nasty bug.

Tis the season and we are starting to see kids with poison oak.
If you suspect an exposure wash off thoroughly with technu or soap and water as soon as you can, and get all the affected clothes into the laundry ( hot water and then wipe the washer with alcohol) Watch out for pets who have been out romping in the poison oak because you can get exposed to the oil after petting them.
If there is a severe case of poison oak rash on the face, hands, or genitals, we will likely want an office visit so that we can help determine on whether a course of steroids is needed or not.

Stay well
Judy

Thursday, May 19, 2011

safety class

I have 2 spots left in next Wednesday's Safety class.
Let me know if you are interested. RSVP is required. More info at www.nursejudy.net
This class will deals with staying calm when accidents happen, We will learn about recognizing a serious head injury after a fall, choking, burns,etc.
Judy

Monday, May 16, 2011

May 16th

The most common call I am getting today is about the tummy bug.
This particular bug has started with a day or two of vomiting, but then has moved to very persistent loose stools that have lasted for more than a week.
The kids seem like they are getting better, but the minute they get too ambitious with the diet, they start vomiting again.
Time will fix this. Probiotics and a very boring, bland starchy diet will get you through.
We also have complaints of a cough that lingers and lingers. We have not seen a lot of fevers or wheezing.
Several kids have complained about sore throats, but today all of the strep tests that we ran were negative.
Of course we saw several ear infections.

Stay well,
Nurse judy

Monday, May 2, 2011

May May May

No one seems terribly sick but this looks like a busy week for some moderate illnesses.
The nebulizers were humming in all of the exam rooms for most of the day, so there are a lot of wheezy coughs going around.

The tummy bug has been much more diarrhea than vomiting this week. If your child has runny stools the most important thing is to keep them hydrated. Replacing all of the fluid that they are losing with just water is NOT the best plan. Breast milk, pediatyte, gatorade or any electrolye solution are better choices. Bland foods, like the BRAT diet ( Banana, Rice, Applesauce toast)pasta, boiled chicken, yogurt ( but avoid other dairy) will be tolerated most easily. Adding probiotics like florajen has been very helpful.
If your child is in diapers, give their little butts as much air as you can manage.

We have a bunch of kids out there with several days of fever. I think there are still a smattering of viral syndromes such as slap cheek, hand foot mouth and roseola making the rounds.

We are still seeing plenty of kids with conjunctivitis..If they are under 2, we will likely want to see them for this.

Summer check ups are booking up quickly...Call for your annual physicals if your child is due.
Remember that all kids going into 7th grade and higher will need a TDaP in order to be admitted to school this fall.

Monday, April 25, 2011

April 25th 2011

It is a relatively quiet Monday.
There is still a tummy bug out there. Once again I had a child that ended up needed iv fluids from this one.
We have some kids out there with several days of moderate fevers.
We are seeing the common cold with some associated conjunctivitis and ear infections.
Stay well,
Judy

Monday, April 18, 2011

April 18th

The chief complaints today are fever and the tummy bug.
This particular virus has been quite the nasty one.. Some of the patients aren't quite back to having a normal stomach for almost a week, with vomiting and diarrhea coming and going the minute we try to normalize the diet too quickly. I had one little one that needed IV fluids due to dehydration.

I also want to share a safety warning. This past week one of our 1 year old babies swallowed a button battery. Thankfully it passed without incident ( we monitored with X-Ray to make sure it was through the esophagus)but button batteries are everywhere these days and are easy to swallow and can be VERY hazardous if they get stuck in the wrong place on their way out. This one was in a pedometer that had fallen, and the back had come off.
Take a moment to pay attention to anything you have around the house that uses these small batteries and make sure that the baby can't access them.
~Nurse Judy

Thursday, April 14, 2011

unhappy tummies/ new classes

The vomiting seems to be a real issue this week. Some of my patients are having a full 48 hours with difficulty keeping things down. One of our little ones ended up in the ER for some hydration. This particular bug has been pretty nasty.
A lethargic child with decreased urine output has me concerned, especially if they are unable to retain even little sips of fluids. If it is during office hours, feel free to call for guidance.

My May classes are now scheduled if you are interested. The safety class ( includes head trauma, burns, choking) is on May 4th
The illness class ( more on vomiting, fevers, rashes, everything) will be on May 18th
more info at www.nursejudy.net

Stay well, Wash hands!!!
~Judy

Monday, April 11, 2011

April 11th

We are having another reasonably mellow day here.
My most frequent calls are tummy related.Most of the cases have both diarrhea and vomiting, but have been easing within 36 hours.
Your job is keeping your kids hydrated.

There are also a few kids with fevers and chills. Perhaps they have the last bits of the flu ( but we didn't bother testing)

I am seeing slap cheek here and there still.

Allergies are still very bothersome this week.

We also saw the child with a fairly large wad of paper jammed in his ear canal..Not all ear aches are ear infections!
Stay well
Judy

Monday, April 4, 2011

April 4th 2011

Last week felt much quieter than today.
We have had a high volume of calls and sick kids.
I have seen a lot of conjunctivitis. Many of these kids have also had ear infections.
If you child has goopy eyes and is also fussy, we should take a look.

I have seen an upswing in the amounts of patients complaining about vomiting and diarrhea today.
I think I may be starting to see patients with 2 of our common spring viral syndromes.. Slap cheek and hand foot mouth.
if you search the blog you can find early entries about both of these.
There are still a few kids with fevers, but flu season seems to have ended.

Allergies are in high gear with all of the pollens around. Allergy complaints are generally watery itchy, eyes, clear runny nose. no fever.

Stay well
Judy

Monday, March 28, 2011

March 28th

Are we finally done with the rain? Today has been the quietest Monday in a long while. There are still sick kids out there but it seems like the light is at the end of the tunnel for the winter illness season.
The patients that we are seeing are complaining about conjunctivitis, fevers, coughs and colds, some tummy aches.
RSV is still going around but decreasing.
We will start gearing up to do more complete exam check ups per day as soon as we are comfortable that the demand for acute care appointments is diminishing.
If your child is due for a check up this year, Spring and summer are the seasons to get them done. Please call early to make sure that we are better able to try to accommodate your schedules.

My recent safety class was full so I did add another one for April 6th..and I do have some spots left in the illness class this Wednesday night if any of you want to come and pick my brain in person for 90 minutes this is your chance.
www.nursejudy.net to RSVP

~Stay well and enjoy the sunshine

Judy

Monday, March 21, 2011

Welcome to spring

This morning we have complaints about
*the tummy bug ( vomiting and diarrhea for several days)
* a persistent cough
* ear infections
*conjunctivitis
*some fevers
* there is still some flu making the rounds. Some of the cases in the city are quite severe ( luckily most of our patients are doing okay)
It is NOT too late to get the flu shot
*I have some poor miserable kids out there with some mouth sores and fever



Below is an FDA update on the US public nuclear threat


U.S. residents do not need to take potassium iodide (KI) as a preventive measure because there is currently "no public health threat" of radiation exposure, the FDA says on its website. The recent radiation leak from a nuclear power plant in Japan has led to public concern about radiation exposure in the U.S., along with increased demand for KI products.

The three FDA-approved over-the-counter KI products — Iosat tablets (Anbex, Inc.), ThyroSafe tablets (Recipharm), and ThyroShield solution (Fleming Pharmaceuticals) — are currently out of stock.

FDA warns consumers to beware of buying non-FDA-approved KI and other products that fraudulently claim to prevent or treat effects of radiation exposure. A list of potentially fraudulent claims by retailers is available on the FDA's website.

Meanwhile, a World Health Organization official told Reuters on Monday that detection of radiation in Japan's food supply is "serious." The FDA says that Japan's exports are currently limited, but the agency is screening imported food for radiation.

Thursday, March 17, 2011

Updates

http://www.sfcdcp.org/tdapclinics.html

the above link is information about a free TDAP clinic for any students entering 7-12th grade. This year the law has changed and all children from 7th grade and higher will have to show proof that they have received a TDap.
If you are not sure about your child's Tdap status, please give our office a call.

The clinic will be held on Saturday March 19th at Roosevelt High school at 460 Arguello ( between Geary and Clement) from 11:00-4:00 or until supplies last. Children must be accompanied by a parent.
On another Note.......

Below is information from the health department regarding the radiation concerns



The Santa Clara County Health Department has issued today the following information for health organizations to share with their employees re the Japan disaster and associated health risks. LPCH Communications plans to keep you informed with these types of communications as the situation continues to unfold.



There is No Current Risk of Radiation Reaching California

As the disaster in Japan continues to unfold, concerns have been raised about windblown radiation making it to California. State and federal experts and authorities agree - there is currently no danger to California residents from Japan's nuclear emergency, and no reason for residents to be concerned about possible radiation effects.



Please know that given the current situation:

* There is no risk of windblown nuclear radiation for California.
* Federal and State agencies are closely monitoring the situation.
* Our local Public Health Department will be informed if there are increased levels of radiation.
* Potassium iodide tablet are not needed and not recommended.



The California Department of Public Health (CDPH) is closely monitoring the situation and working with authorities and experts with the US Department of Energy, US Environmental Protection Agency, the Nuclear Regulatory Commission, and the California Emergency Management Agency. State and Federal agencies conduct weekly air tests at 10 sites around California. These and other tests (food and water are tested monthly) are used to determine if any unusual spikes or increases in radiation have occurred. CDPH is currently looking at the timing and frequency of their testing as the situation in Japan continues.



According to State and Federal authorities, there has not been a major release of radiation into the atmosphere due to the problems with the nuclear reactors in Japan. The current level of radiation being released, while above what is normally accepted, is a threat to only the people in the vicinity of the nuclear power plant in Japan.



Distance is our friend. Given the thousands of miles between us and Japan, we do not expect to find any harmful levels of radioactivity in our state. The Santa Clara County Public Health Department is in contact with the State, and the State will let them know if the situation changes. If that were to happen, the public would be notified immediately about any precautionary measures that should be taken.



Since there is no present danger to the residents of Santa Clara County, there is no need for anyone to take potassium iodide. It is important to know that taking potassium iodide may be harmful for some people, particularly those with a thyroid disease and those who are allergic to it. If you have a seafood or shellfish allergy - it can mean that you are allergic to potassium iodide. Also, many people may have an undiagnosed condition, taking potassium iodide may cause them health problems.



So please remember, there is currently no risk of windblown nuclear radiation for California, a number of Federal and State agencies are closely monitoring the situation and will let our local Public Health Department know if there are any increased levels of radiation, and potassium iodide tablet are not needed and not recommended.



Thank you for taking the time to learn about this situation. You can stay informed by going to the California Department of Public Health website at www.cdph.ca.gov or you can call the CDPH public information hotline at 1-916-341-3947 if you need additional information.

Monday, March 14, 2011

March 14th

I started the Monday with a giant pile of charts on my desk, and most of them were about a tummy bug. Plenty of kids ( and their parents) with soft stools and some nausea.
We have seen some strep throat, coughs and ear infections today.
I have some patients with several days of high fever ( flu and strep negative) One of these poor kids also has mouth sores.
Most of the time the mouth sores are viral, however if they get severe enough that the child doesn't want to eat or drink, we will likely need to see them.
I have gotten plenty of calls today from people wondering if we recommend a course of potassium iodide to deal with possible radiation from the japan nuclear issues.
The SF public health department says that there is no current cause for alarm, but the state does have a hotline 916-341-3947 if you have further questions or concerns about this

Okay and here is a random question for all of you blog readers. Would it be useful for Noe Valley Pediatrics to have a face book page???
~Nurse Judy

Wednesday, March 9, 2011

soccer clinic

Thank you Dr kaplan for sending the link below.



http://sfphysicaltherapy.com/html/soccer_cl.html

Soccer Injury and Prevention Clinic

When you're hurt, it can sometimes be difficult to get in right away, or to get advice from someone familiar with the challenges and demands of your sport. That's why we're here! We love soccer, and know there's a need. Call to schedule time at the Soccer Injury & Prevention Clinic!

Wednesday, March 16th, 2011, 5:30 pm - 7:00 pm
View the Flyer
Call 415.318.8138 to schedule an appointment with:
Christina Allen, M.D.
Orthopedic Surgeon, UCSF Sports Medicine, Team Physician for U.S. Soccer & Cal Soccer
Heather Stone, DPT
Physical Therapist, San Francisco Sport and Spine Physical Therapy

Monday, March 7, 2011

March 7th

Today was out of control busy in the office, and we were double booked by 10AM. I appreciate everyone's patience with us if you were waiting in the waiting room or unable to be seen by us today.
We are seeing a bit of everything. We have been getting positive tests for RSV, FLU and STREP.
There are lots of coughs and colds going around.
I have several patients out there on their second day of a mystery high fever with generally good spirits. My suspicion that we are seeing roseola is quite high. If I am right the fevers will last about 3 days and then will be followed by a cranky kid with a rash ( no treatment needed)
There are some kids with loose stools and vomiting.
Stay well
Nurse Judy

Saturday, March 5, 2011

upcoming classes

I just scheduled 2 of my more popular classes.
On March 23, I will have my safety class. This class includes basic first aid,
Tips on staying calm in an emergency and choking rescue
March 30th will be the illness class, which reviews many common illnesses and answers questions about fevers, rashes, colds etc.
The classes are pretty small and RSVP is needed.
For more info check out my website
nursejudy.net

Monday, February 28, 2011

Goodbye February

We are still seeing new flu cases.
Some of the patients have had the vaccine. The tests in the lab are showing Flu type B.
The A and H1N1 strains that are going around have not gotten through to the vaccinated patients.
We are still seeing some strep throat.
We are still seeing a vomiting/diarrhea viral syndrome that is gone within a day or so.
There are the ever present coughs and colds.
Stay well
~Nurse Judy

Tuesday, February 22, 2011

February 22nd

I hope everyone had a nice 3 day weekend. A great many of our patients were in the after hours clinic.
There is lots of illness out there. Nothing much new or unexpected.
We have a lot of sore throats. About half of them are positive for strep. It is worth checking! Most of the time strep does not come along with congestion, but this week I have had some congested kids end up testing positive.
We are seeing a lot of kids with a flu like syndrome, fever, congestion, watery eyes. Most of them are improving after 3 or 4 days.
There is the ever present tummy bug around. This has been a tough one on several or our patients who did get dehydrated and ended up in the ER for IV fluids.
The important thing to watch out for with this is your child's energy level and urine output.
A happy energetic child who is peeing is managing.. and your job is to give small frequent amounts of an electrolyte fluid ( or breast milk) until they are no longer vomiting. A lethargic child who is not passing urine needs to be evaluated.
Stay well
~Nurse judy

Thursday, February 17, 2011

February 17th

This week in the office we are seeing lots of strep throat.
We are seeing some flu cases as well as plenty of coughs and colds.
There seems to be plenty of kids with a mild tummy bug as well.
I am seeing some long lasting viral rashes with happy kids. I am betting that these are part of the slap cheek spike that we have seen lately.

We are closed on Monday for the 3 day weekend, so call early on Friday if you have concerns, I expect the afternoon to be fairly busy.
~Nurse Judy

Monday, February 7, 2011

February 7th

The nice weather seems to be helping out a bit and things are not quite as wild and crazy as they were last week.
At last weeks end we were seeing lots of strep throat and a viral fever that was lasting about 5 days.
Today we are still seeing that seeminly never ending cough. Two of our patients have pneumonia (although they are doing fine on antibiotics)
We saw one case of probable chicken pox ( we sure don't see that as much as we used to)
There is still some vomiting.
I thought I was starting to see some cases of slap cheek, but no more have surfaced yet today. I will let you know if I get more signs that it is starting to spread. (Dr Kaplan says she has actually seen quite a few cases, so I am guessing that it is here)

Our nvpedi email got spammed...and so if you were one of the lucky folks who got a free movie ticket offer from me this morning.. delete delete delete
Enjoy the dry weather
~Nurse Judy

Monday, January 31, 2011

January 31

This weekend we had some common themes.
Lots of patients had croupy coughs during the night.
Plenty of patients had a fairly short bout of vomiting and diarrhea.
Coughs and colds continue to plague everyone with their persistence.
We have seen lots of ear infections.
If your child is turning 6 months we absolutely want to make sure they get their flu vaccines. Children under nine get 2 shots in the same season the first year and then one flu shot per year after that.
We have lots of wheezy kids out there as well. We are in fact missing many of the nebulizers that we lend out. If you have one of our machines please return it as soon as possible. If you child is still doing treatments, we will make sure that you get a machine of your own.
Stay well
~Nurse Judy

Monday, January 24, 2011

January 24th 2011

Flu is here. It is NOT too late to get the shot if you haven't yet.
Most of the patients with the positive flu tests, did not get the vaccine, but I have had one Flumist and one shot failure. We have also had plenty of kids with flu like symptoms where the flu test was negative.
If you do have the flu and it is diagnosed within the first 24 to 48 hours, we can give tamiflu which can shorten the course.
One of my poor patients has flu and RSV at the same time!
Once the immune system is having a rough time, this can happen and people can have more than one virus, or a virus along with a bacterial infection ( which accounts for why antibiotics don't always clear things right up).
We are also seeing the standard coughs, colds and ear infections.
That tummy bug is still out there making folks miserable.
We have had lots of sore throats..about 25% of those have positive strep tests.
FYI...If you have something that has been lingering, Thursday of this week we will have an extra acute care doctor working so my triage bar will be set very low and it will be easy to get an appointment.
Stay well and enjoy the weather!!
~Nurse Judy

Tuesday, January 18, 2011

January 18th

We certainly paid the price of being gone over the 3 day weekend.
The stack of charts on my desk this morning would have broken the all time weekend call record ( if there was such a thing)
There is a LOT going on out there.
Today we are seeing lots of vomiting patients, but some of last weeks tummy virus kids had diarrhea that lingered days longer than I typically see it.
Coughs, colds and fevers abound!
~Nurse Judy

Monday, January 10, 2011

Monday check in

We are seeing more of the tummy bug that I started seeing on Friday.
This one seems to be more diarrhea than vomiting and has been on and off for as long as 4 days. Some of the kids have had low grade fevers and rashiness with this.
We also MAY be starting to see some slap cheek.
We have had some positive strep tests as well as some positive Influenza A tests.
Lots of our patients have had some mild wheeziness.
(Our RSV babies are doing okay....)
We have plenty of ear infections and mild colds and coughs that have lingered for more than a week.....
At least it isn't snowing!!!!
Stay well
Nurse Judy

Friday, January 7, 2011

RSV

We have several infants who have recently been hospitalized with RSV (respiratory Syncytial Virus)
As scary as that is, they are mostly there for observation and hydration and after a week or so of illness they are quite well.
RSV is in fact a fairly common virus. It is rare for a child to make it to the age of 2 without having had it at least once. Babies with older siblings are of course more at risk.
Treatment for older babies and children is our normal approach to colds and coughs...
Saline and suction to nose, increase fluids, steam, elevating head..

If you have a young infant with a cough they may well need to be evaluated.
If your baby is eating well, sleeping well, No fever, good spirits we will be less concerned.
We are also starting to perhaps have another tummy bug out there.
I am having some reports of vomiting and diarrhea out there as well.

~Have a safe and healthy weekend
Judy

Monday, January 3, 2011

Welcome to 2011

People are back to school and back to work.
We are seeing the same old cough and cold. Some of these come with a fever.
We are seeing some ear infections.
I am also seeing lots of mysterious rashes associated with a viral syndrome.
I will update later in the week if we start seeing anything more interesting.
~Nurse Judy