Monday, February 27, 2012

Monday update February 27th

Since we will actually be on KRON today at 5pm talking about current Norovirus epidemic, I will start today's update with diarrhea.
I think that the calls about the tummy bug are subsiding but there are still some cases out there.

Rotovirus is typically the most common cause of diarrhea in young patients. By the time we get to the age of 5 or so, we usually have some immunity to many of the strains. recent studies are showing a 25% decrease in rotovirus cases since the vaccine came out several years ago.
Norovirus hits the older kids and adults. It can survive on surfaces for several hours, which helps it spread easily. good hand-washing is key to prevention.
Most of the time it lasts about 3 days. It may last longer in the younger kids.
I suspect due to the large numbers of adults and older patients hit with this recent onslaught, that it is Norovirus that we are dealing with.
Most of these patients have some vomiting, several days of loose stools, tummy aches and some low grade to moderate fevers.
If you or your child has diarrhea that comes along with bloody stools or high fever, then a bacterial infection should be ruled out.
If we have ongoing gassy, STINKY stools then at some point we will want to rule out Giardia or other parasites
Aside from the tummy bug...
We are also still seeing quite a bit of RSV
We have had LOTS of conjunctivitis.
There is a fever/ cough virus out there
We have had 2 positive flu tests to date.
They both had Type B strains of the influenza.

Stay well
Nurse Judy

Friday, February 24, 2012

frequently asked questions about the arsenic issue

Thanks to one of our mom's out there for furnishing me with this info to share!

Q: Which types of baby formula should I be worried about?
A: Our researchers tested two toddler formulas on the market that use organic brown rice syrup. Please see http://abcnews.go.com/Health/Diet/arsenic-organics-rice/story?id=15642428#.T0LIEXlW18F, http://video.msnbc.msn.com/nightly-news/46420960/#null, and http://articles.boston.com/2012-02-17/health-wellness/31065888_1_arsenic-levels-rice-syrup-baby-formula. Both products contained amounts of total arsenic that are above **10 parts per billion (ppb), the legal standard set by the U.S. EPA for public drinking water, and amounts of inorganic arsenic that are equal to or greater than this regulatory limit. See, http://water.epa.gov/drink/contaminants/basicinformation/arsenic.cfm

Q: What are the risks from ingesting these products?
A: The risks to an infant or young child who drinks these products for a relatively short period of time are not well-studied. Chronic life-time exposure to arsenic (for example from drinking private well water containing arsenic levels at 10 ppb and above every day), does result in increased risk for bladder, skin, lung and liver cancers, heart and respiratory disease. Very little is known about exposure to low doses of arsenic for short periods of time, but scientists at Dartmouth and other universities are currently studying the health effects of dietary exposure in infants and children.

Q: What can we do?
A: To be cautious, switch to a product that does not contain brown rice syrup. Please consult your pediatrician before you make this change. ( we say please switch!!!!!)

Q: I gave this formula to my child for two years—what should I do?
A: Arsenic does not accumulate in the body so when your child is no longer exposed to arsenic it will leave his/her system in a day or two. Long-term health consequences are unknown because previous studies have not examined childhood exposure at doses equivalent to levels found in these formulas. Scientists at Dartmouth and other universities are studying the potential health effects of dietary exposure to arsenic in infants and children.
To ensure that your children are not exposed to arsenic from other sources, make sure to have your well water tested. If you have additional questions about potential health effects and sources of arsenic, consult your pediatrician and a registered dietician.
The UK Food Standards Agency states that “as a precaution, toddlers and young children between 1 and 4.5 years old should not have rice drinks as a replacement for cows’ milk, breast milk, or infant formula.” The Food Standards Agency represents the UK Government on food safety and standards issues in the European Union.

Q: Should I get my child tested for arsenic?
A: No. Arsenic does not accumulate in the body, and the body normally excretes arsenic in the urine within one to two days of exposure. This is why scientists at Dartmouth are most concerned with long-term exposure. If you have a private well, you should test your well for arsenic to minimize exposure.

Q: Should I be worried about Cereal/Energy Bars?
A: Some of these products contain rice or brown rice syrup, both of which may contain arsenic. We tested 29 bars (multiple brands) of the hundreds of cereal/energy bar products on the market. Of those 29 products, our results showed that the amount of inorganic arsenic in each bar depends on the size of the bar, the concentration of total arsenic, and the percentage of total arsenic that is in the inorganic form. Eating 2 - 3 of the larger bars (approximately 70 grams) per day could contribute 10 micrograms of inorganic arsenic to your diet. If you examine the ingredient list and consider the weight of the bar, frequency and quantity consumed per day, you can make an informed choice.
************************************************************************************************
**In 2001, the EPA set 10 ppb as the legal standard for public drinking water for adults, but it determined the public health goal should be 0 ppb. The EPA set the legal standard based on human adults; it does not account for the low body weight of infants and the corresponding increase in arsenic consumption per pound of body weight. This 10 ppb standard was set as close to the public health goal (0 ppb) as possible, considering cost, benefits and the ability of public water systems to detect and remove arsenic. According to the EPA and many scientific studies, people who drink water containing arsenic in excess of 10 ppb over many years could experience skin damage, problems with their circulatory system, and may be at an increased risk of getting cancer and heart and respiratory disease.
For more information about arsenic and health, please consult these reliable independent sources:
o The World Health Organization produced a 2010 report titled: “Exposure to Arsenic: A Major Public Health Concern.” http://www.who.int/ipcs/features/arsenic.pdf

o The latest U.S. CDC/ATSDR public health statement on arsenic, published in 2007, recognizes inorganic arsenic as a “human poison.” http://www.atsdr.cdc.gov/phs/phs.asp?id=18&tid=3

Tuesday, February 21, 2012

Lots of stuff out there

I hope that some of you managed to have a good weekend.
Many of our patients and families are still plagued by the tummy bug that is out there.
I am tempted to say that the kids with diarrhea that is lasting longer than a week may have Norovirus. We know that it is very prevalent out there with some schools and day-cares closing for a few days.
This information doesn't do a whole lot for us except reassure us that time WILL fix this.
Please check in with us if your child has diarrhea vomiting symptoms IF
*you are concerned about possible dehydration
*your child seems to be losing a significant amount of weight
*the symptoms have been lingering for more than 3 weeks.

See earlier posts for tips on treating

We also have a lot of RSV out there. More than one baby was hospitalized with this this weekend ( happily they are doing quite well and are now home)

There is an illness that comes with a high fever.. I am still gathering data on this one as more folks come down with it.

I haven't been able to come up with many hard facts about the arsenic issue.
In general please don't lose any sleep over this, but do change your habits to avoid further exposure until we know more.
Currently I can only assure you that Similac is not impacted by this, I don't know for sure about the other organic formulas yet.

We had another parent post a comment last week with a question about Tylenol and a link to asthma.
Looking into that, it looks like that was a very poorly done study without any real clinical statistics to back it up.
In general it is best to avoid any medication unless it is needed, but if your child has fever or is very fussy from teething or discomfort, I would be fine giving appropriate doses of Tylenol or Advil ( Acetaminophen/ Ibuprofen)

I will chime back in if there is anything nutty going on this week.
Judy

Friday, February 17, 2012

Arsenic in Baby formula/ Friday update

I am trying to find out more info about the reports of arsenic in baby formula.
What I can currently tell you is that I have been assured that Similac organic formula is NOT affected by this and does not use the ingredients that are being questioned.
As soon as I have more info, I will update.

We will be closed on Monday in honor of Presidents day.
As always the after hours clinic will be available to take care of your needs.
We will be back on Tuesday.;

We had our first positive flu test...Influenza has arrived. I will update when I have a better sense of what this particular virus is looking like. Every year tends to have some variations.
Have a good weekend
Judy

Wednesday, February 15, 2012

fevers out there

I am wondering if we are possibly starting to see the flu.
I now have several patients with lots of congestion and high fevers ( 102-103). The Mucous tends to be mostly clear. This batch of kids are fairly unhappy and so far we are on day 3 of the fever, so I don't know how long it lasts yet.
We haven't tested any of them for flu but may start if other kids keep this up. At this point my 3 day fever rule is still intact.
If your child has a high fever that is on the 3rd day and they have NOT been evaluated yet, I would like to have them seen. ( unless they are absolutely happy, eating with easy breathing..in which case they get an extra day or two.

Judy

Monday, February 13, 2012

new class for parents of young babies

Attention parents of our youngest patients.
By request I will be starting a new class for parents of babies under 3 months.
This class will deal with colic, new born rashes, baby poop, cradle cap, sleeping tips, thrush, cord care blocked tear ducts etc.( in other words anything that is on your mind)
sleepy babies will be most welcome at this class.

If there is enough interest I will try to schedule the first one sooner than later, otherwise look for it in March.
If you are interested email me at nursejudynvp@yahoo.com and I will try to find a mutually convenient time

Judy

Monday Feb 13th

Our patients are still plagued by
* the stomach virus ( the numbers are down a bit so far today but it is still out there)
* coughs and colds that have moderate fevers ( 101) associated with them
* LOTS of wheezing going on
*all sorts of odd rashes


There are several events that I want to let you know about.

UCSF school of dentistry is offering free dental to children 4-17 on Saturday February 18th over at 707 Parnassus from 9-3. no appointments are needed but I would get there early if this is something you are interested in.

SF Birth and Baby Fair is hosting a Free Car seat check over at the sports Basement on Bryant street on Saturday February 25th.
Google the SF Birth and Baby fair and click from the site to make an appointment

Healthychildren.org is also a fun website to check out. They have all sorts of answers to all sorts of questions.
SFkids.org is another good site that has lots of suggestions for great activities to do with your kids

It is preteen vaccination week.
All kids going into middle school next year need to be up to date on the TDaP vaccines.

stay well
Judy

Sunday, February 12, 2012

Tylenol dosing information

I have been getting a lot of questions lately about correct Tylenol dosing. In the effort by the companies to make things simple, things have gotten awfully confusing.
What used to be known as concentrated infant Tylenol drops ( 80mg/1 ml) is no longer supposed to be available. Most of what is being sold is now Tylenol suspension ( 160 mg/5 ml)
Okay moms and dads..It is time to brush off your math skills.
In order to make sure that your child is getting the proper dose regardless of what form you have, from now on we need to focus on how many milligrams of medication your child should get.
Somewhere on the label it should say how many mg there are per ml.
milliliters are standard units of measurement. There are always 5 ml (milliliters)in a teaspoon.
How many milliGRAMS there are in a milliliter will vary from medication to medication.
Once again, In the case of Tylenol the most popular concentration is now 160mg/5ml but please take a moment to find that info on the label ( it might be small) just to be certain.
the proper dosing for the 160/5ml concentration will be as follows

5-8 pounds 40 mg 1/4 teaspoon 1.25 ml
9-10 pounds 60 mg 1/3 teaspoon 1.7 ml
11-16 pounds 80 mg 1/2 teaspoon 2.5 ml
17-21 pounds 120 mg 3/4 teaspoon 3.75 ml
22-26 pounds 160 mg 1 teaspoon 5 ml
27-32 pounds 200 mg 1 1/4 teaspoon 6.25 ml
33-37 pounds 240 mg 1 1/2 teaspoons 7.5 ml
38-42 pounds 280 mg 2 teaspoons 10 ml

Tylenol doses can be repeated every 4-6 hours as needed.
If your baby is under 6 weeks it is essential that you report any elevated fever or significant fussiness rather than automatically treating with Tylenol or Advil.

Wednesday, February 8, 2012

Upcoming Nurse Judy class schedule

Here is the schedule of upcoming Nurse Judy classes



Solids foods class
February 11th 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
Topics range from how interesting your child's poop can get with various foods, to understanding how to read a growth chart to track their heights and weights

Safety Class
February 25th 10:00 am ( Saturday morning)
This class is appropriate for all parents. We focus on accident prevention but teach how to deal with emergency situations
This class covers head injuries, falls, basic first aid, burns, poisoning, child proofing, safe pet interactions and CHOKING rescue

Illness class
March 21st at 7:45 pm ( Wednesday evening)
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

classes are typically 90 minutes

My February Parenting class is full, but this class deals with parenting tips for parents with children over the age of two ( tips are useful for all ages) In this class we talk about appropriate rewards, consequences, tantrums, problem solving, bedtime, mealtime etc....
If you have at least 4 people interested ( best with similar age kids) contact me to set up a class
( parenting class is 2 hours)

Classes are held in the Noe Valley Pediatrics waiting room - you do not need to be a patient of NVP to attend. Cost of the classes is $20/per person. sliding scale available.
RSVP required nursejudynvp@yahoo.com


more info at www.nursejudy.net

Monday, February 6, 2012

Monday February 6th

This week coughs and wheezing are the biggest complaints. We are still seeing RSV. ( see previous posts for more info about this)
We are still seeing lots of vomiting kids with diarrhea so that is still getting an honorary mention. We have actually had a few of our patients end up in the ER to get some IV hydration. Hooray to the parents who recognized that it was appropriate to take the kids in (significantly low energy and decreased urine output should get your antenna up)
We have complaints of sore throats but all the strep tests were negative today.
We have had no positive flu tests yet, but there have been a handful of kids with fever and aches.
Stay well
Judy