Back To School!

15 08 2014

Dr. Mary Beth Koslap-Petraco, PNP, shares her tips for getting kids off to a healthy start this school year.

 

 

Share your ideas for a healthy school year in the comments!

 





Travel in Good Health – Part 3 of 3

26 07 2014

Babies and small children are less able to fight off foodborne and waterborne infections. Little ones who are crawling or walking around and putting things in their mouths increase their exposure risk.

What comes from those infections? Yes, you knew we had to get there. We’re talking poo. The kind that makes you want to pay strangers good money to change an oozing diaper.

But, there are a few things we can do to help prevent the big D.

Breastfeeding helps eliminate foodborne and waterborne transmission to infants.

Use purified water for drinking, ice cubes, formula, brushing teeth, washing food if eating food raw, or just anytime you’d use water. Purify the water, unless you know the water source is safe.

Wash hands with soap and water frequently each day and certainly before eating anything and before preparing foods, after changing diapers, after going to the restroom, after coming in from outdoor activities (this includes shopping!), when you get up in the morning and before going to bed at night. Use soap and water if available and always when you can see any grime on the hands. Alcohol-based hand sanitizer can be used to help disinfect your hands.

Pacifiers and other items made to go into a baby’s mouth that you bring or buy on the trip need frequent cleaning.

Don’t eat food from street vendors. Make sure all your food is either cooked thoroughly or washed with purified water and, if applicable, peeled.

Dehydration due to diarrhea and vomiting

Infants and young children can easily become dehydrated due to diarrhea and vomiting. They need plenty of liquids each time they have a watery stool or vomit. If you’re unaware of the signs of dehydration, you should read up on it prior to departure. Prevention is the best thing, but just in case, there are commercial oral rehydration solutions, or you can make your own. Here are some suggestions from rehydration.org:

Make sure the rehydration drink has in it starches and/or sugars, a little sodium and some potassium. Breastmilk is great for those nursing, or watery cooked cereal, carrot soup, or rice water is fine as long as they’re made with purified water.

You can make a simple solution yourself by using salt and sugar (molasses, raw sugar or white sugar) and something like orange juice or mashed banana for potassium. Add one teaspoon of salt to eight teaspoons of sugar and stir into a liter of boiled and cooled water, stirring until everything is dissolved.

Fresh fruit juice, weak tea or even simply boiled and cooled water will help, if nothing else is available.

Parasites in the soil

There are parasites in sand and soil where children love to play. They should wear enclosed footwear and play on a tarp or covering. Don’t put clothing or towels on the ground to dry, and iron anything you hang out to dry before using. All of these precautions are dependent on your destination, of course.

Rabies

Children are more likely to be bitten by animals yet less likely to tell parents about the bite. Remind the children to stay away from animals and to report any wound immediately. If a child is bitten or wounded, wash the area with soap and water and take the child in for evaluation. If possible, bring the animal in as well.

Water and infectious agents

Children and adults can pick up illnesses or infections by swallowing or simply being in contact with contaminated water. If you don’t know the area, don’t swim in fresh, unchlorinated water and, depending on where you travel, be careful with washing in the bathtub.

Well, that’s about it. We’ve come to the end of our Travel in Good Health series. Hope you enjoyed it as much as we did and, hey, maybe we’ll meet you on the road somewhere and do some trading. Ten diapers for a barf bag?  Anybody?

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Travel in Good Health – Part 2 of 3

25 07 2014

All the prep and stress of getting out your front door is over. Now it’s fun, sun, and bugs.

Wait. What?

Oh yes, wherever your journeys take you, you can be sure that pesky critters will be flying or crawling around, biting, stinging and more…so much more.

Some bugs carry certain diseases, such as West Nile virus, malaria, dengue and others. Whether you’re in Napa Valley, the Sahara or the Alps, there are steps you can take to avoid infection.

  • Use an insect repellent on exposed skin to repel mosquitoes, ticks, fleas and other arthropods. EPA-registered repellents include products containing DEET (N,N-diethylmetatoluamide) and picaridin (KBR 3023). DEET concentrations of 30% to 50% are effective for several hours. Picaridin, available at 7% and 15 % concentrations, needs more frequent application.
  • DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. There are DEET-free solutions available, but check with the pediatrician for a final recommendation. Protection against mosquito bites is the goal.
  • When using sunscreen, apply sunscreen first and then repellent. Repellent should be washed off at the end of the day before going to bed. Put repellent only on exposed skin and/or clothing and don’t apply repellent to open or irritated skin. Don’t let children handle the repellent. Rather than spraying it directly on children, adults should apply it to their own hands then rub it on the children. Don’t get it near a child’s mouth, eyes or hands and don’t use much around a child’s ears.
  • Wear long-sleeved shirts which should be tucked in, long pants, and hats to cover exposed skin. When you visit areas with ticks and fleas, wear boots, not sandals, and tuck your pants into your socks.
  • Inspect your body and clothing for ticks during outdoor activity and at the end of the day. Wear light-colored or white clothing so ticks can be more easily seen. Removing ticks right away can prevent some infections.
  • Apply permethrin-containing (e.g., Permanone) or other insect repellents to clothing, shoes, tents, mosquito nets, and other gear for greater protection. Permethrin is not labeled for use directly on skin. Check label for use around children. Most repellent is generally removed from clothing and gear by a single washing, but permethrin-treated clothing is effective for up to 5 washings.
  • Be aware that mosquitoes that transmit malaria are most active during twilight periods (dawn and dusk or in the evening). Stay in air-conditioned or well-screened housing, and/ or sleep under an insecticide-treated bed net. Bed nets should be tucked under mattresses and can be sprayed with a repellent if not already treated with an insecticide.
  • Keep baby carriers covered with a mosquito net.
  • Daytime biters include mosquitoes that transmit dengue and chikungunya viruses, and sand flies that transmit leishmaniasis.

Don’t forget to come back for Part 3, where we talk about more fun times for traveling parents.

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Travel in Good Health – Part 1 of 3

24 07 2014

[Editor's note: We posted this a few years ago, but find the info timely, so what the heck, we're running it again! Parts 2 and 3 run 25 and 26 July.]

Traveling with children, no matter their age, can be a joyful, tiring, exciting, and exhausting endeavor. Traveling with children who get sick on the trip is just plain exhausting and, sometimes, exciting in a way that we don’t want to experience.

Although dealing with illness in the midst of a family trip isn’t ideal, you can take steps to prevent illness before traveling and equip yourself with supplies to make the treatment of illness easier and more comforting.

Prevention is key, and no one does that better than the CDC. This article captures some tips for traveling families from CDC’s website, and a few other places.

If anyone in your travel group has an existing condition that may affect his or her health, it’s important to discuss travel health safety with a healthcare provider.

If you’re traveling outside the United States and you love detail, download a copy of CDC’s Yellow Book . It’s written for healthcare providers, but many people find it useful. Wherever you’re traveling, these suggestions may help you and yours avoid infectious diseases on the road.

There are steps you can take prior to departure that will protect you and your kids, and many things you can do while traveling. First, the pre-departure list:

Time Zones and Rest

If you’re changing time zones, spend a few days just before travel adjusting your sleep/wake periods to match the destination’s time zones. When you arrive, get out during the sunny periods so that you body realizes it’s time to be awake. Good sleep is critical to good health. Make sure everyone gets lots of rest a few days before and then during the trip.

Vaccinations

You and your kids should be up-to-date on currently recommended vaccines in the U.S.

If you’re traveling outside the United States, you need to check the destination country for recommended vaccines for you and your children, and if you have special health concerns, you need to determine which vaccines to get and which you should not have. Not all vaccines recommended for international travel are licensed for children.

Health Notices

If you’re traveling outside the U.S., read the CDC’s Health Notices first to get the latest updates on infectious diseases in various areas of the world. What you learn may affect your travel plans.

First Aid Kits

Prepare a first aid kit for the trip or purchase one from a commercial vendor. This is a sample list, as not all destinations require the same things.

  • 1% hydrocortisone cream
  • Ace wrap
  • Acetaminophen, aspirin, ibuprofen, or other medication for pain or fever
  • Address and phone numbers of area hospitals or clinics
  • Adhesive bandages
  • Aloe gel for sunburns
  • Antacid
  • Anti-anxiety medication
  • Antibacterial hand wipes (including child-safe) or alcohol-based hand sanitizer containing at least 60% alcohol
  • Antibacterial soap
  • Antibiotic for general use or travelers’ diarrhea (azithromycin, cefixime)
  • Antidiarrheal medication (e.g., bismuth subsalicylate, loperamide)
  • Antifungal and antibacterial ointments or creams
  • Antihistamine (such as Benadryl)
  • Antimalarial medications, if applicable
  • Anti-motion sickness medication
  • Commercial suture/syringe kits (to be used by local health-care provider with a letter from your prescribing physician on letterhead stationery)
  • Cotton-tipped applicators (such as Q-tips)
  • Cough suppressant/expectorant
  • Decongestant, alone or in combination with antihistamine
  • Diaper rash ointment
  • Digital thermometer
  • Epinephrine auto-injector (e.g., EpiPen), especially if anyone has a history of severe allergic reaction. Also available in smaller-dose package for children.
  • First aid quick reference card
  • Gauze
  • Ground sheet (water- and insect-proof)
  • High-altitude preventive medication
  • Insect repellent containing DEET (up to 50%)
  • Latex condoms
  • Laxative (mild)
  • Lice treatment (topical)
  • Lubricating eye drops
  • Malaria prophylaxis and standby treatment, as required by itinerary
  • Medications that the child has used in the past year
  • Moleskin for blisters
  • Mosquito netting, if applicable
  • Oral rehydration solution (ORS) packets
  • Personal prescription medications in their original containers (carry copies of all prescriptions, including the generic names for medications, and a note from the prescribing physician on letterhead stationery for controlled substances and injectable medications)
  • Safe water
  • Scabies topical ointment
  • Sedative (mild) or other sleep aid
  • Snacks
  • Sunscreen (preferably SPF 15 or greater)
  • Throat lozenges
  • Tweezers
  • Water purification tablets

Discuss with your family’s pediatrician any special needs your children might have that require you to prepare beyond this basic list. Also, your pediatrician may be able to give you sample sizes of antibiotics and other meds that may be useful for your kit.

Health Insurance

Before traveling, check your health insurance policy to see what it pays for. It will probable reimburse you for most of the cost of emergency medical care abroad, excluding any deductible or co-payment. For non-emergency care overseas, you may be covered, but check with your health plan about this before you leave home. Failure to get authorization may mean denial of reimbursement.

Travel Regulations

Check travel regulations and carry what you can onboard the plane, particularly prescription medication. Put the rest in your checked baggage. Put your first aid kit in a fanny pack or backpack that you take with you everywhere you go. There’s no sense bringing the kit if you don’t have it when you need it.

Now that you’ve done your pre-departure prep, stay tuned for Part 2 for some tips on problems you may encounter on the road.

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Summer + Mosquitoes = Dengue Fever?

13 05 2014

The dengue fever virus is the most common virus that mosquitoes transmit and infects about 100 million people worldwide every year, killing about 25,000. In spite of this frequency, though, the United States, with the exception of Puerto Rico, has been mostly dengue-free for decades—until 2009.

image by infidelic

That year, a woman in New York turned up with a dengue infection, having just returned from a trip to the Florida Keys. Her case was the first of a handful that led public officials to conduct a survey of the Key West population. To their shock, they found that about 5% of residents, or about 1000 people, showed evidence of dengue exposure in 2009.

The mosquito that carries the virus occurs in warm areas of the country, including Florida and Texas, and indeed, isolated cases of dengue have cropped up a few times since the 1980s along the Texas–Mexico border. But the cases in 2009 and more in 2010 have authorities concerned that dengue now has achieved an intractable foothold on the continental United States.

Work on a vaccine against dengue is ongoing, but in the meantime, the only preventive is to avoid the bug that carries the virus: the mosquito.

Wearing repellent when in areas where they occur is one tactic. Another is removing breeding places, such as any containers with standing water. The precautions apply wherever you’re going, whether to areas where dengue is already endemic or where it is emerging. The CDC provides regular updates for travelers, including a page specific to the Florida cases.

Dengue fever can hit hard or harder, depending on the symptom severity. The “mild” version of the disease can involve a high fever, a rash, severe headache and pain behind the eyes, and nausea and vomiting.  Given that these symptoms are largely nonspecific, if you see your doctor about them and have traveled in a place where dengue fever occurs, be sure to mention it. A more severe form of dengue fever is dengue hemorrhagic fever, which begins much like the “mild” form but then progresses to symptoms that can include nosebleed and signs of bleeding under the skin, known as petechiae.  This form of dengue can be fatal.

The most severe manifestation of the disease, dengue shock syndrome, includes the symptoms of the milder forms along with severe abdominal pain, disorientation, heavy bleeding, and the sudden drop in blood pressure that signals deadly shock.  Onset is typically four to seven days after exposure, and the mild form usually lasts only a week, while the more severe forms can involve either a progressive worsening or a sudden worsening following an apparent improvement.

Oddly enough, having dengue fever once does not mean you’re safe from it. Indeed, some studies indicate that a second bout of dengue fever often can be worse than the first, with a greater risk of progressing to the hemorrhagic form.





Why We Talk About Immunizations

25 04 2014

There are so many ways to prevent infections, I sometimes wonder why we spend the vast majority of our time talking about immunizations.

Well, yesterday the CDC came out with data that are so astounding, all I could think when I listened was: That’s why!

The CDC looked back at children born between 1994 and 2013, and estimated that vaccination will prevent:

  • about 322 million illnesses
  • 21 million hospitalizations
  • and 732,000 deaths over the children’s lifetime

And, of less importance than a child’s life but good to know, the prevention of illnesses, hospitalizations, and deaths nets a savings of $295 billion in direct costs and $1.4 trillion in total societal costs. That ain’t hay, as my dad used to say.

I’m happily highlighting these numbers because it’s World Immunization Week, and because the Vaccines for Children (VFC) program celebrates its 20th anniversary this year. Thanks to the VFC, vaccines are provided at no cost to uninsured kids in our country.

20-year-infographicAbout 25 years ago, there was a big measles outbreak in the US. We saw approximately 55,000 cases of measles and more than 100 deaths. Come to find out, this outbreak was primarily due to uninsured children not being vaccinated.

Shortly after the outbreak, the VFC program was established with the hope that such an event would never be repeated.

We are currently seeing small outbreaks of measles cases in the US. Unlike 25 years ago, these outbreaks are primarily due to a small number of parents choosing not to vaccinate their children.

Measles was eliminated from the US in 2000, but not from the world. It’s estimated that 20 million people on this planet get measles each year, and 122,000 die from the disease. When unvaccinated individuals in this country travel to other countries, or interact with visitors from other lands, they are at risk for measles.

The symptoms of measles include the typical rash, fever, cough, runny nose, tiredness, red and watery eyes, and sometimes little white spots in the mouth. The symptoms stay for several days before gradually disappearing. However, complications are not uncommon. According to the CDC: About 30% of measles cases develop one or more complications, including:

  • Pneumonia, which is the complication that is most often the cause of death in young children.
  • Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
  • Diarrhea is reported in about 8% of cases.

These complications are more common among children under 5 years of age and adults over 20 years old.

Even in previously healthy children, measles can be a serious illness requiring hospitalization. As many as 1 out of every 20 children with measles gets pneumonia, and about 1 child in every 1,000 who get measles will develop encephalitis. (This is an inflammation of the brain that can lead to convulsions, and can leave the child deaf or mentally retarded.) For every 1,000 children who get measles, 1 or 2 will die from it. Measles also can make a pregnant woman have a miscarriage, give birth prematurely, or have a low-birth-weight baby.

In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people. It is the leading cause of blindness among African children.

I look at these statistics and I think: Oh yes, this is the other reason we spend so much time talking about immunizations.

If I may appropriate and paraphrase something I heard the other day: Mom and dad, choosing not to vaccinate or to delay vaccination of your children is like choosing to put them in their car seats only on Thursdays when the sun is shining.

Don’t be a part of that small minority of parents who are afraid to proactively protect their children. Call your child’s healthcare provider today and make sure he or she is current on all immunizations.

Oh, and happy World Immunization Week.

 

by Trish Parnell

(Thanks to Liz Szabo for the thing I heard the other day.)





One Day, on the Way to the Army

24 04 2014

Today is World Meningitis Day, and the start of World Immunization Week. Are you young and healthy? Stay that way! It’s Your Choice, so choose to get immunized and get on with what life has in store for you.

Abby Blanco-Wold was a young woman on her way to the Army when she was attacked by meningitis. This is Abby’s story, as written by her.

 

TWO DAYS TO GO

Two days to go, and I would have been gone, off to the ARMY . . . Tuesday at dawn.

Out to the gun range my dad and I went, I did really well, to our amazement!

I wanted to shoot a gun once before basic training, the old men that were there found it quite entertaining.

Abby before meningitis changed her life

I had this slight headache throughout the day—didn’t recognize the faint scent of death’s bouquet.

Later that night, out with friends one last time, I threw up by a building, but then I felt fine.

We went home anyway, but stopped for a treat. I didn’t even feel bad enough not to eat.

I awoke in the night, throwing up once again . . . except this time throwing up took forever to end.

So I went back to sleep, but when I arose, intense pain was all over, from my head to my toes.

We need to go now, something’s not right. Upon changing my shirt, came the real fright.

Fever, throwing up, aches and pains, purple spots. The familiarity is chilling. Meningitis, I thought!

To the hospital my friends and I immediately rushed. Oh my God, if it’s true, my family’s going to be crushed!

Meningitis it was, but I already knew. I deteriorate quickly—my feet are both blue.

My parents arrive, “Mom, I have to go pee,” but not a drop would come from my failing kidneys.

I said to the doctor, “I know I might die, but can I have some pain medicine so I don’t have to cry?”

So, here I am in this bed instead, more worried about being AWOL than being dead.

In a war against nature, my body will try to fight off these enemies, so that I don’t die.

In this ICU, my family will weep, counting the moments that I am asleep.

Many of my doctors will quickly be stunned, watching my body grow increasingly rotund.

One by one my organs start to shut down; my urine is now coming out blackish- brown.

Covered all over in dark purple spots, as my vessels are littered with millions of clots.

Soon I can no longer breathe on my own, and more IVs into my body are sewn.

A ventilator’s my new buddy, I guess. How much longer can my body handle this stress?

This struggle is one that I simply must win, but things are so bad, more family flies in.

My priest comes to the hospital to say a prayer. My parents and brother are so numb they just stare.

He gives me just one last sacrament, as my body revolts, to my detriment.

Are they right, my last rites? Will tonight be my forever goodnight?

Suddenly, my blood pressure drops so low and so fast, my heart almost stops.

I am so, so very tired of this fighting, but I won’t give up—sorry that it’s so frightening.

Today, things aren’t good, the attending can’t lie, twenty percent chance to live, and that’s high.

Both my insides and outsides are going crazy. Now I’m in a coma, and my adrenals are lazy.

My prognosis looks so terribly bleak. How strong will my family be? Or how weak?

Am I allowed to die? Will you all fall apart? Will you succumb to the pain of your breaking hearts?

A few days later, it comes, a faint beacon of light. Can a miracle save me from this morbid plight?

Slowly but surely from the ventilator I’m withdrawn, and most of my organs start to turn back on!

I lay in this bed, comatose still. Reality sets in, but survive, yes I will!

I hesitantly, emerge from my sleep to hallucinations, pain, a machine’s constant beep.

I wonder, what could have happened to me? I was out for two weeks—how could that be?

I’m hurriedly transported to a new room, but I cannot sit up or hold on to a spoon.

Surrounded by so many balloons, gifts, and flowers, and cards that I read for hours and hours.

Everyone is here rejoicing my life, while knowing my future holds plenty of strife.

Just lying here the pain is so bad, it seems unbearable for my mom and my dad.

My body’s covered with open wounds that need care. An open bed in pediatrics? I’ll be right there.

My first ambulance ride reveals my yellow streak, and I need lots of help, because I’m so weak.

In my new room, tons of doctors I meet, their topic of interest—my gangrenous feet.

I finally see them completely unwrapped, “please be careful, and don’t touch them,” I snapped.

After surgery I’m left with no toes, heels, or skin, so I stayed alive—but did I really win?

Two months with surgery every other day, please let my parents and my brother be ok.

Eventually the big decision day comes—bilateral below knee amputee? Now I’m one.

abby2

So my life goes on and prosthetics I wear, but my family will never get over the scare.

There in that room . . . I was just 22, but oh how through the experience I grew!

Meningitis information I soon eagerly sought. I discovered that there’s a vaccine—what a thought!

The knowledge of inner beauty did finally come, and I realize, somehow, the battle I won!

But in my head, I know some will die, and many families will forever cry.

And in my heart, I am in disbelief that a shot could have prevented all of this grief!








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