The Weird and Interesting Life of a Flu Virus

shutterstock_87645001The first description we have of the influenza virus was from Hippocrates (my hero!) 2400 years ago. He dealt with it every winter, endlessly, just as we do now. Nowadays it makes between 3 and 5 million people sick each year, and kills 250 to 500 thousand people annually. In the US we average 200 thousand hospitalizations and 36 thousand deaths yearly. Persistent, nasty little bugger.

Influenza gets its name from the Italian word for influence, because people initially thought it was caused by the influence of the stars, and later by the influence of the cold. Now we know better.

The Anatomy of a Flu Virus:

The influenza  virus is a tiny spherical particle, only 80-120 nanometers in size. It would take a million of them standing in a row to make a 1 centimeter line. Its core is made of 8 separate segments of RNA (we humans have DNA). This core is surrounded by protective proteins and an envelop with 2 types of “glycoproteins”–the famous Hs and Ns you hear about when people talk about which type of flu is causing problems each year: Hemagglutinins and Neuraminidases.

NPR has a very cool video of the flu virus invading a cell here. The “key” in the video is the hemagglutinin.

How the Virus Works:

The Hemagglutinins (Hs) bind to target cells in your body and inject the virus particle into your cells. How contagious the flu is, what symptoms it gives you, and how sick it can make you depends on the Hs. An H that can bind to cells in your eyes, nose, and mouth is more contagious than one that can only bind to your throat. An H that can bind to a cell deep in your lung is much more serious than one that can only bind to a cell in your throat.

The Neuraminidases (Ns) release the progeny of that prolific particle from that cell so that the little critters can spread further through your body.

How we Fight it:

The Hs and Ns are the molecules our immune systems build antibodies against, whether we catch the flu or just get exposed to the dead virus in the annual vaccine. The Hs and Ns are also the targets for antiviral drugs. There are 16 different Hs and 9 different Ns. Humans are usually infected with H 1, 2, or 3 and N 1 and 2.

There are three groups (genera) of flu viruses in the family Orthomyxoviridae. (I love that word: Ortho-myxo-vir-i-dae.) The three groups are simply labeled A, B, and C. We frequently call the flu by which animal is its main host. Human, bird, and swine are the most common strains we humans catch.

Flu A has the most serogroups (Hs and Ns), infects the most different animals, and is the most virulent. It also mutates 2-3 times faster than B. The critters it infects are mostly aquatic birds, but it can infect many other species.

Flu B has only one serogroup and is almost exclusive to humans. It tends to be less severe and less common. Since it only has one serogroup and mutates slowly, many people develop a degree of immunity to it.

Flu C is even less common and less severe.

What makes Flu unique among viruses:

Viruses enter cells so that they can make copies of themselves and spread. As they make those copies they sometimes make mistakes, creating mutations. They average one mistake per copy, so mutation is constant– what we call antigenic drift. That’s why we never get immune to Flu A–it changes every year.

There is one really cool thing about the flu virus that makes it different from most viruses: its RNA is split into 8 segments. (Most viruses have one long piece of RNA.)

This means that if your local pig catches 2 different strains of flu at the same time, these strains can trade segments. When that happens we get antigenic shifts– much larger changes for which people have no immunity. These larger shifts can create a pandemic, like the Spanish flu in 1918 that killed an estimated 21 million people. We average 3 pandemics each century. We worry a lot about pandemics.

So, those are the ABCs of the flu virus. If you crave something more useful, like what you can do about it, check out my post on colds and flu or info on fever.

Now wash those little hands with soap, keep them away from noses and mouths, break out the bleach, and go get those flu shots! The shots cover an H1N1 and H3N2 Flu A, and two strains of B.

The X’s and Y’s of Sex: What Makes a Boy or a Girl

Infant feet-01Remember high school biology? You were taught that humans had forty-six chromosomes. There were two each of twenty-two pairs, and then there were your sex chromosomes, the Xs and Ys. If you had two X chromosomes (XX), you were a girl. An X and a Y (XY) made you a boy.

It’s not actually that simple. That is the most common arrangement, but there are many variations. When you have a variation on any other chromosome, it causes physical issues that are unfortunate and sometimes deadly. If you have three number twenty-one chromosomes you have Down’s syndrome, and your life will be different.

We don’t ever blame the child, right? Nobody asked them if they wanted the usual forty-six chromosomes or if they would mind having an extra. It’s not their fault.

When the extra or missing chromosomes are the Xs or Ys, suddenly we involve social judgment and religion. Why? I can only assume that we are all so uncomfortable with sexuality that we would rather judge than understand.

You’re reading the wrong blog if you wanted to get away with that.

Variations

One in 840 male births are an XYY. We used to think that this made the men more violent because the tests were all done on men in prisons. Once we started testing men who were not in prison, it turned out that there weren’t actually many differences. Most are completely normal. There is a mild tendency toward tallness, poor fine motor control, weakness, and some speech and language issues. Most of these guys never know they aren’t the typical XY.

One in 500 males have XXY, or Klinefelter’s disease. These kids do have some physical issues, such as a tendency toward long limbs, smaller genitals, and slightly less intelligence than they would have had without that extra chromosome.

When you get into larger numbers of chromosomes, you see more problems. XXYY and XXXY kids tend to need testosterone replacement. XXXY and XXXXY kids tend to be short with small genitals, mental defciency, and elbow issues.

Without any Y chromosome, we get girl babies. XXX girls are usually tall and sometimes uncoordinated. Rather like the XYY males, most won’t ever know they have it. Girls with as many as five X chromosomes have been found. The more X chromosomes they have, the more problems: they tend to become shorter, with mental defciency and behavior issues.

About one in 2,000 live births are XO girls who are missing one X or Y chromosome. They have Turner’s syndrome. They have lymphedema (fluid swelling under the skin) before they are born and frequently have extra skin at the neck. They tend to be short, with wide chests and gonadal dysgenesis (sex organs that do not develop normally).

To add to all these variants, we have mosaics: two fertilized eggs fuse so that the resultant person has half a body with the typical XX or XY and half a body with a variation.

Variations with the Usual Chromosome Count

There are also variations that occur with the typical complement of chromosomes.

Girls with testicular feminization have 46XY. Their chromosomes say “boy,” but their bodies are insensitive to testosterone. They grow up as girls and don’t realize there is a problem until adolescence, when fertility issues arise.

Congenital Adrenal Hyperplasia (CAH) will give you a baby that has been virilized. On a girl, the clitoris will be enlarged, and the labia can become fused. It is difficult to tell when the baby is born if it is a boy or a girl until the chromosomes come back. Since the first question everyone asks is “Is it a boy or a girl?” this can be very traumatic to the families involved.

Adrenocortical tumors can also be virilizing, giving the child more masculine traits than they otherwise would have had.

Enough? There are many more. Biology is not as simple as they taught you in grade school, and throwing judgment and religion at it does not change it or help in any way. Ignorance is ugly.

The gender issues and sexual orientation parts of this blog got really long, so…

Come back next week please!

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Doc’s Top 10 New Years Resolutions for Moms and Dads

storkHappy New Year! Time for those resolutions.

This year, instead of resolving to lose that last ten pounds or eat more veggies (I really need to eat less chocolate…), resolve to do something that will actually make your life better. The reward for parenting well is amazing kids and sanity – definitely worth the effort. You may already be doing all these things (is that even possible?), but skim through if you are merely human and could use some help. So…

Dr. Lovlie’s Top 10 New Year’s Parenting Resolutions:

10.  Require chores. Equal participation is fundamental to receive the reward of being in a family. The pride your children feel serving the carrots they helped peel is well worth the time it takes to get them to do it. Every member of the family contributes, to the best of their ability. Family bonds and trust will form over the raking of leaves.

9.   Make rules, and enforce them consistently. Rules keep kids safe, teach them right from wrong, and civilize them. Make sure your child understands the rules, and every single adult in his life needs to enforce every rule each and every time. No “warnings,” because you made sure ahead of time that they understood the rule. Decide what the consequence will be for a broken rule long before you need to enforce it; make the punishment appropriate for the crime (timeout? loss of the toy? paying for the damage?). Read 5 Reasons Why Kids Need Rules.

8.   Feed the munchkin a healthy diet: whole foods that look like they either grew out of the ground or walked on it (I know, but not everyone is a vegetarian). Teach your children to eat when they’re hungry, and stop eating when they’re not hungry anymore. Aim for about 2/3 fruits, vegies and whole or enriched grains, and about 1/3 protein (meat, eggs, cheese, beans or nuts) and starch (potatoes, corn). Everything else will be easier if they are well nourished. Check out All the Right Foods.

7.   Keep a regular sleep schedule – both enough hours and at about the same time every day – as much as possible. Kids who are short on sleep are irritable, tired and have no attention span. Everything else will also be easier if he or she has had enough sleep.

6.   Keep them safe when possible. There are lots of surprises out there to keep life interesting; there is no need to risk preventable injuries. Use those seat belts and bike helmets, lock up the household poisons, guns and Grandma’s meds, and get those vaccines.

5.   Teach financial responsibility. Spend less than you make, stay out of debt, and save for the future. Do it where they can see you and explain what you are doing. Go through your budget with them in an age appropriate way, and feel free to say, “We can’t afford that.” Give them an allowance for those chores and require that they save some.

4.   Don’t wear blinders. Your primary job is to protect this child, even if it is sometimes from themselves. Children will lie, take things that are not theirs, and sneak out at night when they are 14. You need to catch them so that they learn that it doesn’t work. If they get caught stealing at 7, they have an embarrassing memory of having to go back and pay for what they took. If they get caught at 25, they land in jail and loose their job, partner, and children.

3.   Give them love without condition. Love the child you have, not the one you dreamed they would be. Love is not a prize you can give when your child is good, and take away when they do not live up to your expectations. Without the absolute faith that no matter what happens or what horrible thing they do you will still love them, the foundation on which they build their life will by shaky and unstable. You chose to have them – unconditional love was part of the deal.

2.   Nurture your child’s unique talents and abilities. Don’t try to fit the ones you want them to have on an unsuitable frame. This little person is an original – why would you want to shove him or her into a standard form? And what irreplaceable gifts would be forever lost because you did not value them? Respect the exceptional person that he or she is.

1.   Inspire them with your own life. Be what you hope for them. Find work you love, maintain a healthy relationship with your partner, eat a healthy diet, and exercise. Learn something new every day. Never lie. Give respect, and demand it for yourself. Keep an open mind, explore the world and grab opportunities when they happen by. Make your children proud.

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5 Truths: Why Rewards Work

Parent with Child, parenting
Without rewards, rules become guidelines that tell our children how to get our attention.

We must reward our children when they are good–chiefly with our time and praise–since there is otherwise no benefit to good behavior. Rewards are far more effective at shaping good behavior than punishments will ever be, because children desire their parents’ love and attention above all.

Rewards are not bribes. Rewards are earned, like a paycheck, for desired behavior. Bribes are given beforehand, when they have not been earned.

What Earns a Reward?

As with rules, what behavior is defined as rewardable depends on the particular child’s personality, age, abilities, and the environment in which they find themselves. (Last month’s blog How to Custom Fit Rules to Your Child outlined what children are capable of at different developmental ages.) Think about the behavior you want, look for it, notice it, and reward it. You will see more of it.

Try not to expect behavior that is improbable for the age of the child. Fifteen-month-olds will not be able to control their tempers. Two-year-olds can begin learning that temper tantrums do not get them what they want. A temper tantrum in a seven-year-old is not attractive.

Consider, also, your particular child’s style and ability. Everyone is better at some things than others, and ability changes with age. Think about where they are now compared to where you want them to be and aim in that direction, taking small, attainable steps.

It is far too easy to ignore good behavior–or just not notice. Your toddler shared his toy?Definitely worth noticing. Your five year old is looking through a book? Fabulous. Teenager being civil? Yay! Good behavior is easy to miss or dismiss with the thought He should act that way all the time. But would you go to work every day if there was no paycheck at the end of the week? Would you work as well if your boss did not appreciate you? The human mind is built to respond to approval. If you want to see more of a particular behavior, reward it.

Small Goal, Small Reward

It is vital that you keep your goals small and of short duration. A trip to Disney for straight As sounds good, but can be soul killing to a child who just can’t get there.

Frequent small rewards are more effective. The child can see the end point and know that it’s possible. “If you wash the dishes, we can read that book together” is immediate and obtainable. “If you clean the whole house, I’ll give you fifty dollars” is distant and improbable, as well as overwhelming.  Divide responsibilities into many short sprints rather than an inconceivably long marathon.

Instant Gratification

Rewards should be immediate. Children have short attention spans, and if too much time passes, they won’t be able to remember what they did or why they’re being rewarded for it.

Immediate rewards create an emotional connection to the behavior that will give them a good feeling when they repeat it. Reading that book made them feel happy, so they will grab another book. They probably won’t remember the hug and smile, but the feeling will be there.

Proportion

Rewards should also be proportionate. Small people receive small rewards for small actions. Putting away their toys receives a hug and a smile, not a new toy. Finishing their homework should be rewarded by going with Dad to walk the dog, not by getting a new puppy.

Older kids, who generally want larger things,  can work toward them by getting points for small acts of fabulousness. Working toward an A in history? Homework done? Points toward that bike can be prominently displayed for each small accomplishment.

Respect your children’s intelligence: if you go overboard, they won’t believe the approval is authentic. If the reward is grandiose, they will know they did not truly earn it and may feel manipulated. They might be insulted that you thought they were so dumb. You may want to jump up and down when you find your teenager doing homework, but a nod and a “Cool, good job,” will be more accepted.

He’s Never Good!

What if you don’t ever see the behavior you’re looking for? Sometimes you can create the behavior you want, and then quickly reward it before they figure out that they didn’t mean to do it. Sneaky, but it works. You are smarter than they are—for a while, at least.
If they’ve been in a timeout, grab that instant before they scowl and say, with a relieved smile, “Good, you’re back! I missed you so much when your evil twin took over! Let’s go do something fun.” Most of the time, they will grab that preemptive reward and run with it.

We do this in the pediatric office when we torture kids. Right after a throat swab, their faces will start to crumble. In that instant, we smile and say, “Wow, you were so brave! I think you were the bravest kid all day! Would you like a sticker?” They are so proud of their bravery that they try to live up to it.

If they are exploring and about to get into something they shouldn’t, stop them before they do and tell them they are wonderful for being so curious. It is so much more fun than yelling at them for breaking that lamp! Interpretation is everything.

If your toddlers are not great at eating veggies, give them the ones they like and will eat, then tell them how great it is that they ate their veggies and that they will make them big and strong. Set up the playing field in such a way that they will succeed and you will have something to reward.

But what rewards do you give for what behavior? Check out What rewards? When? How?

How to Keep Your Kid Alive and Still Have a Happy Halloween

Kids Carving Pumpkin At Halloween

A Safe and Happy Halloween

Time again for the annual “How to keep your kid alive and still have a happy Halloween” article. I know you’ve read this sort of thing before, but skim through – you might see something you forgot!

First, costumes:

From tiny ones who want to be lions to preteens dripping blood, costumes are the best part of Halloween. For a few hours we suspend boring reality and play at being something else. How better to encourage creativity and imagination?

Please try for bright, easy-to-see colors. Check to make sure the fabric is flame retardant and add reflective tape. Make sure the costume fits well so your little guy won’t trip. Stick your little gal’s feet into comfortable shoes. Pin a paper with their name, address and phone number inside their pockets in case you get separated.

Paint their faces so they don’t need to wear masks that can obstruct their vision.

Be careful about those accessories! Long scythes and pitchforks can be trip hazards. Accessories should be soft, short, fake and flexible. Guns that look real have caused problems when people were unsure they were toys. Arm them with a flashlight with fresh batteries instead.

Home décor:

I once put a big fat candle on a table decorated with straw. It took my next-door neighbor–a fireman–raising his brow sardonically for me to see that this was not a terribly bright idea. So. Be careful where you put flame. Fire inside a floor level pumpkin with costumes sweeping by–not so good. Try battery powered candles or glow sticks instead. The firemen will appreciate it.

Only the grown ups get to use sharp objects, so pumpkin carving is for big people only. Nothing ruins a holiday like a trip to the ER. Kids can design with markers or paint.

Last, inspect your yard and home for trip hazards such as bikes and hoses. Check for frayed wires, and poorly lit areas.

Trick-or-treating:

There are, I admit, children who may disagree with me about costumes being the best part of Halloween. There is that other thing they like a lot: running around neighborhoods screaming maniacally and getting free candy. I would frown upon such activity but I have fond memories of doing the same.

The number one way children are hurt on Halloween is by running in front of cars in the excitement of the moment. Teach them basic safety, know where your kids are, and know who they are with.

Kids under 12 walk with a grown-up (No, that is not up for debate; blame it on me.) Over 12, it depends on the maturity of the child and the safety of the neighborhood. If they are not with a grown-up, they need to travel in a group, on a preplanned path. If you can find a neighborhood where they close off the streets, enjoy! If not, hike through a familiar neighborhood (it can’t hurt to check the registered sex offender site and avoid those houses).

Trick-or-treaters need to stay in well-lit areas, avoiding short cuts, alleys and darkness. Use sidewalks and walk facing traffic. Be careful when crossing the street: even if the approaching car does see your child, the one behind him or her might not. Make sure they know to never approach parked cars and never enter a house. Have your big kid carry a cell phone and check in every hour. Agree on a curfew.

When they get home, go through their haul. Throw out anything that looks like it was tampered with, anything home made (if you don’t know the maker), choking hazards, and whatever else you can get away with. Freeze some for holiday cookies later.

Last, take care to keep your pets safe during the holiday. Keep chocolate and anything sweetened with xylitol away from your dog. Watch for choking hazards and yummy electric wires, and lock your four legged ones away from the front door so they won’t escape when the hoodlums knock.

Happy Haunting!

Did You Know? Truth, Tips, and Treatment for Warts.

girl-doc-01The common wart, or verruca vulgaris, appears as a small, rough-surfaced bump on your child’s skin, frequently on their hands or feet. Interestingly, kids can be infected for months before the warts actually get big enough to see. Warts are benign, causing little harm to their bearer (the exception being genital warts). They can, however, drive the parent of said bearer insane.

Warts are caused by a virus called Human Papillomavirus. They are contagious. Kids catch them by touching someone else’s wart, or by touching a surface that has come in contact with a wart. The virus prefers to invade through cuts, abrasions, and chewed bits of skin, so children are fertile ground for invasion.

There are about 130 strains of HPV. The type of wart you get depends on the strain and on where it appears.

Types of warts include:

  • Common warts. HPV types 2, 4 and 7, among others, cause the common wart. These warts can pop up anywhere, but they are most often seen on hands. “Periungal” warts are around the fingernails.
  • Plantar warts. Most commonly HPV 1, but can be caused by other strains ( 2, 3, 4, 27, 28, and 58) “Plantar” means on the sole of the foot, so that’s where you find plantar warts. They can be painful, because constant pressure on the sole of the foot forces them to grow inward rather than outward. They can feel like a pebble in a shoe.
  • Mosaic warts are a group of warts clustered together, usually on a foot.
  • Filiform warts. HPV strains 1, 2, 4, 27, and 29.These are rapidly growing long strings, frequently found on eyelids and noses. Luckily they are less common.
  • Flat warts. HPV 3, 10, 28 and 49. These warts are smaller, smooth, and more numerous. Kids will get between 20 and 100 separate warts all at once. They like to show up on the face.
  • Genital warts. There are lots of strains but the worst are 16 and 18, which cause cervical, skin, and anal cancers. This is the one we have a vaccine to prevent, given at age 11 or 12.

There are many therapies for warts, and many interesting traditional remedies. None of them work terribly well. My favorite dermatologist once said, “treating warts is treating a non-disease with a series of treatment failures.” Left alone, warts will resolve on their own, so doing nothing is probably the best option. Duct tape and rubbing with  potatoes are absolutely safe to try.

There are medical treatment options if the warts are driving you nuts. (check out the American Academy of Dermatology)

  • Chemical peels. Paint the wart with an acid every day after a good soak. Then abrade off the top layer of the wart with an emery board or pumice stone. (Don’t use the board or stone for anything else). You can buy salicylic acid over the counter, or a doctor can prescribe a stronger version. Some docs will also use tretinoin or glycolic acid, especially for flat warts.
  • Cryotherapy, or freezing.We use liquid nitrogen to form a burn blister under the wart, so that the wart will die and scab off. This frequently requires repeated treatments every two weeks or so.
  • Imiquimod (Aldara cream). This is a cream that encourages your body to make interferon, a part of your immune system that will fight off the virus.
  • Canthariden. This is a poison made from beetles injected into the wart–not FDA approved.
  • Electrosurgery and Curettage. Fancy words for burning it then scraping it off. Ouch.
  • Excision. Cutting it out.
  • Lasers (usually a pulse dye laser) and Infrared Coagulators. Painful and can leave a scar, both to your skin and your bank account.
  • Bleomycin. This is a cancer chemotherapy drug injected into the wart. Not ideal, as it is very painful and can cause you to lose pieces of fingernails, or fingers. Just say no.
  • DPCP, or diphencyprone. This is a potent contact allergen. The idea is that when your body reacts to the allergen it will attack the wart. Side effects include itching, welts, and blistering. Did I mention that common warts don’t have any side effects?
  • Cidofovir. The new thing, in trials now. It is an antiviral that actually kills off the virus with minimal side effects. Very cool, but still in the future.

So, all in all, my favorite wart therapy is: do nothing. They will usually go away on their own. Exceptions are if the wart changes color, bleeds without good reason, becomes painful, or interferes with your child’s activities. It is also important to see a doc if your child has a weak immune system caused by AID’s or things like cancer chemotherapy.

So, to end, Mark Twain’s advice, via Tom Sawyer:

Put your hand into water collecting in the hollow of a tree stump at midnight and say: “Barley-corn, barley-corn, injun-meal shorts…Spunk-water, spunk-water, swaller these warts.” Then “walk away quick, eleven steps, with your eyes shut, and then turn around three times and walk home without speaking to anybody. Because if you speak the charm’s busted.”

DomesticatedMomster
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The Weird and Interesting Life of a Flu Virus

sick-kid-01The first description we have of the influenza virus was from Hippocrates (my hero!) 2400 years ago. He dealt with it every winter, endlessly, just as we do now. Nowadays it makes between 3 and 5 million people sick each year, and kills 250 to 500 thousand people annually. In the US we average 200 thousand hospitalizations and 36 thousand deaths yearly. Persistent, nasty little bugger.

Influenza gets its name from the Italian word for influence, because we initially thought it was caused by the influence of the stars, and later by the influence of the cold. Now we know better.

The influenza  virus is a tiny spherical particle, only 80-120 nanometers in size. It would take a million of them standing in a row to make a 1 centimeter line. Its core is made of 8 separate segments of RNA (we humans have DNA). This core is surrounded by protective proteins and an envelop with 2 types of “glycoproteins”–the famous Hs and Ns you hear about when people talk about which type of flu is causing problems each year: Hemagglutinins and Neuraminidases. NPR has a very cool video of the flu virus invading a cell. The “key” in the video is the hemagglutinin.

The Hemagglutinins (Hs) bind to target cells in your body and inject the virus particle into your cells. How contagious the flu is, what symptoms it gives you, and how sick it can make you depends on the Hs. An H that can bind to cells in your eyes, nose, and mouth is more contagious than one that can only bind to your throat. An H that can bind to a cell deep in your lung is much more serious than one that can only bind to a cell in your throat.

The Neuraminidases (Ns) release the progeny of that prolific particle from that cell so that the little critters can spread further through your body.

The Hs and Ns are the molecules our immune systems build antibodies against, whether we catch the flu or just get exposed to the dead virus in the annual vaccine. The Hs and Ns are also the targets for antiviral drugs. There are 16 different Hs and 9 different Ns. Humans are usually infected with H 1,2, or 3 and N 1 and 2.

There are three groups (genera) of flu viruses in the family Orthomyxoviridae. (I am a nerd–I love that word. Ortho-myxo-vir-i-dae. It would make a killer rap song.) The three groups are simply labeled A, B, and C. Nerds have no creativity. A, B, and C. Sad.

  • Flu A has the most serogroups (Hs and Ns), infects the most different animals, and is the most virulent. It also mutates 2-3 times faster than B. The critters it infects are mostly aquatic birds, but it can infect many other species. We frequently call the flu by which animal is its main host. Human, bird, and swine are the most common strains we humans catch.
  • Flu B has only one serogroup and is almost exclusive to humans. It tends to be less severe and less common. Since it only has one serogroup and mutates slowly, many people develop a degree of immunity to it.
  • Flu C is even less common and less severe.

Flu viruses enter cells so that they can make copies of themselves and spread. As they make those copies they sometimes make mistakes, creating mutations. They average one mistake per copy, so mutation is constant– what we call antigenic drift. That’s why we never get immune to Flu A–it changes every year.

What makes Flu unique: There is one really cool thing about the flu virus that makes it different from most viruses: its RNA is split into 8 segments. Most viruses have one long piece of RNA. This means that if your local pig catches 2 different strains of flu at the same time, these strains can trade segments. When that happens we get antigenic shifts– much larger changes for which people have no immunity. These larger shifts can create a pandemic, like the Spanish flu in 1918 that killed an estimated 21 million people. We average 3 pandemics each century. We worry a lot about pandemics.

So, those are the ABCs of the flu virus. If you crave something more useful, like what you can do about it, check out my post on colds and flu or info on fever.

Now wash those little hands with soap, keep them away from noses and mouths, break out the alcohol (not the drinkable kind) and bleach, and go get those flu shots! This year’s shot covers Flu A H1N1 and H3N2, and two strains of B.

DomesticatedMomster
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Zika Virus: An Update

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. Evidence shows that these babies may also have eye abnormalities that will  effect their vision. There have been links to serious deformities in the joints in the arms and legs of affected babies. A report published August 30, 2016 noted that 6% of the babies affected by Zika also have hearing loss. According to the AAP as of November 4, 2016, their are five main birth defects: severe microcephaly with partially collapsed skull, decreased brain tissue with subcortical calcifications, extreme muscle tone, eye damage with macular scarring and increased pigment, and limited joint motion range.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 0 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Rashes

little cute girl near the pool with a circle for swimmingWhen the days warm up, pediatric offices see a lot of summer skin problems. Kids aren’t often ill during the summer, but they do get sunburns, bites, jellyfish stings, and rashes.

Sunburn

No one thinks about sunscreen on that first glorious sunshiny day, so sunburns are usually our first evidence that summer is here. Remember to use sunscreen, of course, and don’t forget to reapply it every hour.

If your child does burn, give ibuprofen immediately – it helps with the inflammation and can actually reduce the depth of injury. Use aloe generously: it lessens the pain, moisturizes the skin, and helps heal the damage. If the burn is bad, call your doctor. Prescription steroids and burn creams will help.

Bug Bites

Bug bites are also very popular in the summer, from mosquitos, fire ants, yellow flies, and fleas. Insects inject toxins into children’s skin when they bite; how much a particular child reacts depends on how sensitive he or she is.

Cover up little arms and legs when you can, especially if you are going to be outdoors around twilight. There are excellent clothing treatments available that will keep bugs away and last through several washings, protecting your child indirectly.

If your child is older than 2 months, use insect repellant with DEET on exposed skin, even though it’s nasty. It works and it’s a whole lot better than getting insect borne encephalitis. 10% DEET lasts about 2 hours; 30% lasts about 5 hours. Don’t use anything stronger than 30% on a child. Don’t reapply in the same day, and do wash it off when you go back inside.

Creams with pramoxine or calamine will help with itchiness. Cortisone creams help itch and also swelling and redness, but can only be used a couple of times a day. If there are lots of bites, an antihistamine by mouth will also help with swelling and itch.

Never use antihistamine creams (benadryl is the most common), because children can react to the topical antihistamine and actually get worse instead of better.

Bee stings

Bee and wasp stings are treated much the same way, after making sure to remove the stinger and apply a cool compress (and yes, Grandma’s idea about the wet mud does help).

Poison ivy, oak, and sumac

If your child is a forest dweller, he or she will at some point get poison ivy, oak or sumac. These plants produce a poison called urushiol in their sap and leaves, causing redness, itch and blistering.

The severity of this reaction also varies depending on your munchkin’s sensitivity. My brother’s eyes would swell shut if someone burnt it a block away; I could pull it up and throw it away with no reaction.

Wash both the child and his or her clothes as soon as possible. No lounging on the furniture! The toxin can stay on surfaces for months. Once the toxin is either absorbed into the skin or washed off, the rash is no longer contagious. Blister fluid does not contain urushiol.

The rash will develop first where the most toxin was deposited, in streaks and patches. It can spread for a week or so to the areas where less toxin landed, then take another two weeks to clear.

If the rash is mild, you can treat it at home with cool compresses, baking soda or oatmeal baths, the same creams you used for those pesky bug bites, and that antihistamine by mouth. See? Grandma was right again.

If the rash is not mild, or your child has it on their face, around their eyes, or on their genitals (and how did that plant get there?) call your doc. We can put them on steroids, which help enormously.

Jellyfish stings

If you harbor a small mermaid or man in your home, she or he may get stung by a jellyfish. There are some extremely dangerous jellyfish, so if your child has any trouble breathing, is weak or nauseated, has pain away from the sting, or has sweating, cramping, or diarrhea, call your doctor immediately.

If it is a simple sting, first remove the barbs by scraping it with a towel or a credit card. Don’t rub. Put suntan oil or salt water and hot sand on the sting; heat will deactivate the poison.

Do NOT wash the sting with fresh water – it will make the nematocysts (poison sacks) explode and release more poison into the skin. Your child will scream and not love you anymore. Put only fluids with lots of particles in them on the sting: sting-away, vinegar or steak sauce, for example. Ibuprofen will also help the pain and inflammation.

Allergic rashes

Last, we see allergic reactions to everything from sunscreen to henna tattoos to jewelry to pool chemicals from fun in the sun. Kids with sensitive skin or eczema will rash out in the summer from the heat, humidity and sweat.

By now you can probably sense a common theme (or you could just ask Grandma): give your itchy red bumpy child a cool bath with mild soap. Moisturize and apply topical steroids or give antihistamines by mouth.

If any of this doesn’t work, call me! It gets lonely in a pediatric office during the summer when all the kids are healthy.

DomesticatedMomster
The Blogger's Pit Stop

Top Ten Tips for Summer Vacation Success

skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten tips:

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!