Words on Guns: A Pediatrician’s Perspective

As a pediatrician I have been fighting for sensible gun law for a while. I lost 3 of my small patients to gun violence. So, useful info on how to discuss guns with gun fans:

An AR 15 is an “Armalite Rifle,” after the manufacturer Armalite. Gun nuts will ask you what AR stands for. Don’t say assault rifle or they will dismiss everything else you say.

The problem is the high velocity bullets (they go through a child’s body so rapidly that they destroy tissue 6 inches around a bullet entry), rapidity of fire, and high capacity magazines (more than 10 bullets in a magazine is not necessary unless you want to kill humans). Use those terms.

If they talk about there already being background checks? Only licensed gun dealers are required to do them, and reporting is not mandatory. We need universal background checks with mandatory reporting.

They talk about how Chicago has gun restrictions but still has gun violence? It is because Indiana, across the road, has no restrictions. Easy to cross a road.

“Guns don’t kill people, people kill people”? That’s why we want background checks on the people, not the guns.

“Car accidents kill kids too”? Yes, that’s why we require driver training, a license, registration, and liability insurance. Also why we have traffic law to regulate their use.

We need:

  • to require safe storage of guns.
  • to keep bump stocks and kits that change semiautomatics into automatics illegal.
  • either magazines that cannot be exchanged (rather, need to be reloaded), take more time to replace, or take 2 hands to replace.
  • to limit the amount of ammunition people can buy, like we do pseudoephedrine.
  • to require licensing, registration, and liability insurance. Let the insurance companies pay for the mental health check and decide which guns are too dangerous to insure. The gun lobby and the insurance lobby can have a conversation.
  • red flag laws, the same in every state.

It is generally impossible to sue shielded gun manufacturers (although one case recently did succeed), and was previously against the law for the CDC to fund any research into gun violence – very unusual restrictions passed purely to protect gun manufacturers. The Dickey Amendment, passed in 1996, was recinded in 2018, but we lost decades of research.

The NRA funnels money from gun manufacturers to politicians on both sides – mostly Republican, but some Dems. There is dark money given that is untraceable, so we really don’t know who is on their payroll. The NRA actually supported Bernie Sanders when he first won office because he promised to never vote for any law that put in a waiting period for hand guns (and he never has).

The top ten traceable donations:

  • Mitt Romney $13,637,676
  • Richard Burr $6,987,380
  • Roy Blunt $4,555,752
  • Thom Tillis $4,421,333
  • Cory Gardner $3,939,199
  • Marco Rubio $3,303,355
  • Joni Ernst $3,124,773
  • Rob Portman $3,063,327
  • Todd C Young $2,897,582
  • Bill Cassidy $2,867,074

We need to educate ourselves to even begin the push for change, because what we are doing now is not working.

Gun lobbies only care about sales, while kids are dying.

Lets do this.

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!

4th of July Safety: Tips from the Doc

safety signSunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket.

All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.

Children in the Aftermath of Trauma

Sad child on black background. Portrait depression girlWe try to protect our children from as much as we can, but sometimes life has other plans.

The murders in Orlando have taken over our thoughts, our conversations at home and with friends, the internet, and the television waves. Our children are being bombarded by the nightmare in front of the TV at home, in conversations with friends, and with questions asked by their peers. It can be too much for a child to deal with.

Your child’s experience of an event will vary depending on their age,  personal style,  life experience, and  closeness to the disaster. A toddler will only care that his or her parents seem to be upset. Older children will hurt for the people involved, worry about friends and relatives that are not within their sight, and worry that it could happen to them sometime, at some other event. What seemed exciting to discuss with friends during the day becomes frightening after the lights go off.

Listen to them talk, and be patient when they ask you the same questions over and over. Reassure them, let them know that such things are extremely rare. Answer questions truthfully, at their own developmental level. Never lie.

Monitor what your child sees and hears – adult conversation and the media can magnify fear and confusion and increase their trauma. Repetition can intensify anxiety; pictures can get locked in their heads.

After the event symptoms of post-traumatic stress may appear, even in children not directly involved. They may be sad or moody, easily angered or irritable. They may be afraid to go to public venues. They may have trouble sleeping or sleep too much. Appetites may suffer. Your child may be anxious when his or her people are not all nearby, and wake from nightmares.

Children frequently have concentration problems after a trauma, and their grades will suffer. They may regress developmentally: your independent youngsters may become clingy, or need help doing things they had been able to do on their own. They may avoid activities they previously enjoyed, and withdraw into themselves. They may become anxious at the thought of going to school, or of being separated from mom or dad.

They can also develop physical symptoms like headaches and stomachaches. They may try to exercise more control on their environment, setting up their toys in a particular way, wanting their schedule to be predictable, or demanding activities they find reassuring. Teens may act out or try alcohol or drugs in an attempt to feel better.

Helping them may be as simple as listening. Be available and receptive but don’t push. A younger child may open up and tell you his story when you break out toys or art supplies; an older one may talk if you tell her a similar story about yourself, when you were scared or worried. Schedule time for just the two of you, and wait.

Children may try to hide their symptoms: they think they should be stronger, they don’t want to be a burden, or they think they are abnormal for having the problem. They may even feel that the disaster was their fault; children are not always logical. Allowing them to bury their symptoms will only erode their spirit from the inside.

Also, be a good example. Take care of yourself, eat healthy food, sleep, and discuss events calmly. Turn off the TV and stay off the web. Exercise. Take breaks to play, read a book, and do something unrelated to it.

Keep to recognizable routines– routine is reassuring and safe. Require reasonable behavior: if they still get in trouble for using that bad word, then everything must be OK. They may test you with bad behavior just to get that reassurance. Don’t spoil them with extra treats, because it will frighten them. Things must be really bad if The Parent gives me toys or lets me eat candy.

Lend a hand to other people. It will help to know that you have the power to help and comfort.

The traumatic symptoms may last quite a while. Triggers like parents going out at night or a security guard at a local festival may bring everything back. Fear of it happening again may linger. An anniversary will renew their anxiety.

If time passes and stress is affecting their lives, think about having them see a counselor or getting them into a peer group with similar concerns. We all need a little help sometimes.

My mom also used to say, “Time heals all wounds.” And with a little help from their guardians it always will.

Top 10 Tips for Successful Summer Vacations

little cute girl near the pool with a circle for swimming

School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have a top ten from the Doc:

10. Pack a simple medicine kit: don’t waste a day of vacation at my 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!

8 Easy Ways to Prevent Childhood Cancer

Cute girl of school age in superhero costume

More than 9000 kids get cancer in the US every year (about 1 in 450). The most common are leukemias, lymphomas, and brain tumors, but there are many different kinds. If you would like up to date numbers, the  AAP has them here.

Cancer is a group of more than 100 diseases caused by the cells in a person’s body multiplying out of control. Cancer is separated into different types depending on what sort of cell it originated from (blood, brain, lung…) and if it invaded nearby body parts (a tumor) or spread to other organs (metastasis). That might be a smidge simplified, but you get the idea.

Your children’s genes, the DNA they inherit from you, influence their risk of cancer–not something you can change. But lifestyle and environment also influence their risk, and there you can have an impact.

That impact includes not only your kid’s exposures in childhood, but also the example they see in your behavior and the habits you establish that will carry forward into their adult lives. What you teach them in childhood can protect them throughout their lives.

What to do to lower your child’s risk of getting cancer:

  1. First, the obvious one: don’t use tobacco, and don’t allow anyone else to smoke around your kids. I know, easier said than done, but an estimated four out of five cancers are caused by tobacco. The poisons in tobacco damage DNA, increasing the incidence of 14 different cancers including lung, some leukemias, voice box, throat, liver, kidney… Secondhand smoke alone increases cancer risk by 25%. The sidestream smoke off the burning end of a cigarette has 3 times the carbon monoxide, 10 times the nitrosamines and hundreds of times the ammonia of exhaled smoke. Add to this that if you smoke, your child’s chances of becoming a daily addicted smoker increase by 25 times, boosting their risk even more. Just don’t. No excuse is good enough.
  2. Also well known: protect them from sunburns to prevent skin cancer. Use at least SPF15 and reapply through the day. Seek shade during peak hours. Stick a hat on their head that shades their face, and a pair of sunglasses on their nose.
  3. Feed them a healthy diet with lots of fiber, fruits and vegetables. Avoid processed meats and an overabundance of red meat and salt. A healthy diet helps your body remove harmful chemicals, prevent and repair damage to DNA, and block the formation of cancer causing chemicals. A less healthy diet has been linked to breast, mouth, esophagus and GI cancers.
  4. Encourage exercise. Exercise stabilizes levels of hormones like estrogen and insulin that have been linked to cancer. An active lifestyle decreases the incidence of breast, bowel, and uterine cancers.
  5. Keep them at a healthy body weight. Fatty tissue produces hormones that influence the way cells grow. Cell overgrowth is at the root of cancers. Obesity has been linked to breast cancer, esophageal and bowel cancers, and liver, kidney, pancreas and uterine cancers.
  6. Limit their exposure to chemicals. Indoor pesticides have recently been shown to  increase children’s risk of leukemia by 47%. Be aware of the chemicals you might be exposed to at your job, wear appropriate safety gear, and don’t bring poisons home on your clothes–cancer causing chemicals such as arsenic, benzene, and asbestos are still used in industry. Check the use instructions (do they need to be used in a well ventilated area?) and ingredients in the products you do use at home. You can check for harmful ingredients in household products at nih.gov. Store household chemicals such as cleaners, paints, degreasers, and strippers safely high up and locked away.
  7. In the “be a good example” category: limit your alcohol consumption. Alcohol increases the amount of cancer causing chemicals in your body, and affects hormone levels. It also amplifies the toxic effects of tobacco. Drinking alcohol increases your risk of breast, mouth, throat and bowel cancers.
  8. Avoid certain kinds of infections. Infection can increase cancer risk by causing chronic inflammation and suppressing the immune system. Hep B increases your kid’s risk, so get them the vaccine, and teach them to avoid iv drugs and indiscriminate sex. Be careful with tattoos: Hep C also increases risk, and 41% of it comes from tattoos. Helicobactor pylori  increases cancer risk–doctors look for it with reflux disease, gastritis and ulcers.  Human Papillomavirus  works by causing cells to divide rapidly (hence the appearance of a wart). We lose 4000 women to preventable cervical cancer yearly, and the incidence of oral cancers due to HPV is increasing dramatically. The CDC recently announced that the vaccine has decreased the incidence of HPV in teens by 2/3. Get your child the HPV vaccine when he or she hits 11 or 12.

Cancer risk factors seem to hit the hardest when a baby is still in the womb, and in adolescence when their bodies are rapidly growing and changing, so these are the times when a parent can absolutely have an effect in preventing cancer.

A healthy lifestyle stacks the deck in your child’s favor, dramatically decreasing their odds of getting cancer. Protect them from cancer causing sunburns and poisons, get those vaccines, establish good habits, and be a good example. There is no down side to a healthy diet, regular exercise, and limiting their exposure to toxins, and it may increase their chances of hanging around for a while.

Domesticated Momster

Lead, and the Children of Flint

Toddler-Playing-With-A-Chair-01In April of 2014 politicians in Flint, Michigan changed the city’s water supply from Lake Huron and the Detroit River to the Flint River, in order to save money. The water from the Flint River was more acidic and had more salt and chlorine in it, and it corroded the aging lead pipes through which it flowed, allowing lead into the water and poisoning the inhabitants of Flint.

The EPA allows 15 ppm (parts per million) of lead in drinking water. Water from homes in Flint tested as high as 13.2 thousand ppm. Lead levels in children’s blood doubled, then doubled again.

Nontombi Naomi Tutu said we “needed the people of Flint to remind the people of this country what happens when political expediency, when financial concerns, overshadow justice and humanity.”

Why do we worry about Lead?

Lead is a soft gray heavy metal that functions in our bodies as a neurotoxin–it poisons nerves. Acute lead poisoning causes headaches, stomach pain, clumsiness, agitation or drowsiness, convulsions and death.

Chronic lead poisoning is more insidious. Lead is most harmful to infants, children and pregnant woman, because it damages developing nerves. Kids who are poorly nourished will be more affected because deficiencies in iron, calcium and zinc increase their body’s absorption of lead. Babies are more at risk because they live closer to floors and surfaces and everything goes into their mouths. Exposed children:

  • can lose cognitive function and develop speech and reading problems.
  • can be unable to focus and organize their thoughts, and exhibit behavior problems.
  • have a higher school dropout rate, problems with aggression, and a higher rate of delinquency.
  • can have damage to their hearing.
  • will have problems growing because lead messes with their ability to use Vitamin D and iron.
  • become anemic, which leaves them less able to transport oxygen around their bodies.
  • can cause damage to their kidneys, giving them lifelong problems with hypertension and cardiovascular disease.

Where is lead found?

When I was a kid we wrote with lead pencils and had lead in our gasoline!

Nowadays, lead is used in some industries, found in deteriorating lead paint in old houses, and leached out of old lead water pipes and pipes with lead solder. We also occasionally run into it in old toys, old Christmas decorations, and jewelry, and in toys, ceramics and cans imported from other countries. Cosmetics such as surma and kohl can have lead, as can some home remedies and dietary supplements. A few years ago there were crayons with lead in them. The manufacturer said, “Kids weren’t supposed to eat them!”

Ideally, we prevent lead poisoning.

  • If you work in an industry that uses lead, take off your shoes when you enter your home.
  • Don’t give your kids old toys and jewelry to chew on.
  • If you have lead pipes in your home, run the water for 30 seconds before you use any of it to drink or cook, because lead will gradually leach from the pipes it is sitting in. Never drink or cook with water run hot from the tap–hot water leaches out more lead.
  • If you live in an old house, clean up peeling paint and household dust with a wet mop.
  • Check for lead paint before any home renovations.
  • If you have well water, test it for lead. Most well filters do remove lead.
  • Give your child a nutritious diet to avoid deficiencies in iron, calcium, and zinc.

Treatment for Lead Poisoning:

Pediatricians generally check children’s lead levels at 12 months and sometimes 2 years, and any time there is concern.

Treatment of lead poisoning varies with how high the level is.

Between 5 and 45 mcg/dl, treatment involves finding and eliminating the source and optimizing the child’s nutrition. Levels as low as 5 mcg/dl have been shown to have lasting effects on children, but chelation therapy at these levels has not been proven to have any effect on kids’ cognitive ability or behavior.

Kids with levels over 45 mcg/dl need to be treated with chelating agents, which can be quite dangerous. Chelators bind the metal in the blood and improve its excretion into urine and stool. Unfortunately chelators also bind minerals that your child’s body needs for normal growth and development. Also, kids can be allergic to the chelators, and the medicine can damage their liver or kidneys.

Far better to prevent the exposure.

I do not have words for how horribly the people of Flint were betrayed by their elected officials.

Some resources if you have concerns:

  • EPA Safe Drinking Water Hotline  800-426-4791
  • Poison Control 800-222-1222
  • Pediatric Environmental Health Specialty Unit Network (PEHSU) 888-347-2632

 

Domesticated Momster

Zika Virus and the Brain of the Unborn

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. New evidence shows that these babies may also have eye abnormalities that will  effect their vision.

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 50 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.

 

Domesticated Momster

What’s the Deal With GMOs?

little baby gardener lost in the moment with the sun shinning in

“GMOs” are genetically modified organisms.

Humans have been genetically modifying organisms since we stood upright and developed our big brains. We originally did it by selective breeding. That’s why my Golden Retrievers have that long, beautiful–constantly shedding–golden fur, why broccoli exists, and why that ear of corn you munch on isn’t 2 inches long. We pick the animal or vegetable with traits we want, and we breed or plant those rather than the ones with traits we do not want.

What is different now is that we can modify at the level of the organism’s DNA. We can take the gene for the trait we want and insert it into the DNA of the animal or plant to create an entirely new organism with the preferred traits.

The first genetically modified mouse was bred in 1981; the first genetically modified plant in 1983. Since then, GMOs have taken off. Between 1996 and 2013 GMO crops increased by 100%. Recent stats estimate that 10% of the worlds croplands are planted with GMOs. 94% of the soybeans, 96% of the cotton, and 93% of the corn grown today are GMOs.

Concerns about GMOs include unease about GMO’s effect on the environment and the economy of farmers, and worries about the safety of food products.

Environmental worries arise because GMOs are created to be more herbicide and insect resistant, give a higher yield, have more nutrients, and be more drought resistant. The non-GMO varieties can’t compete economically. Farmers have to grow the improved variety in order to survive. Then, if all of the wheat in an area is one variety, and something evolves that kills that variety, we have a problem. We have placed all of our eggs in one basket.

Another worry is that the GMOs are created and owned. To get them you have to buy from the company that did the work to create them. How do you compete if you can’t afford their product? If there is drift from their fields into yours (pollen travels) have you stolen something?

Will we use more poisonous herbicides because our new plants aren’t hurt by them?

Health concerns generally arise because the science behind the creation of GMOs is pretty extreme. We imagine scientists creating zombie corn that will poison our children. Corn grown on a plant that is more resistant to drought is still corn, with no difference nutritionally. Extra nutrients developed into a GMO plant are thoroughly tested and approved before they can be sold.

The one real issue when food crops are developed with new proteins is that kids with allergies may be effected. The FDA requires proof of safety when foods that are commonly allergic (milk, eggs, wheat, fish, tree nuts, and legumes) are affected. All of our safety standards still apply.

The positives of GMOs are my happy place, as a certified geek.

  • GMOs can produce food in areas of the world that are less fertile or have problems with insects, so children who might otherwise starve will have food. Those foods can also be developed to resist spoilage.
  • Food can be grown that is more packed with nutrients. For example, a tomato might be developed that has protein to help develop strong muscles.
  • Scientists have developed bacteria that produce biofuels that are safer for the environment.
  • A breed of pig now exists that can digest phosphorus, thus decreasing water pollution and overgrowth of algae.
  • Bacteria can produce chemicals that do everything from clot milk to make cheese, to break down starch to make sugar.
  • Bacteria have been developed that produce human proteins. Previously, insulin came from pigs, and diabetics could become allergic to the medicine they needed to stay alive. We can now treat children with hemophilia with clotting factors that do not make it likely that they will, in the end, die of AIDs. We can produce human growth factor to treat some forms of dwarfism. Research is being done that may produce treatments for kids with cystic fibrosis and sickle cell disease, and many forms of cancer.
  • A goat exists now that produces ATryn, an anticoagulant that decreases the chance of having a blood clot during childbirth, in its milk.
  • Scientists are developing animals that have organs that are compatible with human biology. This sounds questionable right up to the point where your child needs a lung transplant.
  • One I find particularly elegant: Scientists produced a male mosquito with a lethal gene, and released it in the Cayman Islands in 2010. The particular breed of mosquito was one that carried Dengue fever, and they decreased the population of that mosquito by 80%. Wouldn’t it be lovely if they could do that with the mosquito that carries the Zika virus–the one that is causing babies brains to not grow in utero?

In the end, GMOs are here to stay. There is no possible way to remove them from the planet even if we chose to. We enjoy the products of GMOs every day without even knowing geeks were involved, and the future possibilities are truly amazing. Gene therapy can cure diseases like cystic fibrosis, sickle cell, diabetes and cancer. Transplantable organs can come from pigs rather than dead children. Biofuels to help the environment–the possibilities are endless.

Opponents are pushing for products to be labeled so that consumers can choose, but even that is next to impossible to implement. A growing number of products contain one or more ingredient from a GMO. How many products have corn oil or syrup? Where do you draw the line–if a food product was grown on a farm near a field with a GMO product, and was possibly cross pollinated, might it not be considered a GMO?

Certainly we need to monitor the science to make sure what it does is ethical and safe, but we do that every day in medicine and science, under the watchful eyes of the Department of Agriculture and the FDA.

What matters is that the food is available, safe, and nutritious. Junk food, sodas, and pesticides on your fruit are a much larger problem. A GMO apple is, nutritionally, an apple.

Domesticated Momster

Top Ten Holiday Poisonings

Cute kid girl in glasses thinking about gift on Christmas holiday. Vintage portrait

or, “how to avoid visiting the Doc during the Holidays”:

  1. Tiny magnets: These aren’t really poisonous but they can get stuck in noses and ears, choked on or swallowed. Keep track of the big kid’s toys so I don’t have to make the little one cry digging something out of his or her ear. Worse, magnets that are choked on or swallowed can require surgery to remove. Two magnets in the gut will stick to each other and wear through the bowel wall.
  2. Button batteries: Same problems as above, plus they can leak and cause burns, eating holes through the bowel that can be fatal.
  3. Grandma’s meds: These are on countertop at her home, and sitting in her unattended purse when she is visiting yours. This is the most common poisoning that I see. Other people’s meds also count, of course.
  4. Household poisons: Both the usual suspects (cleaning products, bug sprays) and the holiday specific (liquid fuels) are more available and less monitored in the holiday craziness. Lock ’em up.
  5. Food: Avoid potato salad that was made on the counter where they just cleaned the chicken. Return leftover food to the refrigrerator quickly. Wash those hands! Pick up and throw out unfinished drinks–kids can drop their blood sugar and fall into a coma with a relatively small amount of alcohol. Throw away cigarette butts, because kids eat them and the poisons in cigarettes can actually throw small people into a seizure. (And we inhale these things on purpose. Blech.) Add e-cigarette refills to this list for the last couple of years. 1/2 tsp can kill a child.
  6. Decorations: It’s actually pretty hard to poison anybody with holiday décor. Antique items will sometimes have lead, so don’t let the little guy eat the metalics. Don’t breath in the spray snow, because it has either acetone or methylene chloride in it. And don’t hit Uncle Joe with that branch, no matter how tempting….
  7. Plants: Poinsettias are not poisonous. Promise. Neither is Christmas cactus. Holly berries, mistletoe berries and peace lily berries are, as are bittersweet and boxwood.
  8. Smoke and carbon monoxide: Very poisonous. Live trees and decorations can be dry and fires, candles and space heaters abound. Keep your eyes open and your smoke and carbon monoxide detector batteries fresh.
  9. Mind numbing toys: Boycott toys that don’t engage your children’s minds. Look for toys that they can create with, explore with, or build with. I know this is not strictly a poison, but it’s my list, so I can bend the rules. So,…
  10. Poisonous soul numbing holiday insanity: Back up and take a breath before you spend money you don’t have on stuff you don’t need. Defeat stress and exhaustion with a healthy diet, exercise and regular sleep. Celebrate your heritage, enjoy your family and friends and create joyful memories. Ditch the rest.