Tuesday, March 31, 2015

Peanut Allergies

Ah... gotta get my blog for March in...

So some of you may have read all the recent news articles encouraging parents to now introduce peanut products early to babies.  A recent New England Journal of Medicine article prompted all this discussion.  They basically took 640 babies who has severe eczema, asthma, allergies to either consume or avoid peanuts until 5 years old.  The conclusion from the study is that early introduction of peanuts significantly decreases the frequency of peanut allergy development among children who are high risk for this allergy.

This is a big deal because in the past, the recommendation had been the opposite.  Although back in 2008, AAP did say that there was no shown benefit in delaying giving solids beyond 4 to 6 months, many continued this practice of avoiding allergenic foods.  Now it is thought that this old recommendation to delay introducing peanuts to babies has caused the rise in peanut allergies we see in the US!

Well... I'm afraid our youngest has a peanut allergy.  None of our other three children had any significant food allergies, so my guard was down with this one.  While the older brother and sisters were eating peanut butter and jelly sandwiches one morning, I decided to also give L some pieces of bread with a good amount of peanut butter on it.  "Mmmm..." he says and seemed to like it.  So I gave him more.

Now, don't do what I did!   I continued to give L peanut butter topped bread pieces right before our 45 minute car ride to a Please Touch Museum.  Plus, I did not think to pack Benadryl in the car.  So as we were driving, I noticed L starting to rub his eyes and getting really fussy.  I was sitting in the back with him and right before me, hives started popping up on his face.  Wow, this kid is allergic to peanuts!  I went into panicky mommy mode.  We did finally stop at a pharmacy and get some Benadryl for him.  L is fine.  But now we'll have to formally allergy test him!  No more peanuts for now... and sadly maybe forever.

So here's the brief 101 on peanut allergies:

What is it?
Immune system over reacts when peanut is ingested causing symptoms

What are some common symptoms?
  • hives
  • itching or tingling around mouth or throat
  • digestive problems like nausea, vomiting, diarrhea, cramps
  • tightening of throat
  • shortness of breath
  • wheezing
  • runny nose
What is anaphylaxis?
Life-threatening reaction that is induced by food ingestion (most commonly peanuts)

Symptoms of anaphylaxis
  • airway constriction
  • throat swelling
  • blood pressure drop
  • rapid pulse
  • dizziness, lightheadness, or loss of consciousnes
How to treat it?
This would be a medical emergency requiring treatment with an epipen.  In fact, anyone with any food allergy should have an epipen for emergencies.

So peanut allergies can be pretty serious.  If allergic to peanuts, must avoid peanuts or any products that contain peanuts!  Also need to know how to treat mild symptoms and how to spot and respond to more serious reactions.  Talk to your doctor.

Now depending on the severity, there is a possibility to outgrow the allergy.  Testing and retesting can help determine this... but never try to orally challenge your child at home!

Sunday, February 15, 2015

The Flu

Husband is down with the flu.  He says he has never felt so sick before.  For two days he was basically in bed.  Yesterday, he was moving around the house some... but tonight he was back in bed by 7pm.  

It is pretty miserable to experience the flu.  Symptoms come on rapidly and most commonly consists of fever, chills, malaise, and body aches.  I wrote a previous post comparing and contrasting the common cold to allergies.  Web MD has a nice chart comparing the common cold to the flu.  I've included it here:

FeverRareCharacteristic, high
(100-102 degrees F); lasts three to four days
General Aches, PainsSlightUsual; often severe
Fatigue, WeaknessQuite mildCan last up to two to three weeks
Extreme ExhaustionNeverEarly and prominent
Stuffy NoseCommonSometimes
Sore ThroatCommonSometimes
Chest Discomfort,
Mild to moderate;
hacking cough
Common; can become severe
Sinus congestion
or earache
Bronchitis, pneumonia;
can be life-threatening
Good hygieneAnnual flu shot or FluMist
relief of symptoms
Antiviral drugs (Tamiflu or
or Relenza) within 24-48 hours
of onset

Since the flu is contagious about 1 day before and 5-7 days after symptoms start, we are watching our kids carefully.  It may be tricky to determine whether or not a child has body aches.  Plus with kids, they can also have nausea, vomiting, and diarrhea.

Now colds usually lasts 2-3 days... maybe 1 week at most.  The flu can last 1-2 weeks... sometimes longer.  Boy, I sure hope husband feels better soon.  The house is just not the same without a functioning daddy!

Monday, January 26, 2015

Snowed In

So here we are gearing up for our first really big "winter storm" of the season.  Last year by now I think we've had 2 major power outages and a zillion days off from school!

What does your family like to do when snowed in on a cold wintry day?

I would love to read a good book while sitting by a cozy fire... sipping hot chocolate and cuddled with a fuzzy blanket.

However, my day will probably look more like... 
  • wiping snooty noses, poopy bottoms, spilled messes...
  • pouring milk, preparing food for breakfast, cleaning up... then pouring milk and preparing food for lunch... cleaning up... then once again for dinner...
Highlights of the day may include some tickle fests and tackle wars...

Lows of the day... I'm sure someone is going to hurt someone's feelings or steal a toy away or mess up whatever creation someone else was making...

Successful day... if no broken arm or leg or head and no blood is spilled...

Memorable day... I hope so... everyone tells me they are only this little once and it goes by with the blink of an eye... so let's create some memorable moments!  Come on snow!

Wednesday, January 14, 2015

Happy New Year!

Happy New Year, folks!

Well... the holidays have come and gone and we are well into 2015...

"Busy" just barely describes my life right now... it is just... full... constant... barraged with unending demands...  both at work and at home... incessant...

My life overflows with warm cuddles... affectionate squeezes... and silly giggles...
and still there are the shrill screeches... the frustrated tears... the sad whimpering...

I cherish the triumphant smiles... the excited whispers... the tender hugs...
and yet deal with the angry scowls... the mischievous ploys... the obstinate insubmission..

My kids are seven, five, three, and one.  They are so little, so cute and yet so physically draining and taxing.  

I love it.  It may not seem like it every second, every moment, everyday... especially when my voice escalates and my face contorts... but I do... I love it.  I love holding their little hand... embracing their little body... kissing their squishy cheeks... I love being their mom.  I love them.

Happy New Year, everybody!  May 2015 bring new memories to be made... accomplishments to achieve... and just treasured times with loved ones...

Wednesday, November 12, 2014

Can you catch the flu from the flu vaccine?

Long time no write!  4 kiddos... at this rate I'm probably posting like once a month but we'll see... maybe it'll get better as I get my act together.  

Well, here's a topic that I'm sure will cause a lot of controversy and buzz but I feel I need to at least give my two cents as a primary care giver and mother of four.  So it's getting to be flu season and this question of whether you can get the flu from the flu shot always comes up.  Many adamantly believe they got sick from the shot in the past.  I do not doubt they got sick... but there are two reasons that are possible:   
  1. mistaking side effect symptoms of the vaccine to be flu symptoms
  2. coincidence in timing (takes 2 weeks for the shot to be in effect and probably already got exposed to the flu and would have been sick anyway)
I tell my patients this... if you are getting symptoms because of a dead virus... imagine how sick you'd be if it were alive!  Scientifically, it is impossible to be infected and get the flu from a virus that is dead.  Now if you get the flu mist (no needle kind) then you are being injected with a weakened version that has been engineered so the parts that make people sick are removed.

Here are some links to articles if you want to read in more detail:

So what are the symptoms if you get the flu?  Note... these symptoms can last typically 2-4 weeks and if you get infected with the actual virus, expect to get these symptoms.  How fast you beat it depends on your immune system

  • Fever/chills
  • Sore throat and cough
  • Stuffy or runny nose
  • Fatigue and malaise
  • Body aches and headaches
  • Nausea/vomiting and/or diarrhea (usually in children)

Compare that with the side effects most commonly associated with the flu shot.  Note... these symptoms last typically 1-2 days and not everyone gets all these symptoms
  • Soreness at site of injection
  • Redness at site of injection
  • Fatigue
  • Mild fever
So I realize that not everyone will be convinced and there will always be those who hold very strongly to their beliefs.  That's fine.  To be honest, it is draining sometimes in the middle of a busy work day to go through trying to explain this logic from a scientific point of view... especially when the waiting room is full of patients, it is much simpler to just skip the remarks and leave each patient to the fate of their choosing.  However, since I believe in this logic... and I believe there is more good than harm in getting this shot, I give it to all my kids every year.  Therefore, I feel it is the right thing to do to at least offer my two cents of why I would vaccinate if it were me, my child, my mom, my grandma etc.

Of course the vaccine is not for everyone (for example if you have an egg allergy or if your immune system is particularly weak)... so you should talk to your doctor in detail about whether it is right for you.  But if you are healthy with no particular health issues, then the benefits of the vaccine, in my opinion far outweighs the potential disadvantages.

Friday, October 17, 2014


This weekend, I’m flying out to Houston to visit my ninety-seven year old grandmother.   Granted, it is not a great time to fly right now with all the crazy things going on in the news… but this trip was planned a while back and it may be the last time I get to spend time with my grandma.  She now has end stage dementia and I feel it may be time to introduce the idea of hospice to the extended family.  I am approaching this topic with some hesitation because I realize there may be a lot of misconceptions and fear associated with hospice.

So the basic 101 about hospice that I hope to convey include:

-    -  most patients could probably benefit from being put on hospice a lot sooner than the family realizes
-    -  just because a patient is on hospice, doesn’t necessarily mean that death is days or even weeks away
o   in fact, some perk up and improve so much from the extra attention, they may even get disqualified from continued service
  -  goal is comfort for the patient and support for the family
o   to make the patient as comfortable as possible with as much dignity as possible… so that the days can be spent hassle-free without a lot of extraordinary measures and invasive procedures
o   to give family and caregivers support, encouragement, and a resource from professionals with tremendous experience with end of life issues

It will be challenging to convey all this with a language and cultural barrier, but we’ll see how it goes.

In the meanwhile, I hope to spend some quality time just being with my grandmother.  Simple things like the sound of ones voice or the feel of ones hand… can go a long way in communicating love and offering comfort.  I also hope to give some relief and provide emotional and physical support to my aging aunt who is the primary caregiver… and the same to my other aunt who carries a lot of the logistical and physical responsibilities associated with the care.

Leaving my four children behind on this short weekend trip is not easy.  I am forced to rely on other caregivers to manage the day to day logistics and needs of my kids.  At the same time, I look forward to sleeping in!  I admit I am a “control-freak” and often feel the need to call or text multiple times a day just to find out what is going on and whether things are smooth.   It so happens that my phone developed an issue and I cannot currently make calls or receive calls and texts on the cellular network.  I am sitting here on the plane typing this hoping to fix the problem the minute I land.  I realize that at the end of the day, even if things are not going as smooth as I like back home… what can I do?  Maybe not having contact for a while can be a good lesson for me to let go and let be.  Oh… let’s see if I can do that.

So back to my earlier comment about it being a crazy time to fly… at least on this flight from Philly… no one seems to be acutely ill or overly worried about contracting anything =)

Tuesday, October 14, 2014

Enterovirus D68

I've been meaning to blog for a while now... and although it is near midnight I feel compelled to jot down a few thoughts.
Crazy things in the news lately... and since so many patients are asking... let's talk about it!  Here is a quick 101 on the Enterovirus D68...

What is it?
The enterovirus is a virus that typically causes cold like symptoms around autumn.  This particular strain, D68 seems to cause more severe respiratory symptoms especially in kids with asthma leading to more hospitalizations and even death.

What are the symptoms?
Starts off as typical cold symptoms like cough, runny nose, sneezing, body and muscle aches.  It can lead to more severe symptoms like wheezing and difficulty breathing.  There are 9 cases in Denver so far where patients with the virus developed paralysis-like symptoms.

Who gets it?
Anybody can get it but this particular virus is causing more critically ill children requiring intensive care.  Spreads from respiratory secretions from cough, sneeze etc.

How do you treat it?
The basic treatment is supportive care and treating the symptoms.  There are no current antiviral treatments for this virus.

How do you prevent it?
There is no vaccine yet for this virus.  Protective measures include:  

  • Need to wash often with soap and water for at least 20 seconds.
  • Avoid touching eyes, nose, mouth with unwashed hands.
  • Avoid close contact with those who are sick.
  • Cover cough and sneezes with sleeve (not your hand)
  • Clean and disinfect frequently touched surfaces often
  • Stay home if sick
These all sound great but getting preschool age children to do them can be a real challenge.  Usually if one of my kids get sick... they all eventually get sick!

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