Wednesday, October 12, 2016

Doc, I Need an Antibiotic!

We are nearing that time of year again where our phones ring off the hook and our waiting room overflows with sick patients. Our medical staff are fielding calls insisting for same day appointments or demanding antibiotics. So I just want to blog a little about what we see and treat this time of year. Let's start with sinusitis.


What are the common symptoms?
  • purulent nasal discharge ("gross yellow/green mucous")
  • nasal obstruction ("can't breathe")
  • facial pain, pressure, or fullness
  • can also get cough from the mucous and postnasal drip
What causes it?
  • viruses are most common (antibiotics don't help here)
  • bacteria 0.5-2% of cases
How do you know if you may need an antibiotic for treatment?  
See your doctor and let your doctor weigh your history and physical exam to determine. Usually these are the indicators:
  • symptoms are lasting for 7 or more days
  • symptoms are worsening, especially if after initial improvement
  • fever greater than 101
  • moderate to severe facial pain
Well, what happens if you take an antibiotic when really you did not need one?
  • you will get better no faster than if you did not take the antibiotic (you will never know)
  • you risk side effects of the antibiotics like diarrhea which may worsen your course
  • you are increasing the incidence of antibiotic resistant bacteria (like MRSA)
So what can you do if you don't need an antibiotic?
  • rest and drink lots of fluids
  • motrin or tylenol for pain
  • saline nasal spray to irrigate or use neti pot to irrigate
  • topical nasal steroids (like flonase) may help
  • topical atrovent (requires prescription)
  • guaifenesin (AKA Mucinex) can break up/thin out the mucous
What to avoid?
  • antihistamines (like benadryl, claritin, or zyrtec) may over dry and increase discomfort
  • zinc preparations show no benefit
How to prevent in the future?
So next time you get sick, you may want to try some of these remedies and give your body a fighting chance for a few days before you pick up the phone to call your doc. Now if you have been sick for 1 week and not improving, call your doc.

One more last pearl... coughs can linger and linger... according to one recent study the average duration of cough is 18 days!  However, if you are wheezing or short of breath with your cough... or it is just getting worse... go see your doctor.

Saturday, October 8, 2016

Probiotics and Colic

Few years back I blogged here about how probiotics can help reduce the severity of viral gastroenteritis (stomach flu) and even prevent antibiotic induced diarrhea in kids.  Well, now there is even a small but randomized, double-blind, placebo-controlled trial that showed how probiotics help colicky babies. You can read the full study here. For 21 days, breastfed Canadian babies who were given lactobacillus had significantly improved reduction in length of crying and fussing times based on recorded diaries and maternal questionnaires. Granted this investigation only involved 52 infants (very small sample). However, for tired parents looking for relief why not give this a whirl? Note that the study was only done with breastfed babies and not formula fed babies so it is unclear whether the same would hold true with the latter. But again, it wouldn’t hurt to try if parents are struggling for relief.

So the official definition of colic is uncontrolled crying for more than three hours per day, more than 3 days per week, and for longer than 3 weeks.... AND infant needs to have appropriate weight gain and a normal physical exam. This is very important! Therefore, if you are suspecting colic in your baby please do not just add yogurt to your infant's diet in hopes that the crying will stop. Consult your doctor first!  Other more significant medical causes need to be ruled out.  Some examples:

  • An infection
  • Acid reflux or stomach problems
  • Pressure or inflammation of the brain and nervous system
  • Eye trouble, like a scratch or increased pressure
  • Irregular heartbeat
  • Injury to bones, muscles, or fingers

If your doctor does confirm the diagnosis of colic in your infant then you can try giving lactobacillus via infant drops.  Here are some other tips that may help:

  • Eliminate all allergens (cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of the breastfeeding mom
  • Switch formula-fed infants to hydrolyzed formula

Majority of infants outgrow colic by 6 months. That may seem like a long time so if you are feeling like you are at the end of your rope, please seek help. It is overwhelming and stressful enough to care for a brand new baby, let alone one that cries often. Having a good support system is critical and knowing when to seek help is just as important.

Tuesday, October 4, 2016


Hello folks! It’s back to school and routine. I actually love this time of year. I love making schedules… color coding all the different activities per kid… typing up excel sheets to figure out how best to maximize time… and yet… and yet… we are warned not to overbook… not too overstimulate… Kids still need to be kids and have down time and play time. Yes, it’s all a balancing act. Parents are encouraged to be involved but not hover like helicopters…

So this year we have 3 kids in the public school system and 1 who just started preschool. We are sliding into a totally different phase of life. Before it was all about diapers, sleep hygiene, food intake… Now we still do keep track of the kids’ input, output and sleep…  but we also have to figure out how to attend Back to School Night for 3 kids at the same time... know when library books are due (...and of course all three kids have different library days)... as well as whether to dress our youngest in orange or black or yellow for whatever color of the day it is at preschool. Helping with homework, driving to activities, talking about friends… our days are full…
How not to get overwhelmed and stressed? Stress is a good topic to chew on for a while. I believe a lot of medical illnesses likely stem and definitely is exacerbated by stress. In fact, a couple of years ago I blogged about it here, how lifestyle modification can prevent/alleviate disease and stress being one of those factors. So what is stress?  It seems like such an overused term. Google defines it as “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances” Well, “very demanding circumstances” may vary in meaning from person to person. Seems to me like a very broad and nonspecific description. Bottom line is your emotions and mental state is feeling strain and tension. So let’s look at this from two perspectives… prevention and treatment.

Easier said than done… but may start with knowing your limits and learning to say “no”. If possible, make choices that avoid those difficult circumstances. Too bad there is no vaccine for stress! But you know how if you are healthier to begin with, you have a better chance of fighting sickness? So you exercise, eat right and sleep right to make sure your immune system is strong to fight when sickness may fall and you may not be as sick. Similarly, I think if you exercise, eat right, sleep right, and have a good support system you will be more equipped to handle stress when it hits.

So the treatment for certain medical illnesses are supportive measures such as fluids, rest and time. Just as nutritious food, sleep, and even exercise help the body fight the bug, the same can help relieve stress. But you know what else? I think laughter is the best medicine for reducing tension. I think after having kids, I forgot how to laugh. Instead of laughing with them, I find myself often annoyed at the silly giggles and ridiculous cackling. O to discover my sense of humor again! Now there is also something called the Relaxation Response that I’ve blogged about before which also combats stress… but I’m telling ya… I’m going to be more intentional about laughing! Finally, just like with sickness, we need a prescription antibiotic to recover if the symptoms become severe and we become infected with a bacteria, we may need a prescription if the stress symptoms become severe and turn into something else. Do talk to your doctor if you are wondering if your stress level requires further intervention.

OK.. going to end with a video I found online that made me tear… Michael McIntyre and his stand up comedy about "people with no kids don't know"...

Monday, July 25, 2016

Zika Virus

Alright, so I gotta tie my vacation post to a medical one. Last year we went to Yosemite where there was news of the bubonic plague. I blogged about it here. This year we were just in the Carribean... and I have a TON of mosquito bites... so guess what I'm going to talk about?  That's right... here's a little 101 on the Zika Virus.

How do you get it?
Transmission is mainly from a mosquito bite. Other ways of getting this virus include:

  • mother to fetus
  • intercourse
  • blood transfusion.

What are the symptoms?
Most people will have no symptoms at all or get very mild symptoms.  Symptoms incude:

  • fever
  • rash
  • joint pain
  • conjunctivitis
  • muscle pain
  • headache
How do you treat it?
Treatment is usually aimed towards alleviating symptoms.  Rest, fluids, and tylenol as needed for pain or fever.

So what is the big deal?
If a pregnant woman becomes infected with the zika virus, the virus can cause a birth defect of the brain in the fetus. This can lead to a miscarriage or still birth. According to the WHO (World Health Organization), the Zika virus is spreading very rampantly in the Americas and in January had declared birth defect due to Zika as an international public health emergency.

Areas with active mosquito-born Zika virus transmission include:
  • Americas
  • Pacific Islands
  • Africa
You can go to the cdc website for more detailed listings. 

Hm.. I don't see Turks and Caicos on the list. But no chance I'm pregnant anyway... so worse case scenario I'd just be sick with a flu-like illness for a week or so.

How do you prevent getting it?
There is no vaccine currently so best prevention is just protecting against mosquito bites with repellent, long sleeves, long pants etc. If pregnant, would avoid traveling to areas that have active transmission.

Friday, July 22, 2016

All-Inclusive Vacation With Little Kids

For the first time, we decided to go on an all-inclusive beach vacation with the kids. We’ve been on cruises and to amusement parks, national parks... but not this. So what did we think?

First of all, location is key… not sure how other all-inclusives compare but we went to Turks and Caicos and since I love the beach… this is the place to go to for a beach! Talk about soft white sand and crystal clear water!

Additionally, this place is only a 3 hour non-stop flight away from PHL. So getting here was a piece of cake. Just need to get passports for everyone. But unlike our 6 hour flights cross country the last 2 summers for family weddings… this 3 hour plane ride went by in a blink of an eye. 

Now the return flight with a layover in Miami and customs etc was not so fun... but still worth it. Just have to find ways to entertain. This was at the Turks and Caicos airport waiting to board our plane coming back...

Since our four kids are 8 and under… vacations are usually super draining for us.  Not just physically tiring (I literally got up five times during dinner one night just shuttling different kids to the bathroom)… but mentally as well (playing referee and judge for squabbles among the older ones especially)… 

Marvelously, this all-inclusive at Beaches includes watching the kids in different kid camp settings for all different ages! Even our youngest who is 2 ½ years old was able to be dropped off. Camps were open from 830a to 10p though I’m not sure if any parent would drop off their kids for all that time. We just use the camps for a couple of hours here or there throughout the day. There was a calendar of events for the different age groups and we basically picked the times to drop them off based on what activities were going on matched with our kids’ interests. 

The waterpark was a hit with our girls. 

Snorkeling lessons, bonfire with smores, pinata party, structured arts and crafts as well as the xbox game room more than entertained the older girls. The younger ones got story times, letter of the day with Elmo, Big Bird or one of the other Sesame characters. Baking cookies with Cookie Monster was a big hit... as well as the ride on the choo choo train that circled the property. In fact, all four kids got to sit on the train and parade with the Sesame Street Parade one evening. Overall, I thought the whole kids camp was pretty well organized. Though at first I felt guilty for dropping off the kids when we were technically on “family vacation”... the positive feedback from the kids was all I needed to convince me to do it again the next day.

We were able to correspond the times so that my husband and I got to go kayaking, sailing, and even go on a snorkeling trip without the kids. We also enjoyed 2 lunches and 1 dinner on our own! Our view while dining at Sky Restaurant...

Hey, a more relaxed and happy momma will make for better family time anyway when we are all six together! I really only need one to two hours here or there in my day to reset my happy meter… especially if it is on white sand with crystal clear water lapping my feet!

Not only did the camp give us adult time but also some quality one on one kid time. It was a useful way for us to divide and conquer. For example, while the youngest napped in the afternoon, one parent could spend some one on one time with another child while two others were entertained at camp. On another day we would flip flop. It would be hard for me to go snorkeling with my older two if I had to also watch my third child who cannot swim well, so he got dropped off for story time with Elmo while we snorkeled.

Now a few other things...

Besides the waterpark, there were lots of swimming pools. My kids love water so they were here a lot... even at night.

In fact, they love the pools more than the beach... but not I... no... beach for me...

And what about the food? This part felt like a cruise ship except many more choices. There were lots and lots of restaurants to choose from. The restaurants all have different themes, ambiences, and serve different types of foods. In fact, there were so many restaurants we were unable to try them all. The kids' favorite restaurant was the hibachi style restaurant called Kimono. Here the chefs cook Japanese hibachi in front of you but the entertainment was different than what we’ve experienced in the States. These guys can sing! Food was just mediocre in my opinion as far as Japanese hibachi food goes… but the entertainment value made up for it. Here is our chef singing and cooking for us!

Hesitations in coming back? Mainly cost… with four kids, we had no choice but to book one of their bigger rooms with concierge service. 

Great room that walked out to the pool... but I don’t think we used the service very much and neither my husband or I are very big alcohol consumers. I wish they would offer a no alcohol package but I guess it would be too hard to enforce. I suppose it was nice to order fruity drinks by the pool and even the kids were able to order virgin drinks which they got a real kick out of… 

Nonetheless, I’m pretty sure if we were to add up all the tab we spent way under what we paid. Well, maybe the childcare made up for the rest of the cost...  

All in all… my kids thought this vacation was “awesome” and I would have to agree. This trip was a nice combo of family time and some adult rest and relaxation time. We found this tree with this sign on it which basically sums up our feelings.

But... back home to reality...

Wednesday, May 25, 2016

A Mom's Weekend Out... Visiting Chicago

Well, it has been forever! 

So every now and then, I'd get these ideas in my head to type up some thoughts for this site.. but then somehow they just slip away into the depths of sleep.  This period of motherhood has been physically draining but I feel I'm in that turning point now... where my younger two kids are still pretty hands on physically demanding, the older two have slipped into the emotional drama world of the pre-tween years!

Therefore, a weekend away with my roomie from college was a welcome break from reality. So it turned out to be a pretty windy, cold, and wet weekend in Chicago... but that was the city we picked... a mid point between Cali and PA.  Despite the miserable weather, I still had a blast.  Not so sure it was as rewarding for my friend because she had to leave sunny, gorgeous San Francisco... but maybe next time we'll choose somewhere in the middle... but south!

Now about Chicago... I want to write a bit about this city.  I've never really spent much time here before and I love to visit different places.

I learned a lot about the history of the city and the architecture of the buildings making up the Chicago skyline on this fabulous river tour called River Cruise Tour.  Too bad it was freezing cold... lasted as long as we could on the top deck listening to the tour guide and gazing at all the tall buildings before heading inside for hot drinks and defrosting.

So what is there to do in a city when it is windy, cold, and wet?  Why, go shopping and visit museums of course! The Magnificent Mile  really does have a ton of stores. My friend bought a scarf and umbrella on this mile. I bought some tasty homemade toffee for my kids at the One of a Kind Spring Show. We also visited the  Art Institute of Chicago and spent most of our time admiring  Thorne’s Miniature Room display.
Doesn't this look real?

Now, a weekend is not complete without good eats.  Boy, we sure hit some yummy spots. Our hosts at our B&B Sono were super nice and made us delicious breakfast every morning.

Wild Berry Pancakes & Cafe  had amazing brunch food, so well worth the wait!  Totally get why they got 2260 reviews on yelp.
This was the mexicana sizzlin' skillet.  Mmmmm!

It was also nice that this place was right next to The Bean ...popular tourist attraction.

Shaw’s Crab House was pricey but a great place for seafood.

The Russian Teatime was probably my favorite. This was surprisingly filling!  We were so full from the top and middle plates that we packed the dessert plate to go.

Café Ba Ba Reeba for Spanish tapas was our last stop before we hit the airport.

Now thinking back to all of the places we visited in Chicago, I was most surprisingly impressed with the Lincoln Park Zoo.
For one thing, it is free... but what's more I loved how they organized and displayed all the different animals. It seems much effort was made to present each habitat to closely resemble the animal's natural habitat... more so than any other zoo I've visited... creative and artistic.
Look, you can almost touch this lion!

I now so want to take my kids here. We will have to plan a family trip here... but that will be a very different kind of trip.