Thursday, September 25, 2008

Fish Reducing Eczema and Outdoor Pools Increase Asthma Risk

Fish in children's diet cuts eczema risk: study

Wed Sep 24, 10:01 pm ET
LONDON (Reuters) – Feeding babies as little as one portion of fish before they are nine months old may cut their risk of developing eczema, Swedish researchers said on Thursday.

Introducing fish of any type into the diet curbed the risk of contracting the skin condition by 25 percent compared with children who never ate it, Bernt Alm, a pediatrician at the University of Gothenburg in Sweden, and colleagues reported in the British Medical Journal.

"The main finding was that early introduction of fish was beneficial," Alm said in a telephone interview. "There was no link with the amount of fish or type of fish. We think it is more the timing of the introduction." Eczema is a chronic condition affecting between 10 and 15 percent of children that can cause the skin to become itchy, red, dry and cracked. It often affects those prone to allergies.The Swedish study is part of research tracking the long-term health of nearly 17,000 babies. The researchers found that genes played an important role in the development of eczema but breast-feeding and keeping a furry pet in the house had no effect.

Fish in the diet appeared to be important, but Alm said it would take further investigation to establish why. There was no extra protection from fish rich in omega-3 fatty acids, which provided other health benefits, Alm said. "It must have something to do with its influence on the developing immune system," he added.

(Reporting by Michael Kahn; Editing by Andrew Dobbie)
Copyright © 2008 Reuters Limited. All rights reserved.

Outdoor pools boost child's asthma risk: study

By Michael Kahn
Wed Sep 24, 7:07 pm ET
LONDON (Reuters) – Swimming in outdoor chlorinated pools appears to increase the odds a child will develop asthma, Belgian researchers said on Thursday. Other studies have linked chlorine and asthma but the new findings published in the European Respiratory Journal cast doubt on the idea outdoor pools are safer than indoor ones where chlorine vapors remains trapped inside an enclosed space."The more you swim, the higher the risk," said Alfred Bernard, a toxicologist at Catholic University of Louvain in Brussels, who led the study. "What is new in this study is that we looked at outdoor pools for the first time."
Asthma, which affects more than 300 million people worldwide, is the most common pediatric chronic illness. Symptoms include wheezing, shortness of breath, coughing and chest tightness.

Bernard and colleagues showed that outdoor pools are just as or more risky than indoor ones because harmful vapors remain at the pool surface and do not drift away. And because children tend to spend more time in pools they are more likely to swallow chlorinated water or ingest vapors containing chemicals that attack the cellular barriers protecting the lung from allergens, Bernard said. "We see that the risk of the outdoor pool is equal and even higher than indoor pools because children tend to spend longer in outdoor pools and they are more chlorinated," he said.

The Belgian team tested 847 students around the age of 15 for allergies and asthma and asked their parents about exposure to asthma risks such as tobacco smoke, pets and pollution, and how much time the children had spent in chlorinated pools.
The researchers determined that the risk for the 50 percent of children predisposed to allergies and asthma was directly related to the amount of time spent in a pool. Children with the highest pool attendance -- one hour per week for 10 years -- were five times more likely to be asthmatic than young people who had never swum in a pool, the study found.
"Young children are more exposed because they take more water into their airways and their lungs are still developing," Bernard said in a telephone interview.
(Reporting by Michael Kahn; Editing by Janet Lawrence)
Copyright © 2008 Reuters Limited.

Very interesting articles. Inhaling chlorine must be bad, period, end of story. It does kill stuff, which is why we use it, so it must be very taxing on the respiratory system, perhaps killing the lung "coating" surfactant, or somehow altering normal function of those exterior cells. I would've guessed only indoor pools did this.

Monday, September 22, 2008

The S%X Talk With My 7 Year Old

NOTE: I'm not spelling S%X out, because I don't want to be googled by gross child predators.

So I had the s%x talk with my daughter. It went surprisingly well, and she seemed to be ready for far more information than I expected. Note to self: Try to pay more attention to #2, she needs to learn how to tell time and how to tie her shoes (only because she's self conscious about it). Where has all the time gone?

So let me set the stage. We are in the car ALONE (good), driving to pick up Leo at baseball practice. We are listening to the soundtrack Juno, which is one of our faves. No, she hasn't seen the movie....It's perfect since we are driving, an activity, and we aren't face-to-face. Here's what happened:

Sydney: "Mom, what's the movie Juno about anyway?"
Mom: "It's a about a young high school girl Juno that gets pregnant. Do you remember what 'pregnant' means?"
Sydney: "Yes, it means you have a baby in you."
Mom: "Right."
Silence on the set, a few minutes pass.
Sydney: "So what happens to Juno? How did she get pregnant? HOW?"
Mom: "Well, she had sex with her boyfriend. That's how she got pregnant. Do you know what S%X means?"
Sydney: To my relief, she says "No."
Mom: "Well, remember how flowers have stamens and pollen?" I can't seem to remember my flower reproduction info.
Sydney: "Yeah"
Mom: "Remember how all animals including people have eggs if you are a girl? Well boys have something called sp$rm."
Sydney: "Yeah"
Mom: "Well, married people, and sometimes people that are dating have S%X. Insert drum roll here as I am sweating profusely now....The p$nis goes into the v$gina. That is S$X. That's how the egg and the sperm get together to make a baby."
Sydney: She has an unexplainable look on her face, not fear, but wonder and amazement and a little shock. A light bulb. She says, "Oh."
More silence, then we talk about other things for a few minutes.
Sydney: "So why did she do that? Didn't she know she could get pregnant?" Bonus points for Sydney! Insightful question!
Mom: "Well, you know how moms and dads hug and kiss? And sometimes boyfriends and girlfriends do that too? Well, in addition to s%x making babies, some people want to do it because they think it's fun. They like to do it. They must have gotten carried away and weren't thinking. They must have forgotten."
Sydney: "Is that what happened in the movie?"
Mom: "I don't know, the movie starts where she is already pregnant, and because she is too little to be a mommy, she goes to her parents and tells them. The whole movie is about Juno and her parents finding a mommy and daddy for her baby so she can go back to being a kid again. You remember how your Auntie is going to adopt because she can't have a baby in her tummy? Juno looks for someone like that, people that REALLY REALLY want to be a mommy and daddy so bad.
Sydney: "What happened. Did Juno find parents for her baby? "
Mom: "She did, and she went back to high school and was a regular kid again."
Sydney: More time passes and I think it's over. Then, I hear "So Mom, is that what you and daddy did to have me and Leo?" She has a somewhat embarrassed look on her face and a little bit of a smirky smile.
Mom: "Yes Sydney, that's what ALL parents do.

I immediately told my DH and said you gotta get on it with Leo. The kids may talk about it. You have the same equipment, so you have to do the "p$nis goes into the v$gina" stat! So the next day he did.

Leo says "Gross."

Yeah, we got it over with! Well, I'm sure there will be more layers to follow another day.

Standardized Testing Results

I had a big mommy day on Saturday. First, my 7 year old daughter annouces she's finally read to get her ears pierced (I've been waiting....). Then, we come home to find Leo's standardized test results in the mail. A wave of nausea and anxiety kicked in while I sit in the car and open the envelope. Here are the results:

Overall Results
Leo scored at goal level on all 3 tests (Reading, Writing, and Math). Goal level is level 4 out of 5 levels. I am so proud of him! What the results mean I'm not sure. We have definite areas where he tested low which brought down his score significantly. Is he testing close to what he knows? Not sure. All I know is he knows how to take an inane bubble test. Here are the details:

Leo: 257
School Average: 265
District Average: 276

He tested low on these subtopics:
Customary and Metric Measurements
Integrated Understandings; Math Applications
Both of these areas make total sense with visual spacial problems.

Leo: 250
School Average: 256
District Average: 257

He tested low on these subtopics:
Examining the content and structure

Read comprehension raw score: 29 out of 40 (not sure if this gap is typical or not.

Leo: 274
School Average: 268
District Average: 272

He tested low on these subtopics:

The good news is that he is testing within normal range! And to top it off, I have some low results to guide me for specific support when Leo needs it. I'm going to research these areas along with anything the Yale report says to put together stuff for when we need it. Yeah! Nothing like being prepared, if only the rest of my life were like this.

I am wondering if there is any downside to sharing the results with Leo. I don't see any, I've always been honest about his challenges. Just not sure, what if he starts to compare results to his friends at school? Not that it should matter? Or should I protect the baby as long as possible. I'll have to think about it. Anyone, anyone?

Monday, September 15, 2008

First week of 4th Grade, He's Catching On

D.C. shoes are IN for both kids. They look like giant puffy clown shoes to me, but I guess I'm not the one wearing them!

Leo and Sydney got on the bus the first day of school like it was a normal day from the spring. No real excitement or anticipation, just business as usual. I, on the other hand, was fine until the bus appeared over the little hill, and my eyes started to well up. Sydney, now in 2nd grade, looks at me while reaching out to touch my shoulder, and says"It'll be okay, Mom." Leo, now in 4th grade, dutifully leaned over for an A frame and off they went, leaving me confused as to where all the time went. I logically know, but man, it's still tough for me.

Sydney and Leo are in the mediocre grades at our schools, they are both considered repeat/reinforcer years. 1st, 3rd, and 5th are challenging and demanding, they throw all the new stuff at them in these grades and let the dust settle in between. I kind of like this strategy, should be a fairly easy year with not very much homework.

But back to the first week, Leo HATES school. Each day he says how absolutely boring it is, and honestly I can't blame him. Now that he's older, they go to lunch later, and they have their specials first thing in the morning, so the day isn't broken up much. He tells me that he tries not to look at the clock, and when he finally does, only 5 or 10 minutes have passed and it "just sucks, Mom." I've been there, and he's finally catching on to the rest of his life. The cheerleading cushy fun energetic times are over I think. But I do like his teacher, a sweet older man, his first male teacher. He's very old school, very ernest, a sports fan, and has a dry sense of humor. It's probably a good fit even though he's not that exciting.

Leo learned that an instrument was optional this year and they do weekly pullouts, he signed up for violin just to escape! I rented the instrument, so hopefully he'll actually enjoy but either way I'm covered. I can already hear the violin practice....

The social makeup looks very good this year. A nice group of boys in Leo's class, including his BFF. We are thrilled because this boy is a great friend in every way, they learn from each other, and we like the parents. Leo is playing AAA fall ball and is loving it per usual. Most of the same kids, some a blast from the past, really fun. He's learning to pitch now, I really like how they take turns playing ALL the positions. I still can't believe he can catch a ball let alone play organized ball sports by choice. Leo takes his football to school every day, and they play touch football games at recess. A nice group of boys that broke off from a large group that are more competitive and aggressive. A turnoff for Leo, but the good news is that he isn't alone with these sentiments. He's happy with his friends, I am estatic about this.

Sydney had a good start, then got a flu that had her miss an entire week of school. She was so sick, I thought for a while she may have had strep or even Lyme. I still think both my kids have some sort of suppressed Lyme based on their makeup of face tics and environmental sensitivities. Her tests came back negative, but they wouldn't test her for blood, which is what I really wanted to see about Lyme. But they wouldn't because she had abdominal symptoms which in theory are not Lyme. Such a hotly debated topic that I need to learn more about. The silver lining was this flu caused her chronic symptoms to get better. After 5 months of chronic tics that kept changing and coming back, she has been tic free for a week. In this house, we have bouts of wellness, so I can say she is now well, no chronic or acute illness!

I'm still working on Leo, he has a minor cold that's almost better, and his tics are minor, about 85% better. We are on our way, a remedy that in theory addressed his underlying root illness seems to be helping. I can put him back on his regular remedy soon and see what happens.

So far so good. I'm still waiting for two big things - the Yale writeup and the standardized testing results that should be mailed to us over the next couple of weeks. With these two instruments I should have something to go on to plan for Leo's future support.

As far as I go, I'm busy studying for my homeopathy degree and slowly updating my main website,, in hopes I can finally publish an article I've ignored for a very long time. I just need to do it. I am feeling pretty good about things these days, the kids seem happy which makes mom happy. I can't complain (well, other than about Sarah Palin or the economy crisis).

Sunday, September 14, 2008

NY Times: Strep Throat That Was Lemiere's syndrome

September 14, 2008
The Strep Throat That Wasn't


"I — can't — breathe," the boy gasped. There was panic in his voice and face. He moved restlessly in his hospital bed, tugging at the clear plastic mask covering his nose and mouth. An alarm sounded distantly, alerting the nurses to the boy's distress in the pediatric intensive-care unit of the Cardinal Glennon Children's Medical Center in St. Louis. Before the nurses could respond, the boy's mother replaced the oxygen mask, stroking his face and murmuring reassurances as if he were 7 years old rather than 17.

Dr. Jeremy Garrett, an associate professor of pediatrics at St. Louis University School of Medicine, was worried about the boy. When Garrett first saw him, early that morning, he wondered what this robust man-child was doing in the ward reserved for the very sickest children. At that point, the patient had a fever but otherwise looked well.

Since then, the boy's symptoms had become significantly worse. The amount of oxygen in his blood was terrifyingly low despite getting 100 percent oxygen through the mask covering the lower half of his face. (The air we typically breathe contains about 20 percent oxygen.) And he was breathing rapidly, at nearly three times the normal rate. He had episodes of shuddering, body-wrenching chills — where blanket after blanket couldn't warm him — followed by fevers as high as 105 degrees.

In reviewing the chart, Garrett saw that the boy had been well until six days earlier, when he awoke with a fever and sore throat. He saw his family doctor the next day, who diagnosed a strep throat and started the boy on a five-day course of azithromycin — an antibiotic widely used in part because it is convenient, needing to be taken only once each day. No strep test was done — probably, Garrett figured, because the diagnosis seemed obvious. Despite the antibiotics, the boy continued to spike fevers up to 102 degrees, and the pain and swelling had migrated from his throat to the right side of his neck.

The boy's parents took him to the hospital because something about the way he looked scared them. He wasn't confused, but his responses were slow and strangely deliberate.

2. Investigation

When the family arrived at the emergency department, the boy had a fever and was breathing rapidly. The right side of his neck was tender and slightly red. The rest of the exam was normal. A chest X-rayrevealed a few small patches of white in both lungs — areas that would normally show up as black. Blood tests indicated that the blood cells that fight infection were quite elevated. And most of those cells were immature forms, called bands, suggesting that many of the veteran fighter cells had already been destroyed by a serious infection.

The emergency-department doctors started the boy on two antibiotics for what they thought was probably a pneumonia. Although the patient didn't have much of a cough and the findings on the X-ray didn't seem significant enough to cause a week of fever and shortness of breath, the doctors couldn't find any other abnormality. After the boy's fever went up and his oxygen level went down 12 hours after his admission, Garrett added a third antibiotic and began to wonder what else this might be.

Garrett's concern was that a hidden infection was now seeding his lungs with flecks of infected tissue. That would explain the intermittent fever and patchy image on the chest X-ray. Was this endocarditis, an infection of the valves of the heart? Endocarditis can cause persistent fervers and desseminate infected tissue throughout the body. What about Lemierre's syndrome — a rare infection caused by bacteria that usually start in the tonsils but then invade the vessels of the neck, causing the blood to clot there and peppering the lungs with infected bits? The boy had complained of pain just below the right side of his jaw. Or was this an abscess hidden in the deep recesses of his tonsils? Such a walled-off pocket of infection might not respond to even the most powerful antibiotics.

As Garrett pored over the chart, he noted that each of these possibilities had already been considered. The boy had been seen by an cardiologist, ear, nose and throat specialist and an infectious-disease expert. An echocardiogram — an ultrasound of the heart — showed no sign of infection of his valves. He had an ultrasound of his neck as well to look for an abscess or clot in the vessels there. When none were found, doctors ruled out tonsillar abscess and Lemierre's. Blood cultures still had not given the doctors any clue what the infectious agent might be.

Overnight the boy's breathing continued to worsen. By early the next morning, he could no longer supply his body with the oxygen he needed, and he was put on a ventilator. Simply keeping the boy alive became the doctor's sole focus.

After three difficult days, the team finally was given a clue — though it was nearly missed. Garrett saw the resident looking through some papers in the boy's chart. What's that? he recalls asking. The blood cultures finally grew strange bacteria, the resident responded, but it was probably just contaminant. What was the bacteria? Garrett persisted. Something called Fusobacterium necrophorum. The identification of the bacteria told Garrett all he needed to know. The boy had Lemierre's disease.

The disease was named for Dr. Andre Lemierre, who in 1936 described an infection seen almost exclusively in adolescents and young adults that begins with a sore throat and progresses to a painful and swollen neck. From there, it usually travels to the lungs and sometimes to the brain as well. Before antibiotics, the disease was usually fatal. The widespread use of penicillin to treat sore throats during the 1960s and '70s virtually, if inadvertently, wiped out the disease. But in the last 20 years, Lemierre's has staged something of a comeback. Its reappearance is an unintended consequence of a more cautious use of antibiotics generally and the development of new drugs — like azithromycin, which this boy was given — that are easier to take and can treat strep but also turn out to be far less effective than penicillin against Lemierre's.

3. Resolution

Fusobacterium necrophorum is the most common cause of Lemierre's. The positive culture, along with the pain that moved from the boy's throat to his neck, led Garrett to diagnose the disease, even though the ultrasound had not shown evidence of a clot.

Garrett quickly changed the antibiotics. He chose one that he thought, at this point, would be even more effective than penicillin. Now that they had a diagnosis, maybe they could help this desperately ill young man.

Sometimes, if you just work hard enough to keep a patient alive — to keep the blood circulating and the lungs oxygenating — the body will be able to survive even a vicious illness. These are the miracles brought on by our technological advances. And yet there are times, there are patients, there are diseases in which all you do is simply not enough. The boy's lungs never recovered, and he was never able to breathe without the help of a machine. He died in the I.C.U. three weeks later. His family was at his bedside when he finally slipped away.

When the boy's mother told the doctor back home that her son had died, he cried like a baby, she told me. "I have never lost a patient — like this — completely unexpectedly," the doctor said recently, his voice wavering as he recalled that day. "Never lost one because I missed the diagnosis." He had never even heard of Lemierre's disease before this boy died from it, but he is determined never to miss the diagnosis again. He has changed his practice: now everyone with suspected strep will have a throat culture to check for both strep and Lemierre's. "Maybe that's overkill, and I'll probably end up treating too many of my patients with antibiotics," he added thoughtfully. "But I don't ever want to lose a patient like this again."

Copyright 2008 The New York Times Company

So sad. Kind of makes you think about testing in general. A difficult choice for doctors because there is a cost associated with ordering tests for everyone. Hopefully this boy's death will raise awareness about Lemierre's. It's also hard on doctors that have never seen a "comeback" disease like Lemierre's. I think of whooping cough, even mumps or measles. My daughter had a very mild case of whooping cough that no one picked up but my homeopath. Younger doctors may have never seen a real case of it unless they are from another country. My heart goes out to the family of this boy as well as the doctor.