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Spring break has arrived for many college students. While students certainly deserve a vacation from the stress of school, parents should stay aware of their children’s spring break plans. Unfortunately, students who spend spring break with friends, rather than family, are much more likely to engage in binge drinking and suffer associated consequences such as injury, unprotected sex, and assault. 

Before the spring breaks end, we encourage parents to review earlier posts about binge drinking and how to broach the subject of alcohol and drugs.

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®

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The bad news is that influenza is now circulating in all 50 states. The good news is that according to the Centers for Disease Control, the vaccine covers all currently circulating strains. 

 

 

The best news: the ground hog predicts an early spring.

 

 

 

For the latest in updated flu information www.cdc.gov

 
Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®
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Although the American Congress of Obstetricians and Gynecologists recommends a first gynecological visit between 13 and 15 years of age, a teen usually does not need to have an internal pelvic exam at the first visit unless she is having problems or unless there is a need to screen for certain sexually transmitted diseases.


For more information, please visit  http://www.acog.org/publications/patient_education/bp150.cfm.


Julie Kardos, MD and Naline Lai, MD

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The American Congress of Obstetricians and Gynecologists in June recommended adolescent girls have their first visit with an ob-gyn between the ages of 13 and 15 to help set the stage for optimal gynecologic health. This visit does not necessarily include an internal pelvic exam. Last month the American Academy of Pediatrics released a policy statement outlining when teenage girls may stay with their pediatrician for routine care. Our guest blogger today, pediatrician Dr. Carly Wilbur, illustrates for us the guidelines.

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Last week, I saw a 14-year-old young lady who suffered painful menstrual cramps.  Her mother wanted her to see a gynecologist, but my patient was reluctant.  At my office, we have a room that is dedicated to providing gynecologic care, including pelvic exams, that contains a proper exam table with stirrups.  The patient, her mother, and I discussed reasons that some adolescents can have their gynecologic health managed in the pediatrician’s office and some teenagers get referred to gynecologists. 

Many pediatricians can handle:

  • Routine/annual gynecological exams, including a Pap test,  in sexually active patients
  • Vaginal/cervical cultures used to diagnose new conditions (some general pediatric offices are even equipped with a microscope to aid in their evaluations)
  • Acute gynecologic concerns such as vaginal discharge, itching, or a change in menstrual flow

Reasons for a referral to a gynecologist include:

  • The patient has pelvic pain and needs further evaluation of her ovaries, fallopian tubes, or uterus
  • Patient and pediatrician have failed to find a birth control pill that is acceptable (too many side effects or unacceptable side effects) and thus require expert opinion of a gynecologist regarding oral contraceptive pills
  • The patient engages in high-risk sexual activity
  • Pediatrician does not provide gynecologic services
  • The patient becomes pregnant

This family opted to have me perform my patient’s first pelvic exam since I was familiar to her and this brought her some comfort. 

Carly W. Wilbur, MD, FAAP

Suburban Pediatrics, Inc.

Rainbow Babies and Children’s Hospital

Cleveland, Ohio

© 2010 Two Peds in a Pod℠
Revised 9:15pm 10/25/10

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A few days ago, I spoke with the faculty of a local early childhood education center about flu vaccine myths. See how you do on the true and false quiz I gave them:


 


I can tell when I am getting the flu and will leave work before I infect anyone.


False. According to the CDC (US Center for Disease Control), you are infectious the day before symptoms show up.




I never get the flu so it’s not necessary to get the vaccine. 


False. Saying I’ve never had the flu is like saying, “I’ve never a car accident so I won’t wear my seat belt.”


 


I hate shots. I hear I can get a flu vaccine in a different form.


True.  One flu vaccine, brand name Flu Mist, provides immunity when squirted in the nose. Non-pregnant, healthy people aged 2-49 years of age qualify for this type of vaccine.


 


I got the flu shot so I was healthy all year.


False. Perhaps it was the half-hour a day you added to your workout, or the surgical mask you wore to birthday parties, but your entirely healthy winter was not secondary just to the flu vaccine.  The United States flu vaccine protects against several strains of flu predicted to cause illness this winter. This year’s vaccine contain both seasonal and the 2009 H1N1 strains. Your body builds up a defense (immunity) only against the strains covered in the vaccine. Immunity will not be conferred to the thousands of other viruses which exist. On the other hand, the vaccine probably did protect you from some forms of the flu, and two fewer weeks of illness feels great.




My friend got the flu shot last year, therefore, she was sick all winter.


My condolences. True, your friend was sick. But the answer is False, because the illnesses were not caused by the flu vaccine.  Vaccines are not real germs, so you can’t “get” a disease from the vaccine. But to your body, vaccine proteins appear very similar to real germs and your immune system will respond by making protection against the fake vaccine germ. When the real germ comes along, pow, your body already has the protection to fend off the real disease. Please know, however, there is a chance that for a couple days after a vaccine, you will ache and have a mild fever. The reason? Your immune system is simply revving up. But no, the flu vaccine does not give you an illness.


 


I got the flu vaccine every year for the past decade. I will still need to get one this year.


True. Unfortunately, the flu strains change from year to year. Previous vaccines may not protect you against current germs.


 


I am a healthy adult and not at high risk for complications from the flu, so I will forgo the flu vaccine this year.


False. The flu vaccine is now recommended for everyone greater than 6 months of age. When supply is limited, targeted groups at risk for flu complications include all children aged 6 months–18 years, all persons aged ≥50 years, and persons with medical conditions that put them at risk for medical complications.   These persons, people living in their home, their close contacts, and their CARETAKERS are the focus of vaccination. 


Even if I get the flu, I’ll just wash my hands a lot to keep the germ from spreading. I have to come back to work because I don’t have much time off.


False, According to the American Academy of Pediatrics Report of the Committee on Infectious Diseases, the influenza virus can spread from an infected person for about a week after infection.


 


Yes, kids get sick from others kids, but as a parent who comes in contact with two children, an early childhood educator who comes in contact with ten children, an elementary school teacher who comes in contact with twenty children or a high school teacher who comes into contact with one-hundred children daily, you may end up the one who seeds your community with a potentially deadly illness.  Right now, flu vaccine clinics are as plentiful as Starbucks. Hit that CVS or Walgreens on the way home, wander into your doctor’s or grab a shot while you get groceries.  By protecting yourself from the flu, you protect the children you care for.


 


Naline Lai, MD with Julie Kardos, MD


© 2010 Two Peds in a Pod℠

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Eeew! Pictured is the raw chicken I left sitting out in a pot for a day (inadvertently, of course).  The putrid mess was teaming with germs and amongst them was probably salmonella. This bacteria is in the news because of the thousands of eggs recently recalled for contamination (Centers for Disease Control , New York Times, National Public Radio.)


 


Non-typhoidal Salmonella usually causes fever and crampy diarrhea.  This stomach bug mainly lurks in raw poultry, raw eggs, raw beef, and unpasturized dairy products. Luckily, salmonella does not jump up and attack humans. People are safe from disease as long as they do not eat salmonella-infested food.


 


In the case of my pot of rotten chicken, the obvious stench warned me that it was inedible.  However, salmonella often hides in food and it is difficult to tell what is or is not contaminated.  A perfectly fine looking egg may harbor the germ. Even before this outbreak, the Centers for Disease Control estimates in the United States as many as 1 in 50 people are exposed to a contaminated egg each year.


 


Luckily salmonella is killed by heat and bleach.  Even if an egg has salmonella, adequate cooking will destroy the bacteria. Gone are the days when parents can feed kids soft boiled eggs in a silver cup, have kids wipe up with toast the yolk from a sunny-side up egg, or add a raw egg to a milkshake.  Instead, cook your hardboiled eggs until the yolks are green and crumble, and tolerate a little crispness to your scrambled eggs.  Wash all utensils well. The disinfecting solution used in childcare centers of ¼ cup bleach to 1 gallon water works well to sanitize counters. Do not keep perishable food, even if it is cooked, out at room temperature for more than two hours.




A mom once called me frantic because her child had just happily eaten a half-cooked chicken nugget. What if this happens to your child? Don’t panic. Watch for symptoms — the onset of diarrhea from salmonella is usually between 12 to 36 hours after exposure but can occur up to three days later.  The diarrhea can last up to 5-7 days. If symptoms occur, the general recommendation is to ride it out. Prevent dehydration by giving plenty of fluids. My simple rule to prevent dehydration is that more must go in than comes out. 


 


According to the American Academy of Pediatric’s 2009 infectious diseases report, antibiotic treatment may be considered for unusually severe symptoms or if your child is at risk for overwhelming infection. People at high risk for overwhelming disease include infants younger than three months old and those with abnormal immune systems (cancer, HIV, Sickle Cell disease, kids taking daily steroids for other illnesses). Using antibiotics in a typical case of salmonella not only promotes general antibiotic resistance, but in fact does not shorten the time frame for the illness. Also, the medication can prolong how long your child carries the germ in his stool.


 


I ended up tying the chicken up, pot and all, in a plastic grocery bag and throwing out the whole mess.  Don’t tell my husband, he is the kind of guy who gets annoyed because I throw out germy sponges on a frequent basis. If he knew, he’d probably want me to at least keep the pot. Yuck.

Naline Lai, MD with Julie Kardos, MD


©2010 Two Peds in a Pod℠

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A common question that many parents ask us in the office is “Howcan I help my overweight child?”


Our newest podcast provides six simple rules for healthyeating. Listen in to find out the “5-4-3-2-1-0” rules of what to feed yourchildren, how to portion their foods, and how to change their behavior to helpthem lose excess pounds and maintain a healthy weight.


(If the podcast is not embedded in your RSS reader page,visit the www.TwoPedsInAPod.com home page directly.)




Julie Kardos, MD and Naline Lai, MD


©2010 Two Peds in a Pod

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Dr. Dave, a friend of Dr. Kardos, is a physician in a Student Health Center at a respectable college in a large city. Here is an alarming, yet typical, scenario involving binge drinking that Dr. Dave encounters on a too-frequent basis.


 


A 19 year old young man comes in to the Student Health Center very concerned because he had woken up that morning in an apartment in bed with a woman he did not know. He had been out with friends drinking at a bar (a frequent occurrence), vaguely recalls meeting a woman, but had so much to drink that he cannot even recall leaving the bar, let alone what happened afterward. His greatest concern is that he has no idea if he used a condom (he left before she woke up), and thus could have been exposed to HIV and other sexually transmitted infections.


Ironically, this student is worried about exposure to sexually transmitted diseases but not about the root of his problem: binge drinking. In other words, he is worried about sexually transmitted diseases but not about his drinking which caused his potential exposure to dangerous diseases.


Here is what Dr. Dave, a career student health doctor, wants parents of college students to know about binge drinking in college students:


Although alcohol use is often considered a rite of passage for college students, it is also one of the major health risks for this age group.  Alcohol-related health problems can present in a variety of ways and do not have to involve any signs of dependency.  Among college-aged students, the most common manifestation of alcohol abuse comes from the consequences of binge drinking.  


The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports the following sobering statistics regarding annual health risks directly attributed to alcohol use among college students between the ages of 18 and 24.  These statistics also serve as an important reminder that a person does not have to be drinking to be adversely affected by alcohol abuse.


·         1,400 student deaths from alcohol-related unintentional injuries (including motor vehicle accidents)


·         500,000 unintentional student injuries 


·         More than 600,000 cases of student-on-student assault 


·         More than 70,000 cases of sexual assault or date rape


·         400,000 students having unprotected sex and more than 100,000 students too intoxicated to remember if sex was consensual.


The first 6 weeks of the first semester of college is an important predictor of first year academic performance and is an important window period to monitor for any significant changes in a new student’s behavior and lifestyle habits.  Parents can help by being aware of these issues and by being open to speaking with their children about the potential risks of alcohol use both before and during the college experience.  A simple rule of thumb for parents is to stay involved, while still allowing their children the space necessary for learning, exploring, and maturing into adulthood. 


If your child begins to exhibit unusual behavior, such as lower grades, mood changes, or a new unwillingness to talk to you, this behavior should prompt you to find out more. 


Additional information is available at http://www.collegedrinkingprevention.gov/.


Dr. Dave, MD is a physician who has been working in college health since 2000.


© 2010 Two Peds in a Pod

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The other day when Dr. Lai asked a dad in her office how his college freshman son was doing, the dad replied that he was in a state of shock. The  reason? His son recently confessed that he drank alcohol and smoked pot at college.




What would you do if your child told you he or she was drinking or using other drugs? Standing with one’s mouth gaping open is probably not the best response. When your child returns home after her first semester away, take the opportunity to discuss alcohol and drugs. Today, licensed psychologist John Gannon who has over 25 years experience as a marriage and family therapist in the Philadelphia area, blogs about what a parent can say.  A father of a young adult and a teen, John Gannon has spoken both locally, and nationally on family matters. He has addressed numerous teacher and parent groups, given advice on a radio call in program and has appeared on The Montel Williams Show.


 


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Okay, it happened. Your child went off to college and now he tells you his college experience is just as bad as yours was. Yes, he is doing well academically. But he is smoking pot and drinking alcohol- it is just about enough to push you over the edge. OMG!

I won’t tell you to relax about this, but remember for the most part, this is a transitional time and not necessarily a life changing scenario. After all, people have gone off to college for 100’s of years and survived. The likelihood that your child will be the exception is not overly high. If this scenario occurs and you comment about drug and alcohol use, you will act responsibly for your child and not necessarily condone the behavior. Most likely, the actions are unlikely to be life changing and isolated to college.

So what is fair to talk about and what is probably too much to talk about? First, if there is any family history for either drug or alcohol abuse this should be discussed. The family secret needs to be revealed so that your child has a chance to minimize the impact of biology/genetics. Painful as it may be, your child deserves the chance to understand why his situation is somewhat unique and that he is at greater risk for drug and alcohol abuse issues than other students.

Secondly, if there is any family history of depression, anxiety, mood disorder, or other significant mental health issues this also needs to be revealed. These disorders run in families.  The presence of these disorders increases the likelihood a person self medicates with drugs or alcohol in order to combat mental illness.

Next, isolated events do occur. We always hear about them from our friends. We are grateful that the events do not happen to us. Although these events do appear random, your child has the potential to experience one of them. For instance, episodic binge drinking can be epidemic at some colleges. Chances are your child will participate at some point or another.

Did you ever have that talk about alcohol and drugs that you promised yourself you would have with your child before he went to school? Did you explain about mixing substances? Did you explain about how the body metabolizes alcohol? Did you talk about how alcohol and marijuana lower impulsivity and reduce judgment? Did you tell him how proud of him you are and yet you also feel scared? Did you set the stage to have a dialogue versus a lecture from parent to child?

So go on! Have the talk even if your child already started college.  Sure you might be met with some eye rolling. Don’t forget, you rolled your eyes at your parents. What goes around comes around. Listen, if your child hears one thing from you that he remembers, that’s a win! With luck, your child’s events are not the ones others are talking about.

John Gannon
Psychologist, Marriage and Family Therapist


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For more information Partnership for a Drug-Free America www.drugfreeamerica.org


 


National YouthAnti-Drug Media Campaign www.TheAntiDrug.com


 


If you are concerned your child is addicted : to find treatment- U.S .Department of Health and Human Services- Substance Abuse and Mental Health Services Administration – Substance Abuse Treatment Facility Locator www.findtreatment.samhsa.gov 1-800-788-2800


 


Naline Lai, MD and Julie Kardos, MD


©2009 Two Peds in a Pod


 

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I wash my hands about sixty times a day, maybe more.  This in combination with cold Pennsylvania fall air leads to chapped hands.  It’s a sure sign winter is approaching when patients start to show me their raw hands.  Here are the hands of a girl I saw a couple days ago.


To prevent dry hands:
•    Don’t stop washing your hands, but do use a moisturizer afterwards.  

•    Whenever possible, use water and soap rather than hand sanitizers.  Hand sanitizers are at minimum 60% alcohol- very drying.  

•    Wear gloves as much as possible even if the temperature is above freezing.  Remember chemistry class, cold air holds less moisture than warm air and therefore is unkind to skin.  Gloves will prevent some moisture loss.   

•    Before  exposure to any possible irritants such as the chlorine in a swimming  pool,  protect the hands by layering heavy lotion (Eucerin cream) or petroleum based product (i.e. Vaseline or Aquaphor) over the skin.  

To rescue dry hands:
•    Prior to bed smother hands in 1% hydrocortisone ointment.  Avoid the cream formulation.  Creams tend to sting if there are any open cracks.  Take old socks, cut out thumb holes  and have your child sleep at night with the sock on his hands.  Repeat nightly for a week or so.  Alternatively, for mildly chapped hands, use a petroleum oil based product such as Vaseline or Aquaphor in place of the hydrocortisone.    

•    If your child has underlying eczema, prevent your child from scratching his hands.  An antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) will take the edge off the itch.  

•    For extremely raw hands, your child’s doctor may prescribe a stronger cream and if there are signs of a bacterial skin infection, your child’s doctor may prescribe an antibiotic.

Happy  moisturizing. Remember how much fun it was to smear glue on your hands and then peel off the dried glue? It’s not so fun when your skin really is peeling.  

Naline Lai, MD

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