Pediatrician’s Advice About H1N1 – Follow-up

Several weeks ago, I posted a letter from our pediatric office regarding the H1N1 virus, the hysteria surrounding it, and some advice about the vaccine. It got a lot of hits, so I thought I would post the follow-up letter that we received about a week and a half ago for your perusal. Hopefully, this will continue to take some of the edge off this relatively mild virus. As with the first time, the italics represent a direct quote from the letter written by Diane Holmes, M.D. and Kenneth Polin, M.D.

We are now into the seventh month of this outbreak, and fortunately, the overall severity of this infection has not increased.  The media reports the most severely affected patients without regard to the significant numbers who are not very ill and recover easily.  According to Center for Disease Control estimates, almost 6 million individuals have been infected, generating approximately 20,000 hospitalizations.  By those statistics, an individual with H1N1 disease has less than a 0.3% chance of even being sick enough to be hospitalized.  Please try not to fall prey to the media-based hysteria.  They are only giving the part of the story that draws viewers.

As we talk with our pediatrician friends in the area, we are all frustrated both with the lack of vaccine and the limitations of administration.  The entire H1N1 vaccine supply in the US is channeled through the federal government and subsequently through state and then local health departments.

Unfortunately, their efficiency is not always up to the standards we would like.   With all our staff working as hard as possible and with some of our nurses and doctors putting in extra time to just vaccinate, we have been able to give slightly more than 2,000 doses of the vaccine so far.  We understand your frustration if your child is not yet in that group.

Please understand that all pediatric patients are now considered in the priority group for the vaccine.  Even if we had enough vaccine for everyone (and we certainly do not) and our personnel did nothing but vaccinate all day, every day, it would still take more than 12 days to give the vaccine to everyone who wants it.  We absolutely want to vaccinate as many children as possible, but we need to also continue seeing sick children and give other essential vaccines.  One additional avenue to obtain the vaccine for your child is to bring him/her along with your other child’s scheduled visit.  We are happy to accommodate you if the proper vaccine is available that day.  Just ask the secretary to pull out the charts for the other child(ren), too, when you check in.

Another area of frustration is in trying to make practice adjustments keep in compliance with changing CDC guidelines.  This might result in inconsistent information at times being given to you by our staff.  We can only continue to try to do our best.

Please know that we take all pediatric illness very seriously.  Symptoms of flu (cough, congestion, fever, muscle aches, sore throat) do not routinely need to be seen in the office or the Emergency Department.  If at any point, however, you have concerns about your child’s illness (especially any fever lasting longer than 72 hours, any breathing compromise, child looking progressively sicker, child unable to drink) you should have your child seen. One frequently asked question is “What is the fever number that we should worry about?”  In children over 6 months of age, there is no “worry number.”  Always evaluate your child’s situation in context and trust your parental judgement.  A child with a 104 fever who is droopy but alert, breathing easily and able to drink is much less concerning than the child whose fever is 101 but is not alert, has respiratory issues, doesn’t have good color or is getting dehydrated.

Many thanks to those of you who have expressed appreciation to our office staff and our nurses recently for all their hard work during this very stressful time.  Your kindness and understanding is truly appreciated.

As always, we are trying to be as responsive to your concerns as possible.  Together, we will get through this.

Be Well!

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Toe Walker – First Follow-up

It has been three weeks since I wrote the article “Toe Walking – Not Just For Ballerinas Anymore” pertaining to toe walking in toddlers. Two office visits and more than 10 hours of exercises later, I thought I’d update you all to our progress, and perhaps get a little more conversation going around this surprisingly common subject.

First, let me say that I really like the doctors we are seeing at Children’s Memorial Hospital. They are knowledgeable, patient, and willing to crawl around on the floor walking like a bear or crab, and rolling large padded columns up and down inclines. They are also expensive, like much of our healthcare in America. Billing at slightly higher than $400 for 30 minutes of thoughtful and targeted exercise is very excessive in my opinion, but I will leave it at that for the healthcare topic. The point is that those weekly visits will not be weekly, but rather bi-weekly or even monthly depending on our feelings about Xavier’s progress. After all, the 30 minute sessions in the office aren’t going to correct the issue, our 30 minutes a day at home will, so other than to officially monitor progress or offer tips and additional exercise ideas, we will save ourselves and the (ahem) insurance company the cost of weekly $400 visits.

Xavier is progressing decently, though slow progress is to be expected. He is physically able to walk with a healthy heel-strike-first gait, a big advantage. His range of motion is normal, so whenever we remind him to “walk on flat feet” he immediately begins walking correctly…for a little while anyway. This is actually one of the more important things we have been advised to do is to constantly observe his walk, and remind him to get off his toes. It is both amusing and annoying to listen to us walk down the street having a normal conversation interrupted every couple of minutes or so with a “FLAT FEET” or “HEELS DOWN” reminder tossed the way of my little man. To his credit, he never complains, and drops his heels down every time, no questions asked.

The other important element of the treatment is the exercise routine. About 30 minutes of each day (not all at one time) we do fun little exercises to strengthen Xavier’s core muscles designed to make it easier and more natural for him to steer his balance back to his heels from his toes. Some of these exercises include:

  • Duck Walking – Stand with feet close together and bending at the knees, put hands just below each knee. Take small steps across the room or around the playground, quacking like a duck while walking. This is both the toughest exercise, but also might be the most effective according to the therapists. Done correctly, it is very difficult to do this without the body weight being centered over the heels.
  • Air Kick-Ball – Lay on back and try to grab a ball held above your chest with both feet, or instead of grabbing, just kicking is OK. Try this once yourself and it will be obvious that this is designed to strengthen the abdominal muscles making it easier to keep body weight balanced over the heels. Xavier actually thinks this one is really fun and will interrupt a regular game of kick-ball to do this exercise.
  • Squat Toy Pick-up – Stand with feet about shoulder-width apart. Keeping heels planted on the floor, squat at the knees and with both hands pick up a toy or small object placed between feet and slightly behind heels. Note that I personally have never been able to squat down with my feet flat on the floor, but can only do so on my toes with heels elevated.
  • Bear Walk – With feet as flat as possible and bending mostly at the waist (as opposed to the knees) place hands on the floor and walk across the room or around playground.
  • Crab Walk – Same concept as the Bear Walk, but with stomach and chest facing the sky as opposed to facing the floor.
  • Push Something Heavy – Push a short and reasonably heavy object along the floor keeping feet as flat as possible, or even better…
  • Pull Something Heavy – Same as above but pull while walking backward. This almost forces the heels to the floor first.
  • Superman (or woman) – Have child lay on stomach across your lap with most of upper body hanging over the side of your lap unsupported. Have the child reach for a ball or other object with both hands. The object should be held high and far enough away so that a good stretch up and out is needed to grab the object. This is designed to strengthen the lower back muscles and complements the abdominal core exercise above. The nice thing with this exercise is that you can easily touch the child’s lower back and feel it working.

There are a handful of others we have been given, but these are in the standard rotation. Xavier is showing progress, and will sometimes stand or walk on flat feet without prompting, but still has a long way to go. It is interesting to me how many people either have a child or know a child who has been through this and has had both success and a definite lack of success in correcting it, even with serial bracing. I am very hopeful our little dancer will be fine, but not without significant effort. I wish nothing but the best to anyone else who is working on the same thing, and would love to hear about your experiences as well.

Be Well!

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A Pediatricians Advice About H1N1

This is a direct paste of a letter sent by Dr. Kenneth Polin to my wife, Kerry, along with what I assume are many other parents today. Dr. Polin works out of Town & Country Pediatrics who operate three offices here in Chicagoland. The immunizations being provided by Town & Country Pediatrics are all Thimerosal-free, so are in limited supply and high demand. This is causing the offices to get swamped with calls throughout the day, making it difficult for actual sick children to get appointments to be seen. The offices have informed all parents this morning that they will only accept calls for day-of vaccinations for a single 30 minute period each morning…so a bit of a lottery system if you will. In any case, here is the letter…

Dear Kerry,

There has been a lot of information and misinformation regarding the current influenza as well as relating to the flu in general. We would like to inform and clarify in order to calm fears and help our patients cope with the current situation.

Influenza is an annual event caused by a virus which changes each year. That is why patients need to have a new influenza vaccine annually. The vaccines given in past year do not cover the new strains which appear. Most of the strains we see annually are somewhat related and can cause significant complications in the healthy population as well as in the population with underlying medical issues.

Every year, in the US, approximately 36,000 people die of the flu and related complications. This new flu which has been around since the spring of this year has taken a toll with about 1000 patients dying including 100 children (this is over six months time). The majority of these deaths have occurred in patients with other medical conditions however, this has not been exclusively the case and some healthy patients may have severe complications and even die. It is important to keep things in perspective and if your child gets sick, to be armed with information and not worry needlessly.

The signs and symptoms of the flu (all types) are a quick onset of fever with a dry cough. There are often accompanying body aches and many patients complain of eyeball aches. There may be vomiting also. Not all patients will have all symptoms. If your child has these and has no other medical issues, routine health measures for comfort are all that is needed. If your child is young (under two years old) or has other health issues we should discuss whether we should see your child or manage at home without a visit to our office. Additionally, if your previously well child appears to be compromised in areas of shortness of breath, significant vomiting, acting strangely, or you are just uncomfortable with his/her appearance, call us ASAP. The CDC no longer recommends the use of a flu test as the in-office test is not that reliable and better diagnoses are made using a history and physical diagnostic skills. The use of antiviral medications has also been discouraged in healthy patients in order to avoid development of resistance by the virus to these medications.

The best way to prevent the disease is vaccinating, but there is at the time of this writing only a limited supply as well as a limited resource availability to administer the vaccine. If you want the vaccine, consider all possible sources. Our office supply of seasonal flu vaccine was reduced as the manufacturers were told to shift their production from seasonal to swine flu. All of the swine flu vaccine was sent to the public health sector who in turn have distributed it to multiple sites including, to a limited extent, our office. We will be sending out information about what we have and what we can reasonably be expected to administer via email and on our website.

Keep in mind this is not a panic situation and with your help we can weather this storm together and not fall into the trap of fear that is not warranted.

As it relates to my previous post, The Drama is Deafening, this letter will hopefully show that both extremes are unwarranted right now, perhaps the hysteria about H1N1 even more so.

Be Well!

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