Teach Your Child How to Swim!

Recently, there have been news reports on accidental drownings of children. This should not happen but unfortunately it does and the statistics are staggering.

1. Drowning is the second leading cause of death in children ages one to nineteen.

2. In 2007, over 3000 people died due to unintentional drownings in the United States.

3. In 2006, over 1000 children died due to unintentional drowning.

4. For every one child who died from drowning, another four were treated in the ER for submersion injuries.

5. Most drownings occurred in a home swimming pool and were left unsupervised for less than five minutes.

The American Academy of Pediatrics recommend children as young as four to learn how to swim. Toddler aquatic programs such as "water-babies" are helpful in teaching children to enjoy the water but may not accelerate the learning process. Studies indicate children learn to be "good" swimmers at a mean age of five and a half.

The best prevention tip is supervision, supervision, supervision!!!
Parents should also learn basic CPR. Contact your local American Red Cross Chapter or hospital for more information.

There are many venues that offer swimming lessons. The YMCA, Boys and Girls Club, and local colleges/universities provide lessons. Salisbury University has a summer program, Sea Gull Swim School, that follows the American Red Cross Learn to Swim Program. The American Red Cross can also help locate a local swim instructor.

Let's keep our children safe! Thanks!

Newborn Sleep Safety Tips

Here are some tips on newborns and sleep.

1. No Co-Sleeping!!! Do not bring your baby to bed with you. This can potentially be tragic. Babies can suffocate on the covers, pillows, or blankets. There is also a higher incidence for SIDS (Sudden Infant Death Syndrome). Place a Pack 'n Play next to your bed and have the newborn sleep there instead.

2. Develop a routine from the beginning. It may take several weeks but it will help in the long run!

3. No plush toys, pillows, blankets, or stuffed animals in the crib.

4. Bumper pads are questionable. If it is used, keep it tightly secured.

5. Babies need to be placed on their backs to sleep. This has reduced the incidence of SIDS dramatically.

6. Check the crib bars. The bars should be no more than 2-3/8 inches (6 centimeters) apart, so that babies can't get their heads caught between them.

7. The mattress should fit snug onto the crib. There should be no more than a 1½ inch (4 centimeter) gap between it and the side or end of the crib. Also use a firm mattress.

8. No items with strings, cords, or ties should be in the crib.

9. Do not have the baby sleep in a room where there is tobacco use.

10. Do not overheat the baby. Dress the baby in light clothing and keep the temperature comfortable. Do not over-bundle.

11. Use fitted sheets for the mattress.

Interesting fact: Newborns sleep on average about 16 hours per day!

Thank you and have a nice day!

Chiggers, Chiggers, Please Go Away...

Chiggers are a type of mite in the Trombiculidae family which live in forests, fields, gardens, or areas with nearby lakes. They are also called red bugs, jiggers, berry bugs, and harvest mites. They tend to infect hunters, farmers, and fishermen, but anyone outdoors can be exposed. An interesting fact is the Spanish Moss on the trees in Savannah are inhabited by chiggers, so beware when walking through the squares.

Chiggers do not actually bite but inject enzymes to feed on the skin resulting in the itchy rash. They do not burrow under the skin but instead attach on top of it. The severe itch typically occurs within 24-48 hours. The rash and itch resolves with time, usually within two weeks.

Here are some tips for treatment:

1. Take a shower as soon as possible to wash away the chiggers.

2. Apply a steroid cream such as hydrocortisone to relieve the itching.

3. Calamine lotion can also help with the itch.

4. Oral Benadryl can also help with the itch.

5. Use insect repellent.

6. Keep the lawns cut low. Chiggers love high weeds/grass.

7. Don't forget to wash the clothes.

8. Some people have reported success with clear nail polish on the areas. In theory, it should not work but it can not hurt to try.

9. Watch for signs of infection.

10. If the rash/itch worsens, contact your health care professional for stronger steroids or possible antibiotics.

Have a great summer!

Tips for Summer Walking

1. Wear comfortable walking shoes and socks. This does not include flip-flops or Crocs.

2. Make walking a family affair.

3. Encourage friends to walk. Find a walking buddy.

4. Eat a healthy snack before walking such as a piece of fruit or peanut butter sandwich for energy. Candy bars and energy drinks like Jolt are not recommended.

5. Bring a camera. You never know when it is a Kodak moment.

6. Wear sunscreen on a sunny day. SPF 30 or higher is best. Do not forget the ears, hairline, and lips.

7. Wear a hat with a brim.

8. Wear sunglasses.

9. Drink plenty of fluids such as water to stay hydrated.

10. Drink water prior to walking and during the walk. (at least 1 and ½ cups for a twenty minute walk)

11. Stretch your legs prior to walking. Focus on the calves, thighs (hamstring and quadriceps), and low back.

12. Swing your arms to maximize the workout.

13. Use good walking posture. Keep your head up and back straight.

14. Vary the route to keep from getting bored.

15. Stay on the walking paths.

16. Wear light colored or reflective clothes when walking in the dark.

17. Stay motivated and make goals. Reward yourself when a goal is achieved.

18. Use a pedometer to track your steps.

19. Start slowly (twenty minute walk) and gradually increase your time and pace.

20. Have fun!!!

Jellyfish Sting

Beach season has begun and so has common beach medical problems. Here are some tips on jellyfish stings...

Jellyfish stings are common during the summer season especially for swimmers and divers. The tentacles have nematocysts which contain the venom that causes the painful stings.

The signs and symptoms include:
1. Intense pain at the site
2. Welts and blisters on the skin
3. Itchiness at the site
4. Burning sensation

The sting can be progressive and systemic with the following signs and symptoms:
5. Nausea and vomiting
6. Diarrhea
7. Numbness and tingling
8. Headache and body aches
9. Dizziness
10. Muscle spasm
11. Fever
12. Trouble breathing

The skin rash/hives/welts/blisters typically last for several hours and then resolves.

If the pain is persistent or if the signs and symptoms worsen, get immediate medical attention. Be aware that jellyfish stings can cause anaphylaxis which is a life-threatening condition that requires immediate medical attention.

Treatment includes:
1. Rinse the area with vinegar for at least thirty minutes
2. An alternative is salt or sea water. Do not use fresh water...it causes more stinging!
3. Remove the tentacles with tweezers and make sure gloves are on
4. Apply shaving cream or baking soda paste to the area and then shave the area with a razor or anything with an edge (credit card) to remove the nematocysts
5. Immerse the area with hot water for thirty minutes
6. Apply ice for the pain after the area is cleaned
7. Ibuprofen or acetaminophen can help with the pain
8. If the sting is in the mouth, mouthwash with a concoction of 1/4 cup vinegar and 3/4 cup water
9. Do not rub the area!
10. There is no scientific evidence that urine, ammonia, meat tenderizer, sodium bicarbonate, boric acid, lemon juice, steroid cream, alcohol, papaya, or hydrogen peroxide will stop further stinging of the jellyfish.

Follow up with your health care professional. Obtain a tetanus booster if it isn't up to date.

One interesting fact is the one of the most venomous jellyfish sting comes from
the Box jellyfish (commonly found in the Pacific Ocean and in Australia).

Talk to your healthcare professional for more information. Have a safe and fun summer!

Tips for Kidney Stone Sufferers

Kidney stone(nephrolithiasis) is a very common medical problem. About 500,000 people go to the emergency room each year due to kidney stones. About one in ten people will develop a kidney stone in their lifetime. Here are some tips on treating/preventing this painful problem.

1. Drink fluids!!! At least 2 liters a day...approximately four water bottles a day.
2. Drink water and citrus drinks such as lemonade, orange juice, cranberry juice.
3. Take citrate either through lemonade or supplements (potassium citrate) to prevent formation of certain stones.
4. Maintain urine volume at greater than 2 liters per day.
5. Limit salt intake to 2 grams per day.
6. Cut back on red meat and animal protein to 8 ounces per day.
7. Avoid high oxalate foods to prevent calcium oxalate stones.

Foods high in oxalate include: Beets and beet tops, Black tea, Chocolate, Cocoa, Dried figs, Lambs, Nuts, Parsley, Poppy seeds, Rhubarb, Spinach, Strawberries, Soybeans.

8. Continue to eat dietary calcium but be careful with supplements. Maintain calcium intake to at least 1000mg/day.
9. Avoid excessive vitamin C. The US recommended daily allowance is about 75-90mg per day. Excessive amounts of >1500mg per day increases oxalate formation thus increasing the risk for stones.
10. Limit soda, tea, and coffee.
11. Exercise.
12. Increase fiber intake and add flaxseed to the diet.
13. Avoid sugar.
14. A glass of wine can decrease stone formation if adequately hydrated.
15. Lose weight and decrease fat intake.

Talk to your healthcare professional for more information. Knowing the type of kidney stone can help with developing a plan to prevent recurrence of the stone.

Thanks.

Tips for Allergy Sufferers

Knoxville, TN was recently named the capital of allergies in America. I think there are many Eastern Shore natives that may disagree. According to reports, about 35 million Americans suffer from allergies. The pollen count is high in addition to mold making this a terrible allergy season. Here are some tips to help...

1. Wash/shower before bed to remove the pollen from your body
2. Keep windows and doors shut to prevent the allergens from coming into the home
3. Use the recirculating air setting in your car
4. Wear sunglasses/eyeglasses to prevent eye exposure to allergens
5. Keep your car windows rolled up during peak season
6. Stay indoors in the morning (9am-2pm) when pollen count is high
7. Clean air filters in your home and dust shelves, vents, and windows
8. Vacuum (HEPA filter preferably) at least weekly
9. Wash bedding weekly
10. Do not dry laundry outdoors during allergy season
11. Wear a mask when mowing the lawn
12. Saline wash/rinse your nose at least twice a day...a combination of warm water, about a quarter-teaspoon of salt, and a quarter-teaspoon of baking soda administered through a squeeze bottle can help
13. Over the counter anti-histamine medications such as Zyrtec, Claritin, or diphenhydramine can help with symptoms
14. Decongestants can help with stuffy noses but should be used with caution. Nasal decongestants should only be used for three days or less.
15. Try a neti-pot to help flush out the allergens...click here for more information
16. Know your triggers and avoid them...talk to your physician for guidance

There are prescription medications ranging from tablets to steroidal nasal sprays that can help with allergies. Immunotherapy or allergy shots can also help. It works by exposing small amounts of the allergen to your body thereby increasing your tolerance to the substances (allergens) that provoke the allergy symptoms.

Hope this was helpful. For more information, talk with your health care professional.

UTI

Urinary tract infections are common infections, accounting for about 8 million physician visits each year. UTI's affect the urinary system which consists of the bladder, urethra, ureters (the connecting tubes), and kidneys. The most common area is the bladder. Women are at greater risk than men; at least one in five women will develop a UTI in their lifetime.

The most common bacteria cause of a urinary tract infection is E. coli. Other organisms involved include Staphylococcus, Chlamydia, Proteus, Klebsiella, and Herpes.




Risk factors include:
1. Female gender due to anatomy (shorter urethra)
2. Being sexually active
3. Men with enlarged prostates
4. Blockage in the urinary system such as a stone
5. Pregnancy
6. Catheters
7. Co-morbid conditions that decrease immune function such as diabetes and HIV
8. Diaphragm use
9. Vesicoureteral reflux
10. Neurogenic Bladder Dysfunction
11. Advanced age

Signs and Symptoms include:
1. Pain on urination (dysuria)
2. Urinary frequency
3. Blood in the urine (hematuria)
4. Urinary urgency
5. Foul smelling urine
6. Passing small amounts of urine frequently

Diagnostic tests for an uncomplicated UTI include a urinalysis and urine culture. Typically, tests are not necessary to treat for uncomplicated UTI's.

Treatment includes:
1. Antibiotics such as Bactrim, Ciprofloxacin, Nitrofurantoin, etc...
2. Good hygiene and proper wiping from front to back
3. Removing diaphragm and utilizing an alternative form of birth control
4. Drinking plenty of fluids
5. Avoiding coffee, alcohol, spicy foods
6. Stop smoking!
7. Analgesic to help with pain (Pyridium)
8. Heating pad for pain relief

There are different guidelines for the management of UTI's in children. It depends on the sex, age, and the frequency of the infections. In some cases, an ultrasound of the kidneys is necessary to evaluate pediatric UTI's.

Recurrent infections will need further evaluation and prophylactic treatment.

Preventative measures include:
1. Drink plenty of water
2. Urinate when you feel the need; don't resist the urge to urinate.
3. Wipe from front to back
4. Take showers instead of baths
5. Cleanse the genital area before sexual intercourse
6. Avoid using feminine hygiene sprays and douches
7. Drink cranberry juice

Talk to your health care professional for more information. Thank you and have a nice day!

Keep Those Teeth Clean or else...

Several years ago I saw a patient in the hospital for bacterial endocarditis. Bacterial endocarditis is an infection of the heart lining or valves. It is a very serious condition requiring intravenous antibiotics for at least one month. The patient was a young male with a relatively unremarkable medical history. Upon examination, he was found to have multiple dental cavities with gingivitis. Poor dentition is a cause for infective endocarditis! Then, several months ago, I was involved in a young female who was admitted due to strokes from endocarditis. After an extensive evaluation, it was presumed that the infection was from her oral cavity.

Infective or bacterial endocarditis affects about 29,000 individuals yearly. Individuals with heart conditions such as prosthetic valves, history of rheumatic carditis, congenital disease, or Marfans syndrome are at risk. The source of infection may come from IV drug use, dental procedures, GI procedures, urinary and prostatic procedures, skin infections, colon cancer, cardiac surgery, or respiratory infections. The bacteria enters the bloodstream and settles onto the heart. A vegetation or infective mass develops on the valve resulting in a cascade of signs and symptoms such as fever, rash, joint pain, fatigue, cough, weight loss, skin lesions, trouble breathing, etc...

One important preventative task is to keep those teeth clean. Routine brushing, flossing, and dental visits will keep the bacteria from developing and seeding into the body.

Antibiotics during dental procedures may be used to prevent endocarditis in high risk individuals. A single dose of Amoxicillin or Clindamycin is typically given one hour prior to the procedure. Guidelines suggest antibiotic prophylaxis in treatments involving gingival or tooth root manipulation.

The following conditions should receive antibiotics:
1. People with artificial heart valves
2. Certain congenital heart disease conditions
3. Previous history of endocarditis
4. Cardiac transplant

Mitral valve prolapse is not an indication for antibiotics.

Practice good oral hygiene and keep brushing those teeth!
For more information, talk to your health care professional and dentist. Thanks!

Male Breast Cancer

A pleasant 60 year old obese male presented to my office with complaints of a left breast lump for the past several months. He described it as tender and firm. There was no redness or pus. It was near his nipple area. He has no family history of breast cancer. His medical history was unremarkable. He does have a 30 year history of tobacco use. Upon examination, a 2 cm mass was palpated and minimally tender. He was sent for a diagnostic mammogram and ultrasound. The results came back highly suspicious for tumor and he was promptly referred to surgery for biopsy. His results are pending.

Male breast cancer is rare. About 1% of breast cancers occur in men. About 2000 men were diagnosed with breast cancer in 2008 with approximately 400 deaths. Typically, male breast cancer occurs between the ages of 60 and 70 with the median age being 67.

Risk factors include:
1. Age
2. Obesity
3. Heavy alcohol use
4. Liver disease
5. Hormone usage
6. Klinefelter Syndrome (chromosomal disorder)
7. Strong family history of breast cancer
8. Radiation exposure
9. High estrogen levels (from obesity, alcohol, hormone use, etc...)

Signs and symptoms include:
1. Lump
2. Nipple pain
3. Nipple discharge
4. Enlarged lymph nodes under the armpit
5. Changes to the breast skin such as redness, dimples, scaling...
6. Nipple soreness
7. Nipple inversion

Diagnosis is made by mammogram, ultrasound, and biopsy.
The most common type of male breast cancer is infiltrating ductal carcinoma.

Treatment depends on the staging/severity. It may consist of mastectomy, chemotherapy, radiation, and/or hormone therapy.

Male breast cancer is very similar to female breast cancer. Prognosis and remission rates are virtually identical and is based on the staging and extent of the cancer.

Two ways to prevent this rare disease is to maintain a healthy weight and to drink alcohol in moderation.

Talk to your health care professional for more information.

Thank you and have a nice day.