Established 1997

Search this site

APP for your mobile device
Search for Roger Knapp
or Pediatric Advice



Jokes     Recipes     Inspiration     Miscellaneous     Pictures     Quotes

Newsymail from 2007


Jan 1, 2007

From the recurring news headlines, you're probably already well aware that MySpace is an attractive target for sexual predators. That's because it's a premier destination for millions of children too young to exercise caution.

You should talk with your children about the dangers of private thoughts and information online, especially on social-networking sites. For example, MySpace profiles include a section encouraging members to share information about their schools. That's already enough information to interest predators that may live nearby.

Even parents who keep tabs on MySpace may know only half the story. The site includes its own e-mail and instant messaging systems, which are private.

If your children are too young to exercise caution online, it may be time to put some Web sites under lock and key. And there are a couple of ways to go about having the family computer block certain sites.

If you use Internet Explorer, you can use the browser's built-in Content Advisor to block selected sites. To activate Content Advisor, start by opening Internet Explorer. Click Tools>> Internet Options. Select the Content tab. Click Enable.

Select the General tab. Then click Create Password. Along with a password, be sure to also enter a hint that will jog your memory should you ever forget your password. Use a hint that helps you but provides little or no meaning to your children. Then click OK.

In the Content Advisor window, select the Approved Sites tab. Here you can enter the names of sites that you want to block. Under "Allow this Web site," enter the address of MySpace. Be sure to enter the full address, such as "http://www.myspace.com" (without the quotes).

After entering the address, click the Never button. That tells Content Advisor to never allow the Web site. You can enter addresses for other potentially harmful sites as well. When you finish, click OK. Then click OK on the next window.

A U3 is a USB "thumb" drive. But it has special software. It is almost like having a portable computer. When the drive is plugged into a PC, it displays a launch menu. This is similar to Windows' start menu.

Usually, U3 drives have Web browsers and other software installed on them.  The programs may write data to the computer hard drive but they are supposed to remove all traces when the U3 drive is removed.

Like any storage media, U3 drives can transfer viruses and other malware between machines.

You're out of luck when it comes to parental controls, too. Parental controls work with the browser. Since U3 drives have their own browsers, they are unaffected by controls.  Net Nanny type monitors will pick up their activity but not prevent them from accessing bad web sites. 

Programs that will help keep an eye on your children’s activity:

1.      SafeEyes: Runs on both Windows and Mac, $50 per year. It filters sites, e-mail and instant messaging, keeps logs, and sets time limits. Keeps detailed reports. It can be customized for different ages.

2.      CyberPatrol or Net Nanny: In addition to filtering Web sites, set time limits for your children to use the computer each day. It can also be used to block file-sharing and chat programs. It sells for about $40. But remember, filtering comes free with AOL, Earthlink, or MSN.  CYBERsitter ($40), CyberPatrol ($40) and NetNanny ($40).

3.      spectorsoft.com: A $99 program that will actually take snapshots of your computer's screen—e-mails, chats, IMs, keystrokes, etc are recorded too. These snapshots are stored privately for you to view later. The program also records visited sites, chat logs, e-mails, and even keystrokes. Reports can be sent via e-mail.
Roger Knapp MD

Jan 7, 2007

Sorry this is long and a copy is at the web site.  This is important so if you do not have time to read it now, it is at my web site in an article called obsity.

This article is written to get you motivated enough to do something as a parent or community leader. The big question: Who's to blame for our current childhood obesity and type 2 diabetes epidemic? Depends on whom you ask. The Institute of Medicine says it's an interaction between genetics and environment. Well, our genetics hasn't changed in 30 years, but our environment has. The body mass index distribution curve shows that all segments of the population are increasing in weight, so whatever's happening is happening to everybody. The U.S. Government calls it a matter of "personal responsibility." How does the 2-year-old population, who is witnessing the greatest increase in prevalence of obesity, accept personal responsibility? The Centers for Disease Control and Prevention says obesity results from an energy imbalance, by eating too many calories and not getting enough physical activity. Big Food says it's a lack of activity, the TV industry says it's the diet. The Atkins people say it's too much carbohydrate, the Ornish people say it's too much fat. The juice people say it's the soda, the soda people say it's the juice. The schools say it's the parents, the parents say it's the schools. How are we going to fix this, when no one will accept responsibility? If you want to just blame American apathy and laxity, all you have to do is look at Japan, China, and France, each of which has witnessed a doubling in the prevalence of childhood obesity in the last 10 years, as well as the rise in prevalence in developing countries in which malnutrition used to be rampant. In other words, it's not Americans; it's humans.

So far, it is just "guilt by association." The not-my-fault two-step has so far succeeded, due to a lack of mechanism, which has allowed each interest group to sidestep their responsibility. So what really has happened in the past 30 years to allow for this? And how did our physiology interact with our environment to create this problem?

The main reason for this conundrum is our casual misinterpretation of the First Law of Thermodynamics, which states: "The energy within a closed system remains constant." In human terms, the First Law is usually interpreted as follows: "If you eat it (energy intake), you better burn it (energy expenditure), or you're going to store it (weight gain)."

There is another equally plausible interpretation of the First Law, which is stated thus: "If you store it, and you expect to burn it, then you have to eat it." In this interpretation, the behaviors of gluttony and sloth become secondary to a pathological process of excess energy storage. Could this instead be what's happening? What is making energy storage go haywire?

To understand dysfunctional energy storage, we must first understand how our body normally regulates energy balance.  Our energy intake vs. expenditure is normally regulated very tightly by the hormone leptin, which transmits the primary controls to the brain for energy balance.

This leptin signal (1) reduces the appetite to decrease further food intake, (2)increases thyroid hormone  and energy expenditure, 3) innervating skeletal muscles to increase energy, and  4) innervating  white adipose tissue to release fat. The magnitude of energy expenditure also increase energy expenditure (eg, caffeine) increase quality of life.

Also leptin causes the brain to reduce the activity of the vagus nerve.  The Vagus increases insulin secretion to increase calories into fat cells, and increases adipose tissue insulin sensitivity to promote energy accumulation in fat.  So when leptin levels are high, the brain senses energy sufficiency, and these vagal energy conserving and storing processes are inhibited.

Every human has a "personal leptin threshold," above which the brain interprets a state of energy sufficiency and the high leptin state is characterized by low appetite, normal physical activity, and feelings of well-being.

Conversely, in conditions of low leptin, such as in the "starvation response," the brain would of  decrease the body’s activity and feelings of well-being, and increase vagal tone to increase appetite and insulin release (to store more energy in adipose tissue). In the energy excess state, humans burn energy at 50 kcal/kg fat-free mass. However, in the starvation state, this is reduced to 40 to 42 kcal/kg fat-free mass.

Obesity is the same process in the brain as starvation. On first thought this sounds ludicrous, but in fact, it actually makes a lot of sense. If you examine the constitutional symptoms of obese and starved individuals, they are similar. Both are associated with fatigue, malaise, lack of activity, inability to motivate, and depression. The reason for this is the ability or inability for the brain to transduce the leptin signal; in starvation because there is inadequacy of leptin, and in obesity because there is resistance to leptin, because it is obviously not doing its job. Furthermore, serum leptin concentrations drop precipitously during periods of short-term fasting (with-in 12 hours), declining faster than body fat stores, which would account for the recidivism of obesity; the hypothalamus is seeing a declining leptin signal similar to starvation, promoting increased energy intake and decreased energy expenditure. Similarly, giving leptin to obese leptin-resistant individuals is not effective.

So what is leptin resistance? And what restores leptin sensitivity? So far, two paradigms for improving leptin sensitivity have been noted.

Forced weight loss.  Rosenbaum employed a 10% weight loss paradigm to induce the starvation response. In these individuals, leptin declined and energy expenditure decreased. However, exogenous administration of leptin in physiologic dosing to approximate the prestarvation leptin level resulted in further weight and fat decrease, along with return of energy expenditure to the prestarvation state. In other words, in the baseline state, subjects were resistant to physiologic concentrations of leptin, while in the weight-reduced state, they were responsive to the same concentrations of exogenous leptin; thus, forced weight loss improved their leptin sensitivity.

We studied children who became obese after brain damage from brain tumors, surgery, or radiation, termed "hypothalamic obesity." Death of these neurons prevents normal leptin signaling, resulting in an "organic leptin resistance," which manifests as a never-ending starvation response and intractable obesity. Hypothalamic obesity is classically unresponsive to diet, exercise, and most pharmacologic manipulations. We treated patients with the somatostatin analog and insulin suppressive agent octreotide. We were able to suppress insulin, stabilize BMI, decrease caloric intake, increase spontaneous physical activity, and improve quality of life commensurate with the degree of insulin suppression. In other words, reduction in insulin reduced hunger, fatigue, malaise, and sloth.

We then treated obese adults (without CNS lesions) with octreotide. We noted significant and progressive BMI loss in about 20% of treated subjects. Recall measurements of caloric intake demonstrated that these responders reduced carbohydrate intake selectively, along with suppression of insulin, while nonresponders did not. In the responders, leptin concentration dropped by 50%, which of necessity should elicit the "starvation response;" despite this, energy expenditure increased in these subjects. We also demonstrated that insulin suppression by octreotide correlated with improved leptin sensitivity.


Rosenbaum through forced weight loss, improved leptin sensitivity as measured by improved energy expenditure in response to leptin. Insulin suppression using octreotide also improved leptin sensitivity, as measured by declining leptin with improved energy expenditure, allowing for weight loss and improved quality of life. Both paradigms share at their core a reduction in insulin concentrations. The similarity of effect between these two paradigms suggest that insulin may be one cause of leptin resistance.

Insulin Antagonizes Leptin Signaling

Although insulin and leptin bind to separate receptors in the brain, they share the same signaling cascade. It is thought that when insulin levels at the brain are high, then leptin cannot turn on its signaling cascade.

Adaptive Advantage for insulin as an Endogenous Leptin Antagonist

Teleologically, what could be the biological advantage of insulin antagonism of leptin action in obesity? Leptin is a necessary signal to the brain for the initiation of high-energy processes, such as puberty and pregnancy. If leptin signaling were not modulable, the weight accrual for reproductive competency during puberty and pregnancy would be compromised. Therefore, reversible antagonism of leptin action is in the best interest of our survival. Since insulin causes energy deposition into fat, it makes sense that it should be the central blocker of leptin as well. Indeed, both puberty and pregnancy are hyperinsulinemic and insulin resistant states;  with requisite increases in insulin levels. In both, leptin levels increase slowly, and then when adulthood is reached or post-partum, insulin levels fall, weight stabilizes or is lost, and leptin returns back toward baseline. However, in maladaptive conditions when insulin rises chronically, leptin signaling continues to be impeded, the brain sees starvation, and obesity worsens.


At least three separate reasons for hyperinsulinemia in children can be discerned.

1)      Genetics: children from certain racial and ethnic groups have increased insulin dynamics even prior to the development of obesity, which may predispose them to increased weight gain.

2)      Epigenetics: the "fetal origins of adult disease" hypothesis states that those born small- and large-for-gestational age at birth are prone to developing obesity; both birth weight extremes are states of hyperinsulinemia and insulin resistance, which may worsen beyond the neonatal period.

3)      Our Western environment through three separate submechanisms.

A)    Increased stress with increased cortisol secretion may lead to insulin resistance. Indeed, television watching may in-crease stress levels, increase food intake, foment insulin resistance (as in Cushing's syndrome) and promote obesity.

B)    The loss of daily physical activity due to lack of sidewalks, automobile transport, and screen time (TV, computers, cell phones) foments insulin resistance.

C)    Finally, and most sinificantly, our current Western food environment is highly insulinogenic, as demonstrated by its increased energy density, high fat content, high glycemic index, increased fructose composition, decreased fiber, and decreased dairy content." In particular, fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic, through their effects on insulin.

The most commonly used sweetener in the U.S. diet is the disaccharide sucrose tie, (table sugar), which contains 50% fructose and 50% glucose. However, in North America and many other countries, non-diet soft drinks are sweetened with high-fructose corn syrup (HFCS), which contains up to 55% of the mono-saccharide fructose. Thanks to its abundance, sweetness, and low price, HFCS has become the most common sweetener used in processed foods. It's not that HFCS is biologically more ominous than sucrose; it's that its low cost has made it available to everyone, especially low socioeconomic groups. HFCS is found in processed foods ranging from soft drinks and candy bars to crackers to hot dog buns to ketchup. Average daily fructose consumption has increased by over 25% over the past 30 years. The growing dependence on fructose in the Western diet may be fueling the obesity and type 2 diabetes mellitus epidemics.  Animal models demonstrate that high-fructose diets lead to increased energy intake, decreased resting energy expenditure, excess fat deposition, and insulin resistance, which suggest that fructose consumption is playing a role in the epidemics of insulin resistance and obesity and type 2 diabetes mellitus in humans. The metabolism of fructose differs significantly from glucose. Fructose is absorbed in the intestine and enters the liver without insulin regulation. There, fructose is converted to fructose-1-phosphate and enters the metabolism without regulation. This leads to an excess which cannot be metabolized, and it is then converted into free fatty acids (which promote insulin resistance), very low-density lipoproteins (VLDL, which promote atherogenesis and serve as a substrate for obesity), and triglycerides. Fructose also does not suppress secretion of the so-called "hunger hormone" ghrelin, levels of which correlate with perceived hunger. In sum, fructose consumption has metabolic and hormonal consequences that facilitate development of obesity and its complications. The highest fructose loads are soda (1.7 gm/oz) and juice (1.8 gm/oz).

Our Western diet also tends to be poor in fiber, which may be one of the characteristics that link it to obesity and insulin resistance. Cohort studies of young and middle-aged adults demonstrate that fiber intake is inversely associated with weight gain, fasting insulin levels, and risk of type 2 diabetes mellitus. Generally, high fiber foods have low energy density. High-fiber meals tend to be more satiating as they induce a greater sensation of fullness than low-fiber meals. Fiber also slows gastric emptying. Fiber-containing foods slow intestinal glucose absorption, which lessens the after-meal  insulin. Why is the Western diet fiber-poor? Because you can't freeze and reheat fiber. Fast food must be shipped to franchises around the world, thus the fiber must be removed first.


This is a difficult proposition, especially given the current "toxic environment”.   The UCSF Weight Assessment for Tee and Child Health (WATCH) Program advocates four simple rules for treating obesity by bringing the insulin down.

1)      Get rid of every sugared liquid in the house. This means soda, juice, Kool-Aid, sports drinks, etc. Look at the bottle: five calories per serving or less is OK; six or more, leave at the store.

2)      2) Eat your carbohydrates with fiber. White food (bread, rice, pasta, potatoes) is fiberless food. Brown food (brown rice, beans, lentils, peanuts, other legumes) is highfiber food. Alternatively, look at the dietary fiber content: 3 g or more per serving is adequate.

3)      3) Wait 20 minutes for second portions. This takes advantage of another hormone called peptide YY located in the distal intestine, which acts as the satiety signal, preventing that second portion, and further insulin rise.

4)      4) Get the TV out of the kid's room. And kids should buy their TV time minute-for-minute with activity. Since when did TV watching become a child's right?


In this review, the mechanism of our "toxic environment's" effects on insulin and weight gain in the genesis of obesity is elaborated. The composition of our diet is highly insulinogenic. The insulin drives energy into fat, and interferes with leptin signaling in the brain. This results in weight gain and the sense of starvation reducing energy expenditure and physical activity; and increased vagal activity, which promotes yet further insulin release and energy storage. Thus, hyperinsulinemia turns the leptin negative feedback system into a "vicious cycle" of obesity.  Externally, this appears as "gluttony and sloth," but it is biochemically driven.

How does this work? A thin, insulin-sensitive, 13-year-old boy might consume a daily allotment of 2,000 kcal, and burn 2,000 kcal daily (or 50 kcal/kg fat-free mass) in order to remain weight-stable, with a stable leptin level. However, if that same 13-year-old became hyperinsulinemic and/or insulin resistant, perhaps as many as 250 kcal of the daily allotment would be shunted to storage in adipose tissue, promoting a persistent obligate weight gain. Due to the obligate energy storage, he now only has 1,750 kcal per day to burn. The hyperinsulinemia also results in a lower level of leptin signal transduction, conveying a CNS signal of energy insufficiency. The remaining calories available are lower than his energy expenditure; the CNS would sense starvation. He would reduce his physical activity, resulting in decreased quality of life; and through increased vagal tone, he would increase caloric intake and insulin secretion, but now at a much higher level. Thus, the vicious cycle of gluttony, sloth, and obesity is promulgated.

Is this personal responsibility, when a kid's brain thinks it's starving? Is it personal responsibility when the American Academy of Pediatrics still recommends juice for toddlers? Is it personal responsibility when the Women, Infant and Children program subsidizes fruit juice but not fruit? Is it personal responsibility when the first ingredient in the barbecue sauce is high-fructose corn syrup? Is it personal responsibility when high-fiber fresh produce is unavailable in poor neighborhoods? Is it personal responsibility when the local fast food restaurant is the only neighborhood venue that is clean and air-conditioned? Is it personal responsibility when in order to meet the criteria for No Child Left Behind, the school does away with physical education class? Is it personal responsibility when children are not allowed out of the house to play for fear of crime? We must get the insulin down. Fixing the "toxic environment" by altering the food supply and promoting physical activity for all children can't be done by government, and won't be done by Big Food. This will require a grassroots, bottom-up effort on the part of parents and community leaders.

Roger Knapp MD

Jan 9, 2007

Well they came out with another study showing a coorelation between too much TV and video games and poor performance in school.  Also there was a decrease in school work with more violent content of the movies.  Plus there was more sexual behavior at a younger age if they watched shows with more sexual content.  And another problem is less exercise and more weight gain with too much TV.   So be a mean parent and keep it down.  Of course that means we can't watch it either.... or record it to see later. 

So too much TV causes several problems.  Also they showed the lung function of bartenders in Scotland improved when they outlawed smoking in public buildings there.  These were non smokers who were exposed to second hand smoke at their work.  So too much smoke, too much TV and too much sun is bad.  Moderation in everything.  Go camping or to the lake park for the day.  We need more fresh air.

DR. Knapp

Feb 8, 2007

The HPV vaccine that was recently approved and the one that the Governor has recommended be required is a safe and good vaccine for preventing genital warts and cervical cancer.  I strongly recommend it and I do not think that it will encourage girls to be active any earlier …. which is over 50% by late teens.  The press has gone crazy over this with way over board reactions.  We require other vaccines and child safety seats to force not-so-good parents to take better care of their children.  I don’t know if we should have it required or not but I encourage every parent to get their girls vaccinated for it.  We give our cats the feline leukemia shots then why not protect our children from a cancer.  It probably should be given to males also and hopefully will be approved for them some day.  They do not want warts down there either and we don’t want the virus transferred from them to their wife. 

  Dr. Knapp

March 6, 2007

Like I sent in a previous Newsymail, fructose in sugar causes more insulin and that causes increased appetite and drives calories into cells.  So too much sugar causes obesity in many people.  The increased insulin can cause obese girls to produce too much androgen hormone and thus cause Poly Cystic Ovarian Syndrone (PCOS).  That is when the female has obesity, diabetes, increased lipids, irregular menses, increased facial hair, and acanthosis nigricans.  Some authors have treated the PCOS by reducing weight and sugar intake and cured the condition without other medications and hormones.

Roger Knapp MD

March 7, 2007

Bank Cord Blood

American Academy of Pediatrics Policy Statement

January 2007 Pediatrics Volume 119

  The AAP came out this month with a statement on Cord Blood Banking.  The full article will be posted at my web site.  In short the opinion is that the chromosomes in that infant’s stem cells still carry the coding for that blood disease or Leukemia and they would not want to use the stem cells from that person.  A blood relative or sibling would be better and in fact the stem cells from a stranger would also work fairly well.  The chances of needing cord blood cells is very rare. I still think a family could save cord blood in case the sibling of that baby becomes ill and might need it.  Or the family could donate the cord blood later on to another family if they did not use it.  If it was me, I would put that money into a savings account for their college education since they are more likely going to need that.

  Dr. Knapp

March 29, 2007

Good weather is headed our way.  Be sure to use off and sunscreen.  Mosquitoes carry encephalitis so use deet and it is safe down to 6 months old and some recommend it down to 4 months.  Tics have to stay on you for 48 hours to cause Lyme Disease.  There watch for red ring coming out away from the tic bite.  There is also less common illness called Rocky Mountain Spotted fever from tics.  It is more common toward Colorado areas.  The child will get high fever, vomiting, severe headache, and small spots on their body but also on their palms.  They will be very lethargic with this so you will be bringing them into the doctor anyway.  It occurs 7-10 days after the tic.

We do see a lot of fevers in the Spring April, May, June.   There are several viruses that cause it.  Have you heard of Spring Fever?  The kids would run fever and be tired in the spring and not want to do their school work and through the years it was transferred to “I don’t care about school in the spring” but it started from the fevers in the spring.   Just like Hay Fever.   Hay does not cause fever but the viral fever in the spring when the hay grew and they blamed the fevers on the hay.  Then through the years that term was transferred to allergies in the spring and we say we have hay fever.   These terms started from the fevers we see in the spring.  The children will run fever for 2-3 days and act normal.   No other symptoms but fever.  If they are over 2 and act normal with no other symptoms, then give it a few days.

Roger Knapp MD

April 2, 2007

Studies showed that zinc supplements daily improved the immune system and there were less illnesses and shorter length of illnesses in the treated group than the zinc deficient group.  That is why I recommend zinc in the vitamins when they go off formula at 1 year old.  Suggested requirements are 7m to 3yr = 3mg/day; 4-8yr = 5mg/day; 9-13 yr = 8mg/day; and 14yr and older = 11 mg/day.  There are some conflicting opinions about these amounts but this is a good average.  There is enough zinc in most breast milk.  Zinc losanges do no halp as much as taking a pill supplement during illnesses.  It helps the most to take it every day. 

Roger Knapp MD

May 23, 2007

Just came out this month is a formula with Probiotics.  Probiotics are really nice bacteria in the gut that is common in Breast fed infants.  They help digestion and decrease eczema and improve our immune system.  We have had studies for many years proving these are good things and finally we have a formula with them (they have had them in Europe for 10 years.).  Good Start Natural Culture is now out and other formulas will follow suit.  I recommend this and if you try it with your infant, always watch out for any reaction since it is not a soy formula.  Almost every baby has been fine on it.

Dr. Knapp

June 4, 2007

We used to give antibiotics to all heart patients before dental visits to prevent infections in the heart and it's valves.  Studies now show that that did not help most situations since we shower bacteria into our blood stream every time we brush our teeth.  So now the cardiologists only recommend antibiotics before dental appointments for heart transplants, other heart operations, artificial valves, coronary bypass surgery, and cyanotic congenital heart defects.  So if your child has a "murmur", then you do not have to have antibiotics before the dentist.

See: http://www.americanheart.org/presenter.jhtml?identifier=11086

R Knapp MD

June 7, 2007

AED is a defibrilator that is now in most malls, airplanes, and increasingly in most buildings.  Studies show that when teen athletes collapse, if defibrilation attempts in less than 5 mintues can greatly increase the chances of successful resusitation.  All sports activities should have one of these on the field to use if needed and some person there should be trained on it's use.  We parents also should learn how to use it just in case.  Many new parents take classes on CPR for their infants and they are just as likely to need AED training as well.

see: http://www.redcross.org/services/hss/courses/

Roger Knapp MD

June 14, 2007

Last week my granddaughter was going up an escalator with us and her Crock shoe became caught in the side of the escalator.  It was half way up the escalator and not at the end.  The shoe was sucked in and it ate half the shoe.  Luckily she slipped her foot out since the strap was on top and not behind the heal.  Then I started finding other cases of this with some injuries.  See: http://www.kfor.com/Global/story.asp?S=6524902

So keep them in the middle of the escalator when using them.

  Dr. Knapp

July 10, 2007

There is an increase in children using inhalants to get high.  This starts as young as 5 yr old and increases to 14 yr old and then declines to 18 yr old.  This can lead to use of drugs and alcohol next.  Inhalant terms are “sniffing, snorting, huffing, glading, and dusting.”  The items used are glue, air freshener, aerosol computer cleaning products, paint, rubber cement, antiperspirants, hair spray, nail polish remover, and butane.  Watch for increased use of personal care products or the disappearance of your household products.  Yes your child could do it.  Just be mindful but not paranoid.

Dr. Knapp


See my web site for info to prevent swimmer's ear.

August 21, 2007

There was a recall of Mattel toys with lead in their paint.  I'm sure you heard it on the news.  We can test toddlers that are below 4 years old who put these toys in their mouths a lot.  See http://service.mattel.com/us/recall/39054_IVR.asp for a list of these toys. 

Just recently they announced that some of the dog chews made in China were tainted with something and making the dogs sick and rare death.  Seams like a lot of products from China are not so good.   Kind of makes you nervous about anything from China.

Roger Knapp MD

Sept 5, 2007

I strongly push vaccinations.  We went from 20,000 cases of meningitis to now less than 50 a year.  Half were brain damaged and 10% died even with treatment.  Vaccines saves millions of lives and have helped change the life expectancy over the last 100 years from 35 yr old to now 80 years old.

There was a vaccine against Rotovirus that causes vomiting and diarrhea.  The vaccine caused almost as many infants to have diarrhea, as did the illness.  It was also a live vaccine.  I did not give it when it first came out many years ago for those reasons.  Studies now coming out showed a significant increase in Kawasaki Disease (sounds like a motorcycle illness.  See: http://www.nlm.nih.gov/medlineplus/ency/article/000989.htm ) in infants who received the vaccine.  So Sometimes we weigh the benefits against the risks before starting vaccines.  Most are definitely worth it.  No they do not cause Autism.

Many infants get the Hep B vaccine at birth and are supposed to get the second one at 1 month and the third one at 6-18 months.  Studies in the past showed the vaccine worked better if doses were 6 months apart.  Since we already had to give quite a few vaccines at 2 months, I have waited until 6 months to give the second Hep B.   Now studies just came out showing that at 16 yr old the antibodies were very low if the vaccines were given below 6 months of age.  So delaying the second two doses helped.  Now I have started not recommending the first dose of Hep B at birth and waiting till 6 months to start them (unless mom is positive for Hep B.).

They now are recommending (but not requiring) a second dose of Varicella (Chickenpox) vaccine at 4-5 yr old because 10% of the children still get a case of it in grade school even though vaccinated.  Since the later case of Chicken Pox is so mild they have only 20 spots and no fever, I have not been giving it.  And that illness is life long protection.  Now they came out with a study showing 1/3 of the cases of grade school Chicken Pox are in children who did have 2 doses of Varicella.  So a second dose will not totally protect you either.  So I do not recommend the second dose of Varicella and will only give it if required. 

I do recommend the HPV vaccine for Girls.  It results in 70% less cervical cancer and 95% less Genital warts.  It should be approved some day for males since they do not want Genital warts and do not want to give the virus to their wives.  But time will tell.   It is a safe vaccine and I would give it to my Daughter if she were still young.  She went and grew up and has her own kids.  Grandchildren are the best things ever!!!

Sept 10, 2007

The American Academy of Pediatrics does not recommend trampolines because of injuries.  Even with the fence around it there are many injuries.  Just jumping up and down becomes boring fast and the kids start doing some stunts that put them at risk.  During 1990-95 there were 41,000 ER visits in America from trampolines and during 2000-05 there were 88,000.  I do not suggest these for Christmas gifts.

Roger Knapp MD

Sept 16, 2007

There are a few cases of leishmaniasis in North Texas.  You may have seen it on the news.  It starts out like the boils of Staph that we have been seeing these last few years.  MRSA is a staph that causes dark and almost black boils.  It starts out like a spider bite and then gets bigger.  We treat it first like it is a staph infection but when it does not heal then we will think of leishmaniasis.  It is not treatable and goes away without medication. 



Roger Knapp MD

This is a complementary email that you signed up for and is many times my opinion.  This should not replace the advice and practice of your personal physician.

I recently had an email about vaccines.  I was pointed out that the Roteq vaccine in the government CDC site says: “CDC is not changing its immunization policy at this time. The available data support the safety and effectiveness of the RotaTeq vaccine in preventing rotavirus infection. “ and that the eight cases of Kawaski Disease “does not exceed the number of cases we expect to see based on the usual occurrence of Kawasaki disease in children. “   Time will tell.

Sept 17, 2007

For decades we have recommended patients with heart murmurs and heart defects be given antibiotics when they go see the dentist.  That was to keep the heart or valve from getting infected.  But sure enough they did a study to look at the risk and it turns out that only helps very few situations.  They now only recommend antibiotics for:

  1. Cyanotic Congenital heart defects that have not been repaired.
  2. defects that have been repaired, but with shunts or conduits.
  3. Cardiac defects repaired within the past six months.
  4. Artificial heart valves
  5. Previous heart infections
  6. transplanted hearts that have developed valve problems.

Actually most of the time we brush our teeth we put bacteria into our blood stream but they are only there for a split second until our white cells eat them up or cleared out by our spleen.  That is why dentist appointment antibiotics did not help prevent most heart infection problems.  But like most new information, it takes decades to change some people’s habits.  Since the risk of one day of antibiotics is very rare, I think most parents will still want the medication and that is OK with me.  You just feel better having taken every precaution.  But it is not necessary any more.

See: http://www.qualitydentistry.com/dental/information/abiotic.html

Roger Knapp MD

Sept 26, 2007

We have flu shots in now and are making appointments for all ages to get the flu vaccine.  There is a miniscule amount of Thymersol in it and no it does not hurt you nor cause Autism.  There is just as much in the fish you eat.  Not enough to hurt.

There is a nasty chest cold and croup going around now.  If there is the start of the cough and fever, that is the virus.  Fever is the first 3-4 days.  Many are getting bronchitis but that is 5-14 days into the illness.  For children older than 2 yr, you can wait to be seen during the first part of the illness and we need to treat them when the fever recurs the second week or the fever lasts more than the 3 days.

I will be gone on vacation until Oct 10th and Dr. Nichols will be there or you can use the Acute Care Center.

Dr. Roger Knapp

Oct 13, 2007

The AAP applauds the decision of pharmaceutical companies to withdraw cough and cold medicines for infants and children under 2 years of age. Evidence from controlled trials show that these products are not effective in children under 6 and can have potentially serious side effects. Dosage guidelines for cold and cold mixtures are extrapolated from adult data and thus inaccurate for children. According to the Consumer Healthcare Products Association (CHPA), the cough and cold medicines that are being withdrawn are:

·  Dimetapp(R) Decongestant Plus Cough Infant Drops,

·  Dimetapp(R) Decongestant Infant Drops,

·  Little Colds(R) Decongestant Plus Cough,

·  Little Colds(R) Multi-Symptom Cold Formula,

·  PEDIACARE(R) Infant Drops Decongestant (containing pseudoephedrine),

·  PEDIACARE(R) Infant Drops Decongestant & Cough (containing pseudoephedrine),

·  PEDIACARE(R) Infant Dropper Decongestant (containing phenylephrine),

·  PEDIACARE(R) Infant Dropper Long-Acting Cough,

·  PEDIACARE(R) Infant Dropper Decongestant & Cough (containing phenylephrine),

·  Robitussin(R) Infant Cough DM Drops,

·  Triaminic(R) Infant & Toddler Thin Strips(R) Decongestant,

·  Triaminic(R) Infant & Toddler Thin Strips(R) Decongestant Plus Cough,

·  TYLENOL(R) Concentrated Infants' Drops Plus Cold,

·  TYLENOL(R) Concentrated Infants' Drops Plus Cold & Cough.

Treatment of colds/upper respiratory infection should include plenty of fluids, rest, use of a bulb syringe to clear nasal passages, and in some instances saline nose drops.

My Opinion:

This withdrawal is more of a medical-legal maneuver.  All the cases of harm from these medications have been overdoses.  The drug companies do not want the risk of selling these products if it leads to lawsuits.  I have always told parents that if the congestion or cough does not bother the child, then wipe their noses and don’t give medications.  And infants below 9 months old are better helped by elevating their head by sleeping them in the swing or carrier all night.  I don’t think these medications are bad if used appropriately and they help some kids.  In large controlled studies they had a hard time seeing a consistent effect.  You also have to watch out for excessive drowsiness or increased activity.  I generally do not recommend concentrated drops except in Tylenol.  You can use the large bottle of what is called elixir of these cough and cold medications.  It usually will be 1 tsp for a 6 yr old.  Then you can give ¼ tsp to 9-18 month olds, ½  tsp to 18 to 2 ½ yr olds,  ¾ tsp to 3-5 yr olds, and 1 tsp to 6+ yr olds.   These doses are extrapolated down by weight and even less than these doses may do the job and have less side effects. 

Roger Knapp MD

Nov 8, 2007

Another study came out showing how daily zinc will boost the immune system and the person will have less infections.

Now this study was in the elderly in Nursing homes:


Serum zinc and pneumonia in nursing home elderly.

Abstract: BACKGROUND: Zinc plays an important role in immune function. The association between serum zinc and pneumonia in the elderly has not been studied. OBJECTIVE: The objective was to determine whether serum zinc concentrations in nursing home elderly are associated with the incidence and duration of pneumonia, total and duration of antibiotic use, and pneumonia-associated and all-cause mortality. DESIGN: This observational study was conducted in residents from 33 nursing homes in Boston, MA, who participated in a 1-y randomized, double-blind, and placebo-controlled vitamin E supplementation trial; all were given daily doses of 50% of the recommended dietary allowance of essential vitamins and minerals, including zinc. Participants with baseline (n = 578) or final (n = 420) serum zinc concentrations were categorized as having low (<70 mug/dL) or normal (>/=70 mug/dL) serum zinc concentrations. Outcome measures included the incidence and number of days with pneumonia, number of new antibiotic prescriptions, days of antibiotic use, death due to pneumonia, and all-cause mortality. RESULTS: Compared with subjects with low zinc concentrations, subjects with normal final serum zinc concentrations had a lower incidence of pneumonia, fewer (by almost 50%) new antibiotic prescriptions, a shorter duration of pneumonia, and fewer days of antibiotic use (3.9 d compared with 2.6 d) (P </= 0.004 for all). Normal baseline serum zinc concentrations were associated with a reduction in all-cause mortality (P = 0.049). CONCLUSION: Normal serum zinc concentrations in nursing home elderly are associated with a decreased incidence and duration of pneumonia, a decreased number of new antibiotic prescriptions, and a decrease in the days of antibiotic use. Zinc supplementation to maintain normal serum zinc concentrations in the elderly may help reduce the incidence of pneumonia and associated morbidity.

So give your kids vitamins with iron and zinc and you should take it too.  Maybe give it to grandma and grandpa too.

Zinc losanges will not help and studies showed they did not help.  Take a pill of zinc every day and will see me less this winter.  Don't waste money with losanges.

Roger Knapp MD

Dec 10, 2007

This time of the year that should be the happiest sometimes turns out to be very depressing.  If you find yourself sad and alone, find someone to be with… even if you have to invite yourself over. 

When we treat depression with antidepressants, the suicide risk goes up slightly but not enough to warrant not treating the depression.  Then there is Accutane with which we treat severe acne and it can cause ideas of suicide.  Now there are reports of Chantix that is used to treat smoking habits can cause suicide thoughts.  This weather makes me depressed in some ways but at least it now feels like winter/Christmas.  These side effects are not severe enough to not treat these conditions and when you know about them, then you realize what it is and not let it cause you to do something you will regret later or in heaven.  When we realize it is a medication or the time of the year that is causing us to feel that way and not a permanent condition, then we do not act on those feelings.  Shake them off and be happy since after the first of the year, the problems will seem insignificant. 

If your teens have severe cystic acne and there are scars coming, then accutane is a great drug and stops all acne.  You only take it for 3-4 months and there is a long list of complications.   They are very very rare and I would give it to my teen if needed.

Have a happy Christmas or Hannaka

Dr. Knapp

Dec 19, 2007

Top-grossing films from 1950 through 2002 indicates that the amount of smoking decreased from an average of 10.7 events per hour in 1950 to a low of 4.9 events per hour in 1980-1982, then began to increase rap­idly to 10.9 events per hour by 2002. Some 87% of the most popular films between 1988 and 1997 showed tobacco occurrences, with two thirds of the I movies showing tobacco use by at least 1 major character. Leading actors smoked in 60% of the popular films from 2002 to 2003. Tobacco use in almost all films is unrelated to movie genre and is unlikely to be a major focus of a scene. The number of smoking occurrences in films increased with the rating of the film, with an R-rated film featuring significantly more smoking than films rated G. Unfortunately, beginning in the Mid 1990s, there was a "down rating" of movies resulting in PG-13 ratings for many films that would have been previously rated R. There was a consequent increase in the prevalence of smoking in such films as well.

It was only after the US Congress held hearings on smoking in the mov­ies in 1989 in response to the revelation that Philip-Morris paid to place Marlboros in the film Superman II did the tobacco industry amend its voluntary advertising code to prohibit paid brand placement. The Master Settlement Agreement also prohibited paid product placement in movies. Despite these agreements by the tobacco industry, the amount of smoking in the movies in­creased rapidly during the late 1990s, reversing the earlier downward trend.

We recognize that smoking may be a cause of birth defects. It is well known that women thinking of starting a family have likely heard that smoking may increase their risks of infertility, ectopic pregnancy, and spontaneous abortion.

This report is one of the most powerful studies of a nationally representative sample of young adolescents demonstrating the strong association between exposure to films in which there are characters who smoke and the early initiation of smoking. The authors even go out on a limb and say that exposure to movie smoking is a primary risk factor account­ing for as much as one third of adolescents who begin to smoke at 10 to 14 years of age.

If you are not familiar with some of the estimates of what a pack of cigarettes should really cost if all the health care costs were built into the price, it appears that $40 per pack is the real cost that a 24-year-old smoker should consider as the true pur­chase price each time he or she lights up a new pack of cigarettes. In one's lifetime, this amounts to $220,000 for men and $106,000 for women. That smoking costs a substantial amount in terms of health care services, lives lost, etc.  This is not to say that all the news is bad in terms of dollars and cents. Smoking actually saves Medicare money by killing smok­ers at earlier ages saving the Social Security program about $1519 per female smoker and $6549 per male smoker for exactly the same reason.

2005 saw a 4.2% decline in sales of cigarettes over previous year, according to data from the Tobacco Committee of the National Associa­tion of Attorney Generals.  The 378 billion cigarettes sold in 2005 was the lowest number since 1951, although the population has more than doubled over the same time period. Most of the decline in the last half-century appears to be directly related to the 1998 Master Settlement Agree­ment on tobacco, which imposed restrictions on the advertising, promoting, and marketing of cigarettes by tobacco companies, including prohibiting the targeting of cigarette advertising at young people. The agreement also stopped the advertising of cigarettes in public transport facilities as well as the use of cigarette brand names on merchandising. While cigarette sales in the United States appear to be on the decline, the World Health Organization databank shows that worldwide sales were still climbing at the turn of the mil­lennium and had reached record numbers at 5,500 billion cigarettes a year, from 1,000 billion in 1940 and 10 billion in 1880 (www.who.int/tobacco/en/ atlas8.pdf). It is interesting that China is now the major con­sumer of cigarettes with more than one third of all cigarettes smoked worldwide are consumed in China.

Despite promises from state leaders to spend a significant portion of the 1998 Tobacco Master Settlement Agreement funds on antitobacco efforts, only an estimated 3% of state Master Settlement Agreement funds are now used for such purposes. Only a few states earmark tobacco excise tax revenue to support state tobacco control programs. Most funds from the Master Settlement Agreement are used by states to fill short-term budget deficits. Some examples of spending from the fund are far removed from tobacco con­trol or health purposes, such as financing support for tobacco farmers, debt service on flood control projects, and industrial bonds. In fact, 5 states and the District of Columbia use zero dollars from their settlement money for tobacco control. This diversion of funds from the Master Settlement Agreement distri­bution and other settlement money has been called "moral treason".  The diversion of dollars from the Master Settlement Agreement is unfortu­nate, since reports show, when such dollars are targeted to support antitobacco advertising, the advertising works to reduce teen smok­ing. In fact, there has been a substantial and unprecedented national decline in adolescent smoking since the late 1990s. The Monitoring the Future Project has been continuously tracking cigarette smoking using nationally representa­tive samples of high school seniors in the United States. The 2003 estimate of teen smoking of 24.4% represents a decline of almost 33% over a 6-year pe­riod, largely a result of early tobacco cessation efforts.

Inhaled, fresh sidestream smoke, which makes up about 85% of secondhand smoke, turns out to be four times more toxic per gram of total particulate matter than inhaled mainstream smoke. Data on sidestream cigarette smoke appeared in 2005 in a report in Tobacco Control,' which described the research conducted by Philip Morris Tobacco in the 1980s. While publically denying that sidestream cigarette smoke was a dan­ger, Philip Morris privately performed extensive in vivo toxicological testing of sidestream smoke at its secret Institute Fur Biologische Forschung in Germany. When this research was reanalyzed (there were 40 million pages of tobacco industry documents related to this), it showed that sidestream smoke caused 2 to 6 times more tumors in laboratory animals and was found to inhibit normal weight gain in developing mice. In addition, mice showed damage to their res­piratory epithelium.  It is clear that sidestream smoke, particularly when compared to filtered "light" cigarette inhaled smoke, is quite a bit more toxic. Most data now con­firm that secondhand smoke causes about 53,000 deaths a year here in the United States

Scientists who study the effects of smoke on mice should be considered candidates for the Ig Nobel Award. If you are not familiar with the Ig Nobel Awards (short term "Igs"), they are awarded for science that "makes you laugh, then makes you think" and "cannot and should not be reproduced."  You must read the winners of these silly studies done.  This past year's winners were investigators that  invented Clocky, an alarm clock with wheels that runs away and hides after it goes off, insuring that people have to get out of bed to turn it off.  An investigator awarded the agricultural historical award for describing the health hazards of exploding trousers among farmers in rural New Zealand.  One  winner of the Ig Nobel Medicine Award was given to an inventor from Missouri, who had designed "neuticles"-that is, prosthetic dog testicles, available in 3 sizes and 3 degrees of firmness, intended to help dogs that might feel disgraced after being neutered. Lastly, professors of physics from the Uni­versity showed that tar can be smashed to bits with a hammer. The experiment, in which a congealed glob of tar was placed in a glass funnel, showed that tar actually can slowly drip at the rate of one drop every 9 to 12 years.

You want a good laugh, then look at the Ig Nobel Awards, see:


Roger Knapp MD