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
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
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
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.
U3 THUMB DRIVES
CAN POSE RISKS TO CHILDREN and COMPUTERS
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:
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.
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).
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?
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.
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.
WHAT IS THE MECHANISM
OF LEPTIN RESISTANCE?
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.
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
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.
HYPERINSULINEMIA COME FROM?
At least three separate
reasons for hyperinsulinemia in children can be discerned.
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.
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.
HOW DO YOU GET THE
This is a difficult
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
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
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
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
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
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.
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.
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.
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.
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:
So keep them in the
middle of the escalator when using them.
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.
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
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
“ 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:
Congenital heart defects that have not been repaired.
- defects that have
been repaired, but with shunts or conduits.
- Cardiac defects
repaired within the past six months.
- Artificial heart
- Previous heart
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.
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
· Dimetapp(R) Decongestant Infant Drops,
· Little Colds(R) Decongestant Plus
· Little Colds(R) Multi-Symptom Cold
· PEDIACARE(R) Infant Drops Decongestant
· PEDIACARE(R) Infant Drops Decongestant
& Cough (containing pseudoephedrine),
· PEDIACARE(R) Infant Dropper
Decongestant (containing phenylephrine),
· PEDIACARE(R) Infant Dropper
· PEDIACARE(R) Infant Dropper
Decongestant & Cough (containing phenylephrine),
· Robitussin(R) Infant Cough DM Drops,
· Triaminic(R) Infant & Toddler Thin
· Triaminic(R) Infant & Toddler Thin
Strips(R) Decongestant Plus Cough,
· TYLENOL(R) Concentrated Infants' Drops
· TYLENOL(R) Concentrated Infants' Drops
Plus Cold & Cough.
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
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
Roger Knapp MD
Nov 8, 2007
Another study came out
showing how daily zinc will boost the immune system and the person will have
Now this study was in
the elderly in Nursing homes:
THE AMERICAN JOURNAL OF
CLINICAL NUTRITION Vol. 86 Issue 4 Oct 2007
Serum zinc and
pneumonia in nursing home elderly.
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
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
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
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
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
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
years of age.
If you are not
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.
lifetime, this amounts to $220,000 for men and $106,000 for women.
smoking costs a substantial amount in
terms of health care services, lives lost,
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
advertising of cigarettes in public transport facilities as well as the
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
Despite promises from state leaders to spend a significant portion of the
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
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
flood control projects, and industrial bonds. In fact, 5 states and the
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
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
smoke appeared in 2005 in a report in
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
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
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