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Newsymail 2009

Feb 7, 2009

 We see a lot of vomiting and diarrhea every winter.  We can’t treat diarrhea with meds but just give fluids that contain electrolytes to replace fluid loss.  Usually kids have to have both vomiting and diarrhea to dehydrate.  It is unusual to dehydrate with one or the other.  Baby Jessica who fell down the well did not get anything to drink for 3 days.(what was Baby Jessica’s favorite Christmas Carol?  Noel.  We can’t give medication to stop diarrhea but if the child has diarrhea past 1 week with no normal BMs, then call for some antibiotic that will kill the germ that is doing it.

 A study came out showing that testing the urine for volume or concentration did not predict dehydration.  I have told many parents that as soon as the child starts vomiting or diarrhea, the fluid content of their body decreases.  They then decrease their urine production in order to conserve fluids and try not to dehydrate.  Most kids drink and urinate gallons and are usually over hydrated.  So every child with V. and D. urinates very little and is not necessarily a sign of dehydration.  Watch their alertness and their eyes.  They will act drunk or lethargic and their eyes sink back in their sockets like the kids starving on TV in third world countries.  Their skin will feel like playdough and when pinched, it will not snap back in place.  So ignore how often they urinate.

 Talking about measuring urine, here are some funny measurement facts.

The unit of an angle is known as a "gon," which is one-four hundredth of a circle. (i.e. octagon) A unit of beauty is called the "millihelen," which by definition is a face that launches just one ship (mythical). Current literature measures fame in units of the "Warhol," which of course is 15 minutes (a reference to Andy Warhol's remark). Heat is measured in "Scoville units," which by definition are based on chili heat units where a capsaicin is one part per million or 15 Scoville units. (I can tell it is hot chili because my bald head sweats.)  The diameter of a tree is measured in units known as "hug." This is about 1.5 meters or about what one person is capable of hugging, circumference-wise. If you were unaware, a googol is simply a number that is 1010° almost the amount of money the founders of Google have made. And last, a measure­ment comes from Northern Finland. It is the "poronkusema." This is the distance a reindeer can travel without passing water.

 Dr. Knapp

 Feb 24

 You can train your kids in grade school age but good luck with teenagers.

During 5-12 yr you need to “brainwash” them into your morals.  When you see bad stuff happening on TV or in real life, tell them how you feel about it.  They don’t get it out of thin air.  So when you see bad stuff and you think.. Oh I hope they did not see that.  Actually you do (and they probably already saw it) and then turn it around into a lesson of what not to do.  For example:  if you see someone driving wrecklessly, state how you feel firmly “I don’t like people who drink alcohol and drive at the same time.  They are going to cause a wreck. Isn’t that bad.”  This really works if you start it early.

 Actually it also helps teens later.  I can still remember the advice and words of my parents even 20 yrs after they have been gone.  Their sage advice comes back to me almost daily.  But I thought I knew it all at age 20.  So the advice and your words that you say to your teens will stay with them.  It just won’t take affect until their late 20s.  Even though they seem to be ignoring you, keep up the advice.  It will work on them later. 

 I think we all learn by the school of hard knocks.  Our parents said don’t drive fast or you will get a ticket or wreck….  And we did.  They said don’t drink too much or you will get sick…. And we did.  I think we learn faster when our parents advice comes back to us after trying what they said not to do.  Hopefully our teens and young 20 yr olds will not get hurt too bad as they test the limits. 

 So now at my age if there is someone talking about retirement, I take notes.  If they are older and been-there-done-that, they have advice I need to heed. (No I am not retiring any time soon.)  I may not follow their exact advice but I weigh it in heavily.

 Roger Knapp MD

 When things are easy, a person doesn’t really learn about himself It’s what a person does at the moment of his greatest struggle That shows him who he really is. 

 March 8

I have already been asked about swim lessons for infants.  I do not recommend them for several reasons. 

They swallow too much water and can get "water intoxication".  It lowers their serum sodium and they have a seizure.

It gives the adults a false sense of security and they think the baby will be safer.  Then they do not watch them close enough.  It is the job of the parent to make sure the infant does not drown.  Do not put that responsibility on the infant.

Now if you want to get together with other moms and babies, splash in the pool and socialize... great.  That is fun and OK. But that is not swim lessons where you teach the infant to "swim" or paddle over to the edge and save themselves. Be sure to use plenty of sunscreen and the shirts that block UV sun to swim in.  The infants can take only 3-10 minutes of colder water (depending on the size of the baby and the temperature of the water) and they can get low body temperature: hypothermia.  If they start to shiver, take them out immediately and dry and warm them.  You also can take their body temperature every 5 minutes and below 97 degrees axillary is bad.  I prefer you get the blow up pool in the backyard, let the water in the hose heat up in the sun and then pour it into the pool of cold water to take the chill off of it, and let them splash in the 3 inches of water.

Lets have fun but lets be safe.  Tragedy can happen quickly.

Dr. Knapp

March 17

 Flat feet… Oh my gosh.  Lets get expensive special shoes!

 As it turns out it is not as bad as once thought.  One study showed that 40% of one year olds had flat feet and only 5-10 % had them as adults.  Most grow out of it without special shoes.  Then another study published in Pediatrics this month showed that the athletic performance was the same if the kids had flat feet or not.  It did not affect their athletic performance.  Now some kids in their teens will have sore feet caused by flat feet and even though it does not cure it, the special shoes will help the discomfort.

 Dr. Knapp

 March 18

 Well the state of Texas keeps changing the vaccine requirements.

 Even the American Academy of Pediatrics does not “require” a second Chicken Pox (Varicella) vaccine but it seems the drug company convinced enough state officials to require it for school.The other vaccines listed below we have been giving them for several years and now are going to be required. 

So here are the new changes as of this month (March 2009) for required vaccines for school starting the school year 2009-2010 (next Fall):

 Meningococcal Meningitis Vaccine

7th grade requirement

Varicella Vaccine

2 dose requirement for kindergarten and 7th grade entry

 Tdap Vaccine

a booster dose requirement for Tdap for 7th grade

 MMR Vaccine

2 dose requirement of MMR vaccine for kindergarten entry

 Hepatitis A Vaccine

2 dose requirement for kindergarten entry statewide

 If your child has not had a second dose of Varicella and they are going to start Kg or 7th grade this coming Fall, they will need to get it.  If you already had a well check up in the last 12 months, then just call for a shot only appointment with the nurse.  If the child is already in school, then they will need the Varicella some year between now and 7th grade.  That can be done at the next well checkup.

 If your child has not had a Tdap and Meningococcal Vaccine at 11-12 yr old, then they need one before entering the 7th grade.

 If your child is now in the 7th grade or higher, then this will not be required but we strongly recommend these vaccines.  (It is interesting they required a second Chicken Pox shot and not the HPV and prevent cervical cancer.    Hmmmm!)

 As an aside, the HPV needs to be given to the boys also.  The HPV germ causes many other diseases and cancers and has by found in 50% of prostate cancers.  We are trying to get the FDA to approve this important vaccine for the boys.  10% have the virus by 20 yr old, and 50% by 26 yr old.

 Dr. Knapp

 March 28

 Survival of the fittest?

Elk across America are smaller.  Every hunting season brings a greater challenge to find the sought-after bull with a towering spread of antlers.  Africa and Asia still have elephants but they don't have tusks.  Researchers describe what is happening as none other than selection process of survival of the fittest.  The strongest survive and pass on their traits to succeeding generations.  Selective hunting ... picking out individuals with the best horns and antlers, or the largest piece of hide... works in reverse.  The evolutionary loser that is small and defenseless is surviving since they do not want to shoot that one.

 We also stopped evolution of the fittest with humans.  There is a grandma saying: “You gave so many antibiotics that you weakened the immune system.”  It is the other way around.  The kids with the weak immune system had to get more antibiotics.  In the 1800s, 10% of the kids died the first year of life because of weak immune systems.  In the 1900s we developed antibiotics and the kids survived.  We had to give a lot of antibiotics so the kids grew older and their immune system was better able to defend them against germs.  So the weak immune system caused us to give more antibiotics.  It was not the antibiotics that weakened the immune system.  It is just Grandma did not see them in the old days because they were 6 feet under.  And these kids are growing up and having more kids with weak immune systems.  We interrupted survival of the fittest.

 Also women with small pelvises died in child birth in the 1800s.  Now we have C-sections and they are living ..., which is a good thing.  But these women are having more daughters with small pelvises and we are having more c-sections.  Again we interrupted survival of the fittest. 

 Interesting huh?

 Dr. Knapp

 April 1

 A study came out in Feb 09 about people that had cardiac arrest who were cooled way below normal body temperature had 20% more survival.  Even if they had been "dead" for more than 1 hour.  There was a higher survival when the person was cooled before restarting the heart.  So if a person has a cardiac event in the grocery store, one person should find the AED and the other find the ice machine and load them down with ice bags.

 April 5

 The FDA is considering approving the HPV vaccination for males.  It was originally approved for females to prevent cervical cancer.  That virus also causes genital warts, nodules on the vocal cords, oral cancer, and it is found in 50% of prostate cancer.  They announced that the FDA will very likely approve it for males this Fall.  That is good.

 Also they are in the final stages for approving a better Pneumococcal (Prevnar) vaccine that has 14 strains instead of the present 7 strains of germs.  That will help decrease more pneumonia and ear infections and meningitis caused by that germ.  We have been seeing an increase of infections caused by the strains that are not covered by the present vaccine.

 http://www.windows.ucar.edu/  great site for kids (and adults) to learn about earth, climate, weather, volcanoes and such.  Very cool site.

 Dr. Roger Knapp

 p.s. We also saw a study showing recess is tied to improved classroom behavior.  No duh.

 April 23

 It’s summer time.  There are health problems with it.

 Sun Screen is fine down to 3 months and a SPF of 20 is adequate.  There is not much difference between SPF of 20 or 50.  Also deet is safe for kids down to 6 months.  Use the standard “Off” with 20% deet or less.  We see several cases of encephalitis every summer.  Put sun screen on first and then repellants.  But better is to cover the body.  Farmers are out in the fields in the sun with long blue jeans and long sleeve shirts.  Put long pants and even shirts when going to the park or out camping.  Then you have less bug bites, less itchy rashes from the grass, less sun, and less skinned knees.  Use swimming shirts that block the UV waves.

 Drink plenty of water and if they have red cheeks, cool them off with water, shade and wind. You do not loose much salt so it does not have to be Gatorade.  Just water is fine.

 Watch out for infants in the pool.  It is not the chorine but the temperature.  They can get hypothermia (low body temperature) fast.  And if they start shivering, get them out immediately and warm them up.  And I do not recommend actual swimming lessons for infants.

 If your older kids do not usually get swimmer’s ear, then don’t worry about putting stuff in their ears.  If they do tend to get it, then you can put olive oil in their ears before they swim or afterwards you can put ½ alcohol + ½ white vinegar solution.  The products in the drug store like “Swim ear” & “Ear Dry” do not work good since it is only alcohol. Swimmer’s ear hurts to move the ear lobe and usually hurts to take off their t-shirts.   None of these cure the infections, they only prevent them.

 Have a great summer.

Dr. Knapp

p.s. you thought you knew how to tie a shoe?  Try watching this: http://www.rogerknapp.com/Miscellaneous/tieshoes.html

April 28

 Everyone is talking about the swine flu.  It is a new strain of flu and we see this every few years. 

 There are always a certain number of people who will die of viral illnesses like measles, chicken pox, and the flu.  That is why we developed vaccines for chicken pox since there were rare kids who died of the disease.  The higher the death rate then the more pressure there is to get a vaccine.  Across the country, 83 children died from flu last winter, according to the CDC.

 This new strain will eventually go across the country.  Travel should not be stopped and wearing masks will only help those who cough from spreading germs outward.  Masks will not stop those tiny viruses.  Good hand washing is critical.  Cough will spread the germ if you are within 3-6 feet of someone ill. 

 The death toll in Mexico is 152, with 1,614 cases ill.  But all other countries have mild illnesses and no deaths yet.  (There will be some rare cases of death as mentioned above.)  Why is there 10% deaths in Mexico? We have had 50+ cases here in America so we should have had 5 deaths.  ???  We have not had any.   My personal opinion is that the air pollution in Mexico City is terrible and there are cases of Aids that are not diagnosed or treated.  But we will see as the illness spreads and it will spread.  I do not think it is a scary thing but the news media loves this kind of hype.  Just realize there are always rare cases of death for even minor illnesses.  

 God bless us all

Roger Knapp MD

 May 13

 Well it is Spring and the weather should be getting warmer.  But the rains have increased the mosquitoes so use deet in OFF and other repellants.  It is safe down to 6 months old.  The mosquitoes carry viral encephalitis and we see several cases every Spring and Summer. 

 Well as we told you, the swine flu H1N1 is not any worse than the regular flu and is not  much in the news anymore.  But do get your flu vaccinations next Fall.  I think a more serious infection is the MRSA staph.  It is not as much in the news anymore but still alive and well.  I worry about that germ on the grocery cart handle more than the flu.  Now reports are coming out how there is a lot of MRSA on Pigs!!! More swine problems… ha ha.  Here is an article from the New York Times:

 "The late Tom Anderson, the family doctor in this little farm town in northwestern Indiana, at first was puzzled, then frightened. MRSA (methicillin resistant Staphylococcus aureus) sometimes arouses terrifying headlines as a ‘superbug' or 'flesh‑eating bacteria.' The best‑known strain is found in hospitals, where it has been seen regularly since the 1990s, but more recently different strains also have been passed among high school and college athletes. Dr Anderson at first couldn't figure out why he was seeing patient after patient with MRSA in a small Indiana town. And then he began to wonder about all the hog farms outside of town. Could the pigs be incubating and spreading the disease? One of the first clues that pigs could infect people with MRSA came in the Netherlands in 2004, when a young woman tested positive for a new strain of MRSA, called ST398. The family lived on a farm, so public health authorities swept in‑and found that 3 family members, 3 co‑workers and 8 of 10 pigs tested all carried MRSA. Since then, that strain of MRSA has spread rapidly through the Netherlands‑ especially in swine producing areas. A small Dutch study found pig farmers there were 760 times more likely than the general population to carry MRSA, and Scientific American reports that this strain of MRSA has turned up in 12% of Dutch retail pork samples. Now this same strain of MRSA has also been found in the United States. A new study by Tara Smith, a University of Iowa epidemiologist, found that 45% of pig farmers she sampled carried MRSA, as did 49% of the hogs tested. The study was small, and much more investigation is necessary."

New York Times. March 12,2009

 Oik Oik

Dr. Knapp

 June 10

 As parents it is our job to watch our children closely.  Children really do not have a right to “privacy” since they are a minor and under our roof.  We are responsible for their wellbeing and as kids they will want to do things that are not right or proper.

 Keep an eye on what they are saying to their friends.  What would they say to their friends that you should not be able to hear??  And of course there is text messages.  Teens have been caught under their blankets in bed texting all night.  Or cheating on tests by texting in class.  There is an age when they should be given a phone and also be able to text.  Each parent has to decide when they are mature enough to deal with the responsibility.  Just like some parents do not let their children drive until 17 or 18 yr old. 

 There is a list of abbreviations that are used.  ( 9 means parents are watching and 99 they are gone.)  So see: http://www.netlingo.com/acronyms.php if you need to learn what they are typing.  They could be talking about very sinister topics without you knowing.

 There are programs to record every key stroke on the computer:

TrueActive Monitor ($100)
Spector Pro ($100)
SpyBuddy ($70)

 Dr. Knapp

 p.s.: a good website for children’s activities going on in the metroplex is this one:

http://www.metroplexbaby.com/

 June 16

 Kim Komando sent message on her email and I thought I would send it on to you.

Microsoft's Bing.com gives people instant access to hardcore porn. I know my children will stumble across this. What should I do?

 ABing is a new search engine from Microsoft. It's trying to move beyond simply providing a list of related links. And it uses some innovative tools to do that. Unfortunately, one has backfired big time.

All search engines let you search specifically for videos. But Bing provides in-result video previews. Roll your mouse over a result and the video starts playing. You get about a minute preview, complete with audio.

It's actually a neat idea. You can preview videos without leaving Bing. But the site doesn't distinguish between a funny YouTube clip and pornography. The right search turns Bing into a porn theater.

This can circumvent parental controls. And it leaves no trace. The porn site won't be logged in the browser history. You may have no idea what your fifth grader is watching.

Bing has built-in obstacles for porn. Unfortunately, any knowledgeable fifth grader—like yours!—can evade them.

See: http://www.komando.com/

 Roger Knapp MD

July 4

 Man’s best friend.  Studies showed that children positive to allergies to skin tests who had a dog had only 14% eczema and whose without a dog had 57% had eczema.  Those with negative skin tests who had a dog had only 9% eczema and whose without a dog had 14% eczema.  So a dog seems protective for getting eczema.  Sorry… eczema was increased if they owned a cat. 

 Also Tylenol (Acetaminophen) was in the news about causing liver damage.  Too much will wipe out your liver and it was the main way people in England committed suicide.  So now it is only by prescription there. There is a medication to stop the liver damage if you overdose Tylenol but you have to give it in 12 hours of taking the overdose.  But some damage can occur when taking Acetaminophen with other narcotics and medications.  They are talking about taking off the market Vicodin and Percoset.  Also alcohol and Tylenol can cause harm.  That is why I do not recommend alternating Tylenol and Motrin (Ibuprofen) for fever.  It is too much for the liver to handle … plus

FEVER DOES NOT HARM YOU!

 Have a great fourth…. try to stay cool.

Dr. Knapp

 July 23

 We are seeing a lot of swimmer’s ear so if your child is prone to it or you are going to spend several days in lake or ocean water, then put drops in their ears after swimming.  What is recommended is ½ alcohol and ½ white vinegar and put several drops in their ears after swimming.

 Also remember the Swine Flu is not any worse than the regular flu we have had for decades.  It is dangerous to infants, elderly, those with immune problems, respiratory problems,  and heart problems.  Otherwise I do not recommend Tamiflu to children to prevent or treat the flu.  It only shortens the illness 1 day if you take it in the first 48 hours.  Also the previous flu became resistant to Tamiflu because it was used to everyone with a cough.  So if we use these medications too much, then the germs become resistant and it will not work on them.  Then we do not have anything for grandma or the infants if they get the flu.  So only take the Tamiflu if you are high risk. 

 The news media loves to scare us to get viewers.  This flu is not any more deadly than the previous flu we have had for decades.  But it started in Mexico where there are many people with pulmonary problems from the air pollution and there are many cases of Aids that go undiagnosed.  Other countries have not had high death rates from it.  But the news media will blow this up coming this next winter so don’t get rattled.  I do recommend the flu shot this Fall, but we have always recommended it.  Especially for the infants below 2 yr, those with lung problems, and the teens so they do not miss a week of high school. 

 Roger Knapp MD

www.rogerknapp.com

 Additional comment:

Twitter is a BIG deal in the evolution of Internet communications however the spam problem has grown quickly. And that is magnified by the fact that some people choose to auto-follow. Auto-following is when a person uses an automatic system to follow back a person who follows them. It is completely automatic, and not personal.  The problem is that it attracts other people who auto-follow. And it leads to people who are seeking large numbers of followers just for ego purposes. It completely defeats the point. If a person uses  auto-follow, then that person ends up following spammers and pornstars.  Stop auto-following, and  unfollow  the people you are not interested in. If you use Twitter, I recommend that you not auto-follow. Having a large number of followers isn't that big a deal. And if you get followed back by a person who already follows thousands of people, realize they're not reading your tweets. They don't care about you. Its just a numbers game. A shell game. And completely meaningless.

 August 4

Study just came out about Vit. D

More than 50 million children (or 60% of the U.S. pediatric population) get insufficient vitamin D and another 7.6 million (9%) suffer from more severe deficiency, according to one of the studies published online in Pediatrics.

Older children, girls, non-Hispanic blacks, Mexican Americans, those born outside the U.S., and obese children were more likely to suffer a deficiency.

Low serum vitamin D in U.S. adolescents is strongly associated with hypertension, hyperglycemia, and metabolic syndrome, independent of adiposity

I have always asked parents to give their kids multivitamins starting at 1 yr. old.  Give them a vitamin with zinc and iron.

Roger Knapp MD
 I love Nanny 911.  They are very good at telling good parent techniques.  They have extreme cases but they have good advice.
http://www.parentsconnect.com/articles/child-discipline-boot-camp-nanny-911.jhtml

August 28

 We see croup usually in the Fall.  It is a viral chest cold with a Seal Bark cough.  They do not need antibiotics since it is viral and some will have secondary ear infections a week later from the congestion.  We need to see them if they are below 2 yr old or if they have breathing difficulties.  There is a steroid we give them to open their windpipes so they breath.  It is safe and keeps them from going into the ER.  Also run a humidifier or take them into the bathroom and steam it up.  If it is cool and humid outside, take them out on the back porch.  It lasts a week and the worse nights are typically the second and third nights.  They will be better in the daytime and you can get fooled into thinking it is getting better and not bring them in. 

 Like we have said in the last few months, the swine flu is not more deadly than the regular flu.  We do not know how much swine (H1N1) flu vaccine we will have this Fall and to which patients will be given.  I will let you know as soon as we know.  They still recommend the regular flu vaccine too.

 Roger Knapp MD

 p.s.  This is sports time of year.  See web site on treating acute injuries. Wrap… not ice.    http://www.rogerknapp.com/medical/injuries.htm

August 31

 I have always told parents that height of the child is the best way to choose the correct car seat.  Not age or weight.  There is a double difference in size or weight of children.  A small 8 yr old could be the same as a large 4 yr old.  So the new car restraint laws should be based on height and not age.

Dr. Knapp

New Texas Law Requires Kids up to Age 8 to Sit in Boosters

The Texas Legislature enacts new laws every year that usually go into effect on September 1 of that year. Beginning September 1, 2009, one of the new laws that will go into effect is the requirement that children up to age 8 (or children up to 4 foot 9 inches tall) must sit in a booster seat in a vehicle. Previously, children did not have to ride in a car seat or booster seat once they reached their 5th birthday or were at least 3 feet tall.

Traffic accident studies have shown that children 5-8 years old are not properly protected by a normal adult seat belt and are injured more often in auto accidents because of inadequate protection.  According to National Highway Transportation  and Safety Administration (NHTSA), seat belts are not designed for children and children do not have the physical stature to be protected fully by a seat belt.  Children who are moved to an adult seat belt system prematurely are at an increased risk of abdominal, spinal, facial and head injuries in the case of an accident.  Many children are not being properly restrained in a car and surprisingly, a large number of children are not being restrained at all.  This puts children at a heightened risk for serious injury or even death in the event of a car accident.

 p.s.   Also there is a neat place for kids and parties with animals and dinosaurs in the DFW area.  Looks like fun.
http://www.indoorsafaripark.com/

September 12

 Two things about vaccines.

 1. The HPV Gardasil was approved by the committee of the FDA (and the full FDA board usually follows it’s recommendations) to be given to boys/men 9 to 26 yr old.  It says it will be to prevent venereal warts but it will decrease other cancers caused by HPV: mouth, esophagus, penis, anus, and prostate.  It is a safe vaccine.  Ignore all the weirdos that come out when vaccines are mentioned.  But if you google it you will find parents who claim that their daughter’s hair fell out or she died 2 days later or whatever.  About the main thing to watch for is fainting when you give them  a shot.  The FDA will announce the official word soon.

 2.The vaccine for the H1N1 flu(swine) is close to production.  We will have it late Oct or Nov.  Studies show good antibodies after one shot and they may only recommend one shot instead of 2 shots like they were suggesting last month.  That makes sense to me.  You need two vaccines 1 month apart if it is the first year you get flu vaccines.  We will not know how much vaccine supplies we will have and what age or category will be given the vaccine.   Maybe we will be given enough vaccine to vaccinate everyone.  We shall let you know.

 Many parents have asked should I give the H1N1 vaccine to my child?   It is recommended for all children to 18 yrs old.   Remember this flu is not more dangerous than past flu.   There will be more cases because no one is immune to it.   My recommendation: do this year what you usually do.  If you think it is a good idea to vaccinate your children to flu and you have been doing that for years, then vaccinate them to both flu viruses.   If you don’t usually want to vaccinate them in the years  past and you still think it is not for your child, then don’t vaccinate them for either flu. 

 Don’t let the news media scare you on this thing.  Use good hand sanitation all year.

 Roger Knapp MD

 September 14

 I generally do not get political in my Newsymail but this will affect all parents and families.
Roger Knapp MD

- - - - - - - - - - - - - - - -

This was an email from Michael Farris of Parental Rights Organization.  See: http://www.parentalrights.org/index.asp?Type=B_BASIC&SEC={1F86E588-AA4A-43A1-998D-D9BF4FBE4D09}

Dear Friend of Parental Rights,

Monday in a Harlem middle school, U.S. Ambassador to the United Nations Susan Rice told a group of 120 students that administration officials are actively discussing “when and how it might be possible to join”  (that is, ratify) the UN Convention on the Rights of the Child (CRC). {See below the points of the UNCRC.}   As before, she also communicated what a disgrace it is that the U.S. would stand with only Somalia against such a widely-accepted treaty.

This is the first direct public statement by the Obama administration that it will seek ratification of the UN CRC.

In my 30 years of political involvement, I have learned to recognize this as what is called a “trial balloon.” Like in World War I trench warfare, our opponents have “sent up a balloon” to see if it will draw fire. If things remain quiet, they will proceed with their plans to push for ratification of the CRC in the U.S. Senate.

To discourage them from doing so, we need to make sure that our voices are heard with unmistakable clarity.  We must let the Obama administration know that we oppose this anti-family, anti-American treaty.

Here’s what we need you all to do:

1.      Call the White House comments line at 202-456-1111. Tell them you heard the administration wants to ratify the CRC, and you strongly oppose this giving away of U.S. sovereignty to the UN. Also keep in mind that this treaty gives the government jurisdiction to override any decision made by any parent if the government thinks that a better decision can be made—even if there is no proof of any harm.

2.      Call Ambassador Susan Rice’s office at the United Nations. Tell her that you want her to represent the United States to the world rather than trying to get the United States to go along with international law initiated by the UN.  Her office number is 212-415-4000.

3.      Contact your Senators and urge them to oppose ratification of this treaty.  Ask them also to defeat it once and for all by cosponsoring SJRes 16 – the Parental Rights Amendment.

It is very important that we speak up right now.  Please call before you close this email!

Sincerely,
Michael Farris

To contact your Senators:  Click to this link:  Congress  and put in your zip code.

 Ten things you need to know about the structure of the CRC:

  • It is a treaty which creates binding rules of law.  It is no mere statement of altruism.
  • Its effect would be binding on American families, courts, and policy-makers.
  • Children of other nations would not be impacted or helped in any direct way by our ratification.
  • The CRC would automatically override almost all American laws on children and families because of the U.S. Constitution’s Supremacy Clause in Article VI.
  • The CRC has some elements that are self-executing, while others would require implementing legislation.  Federal courts would have the power to determine which provisions were self-executing.
  • The courts would have the power to directly enforce the provisions that are self-executing.
  • Congress would have the power to directly legislate on all subjects necessary to comply with the treaty.  This would constitute the most massive shift of power from the states to the federal government in American history.
  • A committee of 18 experts from other nations, sitting in Geneva, has the authority to issue official interpretations of the treaty which are entitled to binding weight in American courts and legislatures.  This effectively transfers ultimate authority for all policies in this area to this foreign committee.
  • Under international law, the treaty overrides even our Constitution.
  • Reservations, declarations, or understandings intended to modify our duty to comply with this treaty will be void if they are determined to be inconsistent with the object and purpose of the treaty.

Ten things you need to know about the substance of the CRC:

  • Children would have the ability to choose their own religion while parents would only have the authority to give their children advice about religion.
  • The best interest of the child principle would give the government the ability to override every decision made by every parent if a government worker disagreed with the parent’s decision.
  • A child’s “right to be heard” would allow him (or her) to seek governmental review of every parental decision with which the child disagreed.
  • According to existing interpretation, it would be illegal for a nation to spend more on national defense than it does on children’s welfare.
  • Children would acquire a legally enforceable right to leisure.
  • Christian schools that refuse to teach "alternative worldviews" and teach that Christianity is the only true religion "fly in the face of article 29" of the treaty.
  • Allowing parents to opt their children out of sex education has been held to be out of compliance with the CRC.
  • Children would have the right to reproductive health information and services, including abortions,  without parental knowledge or consent.
  • Parents would no longer be able to administer reasonable spankings to their children.
  • A murderer aged 17 years and 11 months and 29 days at the time of his crime could no longer be sentenced to life in prison.

September 16

 The decision to do a CT scan on children who come into the ER or clinic has gone through many variations.  There are rare side effects of the tests and one weighs that against the benefits and needs of the tests.  We do not want to scan everyone who walks through the door.  For children who do not likely have serious injury, the risk of developing cancer because of radiation exposure outweighs the risk of clinically important traumatic brain injuries.

 Previous studies have suggested that CT scans were being overused for pediatric head trauma, but they were subject to various limitations for example small sample size.  So, using a derivation cohort of 33,785 children, Kuppermann and colleagues developed rules for classifying children as low risk.

 They found out that certain children would not need CT scans:

1.       Older children are considered low-risk if they have normal mental status, no loss of consciousness, no vomiting, no signs of basilar skull fracture, and no severe headache, and did not sustain their injury in a serious accident.

2.       Because children younger than 2 are generally unable to communicate their symptoms, are more sensitive to the effects of radiation, and have different mechanisms of injury, the researchers said, they needed slightly different rules.  Those who had normal mental status, no scalp swelling except frontal, no loss of consciousness more than five seconds, and no palpable skull fracture, and were acting normally according to the parents and sustained their injury in a non-severe way were classified as low risk.

 So you know what to expect when seeing the doctor.  You could also use it to decide if you need to bring in your child.

 See the four misconceptions of head injury at the web site and when I suggest you bring them in: http://www.rogerknapp.com/medical/Head%20Injury.htm

 Dr. Knapp

 September 22

Heart attack rates associated with breathing secondhand smoke dropped rapidly and continued to decrease over time after smoking was banned in public spaces in North American and European communities, a new study found.

The number of acute myocardial infarctions dropped by an average of 17% a year after smoking bans were put into effect, compared with communities with no such smoking restrictions according to a meta-analysis published in the Sept. 21 issue of Circulation.

The decline in heart attacks continued in subsequent years, with rates dropping by about 36% within three years of smoking prohibitions taking effect.

"Passage of strong smokefree legislation produces rapid and substantial benefits in terms of reduced acute myocardial infarctions, and these benefits grow with time," wrote James M. Lightwood, PhD, and Stanton Glantz, PhD, of the University of California San Francisco.

Previous studies on smoking bans in public areas and workplaces differed in their findings concerning rates of acute myocardial infarction after prohibitions were put in place, with reductions ranging from 11% in Italy and Ireland to 40% in Montana.

As annoying as these laws are... they save lives.  Not only with heart attacks but with cancer. 

Roger Knapp MD

October 7

 The news came out about a report in the Pediatrics Journal about an increase of Autism and it is now 1/91 children.

This is study shows an over estimated occurrence.  20 yr ago children were called Retarded. 

That sounds bad so they started calling them Autistic. 

So there was an equal decrease in the diagnosis of retardation as there was an increase in Autism.  So there was

a shift in labels.  Also they piled Downs Syndrome, Aspergers, Rett’s Syndrome,

and many other problems into Autism Spectrum.  Then any child who was slow in reading or

had other problems were dumped into Autism to get funding for help.  (See links below.)

So most of us do not think there is a significant increase in true Autism.  And remember

Autism is NOT CAUSED by vaccines or mercury in the vaccines.  

 http://www.nytimes.com/2009/10/06/health/research/06child.html

 http://www.theatlantic.com/doc/200910u/autism-diagnoses

Dr. Roger Knapp

October 20

 In 1975, the FDA banned the sale of turtles with a carapace length of less than four inches to reduce turtle-associated Salmonella transmission.  Those tiny turtles banned from sale are still on pet store shelves and have been linked to disease outbreaks.  During a 2007 outbreak, youngsters who handled a small turtle were at a 41-fold increased risk of contracting Salmonella, compared with controls. Salmonellae are natural intestinal flora for all reptiles, but turtles likely pose a greater hazard for children than other reptiles since they may be handled differently from pet snakes, lizards, or iguanas.  The American Veterinary Medical Association estimates that America's household turtle population doubled from roughly 950,000 in 1996 to almost 2 million in 2006. Now, evidence suggests that reptile-transmitted Salmonella outbreaks may be on the rise again.  Public health officials discovered what turned out to be the largest reported outbreak in the U.S. in September 2007 many patients were from recent turtle exposure.  More than a third of the turtles  (34%) were purchased in a retail pet store.  Although some retail shops may provide information on the risk of Salmonella, in many states there is no legal obligation for them to do so.   Some pet stores are under investigation for claiming that they sell turtles that are "Salmonella-free."

 Dr. Knapp

 October 22

 This is Breast Cancer Awareness Month.

A woman’s lifetime risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful mutation in BRCA1 or BRCA2.

According to estimates of lifetime risk, about 12 percent of women in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women who have inherited a harmful mutation in BRCA1 or BRCA2.  Lifetime risk estimates for ovarian cancer among women in the general population indicate that 1.4 percent  will be diagnosed with ovarian cancer compared with 15 to 40 percent of women who have a harmful BRCA1 or BRCA2 mutation.

The likelihood of a harmful mutation in BRCA1 or BRCA2 is increased with certain familial patterns of cancer. These patterns include the following:

  • For women who are not of Ashkenazi Jewish descent:
    • two first-degree relatives (mother, daughter, or sister) diagnosed with breast cancer, one of whom was diagnosed at age 50 or younger;
    • three or more first-degree or second-degree (grandmother or aunt) relatives diagnosed with breast cancer regardless of their age at diagnosis;
    • a combination of first- and second-degree relatives diagnosed with breast cancer and ovarian cancer (one cancer type per person);
    • a first-degree relative with cancer diagnosed in both breasts (bilateral breast cancer);
    • a combination of two or more first- or second-degree relatives diagnosed with ovarian cancer regardless of age at diagnosis;
    • a first- or second-degree relative diagnosed with both breast and ovarian cancer regardless of age at diagnosis; and
    • breast cancer diagnosed in a male relative.
  • For women of Ashkenazi Jewish descent:
    • any first-degree relative diagnosed with breast or ovarian cancer; and
    • two second-degree relatives on the same side of the family diagnosed with breast or ovarian cancer.

These family history patterns apply to about 2 percent of adult women in the general population. Women who have none of these family history patterns have a low probability of having a harmful BRCA1 or BRCA2 mutation.

To see the whole article, go to my web site: http://www.rogerknapp.com/medical/BRCA.htm

The reason I am bringing this topic up is the question:  "Should I test my daughter for this gene?" 
Personal Opinion:  Absolutely do not tell your daughter that this in the family.  If you do test her, do it secretly so they do not know.  Tell them if they are positive at age 20.  They do not need to grow up thinking they possibly may have their breasts removed.

October 26

 The X-ray and the diagnosis of pneumonia.

The X-ray is not as accurate as most people think.  Many children (and also adults) are diagnosed with “pneumonia” in ERs, Emergency Clinics, and even physician’s offices when they really do not.  The X-ray does not see bacteria.  It sees fluid, mucous, congestion, or any stuff.  The mucous in the chest could be allergy like asthma, bacterial pneumonia, viral (pneumonia) infection like a bad chest cold or flu, fungal infection, or even rarely cancer.  The radiologist reads the X-ray as “pneumonia” but that is the radiologist’s term for congestion.  And the radiologist does not know the patient so he will call it pneumonia if there is very little congestion not wanting to miss pneumonia and get sued later.  Some physicians will also over call the diagnosis not wanting to get sued.  Most patients with an asthmatic attack or flu will have an abnormal X-ray.  When there is what is called a consolidation, where the whole lobe of the lung is a white out, then it is most likely a bacterial pneumonia.  But many X-rays have steaks or some fluffiness that is called “pneumonia”. and then the patient gets antibiotics many times needlessly. 

See full story : http://www.rogerknapp.com/medical/pneumonia.htm

Dr. Knapp

October 28

 Pennsylvania researchers published in the journal Lancet using gene therapy have made significant improvements in vision in 12 patients (5 children) with a rare inherited visual defect, a finding that suggests it may be possible to produce similar improvements in a much larger number of patients with retinitis pigmentosa and macular degeneration.

9-year-old Corey, was considered nearly blind before treatment. He was confined largely to his house and had difficulty in navigating obstacles.  Now, after a single injection of a gene-therapy in one eye, he rides his bike, and needs no assistance in the classroom.  He even played his first game of softball.

The 12 patients have Leber's, a congenital amaurosis. Approximately  3,000 people in the United States have this. Patients are born with impaired vision that deteriorates in childhood or adolescence. There was no treatment. All 12 of the patients suffered a defect in a gene called RPE65. 

The good copy of the RPE65 gene was inserted into a weakened version of a human adenovirus. The engineered virus then invaded retinal cells and inserted the gene into the cells' DNA.   Within 2 weeks their vision improved.  Their improved vision has lasted 2 years.

Maguire inserted the preparation into the retina of the worst eye in each of the patients. Within two weeks, the treated eyes began to become more sensitive to light, and within a few more weeks, vision began to improve. The younger the patients were, the better they responded.

A lot of research still has to be done.  This disease is a form of retinitis pigmentosa, which affects an estimated 100,000 Americans.  The hope is that this therapy will apply to macular degeneration, which affects an estimated 1.25 million Americans.
 

For the article in the news:
See:  http://www.latimes.com/news/nationworld/nation/la-sci-gene-therapy25-2009oct25,0,2334183.story

 For a video: 

http://multivu.prnewswire.com/mnr/chop/40752/

 Dr. Knapp

 November 2

 With all the news about the Swine H1N1 flu, we forget about other illnesses.  There was a recent outbreak of E. coli illnesses up in New England with 2 deaths and 2 dozen sick.  (http://www.nytimes.com/2009/11/03/health/03beef.html )  It usually is from poorly cooked hamburger but can be from lettuce and other foods that are not washed.  With our economy, we are eating more meals at home which is a good thing.  So cook your food well but also watch out for your hands, utensils, and counter tops that touch the raw food before cooking.  Even Elton John because ill recently with E coli and flu (http://www.newsday.com/entertainment/celebrities/elton-john-recovering-from-flu-e-coli-1.1560117 )

 Roger Knapp MD

 November 14

 We recommend vitamins in breast fed infants and for children 1 yr and older through the teen years.

Dr. Knapp

www.rogerknapp.com

 It has traditionally been believed that normal dietary vitamin D intake will produce adequate serum  levels. The most recent guidelines from the Food and Nutrition Board suggest a daily minimum vitamin D intake of 200 International Units (5 mcg) for infants, children, and adults up to 50 years of age to achieve serum D levels ≥ 20 ng/mL and prevent bone disease. The recommended daily intake increases to 400 International Units (10 mcg) for adults 51 to 70 years of age and 600 International Units (15 mcg) for adults over 71 years of age.

 In most clinical studies, vitamin D deficiency has been defined as a serum D level < 20 ng/mL. Levels between 20 and 30 ng/mL are indicative of vitamin D insufficiency. The target D level goal of 20 ng/mL has recently come under criticism. Newer research has strongly suggested that serum D levels of 30 ng/mL or greater may be needed for optimal health benefits.

 Prevention of vitamin D deficiency may be most important during infancy, to produce optimal bone formation and prevent rickets.  After birth, vitamin D goals may not be met with exclusive breastfeeding, since breast milk provides only 20–70 International Units/L.

 Several studies have documented a relatively high incidence of vitamin D insufficiency or deficiency in infants and toddlers. In 2008, Gordon and colleagues evaluated a cross-sectional sample of 380 healthy infants and toddlers in an urban primary care clinic in Boston.  12.1% had serum D levels < 20 ng/mL, while 40% had levels less than 30 ng/mL. Three patients had radiographic evidence of rickets and another 13 had evidence of bone demineralization.

 Unlike some earlier studies, the prevalence of vitamin D deficiency in this group of patients was not correlated with age or skin pigmentation. There was an inverse correlation between serum 25 (OH)D and parathyroid hormone levels (p < 0.001 for infants, p < 0.02 for toddlers), indicative of increasing secondary hyperparathyroidism. Multivariate analysis revealed that breastfeeding without vitamin D supplementation and a lower milk intake in toddlers were significant predictors of vitamin D deficiency. The authors concluded that their study added evidence for the increasing prevalence of vitamin D deficiency in infants and young children and suggests the need for routine supplementation.

 In addition to studies conducted in infants, there has been considerable interest in the vitamin D status of older children and adolescents during the past decade.  Data collected between 1988 and 1994 showed 14% of the 2,955 teens had vitamin D deficiency. 48% had levels below 30 ng/mL,

An extensive review on vitamin D deficiency in children, with new recommendations for supplementation, was published in the August 2008 issue of Pediatrics.   Based on a review of the literature, the group recommended that serum D levels be maintained at least above 20 ng/mL and that daily supplementation with 400 International Units (10 mcg) of vitamin D be initiated within days of birth for all breastfed infants and in formula-fed infants and children who do not ingest at least 1 L of vitamin D-fortified milk each day. Premature infants, dark-skinned children, and children who live at higher latitudes may require larger doses of vitamin D, up to 800 International Units (20 mcg) per day.

 In November 2008, the American Academy of Pediatrics (AAP) released a guidance paper on the prevention of rickets and vitamin D deficiency in infants, children, and adolescents.  This new report replaces their 2003 statement which recommended a daily intake of 200 International Units. As in the Lawson Wilkins Society article, the 2008 AAP statement recommends that the daily vitamin D intake for all pediatric patients be increased to 400 International Units (10 mcg), with a goal vit D level of at least 20 ng/mL. The AAP statement also recommends that breastfed infants receive a vitamin D supplement at a dose of 400 International Units/day beginning shortly after birth and continuing until they are weaned and consuming at least 1 L of vitamin D-fortified formula or milk per day.  Daily supplementation is also recommended for older children and adolescents who do not consume at least 400 International Units of vitamin D with their usual diet. The AAP guidelines were based on studies documenting the safety of vitamin D at this higher dose as well as new evidence suggesting a possible role for vitamin D in preventing cancer, cardiovascular disease, and diabetes

 November 24

 The Growing Backlash Against Overparenting

By Nancy Gibbs

http://www.time.com/time/nation/article/0,8599,1940395-1,00.html

This is a good article about over bearing parents.  We need to guard, protect and parent our children.  But how much?  Are we too lax and let our children stagnate and be in danger?  Are we over protecting and smothering them so they cannot try things or make mistakes (which is the way we learn).  This article is great reading for all of us.  We can assess how we are and how is the job going.  Ask others to read this and give you an honest opinion about how you parent.  We cannot see ourselves as well as others see us.  Most of us are OK.  Some of us may be helicopter parents.

Here is a small quote from the article:

The insanity crept up on us slowly; we just wanted what was best for our kids. We bought macrobiotic cupcakes and hypoallergenic socks, hired tutors to correct a 5-year-old's "pencil-holding deficiency," hooked up broadband connections in the treehouse but took down the swing set after the second skinned knee. We hovered over every school, playground and practice field — "helicopter parents," teachers christened us, a phenomenon that spread to parents of all ages, races and regions. Stores began marketing stove-knob covers and "Kinderkords" (also known as leashes; they allow "three full feet of freedom for both you and your child") and Baby Kneepads (as if babies don't come prepadded). The mayor of a Connecticut town agreed to chop down three hickory trees on one block after a woman worried that a stray nut might drop into her new swimming pool, where her nut-allergic grandson occasionally swam. A Texas school required parents wanting to help with the second-grade holiday party to have a background check first. Schools auctioned off the right to cut the carpool line and drop a child directly in front of the building — a spot that in other settings is known as handicapped parking.

We were so obsessed with our kids' success that parenting turned into a form of product development. Parents demanded that nursery schools offer Mandarin, since it's never too soon to prepare for the competition of a global economy. High school teachers received irate text messages from parents protesting an exam grade before class was even over; college deans described freshmen as "crispies," who arrived at college already burned out, and "teacups," who seemed ready to break at the tiniest stress.

November 30

 Here are some new state laws of Texas concerning your teens and their driving.  I have always encouraged parents to make their teens drive for 9-12 months before getting their driving license.  Even pilots have to have so many hours of flying before being allowed to solo their plane.  Here is the website that has a lot of other new laws.

Dr. Knapp

 

http://www.txdps.state.tx.us/director_staff/public_information/pr081109.pdf

  

1.       HB 2730 requires that all applicants under the age of 18 take the driving skills exam to receive a driver license. The law also requires that a provisional driver license (under 18) or instruction permit expire on an individual’s 18th birthday, removes the requirement that a provisional driver license or instruction permit be renewed annually and increases the fee for those licenses from $5 to $15. It also extends the current phase-two restrictions for holders of a graduated driver license from 6 months to 1 year. These restrictions include limited night driving and limits the number of passengers.

2.       HB 2730 and HB 339 restrict all drivers under the age of 18 from using a wireless communication device while operating a motor vehicle.

3.       HB 339 increases the total hours of behind-the-wheel driving instruction a teen receives from 14 to 34 after TEA develops criteria for curriculum. (Goes into effect May 1, 2010)

4.       HB 2730 increases the driver license sanction from a one-year CDL license disqualification to a lifetime disqualification if a person uses a motor vehicle to transport, conceal or harbor an alien. If a child is engaged in conduct involving a severe form of trafficking persons, a judge at a juvenile hearing is required to order the juvenile’s driver license or permit to be suspended.

 December 14

 The State of Texas finally approved the screening of newborns for Cystic Fibrosis.  We are the last state in the Union to start this screening.  The first states to screen was in 1997.

 CF affects all races, and is the most common autosomal recessively inherited disorder in Caucasians (about 1/3000 births). Fifty years ago, most children with CF died before they reached school age, but today, with early diagnosis and improved treatment, the median survival is 36 years.  Carriers of the genes can be tested for and councelled on pregnancy.

 The screening will go according to the chart below.  They screen for a chemical with the initials of IRT.  The identification of increased immunoreactive trypsinogen (IRT) levels in the blood of infants with CF has made neonatal screening for CF possible. Trypsinogen is one of the secretory products of the pancreas making its level in the blood a specific marker of pancreatic function. Detection of high levels of IRT in the newborn period place the infant at risk for CF.

 See for more information:  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5313a1.htm

 Roger Knapp MD

 December 23

 There was a recent recommendation for car seats.  You can see my web site for my suggestions.
http://www.rogerknapp.com/medical/restraint.htm

The recent reviews showed some are not recommended.

Insurance Institute for Highway Safety's best bets for booster seats:

  • Combi Dakota backless/clip
  • Recaro Young Sport
  • Recaro Vivo
  • Maxi-Cosi Rodi XR
  • Evenflo Big Kid Amp backless/clip
  • Eddie Bauer Auto Booster
  • Cosco Juvenile Pronto
  • Britax Frontier
  • Clek Oobr

Insurance Institute for Highway Safety's list of "not recommended" booster seats:

  • Harmony Secure Comfort Deluxe backless/clip
  • Combi Kobuk
  • Evenflo Express
  • Eddie Bauer Deluxe
  • Safety 1st Alpha Omega Elite
  • Evenflo Sightseer
  • Alpha Omega Elite
  • Eddie Bauer Deluxe 3-in-1
  • Safety 1st All-in-One
  • Alpha Omega Luxe Echelon
  • Alpha Omega

You all have a safe and fun holiday.

Merry Christmas
Roger Knapp MD

December 28, 2009

 Teen drug gateways.  Studies show the seven top 10 drugs abused by high school seniors last year were prescribed or purchased over the counter.

 There has been a 20% decrease in illicit drug use from 2001-2005.  But there has been an increase in use of OTC medications like Dextromethorphan cough suppressant.  Also prescription meds like Oxycontin, Vicodin, and Adderall (med for ADD).  These meds have now become the drug of choice replacing Mariquana as the gateway drug of choice (22%). 

 Remember the pain meds given Michael Jackson for the burn on his head.

 Symptoms include personality changes, mood swings, irritability, excessive energy, sleepiness, loss of appetite, forgetfulness, clumsiness, secretiveness, loss of interest in personal appearance, borrowing money, decline in school performance, pills missing or running out of prescription meds too soon.

 Things you can do:

  • Properly store or lock up meds.

  • Take regular inventory of meds that are kept around the house.

  • Set clear rules with teens about sharing medications.

  • Properly dispose of old meds.

 Roger Knapp MD