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Newsymail 2010


Jan 11

Soon the old incadescent bulbs will no longer be sold after 2014.  Then all the bulbs will have mercury.  
The long-lasting curled-tube bulbs now are CFLs (Compact fluorescent lights).  But they contain more mercury 
than were in the vaccines(which was organic Ethyl Mercury that did not cause Autism). 
Exposure is not good.  You do not have to call expensive clean up crews but
here are the instructions for clean up. 

What to Do if a Fluorescent or Other Mercury-Containing Light Bulb Breaks

Compact fluorescent lights (CFLs), Fluorescent bulbs, which include linear, U-tube and circline fluorescent tubes, bug zappers, tanning bulbs, black lights, germicidal bulbs, high output bulbs, cold-cathode fluorescent bulbs, and compact fluorescent bulbs; High intensity discharge bulbs, which include metal halide, ceramic metal halide, high pressure sodium, and mercury vapor; Mercury short-arc bulbs; and Neon bulbs.


Before Clean-up: Air Out the Room

·                     Have people and pets leave the room, and don't let anyone walk through the breakage area on their way out.

·                     Open a window and leave the room for 15 minutes or more.

·                     Shut off the central forced-air heating/air conditioning system, if you have one.


Clean-Up Steps for Hard Surfaces

·                     Carefully scoop up glass pieces and powder using stiff paper or cardboard and place them in a glass jar with metal lid (such as a canning jar) or in a sealed plastic bag.

·                     Use sticky tape, such as duct tape, to pick up any remaining small glass fragments and powder.

·                     Wipe the area clean with damp paper towels or disposable wet wipes. Place towels in the glass jar or plastic bag.

·                     Do not use a vacuum or broom to clean up the broken bulb on hard surfaces.


Clean-up Steps for Carpeting or Rug

·                     Carefully pick up glass fragments and place them in a glass jar with metal lid (such as a canning jar) or in a sealed plastic bag.

·                     Use sticky tape, such as duct tape, to pick up any remaining small glass fragments and powder.

·                     If vacuuming is needed after all visible materials are removed, vacuum the area where the bulb was broken.

·                     Remove the vacuum bag (or empty and wipe the canister), and put the bag or vacuum debris in a sealed plastic bag.


Clean-up Steps for Clothing, Bedding and Other Soft Materials

·                     If clothing or bedding materials come in direct contact with broken glass or mercury-containing powder from inside the bulb that may stick to the fabric, the clothing or bedding should be thrown away. Do not wash such clothing or bedding because mercury fragments in the clothing may contaminate the machine and/or pollute sewage.

·                     You can, however, wash clothing or other materials that have been exposed to the mercury vapor from a broken CFL, such as the clothing you are wearing when you cleaned up the broken CFL, as long as that clothing has not come into direct contact with the materials from the broken bulb.

·                     If shoes come into direct contact with broken glass or mercury-containing powder from the bulb, wipe them off with damp paper towels or disposable wet wipes. Place the towels or wipes in a glass jar or plastic bag for disposal.


Disposal of Clean-up Materials

·                     Immediately place all clean-up materials outdoors in a trash container or protected area for the next normal trash pickup.

·                     Wash your hands after disposing of the jars or plastic bags containing clean-up materials.

·                     Check with your local or state government about disposal requirements in your specific area. Some states do not allow such trash disposal. Instead, they require that broken and unbroken mercury-containing bulbs be taken to a local recycling center.


Future Cleaning of Carpeting or Rug: Air Out the Room During and After Vacuuming

·                     The next several times you vacuum, shut off the central forced-air heating/air conditioning system and open a window before vacuuming.

·                     Keep the central heating/air conditioning system shut off and the window open for at least 15 minutes after vacuuming is completed.

 Dr. Knapp




 Parenting practices as predictors of substance use, delinquency, and aggression among urban minority youth: Moderating effects of family structure and gender.

By Griffin, Kenneth W.; Botvin, Gilbert J.; Scheier, Lawrence M.; Diaz, Tracy; Miller, Nicole L.

Psychology of Addictive Behaviors. Vol 14(2), Jun 2000, 174-184.


This study examined how parenting factors were associated with adolescent problem behaviors and to what extent these relationships were moderated by family structure and gender.  6th grade students reported how often they use alcohol, smoke cigarettes, or engage in aggressive or delinquent behaviors; a parent or guardian reported their monitoring and other parenting practices. Findings indicated that boys and those from single-parent families engaged in the highest rates of problem behavior. More parental monitoring was associated with less delinquency overall, as well as less drinking in boys only. Eating family dinners together was associated with less aggression overall, as well as less delinquency in youth from single-parent families and in girls. Unsupervised time at home alone was associated with more smoking for girls only. Implications for prevention interventions are discussed.

 Many studies have shown there is less delinquency, pregnancy, alcohol and drugs, and aggression.  Sit down to a meal, turn off the TV and ask “How did your day go?”  Keeping the family together also is important in these factors.

 (If you are thinking of divorce, …. Don’t!      see:

 http://www.rogerknapp.com/medical/divorce_letter_to_parents.htm )

 Also try to keep the balance: time for yourself, time for your spouse, time with your kids, and time for the whole family.  Don’t be afraid to leave the kids and go out on a date.  Go have fun and laugh together and do the fun things you did when dating.  If it is good for the marriage then it is good for the kids. 

Ten Stupid Things Couples Do to Mess Up Their Relationships by Laura Schlessinger (Paperback - Dec 24, 2002) Buy new: $10.07

 The Proper Care and Feeding of Marriage by Laura Schlessinger (Paperback - Dec 26, 2007)

Buy new:  $10.07

 Feb 5

 As we have discussed, vaccines have nothing to do with autism.  This week the medical journal Lancet retracted the only medical paper claiming the connection.  The doctor-author has been discredited and may face charges.  Most of us doctors do not think there is a big increase in autism because 20 yrs ago these kids were labeled retardation and now are called autism.  There was a shift in label.  Also many other disorders were dumped into autism spectrum disorder such as Downs and Aspergers.  Plus many slow readers are labeled autistic to get funding or special classes.  There is a slight increase and the theory is that the age of mothers having babies is getting higher.  The average age over the last 25 years has gone from late twentys to the late thirties.  This has resulted in a higher incidence of Downs Syndrone and other genetic problems.  This is more likely the cause of the minimal increase in real Autism.

 In England there was a big increase in Measles cases with parents afraid to vaccinate resulting in hospitalizations and deaths.  So get the vaccinations (which we do in spite of colds and minor illnesses.)

 Dr. Roger Knapp

 (Watch out this weekend.  Most alcohol car wrecks are on Super Bowl Weekend.)

 Lancet retracts 'utterly false' MMR paper

Sarah Boseley, health editor guardian.co.uk, Tuesday 2 February 2010 16.29 GMT

 After medical council ruling last week that MMR doctor Andrew Wakefield was dishonest, journal finally quashes paper

The Lancet today finally retracted the paper that sparked a crisis in MMR vaccination across the UK, following the General Medical Council's decision that its lead author, Andrew Wakefield, had been dishonest.

The medical journal's editor, Richard Horton, told the Guardian today that he realised as soon as he read the GMC findings that the paper, published in February 1998, had to be retracted. "It was utterly clear, without any ambiguity at all, that the statements in the paper were utterly false," he said. "I feel I was deceived."


MMR vaccination and pervasive developmental disorders: a case-control study

Concern that measles-mumps-rubella (MMR) vaccination might cause autism has led to a fall in vaccine coverage. We investigated whether MMR vaccination is associated with an increased risk of autism or other pervasive developmental disorders.


We did a matched case-control study using the UK General Practice Research Database. Cases were people born in 1973 or later who had first recorded diagnosis of pervasive developmental disorder while registered with a contributing general practice between 1987 and 2001. Controls were matched on age, sex, and general practice.


1294 cases and 4469 controls were included. 1010 cases (78·1%) had MMR vaccination recorded before diagnosis, compared with 3671 controls (82·1%) before the age at which their matched case was diagnosed. After adjustment for age at joining the database, the odds ratio for association between MMR and pervasive developmental disorder was 0·86 . Findings were similar when restricted to children with a diagnosis of autism, to those vaccinated with MMR before the third birthday, or to the period before media coverage of the hypothesis linking MMR with autism.


Our findings suggest that MMR vaccination is not associated with an increased risk of pervasive developmental disorders.

 UK 'in grip of measles outbreak'

Numbers of measles cases in the UK have risen to their highest level in nearly 20 years, experts said.

Surrey and Sussex could have up to 156 cases and South Yorkshire may have 180. Last year there were just 77 cases across England and Wales.

The south east's health agency blames low MMR vaccine. It comes as a doctor who linked MMR with autism faces possible misconduct charges.

A boy's death from the disease in April was the first UK fatality in 14 years. The Surrey and Sussex Health Protection Agency (HPA) said there had been 106 confirmed cases in the two counties with 50 more unconfirmed. In Doncaster alone there have been 100 reported cases, with as many as 80 further cases elsewhere in South Yorkshire.

Dr Peter English, consultant at the HPA, said: "We haven't had an outbreak as big as this in this country since the MMR jab was introduced in 1988."  He said the outbreak was not a surprise as low MMR uptake had left "a lot of people now susceptible to the disease".

Parents have been warned the highly-contagious disease could bring on breathing difficulties, diarrhoea, ear, lung and eye infections and even swelling of the brain. Dr English, urging parents to ensure their children have the initial vaccine and the booster jab, said without fast action there could be an outbreak similar to that in Dublin in 2000, when two children died and hundreds were hospitalised.

Earlier this week, it was revealed that Dr Andrew Wakefield, the doctor who first suggested a link between the MMR vaccine and autism, could be charged with serious professional misconduct.

 Feb 7

 I am seeing several kids with a rash on their hands.  It is rough slightly itchy sandpaper like rash on the back of their hands.  It is either dry skin, or mild eczema, or an allergy to the alcohol sanitizing solutions that we frequently use (and I recommend).  You can treat this with 1% Hydrocortisone and if that does not help we can call in a stronger cream.  You might try changing brands of alcohol sanitizer and one the a little moisturizing cream in it.  Also you can put moisturizing creams on their hands before bedtime (Eucerin, Aquaphor, etc.).  Use cream and not lotion.

 Hand foot and mouth is a rash from a virus usually in the Spring.  It causes a few blisters on their hands, feet and roof of the mouth. (see: http://www.rogerknapp.com/medical/handfootmouth.htm )

 Feb 11

 New problem to think about.  Not only do we worry about the germs on the toilet seats but also getting an allergic rash from them.   Studies coming out in Pediatrics Journal are talking about rashes on buttocks from the chemicals that are used to clean seats but also from wooden seats.  If there are frequent itchy rashes that occur in the same locations, then it is usually caused by things and chemicals that touch those same areas. 

 Their recommendations are:

To prevent toilet-seat dermatitis, Cohen and colleagues recommend:

  • Using paper toilet seat covers in public restrooms, including hospital and school restrooms;
  • Replacing wooden toilet seats with plastic ones;
  • Cleaning toilet seats and bowls daily;
  • Avoiding harsh store-brand cleaners, which often contain skin irritants like phenol or formaldehyde.

Equally effective and gentler substitutes such as rubbing alcohol and hydrogen peroxide could be used instead.


 What a snow storm.  Drive careful and don’t let the kids hypothermic from getting too cold and wet.  I love making snow angels.

 Feb 21

 Why do we vaccinate??????  This story is a good example.

 The CDC continues to investigate a mumps outbreak that began in New York in June 2009. The index case occurred in a boy aged 11 years who had returned from the United Kingdom, where  was approximately 7,400 reports of mumps in 2009.  The 1,521 outbreak-related mumps cases have been reported from several counties in New York and New Jersey 

This is the largest mumps outbreak that has occurred in the United States since 2006. Although mumps vaccination alone was not sufficient to prevent this outbreak, maintaining high measles, mumps, and rubella (MMR) vaccination coverage remains the most effective way to prevent outbreaks and limit their size when they occur.

 Of the 1,518 patients whose age is known, 91% are aged >6 years. The median age of patients is 15 years (range 3 months--90 years) and is similar in all areas. Complications from mumps have been received: orchitis (55 cases) (many of whom will become sterile), pancreatitis (five cases), aseptic meningitis (two cases), transient deafness (one case), Bell's palsy (one case), and oophoritis (one case). Nineteen hospitalizations from mumps have been reported; no deaths have occurred.

 88% had received at least 1 dose of mumps-containing vaccine before the outbreak, and 75% had received 2 doses. Among patients aged 7--18 years, the age group with the majority of cases and for whom 2 doses of MMR vaccine is recommended, 93% had received at least 1 dose, and 85% had received 2 doses.

 Beginning on January 19, 2010, in Orange County, New York, public health officials began offering a third dose of MMR vaccine in three schools where, despite documentation of a high level of 2-dose coverage among students, transmission had continued for >2 months.

 From 1967, when the mumps vaccine was first licensed, to the early 2000s, the number of reported cases decreased from 186,000 to <500 annually. Nonetheless, the effectiveness of the mumps component of the MMR vaccine is lower than that of the measles and rubella components. Estimates of the effectiveness of the mumps vaccine have varied in previous studies, ranging from 73% to 91% after 1 dose and from 79% to 95% after 2 doses (3--5). 

This outbreak emphasizes that mumps outbreaks can occur in highly vaccinated populations. Although several factors play a role in mumps control in the United States, maintenance of high 2-dose MMR vaccine coverage remains the most effective way to prevent and limit the size of mumps outbreaks.

 Feb 26

 The weather will be getting better soon.  Just a reminder about injuries.  Falls are the most common cause of death in the home.  This is especially true the older we get.  See: http://www.homehealthnetwork.com/portal/index.php?option=com_content&view=article&id=107:fall-prevention&catid=67:fall-prevention-c&Itemid=190

 Also remember we have had past emails about wrapping injured areas of the body.  Common are sprained ankle and jammed fingers.  Ice is the last thing you should put on an injury.   First wrap the area with tape so it does not expand and swell.  The more it bleeds into the joint, the longer it takes to recover.

 Also……A new version of an old vaccine is not approved.  Pneumococcal bacteria causes blood infections, meningitis, pneumonia, and ear infections.  The vaccine (pncv7) we have had the last 10 years protected against 7 of the more common strains of bacteria.  Since then there was a 68% drop in invasive disease in the first 4 years and in 2007 many states reported no cases of invasive disease by the strains in the vaccine in infants below 1 yr old.  Penicillin resistance has dropped from 15% to 5% because less antibiotics were used.  There was a slight increase in the number of diseases caused by the other strains not in the vaccine.  Now a new version of the vaccine covers 11 strains and will replace the old one that covered 7.  I used to see 1-2 children per month with high fever, critically ill, and hospitalized.  Now I see maybe 1 every year or two.  Many lives have been saved by this one vaccine and it will be better with this new improved vaccine.  

 March 26

 We see viral fevers every Spring.  It usually is 101-102 for 2-3 days and not any other symptoms.  They usually are playful but some are lying around.  A few might have headache or sore throat.  Frequently we see them to check for strep throat but strep is on the decline now and their throat would look bright red if they had strep. 

 In the old days they called it Spring fever.  They were fevers we saw in the Spring and it made the kids tired and not do their school work.  And through the years that term was applied to kids not wanting to do their work in the Spring.  But it started out as “Spring Fevers.”

 They also blamed the fevers on the hay growing in the Spring.  And through the years the term hay fever was shifted to allergies and having hay fever.  But it started out as the child having “Hay Fever.”

 So if your child has a fever this Spring and nothing else and does not seem very ill, you might give it a few days to see if it does not go away.  Also I sent an email out in Jan about Hand Foot and Mouth which is common in the Spring also. 

 Be sure to use plenty of sunscreen and Off.  I see several cases of encephalitis every Summer from the mosquitoes.  Have a great weekend.

 March 30

 Who is it bothering?

 That is my favorite question when talking about most medications and especially allergies.  There are several degrees of symptoms like allergies.  Runny nose…. Runny nose and stopped up…. Runny nose, stopped up, cough…. Runny nose, stopped up, cough and can’t sleep … etc.   Different people tolerate a different amount of symptoms until they want some help or medications.  Some will want drugs with just a runny nose and some will tolerate severe symptoms and not want to take any thing for it.  They just “sniff, blow, and go”. 

 Everyone has some allergies.  It is a response to a foreign protein.  But our body does not understand a pollen that is nothing, a bacteria that can kill us, or a heart transplant that will save our life, our body will try to reject them all.  It is our defenses against illness and we would not make it without this system.  So everyone has some degree of allergies.  Just some more than others.

 In children,  you need to ask yourself “Who is it really bothering?  The child or the parent?”  Many times the parent comes in wanting to treat the child’s symptoms because it is bothering the parent and the child could care less.  They are sleeping and not bothered by their symptoms.  It is bugging the parent.  I like less medications.  I would like the parents to wipe their noses and ignore it.  If it IS bothering the child and they are miserable and can’t sleep, then we need to treat it. Treating the allergies will not prevent ear infections.  It will help decrease slightly sinus infections and bronchitis in asthmatics.

 Then next question is “Which medication?”   Everyone is different in how they respond to antihistamines.  Claritin helps one child and not this other one.  Benadryl makes that child sleepy and this other one hyper and not sleep.  So which one helps without bad side effects differs in everyone.  It is a trial and error to find out which one helps. 

 Prescription ones are not stronger, they are newer on the market.  Claritin was prescription but only helped half of the population.  When they get generics, then they go over the counter. 

 When you exhaust all the oral meds and inhalers; and nothing helps and the child is bothered by the symptoms, then we go see the allergist and get tested.  The main reason to see the allergist is when you are considering getting allergy shots every week.   If they do not test them, then all they will do is give them an antihistamine or nasal sprays like we give out.  Why test them to see if it is this grass or that tree causing your symptoms if all you are going to do is take meds.  You want to get tested so you can give allergy shots.  Studies show they help 50-75 % of nasal allergies and it takes months to years to find out.  So if all else fails, go see the allergist for allergy shots.  It will help most people.  But that is the last thing after we try everything else.

 So the two questions are:

  1. Who is it bothering?
  2. Which medication will help my child?

 April 18

During 2007, 49 states and Puerto Rico reported 7,258 cases of rabies in animals and 1 case in a human to the CDC, representing a 4.6% increase from the 6,940 cases in animals and 3 cases in humans reported in 2006. Approximately 93% of the cases were in wildlife, and 7% were in domestic animals. Relative contributions by the major animal groups were as follows: 2,659 raccoons (36.6%), 1,973 bats (27.2%), 1,478 skunks (20.4%), 489 foxes (6.7%), 274 cats (3.8%), 93 dogs (1.3%), and 57 cattle (0.8%). The United States remains free of dog-to-dog transmission of canine rabies virus variants. The total number of cases of rabies reported nationally in foxes increased 14.5%, compared with 2006. Increases in the number of reported rabid foxes were attributable to greater numbers of foxes reported with the Arctic fox rabies virus variant in Alaska, the Texas gray fox rabies virus variant in Texas, and the raccoon rabies virus variant in Virginia. The 1,973 cases of rabies reported in bats represented a 16.6% increase over numbers reported in 2006. One human rabies case was reported from Minnesota during 2007. Although typing of the rabies virus variant in this case was not possible, an investigation of this case indicated a bat as the most likely source of exposure.

I have a longer article at my web site:  http://www.rogerknapp.com/medical/rabies/Rabies.htm

A couple of points:

 1.      More than 55,000 people, mostly in Africa and Asia, die from rabies every year - a rate of one person every ten minutes.

2.      Although rabies in humans is rare in the United States (only one case in 2007), as many as 18,000 Americans get rabies shots each year because they have been in contact with animals that may be rabid.

3.      For many types of bite wounds, immediate gentle irrigation with soap and water or a dilute water povidone-iodine solution (Betadine)  has been shown to markedly decrease the risk of bacterial infection and rabies.

4.      You cannot feel the bite of bats so if there is a bat found in the house, everyone should get vaccinated.  If the bat can be safely caught, then have the bat tested for rabies.

5.   Bites from cats or dogs from families (not strays) you can observe the animal for 10 days before getting shots.

6.      The vaccine is not 21 shots in the stomach any more.  It is 4 shots in the arm and as painful as flu shots.  The emergency room and county health clinics are the places that carry vaccine.  The average doctor does not have it in his office. 

CDC pamphlet on the rabies vaccine

 For bite care and vaccine information:  http://www.cdc.gov/rabies/medical_care/index.html

 Video of child dieing of rabies.  Caution, this is not pleasant: http://www.youtube.com/watch?v=iO_E1SO8_io&NR=1

April 27

 Kid’s self-esteem.

I think most of us parents worry about our children’s morals and for them to grow up into fine honest respectful adults.  In our effort to make them perfect, even though we are not perfect, we tend to be too critical of our kids.  I know I used to correct the minor errors when my kids drew pictures, cleaned up their rooms and such.  They would bring home a school paper that they were proud of doing.  I would say what a great job but then point out the minor errors.  If they do a job that is good for their age, then praise them and drop it.  They will make careless mistakes in their school work and chores around the house… just like we make careless mistakes at our work or personal checkbook. 

One of our sons took violin lessons at age 5.  The Suzuki instructor told us never to criticize… only praise him that he is doing better.  So the first lesson he grabbed the violin and bow in his fists and scratched the strings.  Sounded like a cat dieing.  She clapped and said you are doing well.  I’m thinking “I paid $15 dollars for this?”.  We go lessons once a week but the parent has to do the lesson the other 6 days.  So as time goes my wife performs most of the lessons.  Occasionally I would be off and do the lesson.  Being a doctor and needing to be precise, I tended to be more critical.  The violin is hard since just a few degrees off and you are on the wrong string.   So I tended to fuss at him: “You finger is on the wrong string!   Move it over!!!” and his reaction was to put it down and frown.  Then I would remember the teacher’s instructions so I would say: “you were close …. Keep up the good work.  You are doing better.”  After 6 months he was playing Twinkle Twinkle flawlessly and in 2 years playing Bach and Beethoven.  Never being critical… just encouraging him to do better.  So when your child tries to pick up their room and misses some items on the floor, don’t be critical of the errors and mistakes.  He did do a good job for an 8 yr old.  He isn’t 25 yr old.  Just ignore the mistakes and complement him.  Go in there later and pick up the things he missed. Or go in there later and pickup the things they missed.  Compliment them that they did a good job of cleaning the room and they will continue to do a better job as they get older.

 Never say anything negative in your child’s hearing range.  They hear every word even though they look like they are not listening and just playing over there.  It really is more effective in what you say to others in your child’s presence rather than what you say directly to them.  And you should tell them you think they are smart, etc.  But if you are talking to Grandma on the phone or in person telling the bad things you child has done, they are getting the impression of poor self-esteem.  But if you are bragging about things they did well, then they are over there thinking that they are a wonderful person.  If you need to complain and gripe about the bad things, do it when they absolutely cannot hear you.

 Also if the child is starting to lie or do things that are not proper and moral, then brag to everyone in their presence how they are honest and never lie.  Now they have to try to live up to your expectations.  And you are drilling into their mind that “I am honest and don’t lie”.  We tend to complain how the child lies all the time and you are instilling that attitude into their minds.   You could try the reverse and brag how good they are to other people in their presence. 

 May 8

 Programs that claim to make children safe in water or safe from drowning are misrepresenting what is possible and are giving parents a false sense of security about their child's safety in the water.

Swimming skills (as, the ability to perform standard swimming strokes) should be distinguished from water safety skills (as, survival flotation, energy conservation "swimming," or poolside safety behavior). Without specific training, children can perform rudimentary swimming movements in the water sometime around their first birthday." The types of swimming movements a young child first demonstrates are not traditional strokes, such as the front crawl, but are more basic movements similar to the dog paddle. The optimum time to master more complex skills of swimming  can be acquired more readily once motor development has reached the 5-year-old level. Although some children may acquire swimming skills earlier, Parker and Blanksby found that children younger than 4 years require longer instructional periods to learn skills and are limited by their neuromuscular capacity. Therefore, having children begin swimming lessons at an earlier age does not translate to a more rapid mastery of aquatic skills or a higher level of swimming proficiency compared with those taking lessons at a later age.

When instruction attempts to optimize learning by reducing fear of water, children may unwittingly be encouraged to enter the water without supervision.  There is a risk of hypothermia and because they swallow too much water, they can have a seizure from water intoxication.

Regardless of an infant's or toddler's apparent level of comfort and competence in or around water, constant close supervision by an adult is necessary to prevent drowning and near-drowning. Even a brief lapse in supervision can have tragic results. The concept of "touch supervision" has been advocated, which requires the caregiver to be within an arm's reach or able to touch the swimmer at all times.

RECOMMENDATIONS Until more clear-cut scientific evidence exists on the effects of infant and toddler aquatic programs, the AAP recommends the following:

1. Children are generally not developmentally ready for formal swimming lessons until after their fourth birthday.

2. Aquatic programs for infants and toddlers should not be promoted as a way to decrease the risk of drowning.

3. Parents should not feel secure that their child is safe in water or safe from drowning after participation in such programs.

4. Whenever infants and toddlers are in or around water, an adult should be within an arm's length, providing "touch supervision."

5. Hypothermia, water intoxication, and communicable diseases can be prevented by following existing medical guidelines and do not preclude infants and toddlers from participating in otherwise appropriate aquatic experience programs.

(Keep small infants exposure to cold water very short until their body is larger after 18months old. Take their temperature after swimming and be sure it does not go below 97 degrees.  If the infant starts shivering, immediately take them out of the water, dry them off and warm them up.)

 Also remember to use swim shirts, sun screen and insect repellants.  These are safe after 6 months of age.

 PS.  Another study came out showing Baby Einstein DVD had no effect on the baby’s development.  It is the parent that makes the difference.

 Roger Knapp MD

 June 11

 Summer is here.  Keep up the sunscreen, swim shirts, and bug repellants.  Deet in Off is safe down to 6 months old.  If they get bites, put Lanacain cream or antibiotic cream with anesthetic component on them.  A tick has to stay on you for 48 hours for diseases to be transmitted.  So check every night for them.  Get them off by gently scraping with credit card until they let go or gently pinch with your fingers and steady traction until they let go.  It is too hard to judge how hard you are squeezing with tweezers.  If you do leave the head in the skin, it will not cause any more disease than has already occurred.  Watch for redness around the bite.  Most of the time the parent brings in a child with a "spider bite", it turns out to be just a boil with Staph.  They are dime size or bigger and dark brown/black.  Bring them in with those "spider bites".  We do not recommend swim lessons until 3 years old.  I like the rubber swimming pool with 1 foot of water in the back yard.  Also if you or the kids are allergic to poison Ivy, if you will come in right away and take a sudsy bath and put clothes in the washer, you usually will  not break out.

 Lets have a fun and safe summer.

 p.s.   Studies show there is less MS in adults who had more VitD and sunlight as a child.   So keep up the vitamins like I have been preaching.

 Dr. Roger Knapp MD

June 27

 This is the time of the year for camping and mosquitoes and ticks.  You can use repellants starting at 6 months but use 20% deet or less.  Here is an EPA list of approved repellants and how many hours they last:    Insect Repellants  (click on “view all” at the lower left.)

 We see several cases of encephalitis every summer so spray down the kids.  And of course some day the news will blow up the disease Dengue Fever.  It is a viral infection from mosquitoes and is moving into South Texas from Central America.  Dengue Fever

 Ticks have to be imbedded in your skin for over 24 hours to cause infections like Lyme Disease so check the kids and yourselves every night.  It is less common here and more frequent as you to North East toward the New England states.  Many people recommend tweezers to remove ticks but I like to use my finger-thumb pincher with steady pulling until the tick lets go.  You can squeeze too hard using tweezers.  Some recommend using a credit card scraping action.  Do not use liquids or heat!

 Signs of infection: Lyme Disease Pictures

 Roger Knapp MD

 ps.  Want a cool but wild birthday candle :   see www.happybirthdaycandle.com

 July 7

 Some People have not heard of this and many not even believe it.  It is rare but good info to know.

 Commotio Cordis is a gentle blow to the chest in just the right part of the heart beat and it causes the heart to go into fibrillation.  Immediate CPR and shocking in 3 minutes will save the person.  

 Although reported as the second most common cause of sudden cardiac arrest in young athletes, commotio cordis is believed to be underreported and underrecognized. The US Commotio Cordis Registry (USCCR), in Minneapolis, Minnesota, reported that as of September 2001, only 180 cases had been documented. Up to 62% of these cases involved engagement in organized, competitive sports, 66% of the patients were younger than 16 years of age, and 80% were male. The oldest reported case was that of a 20-year-old man struck in the chest by a baseball, and the youngest case was that of a 7-week-old crying infant struck in the chest by his frustrated father. Eighty-one percent of cases involved a blunt, precordial blow from a projectile object propelled against a stationary chest wall, resulting in a relatively localized area of contact. It is notable that those who are most susceptible to commotio cordis are young athletic males. This is probably the result of the fact that there is less protection of the heart by subcutaneous fat, muscle bulk, and fully ossified ribs, all of which become more common in adulthood.

A baseball accounted for 53 of the cases, with a softball 14 and a hockey puck 10 cases.  Other documented sporting cases have been caused by blows delivered by body parts, such as an elbow, knee, foot, or fist hitting the anterior chest wall (5-6 cases of each). Finally, daily activities, including parent-child discipline (5 cases), and even a fall from monkey bars (1 case), can lead to commotio cordis. Regardless of the mechanism, impacts resulting in commotio cordis are typically of low energy and velocity between 25 and 30 miles per hour. The victim may collapse immediately after the blow, but in up to 50% of cases, there is a short delay (less than a minute) between the impact and collapse.

When the speed is over 50 miles per hour, however, the likelihood of ventricular fibrillation actually decreases, although the possibility of heart muscle bruise becomes greater. Furthermore, the authors stated that the impact must be directly over the heart near or just to the left of the

The use of a standard baseball leads to the incidence rate reported above, but if the core of the ball is softer, then the rate for ventricular fibrillation drops.

Not all impacts to the anterior chest will lead to the ventricular fibrillation observed in commotio cordis. The impact must be delivered in the exact part of the cardiac cycle 

Regardless of the cause, if a young athlete goes into sudden cardiac arrest, CPR should be implemented immediately. Among sports-related cases of commotio cordis, 15% of patients survived. When CPR was instituted within 3 minutes of the impact, 68% of patients survived; however, if CPR was delayed by more than 3 minutes, only 3% of patients survived.  With an AED recognizing ventricular fibrillation at a sensitivity of 98% and a specificity of 100%, defibrillation within the first 3 minutes can increase the survival rate by an additional 50% or more, yielding a survival rate of 46% at 4 minutes and 25% at 6 minutes. The USCCR has recommended that all athletic venues have an accessible AED. Preventive measures for commotio cordis include parental education, softer baseballs, and protective padding of an athlete's precordium.

 July 11

 Recently they announced that Walgreen’s was going to sell genetic tests for many diseases.  Then they decided to not sell it pending FDA approval.  I do not recommend it since they are not accurate and can give you a false sense of security in making you think you will not get the disease or a false sense on doom that you might get the disease.  It also may have implications for the person to get a job or insurance later in life.  The only gene testing I recommend is the BRACCA gene for breast/ovarian cancer and I have sent newsymails on this in the past.

 Also: I (and the AAP) do not recommend saving your newborn's cord blood for future stem cells.  See web site for reasons.

  Also: if you have a Mr. Coffee and the coffee pot spills when you pour it, there is a better way so it does not spill.  Use your thumb to lift up the lid slightly when pouring and it will not spill.   Have a good weekend.

Roger Knapp MD

 July 16

 Many Teens ask about protein supplements in building more muscle.

 The normal protein intakes are:

 4-8yr  =  19g of protein.

9-13yr  = 34g

14-18  boys = 52g and  girls = 46g.

 During training and body building the amounts are increased.

The amount of grams for pounds of body weight for different activities are:


Training 0.5 - 0.7 g of protein/lb of body weight

Endurance  0.5 - 0.8 g/lb

Strength training 0.5 - 0.8 g/lb

Max usable protein: 0.9 - 1.0 g/lb


Therefore for the average person weighing 120 lbs

120 lb = 100 g protein in their diet.

  If one looks at the amount of protein we eat in different foods:

glass of milk, hamberger, 1 taco, 1 enchalada, ham and cheese sandwitch, one slice of pizza, 2 eggs, sausage, turkey, .... all 20 g of protein each.

fries have 7 and a steak has 36


So if you eat 2eggs and sausage, hamberger at lunch, and steak and fries for dinner (or 2 slices of pizza) and 2 glasses milk =  110 g protein.  Most teens eat more than this.  

Most teens do not need protein supplement.


If your intake is less and you need some supplement, then Whey protein is the best.


Dr. Knapp


 August 11

 There is an uproar over the article published in Pediatrics on the decreasing age of Puberty.  As usual the News horriblizes things to scare people and get viewers.  Let us go over the situation.

 In 1840, the average young woman in Europe and the United States menstruated for the first time at the age of 17; her modern counterpart reaches the age of menstruation at about 12. Well known to biological anthropologists as the "secular trend," this decrease in the age of sexual maturity has proceeded at the rate of four months per decade. (Long before chemicals in food, cows milk, or plastic.)

Boys and girls now experience puberty at younger ages than previous generations. In general, girls enter puberty between ages 8 and 13 and boys enter puberty between ages 9 and 14. The reasons for earlier menarche in girls are not well understood. Most of the change is attributed to better health and nutrition in the early 1900s and attributed to the increase in obesity during the last 50 years. In North America age at menarche decreased by three to four months each decade after 1850; in 1988 the median age at menarche was 12.5 years among US girls. In some developing countries age at menarche appears to be decreasing even faster. For example, in Kenya average age at menarche fell from 14.4 in the late 1970s to 12.9 in the 1980s.  


 This study was paid and run by Breast Cancer and the Environment Research Centers (BCERC), established in late 2003 as a partnership with the National Institute of Environmental Health Science and National Cancer Institute.  These organizations have an agenda… especially the Environmental Health who want to blame the chemicals in the plastic or in the foods.  They will in a future have a report showing the amount of chemicals in this very small sample of children who live in the poor economic and social areas of large cities.  1/3 were Black, 1/3 white, and 1/3 hispanic.  This may not represent all of America and they did not use controls to compare any chemicals in the girls who started menarche at a normal age or even those who started late.

 They found that 10.4% of white girls in the current study had breast development, compared to 5% in the 1997 study and 23.4% of African-American girls had breast development, compared to 15.4% in the 1997 study.  However when you look at the actual data from the article, There was a 10% difference in the staging of the examiners of the breast stages and in the 8 yr olds,  there was no difference in the 8 yr old black children from 1997 and this study.

 Body mass index (BMI), which represents normal weight and obesity, was found to play a role in onset of puberty in previous studies. Girls who had breast development at age 7 were more likely to have a higher BMI. Body fatness has been linked with onset of puberty in girls.  Among 6- to 11-year-olds, obesity has increased from 6.5% in 1976-1980 to 19.6% in 2007-2008, according to the CDC. 

The researchers also collected urine and blood specimens from the girls to look at levels of compounds called endocrine-disrupting chemicals, Biro says, to see what role these environmental exposures might play in early puberty.  They said: "That would have to be speculation," to implicate the interaction of these chemicals, "But we do know BMI is doing it."

 There is also a theorized or possible association with an increased risk for breast cancer or cardiovascular risks later in life.  Some studies show a slight increase and some do not show a significant difference with earlier menarche.  ?? maybe.

 In summary, I think this is a poor study but does indicate a gradual decrease in the age of menarche.  This has been going on for a long time and not related to our environment.  If parents are concerned about the chemicals in foods, milk, and plastic bottles, then it does not hurt to avoid them.  I just don’t think it is a factor in this evolution of humans through the decades.  I do not think this difference will matter in the discussion of puberty with our children and it will not affect them psychologically.  If we are calm and matter of fact about all this, then they will also be accepting of it.  They relate to our emotional stability. If we are upset, then they get upset.  If we are “cool” then they are more calm. 

 Stay cool…..

Dr. Knapp

 Sept 1

 Bed bugs were common in the U.S. before World War II and became rare after widespread use of the pesticide DDT began in the 1940s and 1950s. They remained prevalent in other areas of the world and, in recent years, have been increasingly observed again in the U.S. because of immigration and travel as well as restrictions on the use of stronger pesticides.

 Bed bugs can live in any area of the home and can reside in tiny cracks in furniture as well as on textiles and upholstered furniture. They tend to be most common in areas where people sleep and generally concentrate in beds, including mattresses, box springs, and bed frames. They do not infest the sleeping surfaces of beds as commonly as cracks and crevices associated with the bed frame and mattress. Other sites where bed bugs often reside include curtains, edges of carpet, corners inside dressers and other furniture, cracks in wallpaper (particularly near the bed), and inside the spaces of wicker furniture.  Bed bugs can travel over 100 feet in one night, but they tend to live within 8 feet of where people sleep.  Since bed bugs can live for months without feeding, they can also be found in vacant homes.  Bed bugs live in any articles of furniture, clothing, or bedding, so they or their eggs may be present in used furniture or clothing. They spread by crawling and may contaminate multiple rooms in a home or even multiple dwellings in apartment buildings. They may also be present in boxes, suitcases, or other goods that are moved from residence to residence or from a hotel to home. Bed bugs can live on clothing from infested homes and may be spread by a person unknowingly wearing infested clothing.

 When bed bugs bite, they inject an anesthetic and an anticoagulant that prevents a person from feeling the bite. Because bites usually occur while people are sleeping, most people do not realize they have been bitten until marks appear. The bite marks are similar to that of a mosquito or a flea - a slightly swollen and red area that may itch and be irritating. The bite marks may be random or appear in a straight line. Bed bugs are most active at night and bite any exposed areas of skin while an individual is sleeping.

 Getting rid of bed bugs is not an easy process, and most cases of bed bug infestation will require treatment by a pest-control expert. A variety of low-odor sprays, dusts, and aerosol insecticides can be used to eradicate bed bugs. These must be applied to all areas where the bugs are observed as well as spaces where they may crawl or hide. Since beds cannot readily be treated with insecticides, it's often necessary to discard infested mattresses and beds.

 The pest-control expert may recommend certain forms of deep-cleaning such as scrubbing infested surfaces with a stiff brush to remove eggs, dismantling bed frames and furniture, filling cracks in floors, walls, and moldings, encasing mattresses within special bags, or using a powerful vacuum on cracks and crevices.  Try removing clutter where bed bugs can hide, applying heat treatment, vacuuming, sealing cracks and crevices to remove hiding places, using non-chemical pesticides (such as diatomaceous earth) and judicious use of effective chemical pesticides usually from exterminators

 Avoidance of infested areas is the method for prevention of bed bug bites. Recognition of bed bug infestation and proper treatment of affected rooms (usually with the help of a pest-control specialist) is the best way to prevent bed bugs in the home. Those concerned about the potential for bed bugs bites in hotels should examine hotel beds and mattresses for signs of a bed bug infestation.  Keep your suitcases up on a stand instead of on the floor. Sealing your mattress in a bed bug prevention casing can be beneficial.

 For more information



 Roger Knapp MD

 Sept 6

 Erythema ab igne (also known as "Fire stains, and "Toasted skin syndrome") refers to skin that is reddened due to long-term exposure to heat and infrared radiation.  It was once commonly seen in the elderly who stood or sat closely to open fires or electric heaters. But since Central Heating became widely used it is still sometimes found in people exposed to heat from other sources like heat packs, laptops, and hot water bottles. Occupational hazard for silversmiths and jewellers (face exposed to heat), bakers and chefs arms.     

Overexposure to heat causes a mild red rash that might be described as 'blotchy'. Prolonged and repeated exposure causes a marked redness and coloring of the skin. The skin and underlying tissue may start to thin, and sometimes sores or lesions can develop. Some people may complain of mild itchiness and a burning sensation but often unless you can see the change in pigmentation it can go unnoticed.


Treatment: The source of heat must be removed.(Duh)  If the area is only mildly affected with slight redness, the condition may resolve by itself in a few months. If the condition is severe and the skin pigmented and atrophic, resolution is unlikely. In this case, there is a possibility that Skin cancer may form. If there is a persistent sore that doesn't heal or a growing lump within the rash, see a doctor.  Abnormally pigmented skin may persist for years.


This was a new one for me.  I never heard of this until lately.

Now we are getting reports of this occurring on the thighs of teenagers who set the laptop on their lap for extended periods of time. 


See: http://emedicine.medscape.com/article/1087535-overview


Dr. Knapp

September 6

 It is Fall and we see the most Croup this time of year.  It is a viral chest cold that mainly settles in the voice box and trachea windpipe just below it.  There maybe fever with it the first few days and hoarseness of the voice.  It is characteristic with a seal bark honk of a cough.  But larger kids and adults can get it but they do not have that sound to their cough.  They have pain in their trachea with coughing.  Breathing in smaller kids can get severe and especially by the 2nd and 3rd nights.  Bring in your kids who have a seal bark cough soon so we can give them medicine to keep their airways open and you can avoid scary nights and trips to the ER.  At home you can run a vaporizer, take them into the bathroom and steam it up, put their head in the refrigerator (ha ha but it works), or take them outside and the moist cool night air will help. 

 We have flu vaccine in stock now with shots and nasal drops called flumist.  Flumist is for children 2 and older. 

 Also Neil Sperry advises putting out pre-emergents on your lawns now to prevent weeds in the Spring.  This needs to be spread NOW in North Texas.  Also furtilize now for winter.  See:   http://neilsperry.com/articles/2010/08/25/timely-tips-for-september.html

 Roger Knapp MD

 September 9

 Ah to sleep, perchance to dream.

 Now more studies show that sleep is important to all of us.  Your and your child’s health is dependant on it.  And enough hours of it.  Another study came out showing preschoolers who averaged fewer than 11 hours of total sleep in a 24 hour period had significantly lower test scores on language, early math, and literacy skills.  I guess it may be true that “early to bed and early to rise, makes a man healthy, wealthy, and wise.”  In this study children from higher socioeconomic status households went to bed significantly earlier and were 36% more likely to have a rule about bedtime.  It would be interesting to know if it was the sleep or the IQ of the parents that caused this.  We do know the strongest factor in the child’s performance in school is the IQ of the parents and especially the mother since they interact with the child more.  I do think getting enough sleep does help.  Look at the studies showing the children with sleep apnea having poor school performance.  (Yeah melatonin) 

 Speaking of sleep, a different study came out looking at high school students sleep.  Most parents will tell you teens biologic clock is delayed and they have a hard time going to sleep in the evening  and they have a hard time getting up early.   So some researchers studied teens in a school district that changed their high school hours 30 minutes later.  Those teens that said they never got enough sleep fell from 70% to 34%.  Those that reported they got at least 8 hours of sleep rose from 16% to 55%.  There was a significant and dramatic decrease in those who felt tired, unmotivated, and depressed.  Teachers reported absences and tardiness in first period classes fell in half.  Even the food services department saw in increase in healthier foods at breakfast rise form 35 to 83. 

 Be sure to take the cell phone away at 9PM.  Many teens stay up till 1AM texting under the covers. 

 Nite Nite….Dr. Knapp

October 6

Studies and research on kids and drugs and gangs are reported each year.   Their reports this year  show an increase in kids reporting they go to schools where drugs are used, kept and sold and where there are gangs.  Middle school children reporting drugs in their schools increased from 23% last year to 39% this year.  Public schools had 57% reporting drugs and 22% private and religious schools. (I am surprised that it is as high as 22%.)  Gangs were reported 46% in public and 2% in private schools.  Schools that the teens reported drugs and gangs, as compared to those schools that don’t, they had more smoking (23% vs 2%), more alcohol use (39% vs 12%), and more marijuana use (21% vs 4%).  These teens also reported 4-5 times more likely to associate with friends who use those products.  The teens that reported not using drugs and joining gangs reported closer ties with the family.  Strong family involvement was the main factor with good relationships, their parents listened to them, they attended religious services, and they had family dinners together.  (These are the same factors in those teens with less delinquency and pregnancy.)  So turn off the TV and phones and text messages and have dinner together.  Talk and laugh and do not fuss at what they are eating.  Go camping or join in with your kids to see their sports games or be a youth leader in your religion or in scouting.  YOU will have fun and you will have less headaches with your kids not getting into trouble.


Also if you are interested in a great Pumpkin Patch, the one in Flower Mound is worth the drive.

http://www.flowermoundpumpkinpatch.com/index.html  They have pumpkins (duh) but also hay rides, bounce houses, face painting and hay mazes in which to get lost…. with most of it free. 


Roger Knapp MD

October 23

Well with Halloween around the corner, here are some scary diseases that may come into the news in the next few years.  Don’t worry about them until they get here if at all.  No treatment is available and we will get vaccines if they reach America.  Other countries do not develop many vaccines or cures for things like AIDS.  The US with it’s outstanding medical facilities produces these cures.  It is not perfect but we have the best medical care in the world.  Hopefully it will continue.


First Disease:

Chikungunya fever is a dengue fever–like illness characterized by 2–5 days of sudden-onset high fever and chills, and a petechial or maculopapular rash, mainly on the trunk. This is followed by arthralgic disease that can last weeks or months. Indeed, the root of the word “Chikungunya” in Tanzania, where the virus was first isolated in the early 1950s, comes from a verb for “to become contorted” in local dialect, reflecting the severe joint symptoms.  Neurologic manifestations in children include encephalitis, meningitis, and febrile seizures. This mosquito-borne disease mostly occured in sub-Saharan Africa and Asia. The traditional mosquito is the Aedes aegypti . But when the virus underwent a mutation, the mutant strain infected the A. albopictus mosquito, also known as the Asian tiger mosquito.  Transmission by A. albopictus was responsible for a 2005–2006 outbreak of 500,000 cases in the Reunion Islands off the coast of Africa. The outbreak then spread to India and Sri Lanka, where it caused more than 1.3 million cases.  This would be just an interesting event in a out-of-the-way part of the world except the disease was imported to Northern Italy by a traveler from India who arrived June 21, 2007; got sick 2 days later; and somewhere along the line was bitten by the A. albopictus mosquitos endemic in that area of Italy. The virus quickly established itself in the A. albopictus population. The Italian outbreak ensued.  Now as it happens, this mosquito A. albopictus is endemic throughout the Southeastern United States. The mosquito is thought to have arrived in 1985 via the port of Galveston, Tex., in a shipment of tires from Southeast Asia and has since gradually spread through much of the South. And 37 U.S. cases of Chikungunya fever imported from the Indian Ocean outbreak have been documented, including 5 viremic patients. Two of those five returned to Louisiana and South Carolina, states where A. albopictus is endemic. So perhaps a U.S. outbreak was a near miss or will more cases occur?


Second one:

Dengue (DENG-gay) fever is a disease caused by viruses spread by Aedes aegypti (rarely Aedes albopictus) mosquito. Sign and symptoms usually begin about four to seven days after being bitten.  Mild dengue fever causes high fever, rash, muscle and joint pain, pain behind your eyes, and nausea and vomiting. More-severe forms cause dengue hemorrhagic fever and dengue shock syndrome with severe bleeding, a sudden drop in blood pressure, and death.  No specific treatment for dengue fever exists, and most people recover. But if you have a severe form of the disease, you need hospital care.  Millions of cases of dengue infection occur worldwide each year. Most often, dengue fever occurs in urban areas of tropical and subtropical regions. A few cases have been reported in the United States — particularly in Texas, along the border with Mexico, and in Hawaii.



The latest threat to your health has New Delhi as its first name. A new enzyme discovered in the city is turning a number of disease- causing bacteria into superbugs, posing a new threat to global health.  The enzyme called 'New Delhi metallo- beta- lactamase' or NDM-1 makes several serious infections antibiotic-resistant. It has been isolated from bacteria that cause a number of diseases ranging from urinary tract infection to pneumonia. It can make all of them resistant to our best antibiotics leaving you with no cure.  What is alarming is that the new threat is not limited to hospitals or to one city. NDM-1 has already been found in over 100 patients who suffered various bacterial infections in a dozen cities across the country and has even spread to the UK, the US, the Netherlands, Australia and Canada through people who had traveled to India for surgery or treatment.  The enzyme is "extremely mobile" because it can jump from one bacteria to another in the environment. Even more disturbing is the fact that most of the India isolates were from community acquired infections, suggesting that NDM- 1 is widespread in the environment.  Experts said this will cause morbidity and mortality due to these infections to go up significantly if this germ enzyme spreads.   The World Health Organization is trying to contain it.


Have a safe and scary Halloween.

Roger Knapp MD

October 26

Well I hope everyone has a safe Halloween.  Here is a recipe from Disney World.  It is from the
restaurant that is on the right just as you go in the gate of the Magic Kingdom.  We personally got this from 
one of the chefs so I it is true and not an urban legend.  So if you have left over pumpkin, you 
might try this. It was delicious.

Dr. Knapp
Tony’s Town Square Restaurant
Walt Disney World

Pumpkin Soup



                        Pumpkin                                 3 ½ Lbs

                        Curry Powder                        1 Tsp              

                        Onions (Diced)                       13 Oz             

                        Carrots (Diced)                      13 Oz

                        Butter                                      4 Oz

                        Heavy Cream                          1 Qrt               

                        Salt                                         To Taste

                        White Pepper                         To Taste




                        Crème Fraiche                        1 Cup

                        Cinnamon                               1 Dash

                        Nutmeg                                  1 Dash



Place all ingredients in a pot except for the cream and let simmer for one hour.

While cooking the soup assemble garnish by mixing all together.

Puree the soup and finish with the heavy cream.

November 8

My opinion about education in America today.


We all have areas and talents in which we are good and not so good.  It seems that we spend a huge amount of time working on our weaknesses and very little time on our strengths when that is what we will be doing in life later.  So a child who has poor handwriting will spend hours in physical therapy.  Or the slow reader will spend many hours in Resource class working on reading skills (or get labeled as autistic!).  For example, Albert Einstein did not say two words until three years old and was very dyslexic in school.  He was great in math and physics and did wonderful things things.  Also his handwriting was atrocious.  But in our present education system, he would not be promoted or spend so much time in physics class because he had to spend hours in reading class and occupational therapy.   He has to be perfect in everything.  Or Michael Angelo would not become a great artist because he would not have been allowed to go to art class because he was very poor in Math.  That is why I do not agree with No Pass No Play.  I understand what it is trying to do… get these kids an education.  But there must be a better way to encourage them.  Sports is not a fun game anymore.  It is a future job and they make more money than I do.  Why would you not let them learn a sport just because they can’t read so well?  Same thing with band or orchestra.  All of us need to work on our weaknesses but not so much that it ruins our self-esteem.  But it should be in better balance.  Work less on our weaknesses and more on our strengths.  All of us mature at a different rate in different areas.  The slow reader will eventually improve during the years with extra practice.  Is it necessary to go to a special school where they get hours of special help learning to read faster... so he can be perfect in everything?   So let us work on our weaknesses but remember most of our improvement is limited by our brain’s maturation.  It cannot be forced any quicker.  Have patience. 


Roger Knapp MD



Also I have mentioned for years that a great place to take the kids for a Santa picture is Bass Pro.  He is a wonderful Santa and you get a free picture.  There are games to play, free crafts that you can take home, and in the back right corner near the boats is a reindeer merry go round.  Too cute.  But so many people have figured it out that they now give tickets to come at a certain time to get the picture.  That way you do not have to stand in line very long and can to shopping or eat at the restaurant Big Bucks.  It is very good. 


See this site for complete information: http://www.basspro.com/webapp/wcs/stores/servlet/CFPageC?storeId=10151&catalogId=10001&langId=-1&pageID=4638&cm_ven=redirects&cm_cat=mktg&cm_pla=store&cm_ite=santa


For times see here:


November 20

Recently workers in NY City who were cleaning up ground zero received money for lung injuries.  They breathed the dust and fumes without proper protection.  So parents ask when can they bring the baby back into the house after painting a room.  The answer is when you cannot smell anything.  Same thing when you have the house sprayed for insects.  I worry about people who breath the fumes of hair spray much less indirect smoke if there is a smoker in the house.  If you can smell it… it most likes is not good for you.  If you live beside a chemical plant and the air smells bad… move. (duh) 


Roger Knapp MD

p.s. The FDA has taken Darvon and Darvocet off the market and if you have some in the house… destroy it.

December 10

For years we gave a DaPT at 4 yr old and after that only gave a tetanus booster.  But many infants were getting Whooping Cough (Pertussis) from the adults around them.  It turns out many adults get whooping cough because their immunity wore off.  So around 5 years ago they developed an adult TdaP to be given at 12 yr old and recommended for all adults up to 65 yr old.  The OB doctors  started giving it to mothers who delivered a baby and recommended the other adults who come in contact with the baby get one as well.  I got the vaccine when it came out since I don’t want to cough for months and sure do not want to give it to my patients, kids, or grandkids.  All adults should get it since most of us come in contact with infants in our daily lives.  While Tetanus is quite rare in America, Pertussis is common.  Two years ago there were 13,000 cases reported but it probably was 10 times that since many go undiagnosed or unreported.  There was a big outbreak in California this year with 6000 cases this year alone and 10 deaths in infants.  It may be a result of too many people coming into America from other countries and not vaccinated.  The babies are not fully immune to Pertussis until 6 months and 3 vaccinations.  So all you adults go get vaccinated.


Speaking of one age group being vaccinated to protect another age group, there were interesting statistics from the flu epidemic last year.  The CDC recommended for the last several years that all children be immunized for flu and not just those at high risk.  The reason is to not only have them not get sick and parents miss work, but also not give the illness to the adults in the family.  It also worked in the other direction.  The study last year showed that the rate of infants and children being admitted to the hospital for the flu and it’s complications were cut in half if the adults in the home were immunized.   (Also the rate of hospitalization was doubled if there were cigarette smokers in the home.)  Since we cannot vaccinate infants for flu until 6 months, we recommend the other members of the family get vaccinated for the flu.


Roger Knapp MD


Great history of Santa Clause at the History.com site:


December 22

Here are the 12 medical days of Christmas.


1.  A study just released showed Echinacea did nothing for the common cold. The FTC says to be wary of ads that include the following claims: No Diet! No Exercise! Eat Your Favorite Foods and Still Lose Weight! Scientists Announce Incredible Discovery! Revolutionary European Method! Ancient Chinese Secret! Absorbs Fat! New Scientific/Medical Breakthrough! Our product cures many different kinds of ailments! And any ad that describes the product as 'incredible,' 'a miracle cure,' or 'a breakthrough' should be viewed with suspicion.


2.  Preschoolers watch too much TV.  The recommendation is 2 hours maximum TV a day for preschoolers.   Too much TV is associated with Cognitive, and speech delays, aggressive behavior, decreased academic performance and obesity.  Studies found excessive TV viewing in 52% childcare centers, 70% head start, and 87% of children staying at home. 


3.  Head lice in children should not keep them home from school.  It takes 4-6 weeks for the head lice to be noticed.  The no nit policy should be abandoned.  Once treated, they should return to school immediately.  Treatment with OTC pyrethroids usually works well.  Also see web site for applying greasy creams/oils and using hair dryers.  There is also a medication now approved called Ivermectin.  Retreating once a week for a few weeks will also help.  Also treating others in the family is a good idea. 


4.  Studies showed those who were physically fit and exercised weekly had a 50% decrease in colds and infections.  It is hard to say if the exercise caused it or the persons with a healthier body were able to exercise.  But it is a good idea to get exercise for your heart and you feel better.  It helps you loose weight and especially men are less gripey if they exercise.... they get rid of that tension and that pent up energy.


5.  A vaccine for C. difficile bacteria that infects the intestines is on a fast  track to be approved and manufactured.  If you are not familiar with this, thank goodness.   If you are ... sorry you are having difficulties.  It is hard to say when we have it and who they will recommend get it.


6. New study showed that DHA taken during pregnancy did not improve IQ in children later on.  But it does not hurt so keep it going.   There are some studies suggesting less preterm babies but hard to tell if that was a true finding.  Take multivitamins and give it to your kids.  Kids need one with iron and zinc so forget gummy vitamins.


7.  Watch out for Salmonella bacteria that causes diarrhea.  It is in most pet turtles, lizards, and frogs.   Sanitize your hands after handling them.  Also the most germs in town are on the cart handles in the stores.  Wipe down those handles when you get a cart.  Most stores now have them at the front.


8.  Car seats for children until they are 4ft 9in.  That is usually an eight year old.


9.  Keep the day in balance.  Give your kids adult stimulation by reading with them and playing board or card games.  Part of the day have electronic stimulation like TV and video games.  But also part of the day turn everything off and tell them to go find something to do.  If the are constantly stimulated by outside things, then they cannot sit and think about things on their own and output ideas.  Go play outside or play with your toys.


10.  Fever at the beginning of the cough and cold is a virus.  Secondary infections occur typically 5-7-10 later.  Watch for fever or ear pain/crying at night during the second week.


11.  Injuries like toddlers falling and hitting their head or older kids with sprang ankle or jammed finger need compression and not ice.  Hold their head for a few minutes or wrap the ankle or finger in tape for 12 hours.   Try to keep it from bleeding inside the body.


12. Mistletoe is a poison.  Kiss under it but keep the seeds and plants away from small children.


Merry Christmas.

Dr. Knapp



Christmas lights on youtube:


Flu season is here.   We are seeing a slight increase in cases.  Half of the flu now is type A, half type B, and 5% H1N1.  I guess everyone susceptible had already contracted it last year since we are not seeing very many cases.   The tests for the flu are not very accurate.  The tests only detect 40-70% of the cases.  It also has some false positives where the tests are positive but it is not the flu.  So some times we will test for the flu but the CDC tells us to use our clinical judgment and if it looks like the flu, then treat it as if it is the flu …. irregardless of a test.  So if the person has all the symptoms of the flu, why test if the doctor is to treat it.   Now most people should not be treated.  The recommendations are to treat the high risk patients and not treat the others.   You have to treat it in the first 48 hours to be effective.  That is because the mediations only shorten the illness by one day!!!!  And there are rare psychiatric complications in teens.  The main worry is the pneumonia which is signaled by fever after the fourth day.  And take vitamins with Zinc every day so your body can fight off both the flu and pneumonia.   It helps the immune system.  


Here is a graph of the cases during the last few years.   It starts in Jan through Dec. 


The black spike was the normal flu in 2008.

The large grey spike was 2009 H1N1 epidemic. 

Notice there is not a red spike for this year.

There will be a small spike this winter in 2011.


For more information.

See: http://www.cdc.gov/flu/weekly/



Happy New Year. 

Dr. Roger Knapp MD