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Newsymails sent out in 2015



Painful urination (Dysuria)

Children can have symptoms of stinging when they urinate.  It is called Dysuria and can be a sign of infection.  But 90% of the time it is just irritation caused by soaps and/or poor hygiene.  The kids become potty trained and want to go to the restroom by themselves.  Then they do not wipe or wrong direction.  You will go in there and they did not flush and there is no paper in the toilet.  The girls will have a little odor and periodic chafing which will cause occasional stinging when they urinate.  But the next time they urinate it does not.   That is not an infection.  A urine infection will cause all day long burning, frequency and accidents.  There can be some white cells in the urinalysis from irritation but the culture is what will prove infection.   Do not accept a urinalysis to diagnose urine infections… request a culture.  Also cleaning their private area too vigorously with chemical wipes can cause irritation.  Swimming a lot in the summer and riding trikes or bikes with the sweat and friction can cause irritation also.  Past 2 years old I do not recommend baby soaps, fragrance soaps, or any products that causes bubbles on the surface of the water.  They remove the protective mucous lining of their privates.   Use Dove or Oil of Olay unscented bar of soap.  Put Vaseline or A&D ointment down there if it becomes chafed and if it is getting irritated every week, then put a thin coating of ointment down there after every bath.  It will be several years until they take better care of that area.  Males can be irritated also and especially if not circumcised.  Plus it is hard to potty train them if it hurts.  There is no therapy for the symptom but the ointment or warm tub bath.  If it is all day symptoms then see the doctor.



I am sure you heard about the outbreak of Measles from the Disney Theme park.  Most cases were unimmunized people.  The vaccine does not work in 100% of people but if 90% are immune then we do not see an outbreak of illness.  There is a thing called herd immunity.  Herd immunity theory proposes that, in contagious diseases that are transmitted from individual to individual, chains of infection are likely to be disrupted when large numbers of a population are immune to the disease. The greater the proportion of individuals who are resistant, the smaller the probability that a susceptible individual will come into contact with an infectious individual.  For most diseases if 85% are immune to a disease then there are no major outbreaks of the illness.


The chart below shows the number of cases of Measles over the last 13 years.  There was a huge increase last year.  The Philippines is experiencing a large, ongoing measles outbreak then and many of the cases in the U.S. in 2014 have been associated with cases brought in from the Philippines.  In 2011, more than 30 countries in the WHO European Region reported an increase in measles, and France was experiencing a large outbreak. Most of the cases in America that year were brought in from France.  The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people.  So those who do not vaccinate are risking their children and endangering our infants below 1 yr old who have not had their MMR. 



Talking about “M” diseases…. What about Mono!  Infectious Mononucleosis is more frequent than you might think.  We used to say it was strictly teenager kissing disease (altho most are from sharing drinks).  Our old fashioned blood test was not very accurate and about 15-20 years ago we got a more accurate one.  By 5 yr old 50% of kids have had mono.  It is very mild and not diagnosed often.  By 26 yr old, 90% have had it.  Probably most of the other 10% will get it later.  So I will see a patient with a horrible throat and start antibiotics.  But I warn the mother it also could be mono and if they are not well in 24-36 hours… it is viral and probably mono.  There aren’t any strep resistant to penicillin/amoxicillin.  5% of kids carry the strep all year and they can have a viral sore throat with a positive throat culture.  The Strep was not the cause of the sore throat.  So when not better in 2 days the doctor changes the antibiotic thinking it is resistant and starts a different antibiotic.  The viral sore throat finally gets better and everyone thinks it is a result of the new antibiotic.  Interesting huh?



Taste preferences can change food preferences.  A study showed bitterness in food triggers an inborn aversion to certain foods that is responsible for dietary choices in children and adults.  Unpleasant taste such as bitter or sour evolved to detect potentially lethal compounds such as plant metabolites or toxins.  Salty taste developed to ensure ion and water balance.  Good taste such as sweets and meats elicited by energetic compounds with carbohydrates and proteins supplied more safe energy.  Certain tastes are detected by the four different taste buds on the tongue and receptors on the palate.  Sweet and bitter are recognized by protein receptors and Salty and sour are detected by ion channels.  Some people are hypersensitive to bitter or to wide spectrum of flavors.  They tend to have more restricted diets compared to those with less sensitivity.  These receptors also decrease as we get older and we broaden our diets as we get older.  Definitely children’s diet is different than adults.   Some kids like vegetables from birth and some like sweets from birth.  There is a debate whether one can get used to those tastes that we naturally dislike.  Many kids start out liking vegetables but as they get to school age then prefer meat and potatoes.  Can you give vegetables starting at 6 months and keep giving it to the child every day so they get used to that taste???? I don’t know.  But definitely there are people who have their preferred tastes and it changes with age.  See my article on Picky Eaters at the web site.

Roger Knapp MD

What is difference between broccoli and buggers?   Kids will eat their buggers.   J



Parents come in and complain that their child is stubborn, shy, not speak to strangers, or has a temper.  Every child has a different personality from birth.  Look at your own brothers or sisters… totally different even though same parents and family.  And sister or brother who was stubborn as a child, still is!  We as parents modify them but not change their inborn temperament.  The shy child will eventually come out from behind mother’s skirts and be more active.  They will do it at their own pace.  You have not changed your wife or husband.  You look for a person to marry who has the personality you like.  But when you have a child, God gave you that child with that personality.  So it is important as parents to accept what God gave you and not be so bent on changing them.  They will get better as they get older and with your guidance and wise advice, they will be less stubborn and make great adults as we did.  But you will not make a pessimist into an optimist.  I know there will be those of you who do not agree but think about it. By the way, this concept is true of pets like cats and dogs. 

Roger Knapp MD

You know, the advice of my parents come back to be every week.  They died many years go but their sage comments are in me and still guide me.  So the comments and wise advice you give your kids is in there but you will not see it for 20 years.  So keep telling them your sage advice even though you swear they don’t listen to you.



Most girls get their first period (menarche) between the ages of 10 and 15, but some get it earlier and some later. If not by 16 yr it still may be fine but see your doctor.  Premature puberty and you need to see your doctor if they start before 7 in girls and 9 in boys.  No it is not the hormones in food or milk.  It has been getting younger over the last 2-3 hundred years. I like the American Girl Book on puberty for girls.   They will have full development, growth, and then the cycles start.  Then they will grow only 2-3 inches more.  Boys can keep growing and even into college years …. Because they never mature.  At least I don’t plan on growing up! LOL


The number of days of a cycle is a 28-day cycle it varies from 24 to 34.  It frequently is variable or even skipping months for the first year and a half.  While irregular periods are common among teenage girls, an underlying hormonal disorder may be to blame if this problem persists.  Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that is characterized by an excess of androgens or male hormones in the body. The imbalance of hormones interferes with the growth and release of eggs from the ovaries, which can prevent ovulation and menstruation. PCOS can be overlooked because irregular periods are normal in teens but if erratic menstrual cycles persist later into the teen years, girls should see a specialist to determine if something else might be causing this issue."  Other symptoms associated with PCOS can include weight gain, hair growth on the body and face, thinning of the hair on the head, acne and infertility. Women with PCOS are at risk for high blood pressure, high cholesterol, endometrial cancer and tend to become resistant to insulin.

Sometimes we and the GYN docs will cycle them with hormones and that is safe in teens.   They will also give them hormones if their periods are horrible and flooding or if severe acne.

Anyway…. Hope you had a good Valentines.


Silicosis is lung damage from breathing in fine dust from silica.  Silica is from sand and is used to make many glass objects. 

A silica-based aerogel was used in the Stardust spacecraft to collect extraterrestrial particles.  Silica is also used in the extraction of DNA and RNA due to its ability to bind to the nucleic acids

A statistically significant decline in silicosis death rates was observed during 2001–2010 but some deaths still occurred among persons aged 15–44 years. It is now rare but OSHA continues to educate  at-risk workers and their employers regarding the exposure.  Approximately 2 million U.S. workers remain potentially exposed to breathable crystalline silica

HOWEVER crystalline silica is used in hydraulic fracturing in the production of underground  tight oil and shale gas, a use which presents a health hazard to workers. In 2013 OSHA announced tightened restrictions on the amount of crystalline silica which could be present and required "green completion" of fracked wells to reduce exposure.  So we now have to worry about earthquakes and toxic fumes from these well.  All for cheaper gas.



Roger Knapp MD

 P.S. Flonase ... a nasal spray with steroid is now over the counter.  Hopefully a generic soon.  It helps nasal allergies and the trees are starting to bloom now.  Also Zaditor eye drops for allergies. 



Another silly report in the press.  “Washing dishes by hand will cause fewer allergies!” 
WHAT!! Get real.  This study was done in Sweden on 7-8 year olds.  Those families who did dishes by hand had 23% eczema compared to 38% of those with dish washing machines.  But it did not change the incidence of other allergy problems like asthma. These families were also in lower socioeconomic class and higher number of immigrants who are also linked to fewer allergies.  Several other studies have linked lifestyle factors like having pets and living on farms to lower allergies.  So hand washing your dishes is not going to help your hay fever. 


Now they are talking about peanuts.  It is true earlier introduction of these allergenic foods can decrease allergies.  Even eating peanuts in pregnancy can lower their risks of peanut allergy.  I have recommended for many years starting allergenic foods like peanut butter or eggs starting at 6 months…. just make sure it is in a safe condition where they cannot choke on it.  We used to wait until 2 years to start them on the allergenic foods and they had higher risks of the allergies.  That is why you hear about so many people allergic to peanut butter is because we waited later.  Giving it younger caused them to identify the protein as self-proteins rather than foreign proteins.  There is now a patch with peanut protein in it that is worn and causes you to be able to eat it.  Awesome!


I think I am allergic to the cold… I am ready for Spring.  I’m just not crazy about the tree pollens.



In 2012, a study was reported involving 2358 children with radiographic evidence of pneumonia. 21% required intensive care, and 3 (<1%) died. Tests were run to determine the cause of the pneumonia. 


A viral or bacterial pathogen was detected in 1802 (81%),
one or more viruses in 66%,
bacteria in 8%,
and both bacterial and viral pathogens in 7%.


The x-ray only shows mucous or congestion in the lung but does not differentiate between viral chest cold, allergy asthma, or bacterial pneumonia.


The annual incidence of pneumonia was 15.7 cases per 10,000 children with the highest rate among children admitted to the hospital were younger than 2 years of age. 

Respiratory syncytial virus was more common among children younger than 5 years of age (37%) than among older children (8%),

adenovirus 15% vs. 3% in older

and metapneumovirus 15% vs. 8% in older.

Mycoplasma pneumoniae (Walking pneumonia) was more common among children 5 years of age or older (19%) vs younger children (3%).


30 years ago there would have been mostly bacterial pneumonia but with the HIB and Prevnar vaccines, it now is only 15% bacterial pneumonia. Vaccines prevent pneumonia and meningitis.


So the x-ray will be read out as “pneumonia” meaning there is some white stuff in the lung field of the x-ray.   But what is it?  Generally kids get a lung injury from asthma attack, or viral chest infection, or smoke inhalation or some insult to the lung.  Then the bacteria infect the mucous and it generally starts with fever the second week of the cough or cold.  Fever the first week is usually the viral chest cold or flu.  Watch for fever the second week of your child’s cough/cold. It still is very uncommon if you vaccinate your children.



Headlines: Burger King Quietly Drops Sugary Soft Drinks From Kids’ Menu

I love it.  There is the same amount roughly of sugar Fructose in both soft drinks and apple juice.  Sounds healthy or “natural”… NOT.  Same thing.  Like my brother-in-law always says: “It is not the deal you get but the deal you think you get!”   So true.  See this web site for a discussion and comparison: Fruit Juice Vs. Soda? Both Beverages Pack In Sugar, Health Risks




When mothers do not or cannot make enough breast milk, some have purchased breast milk on the internet. (really?) There is a regulated breast milk bank in America which pasteurizes it to kill viruses and bacteria, and it is tested for bad diseases like Hepatitis C, Hep. B, CMV, and HIV aides.  However, one study found 21 % of privately sold breast milk on the internet had CMV.  Giving someone else’s breast milk is like giving the other person’s blood to drink.  I am a big breast man J but the pros and cons of breast vs formula is not that huge.  My recommendation: if you can’t breast feed, then feed them formula.  I and the American Academy of Pediatrics do not recommend purchasing internet breast milk.




The weather is getting better and better.  So are the pollens.  Use antihistamines like Zyrtec and Allegra.  Also there is Nasonex and Flonase over the counter nasal sprays.  For the eyes I like Zaditor eye drops.

Be sure to use sunscreen.  See: http://www.rogerknapp.com/medical/sunscreen.htm

Shirts that are UV protecting are even better. 


Dr. Knapp MD

p.s.   The CDC has made some fairly good “parenting” videos”:




Swimming season is getting close.  I am already seeing some swimmer’s ear infections.  You can usually tell it is swimmer’s ear instead of inner ear infections by grabbing the ear lobe where it connects to the head and moving it.   That will cause pain.  Once it is infected the over the counter medications will not cure it and you need to call the doctor for a prescription. 

You can prevent this infection in two ways.  Put a few drops of solution ½ alcohol ½ white vinegar after they swim.  The ENT doctors found that it was not as much the wetness as the water changed the pH from normal acid to basic and the germs grow.  The over the counter “Swim Ear” preparations only have alcohol so make your own.  Or if you have some of those drops, pour out enough to add 50% vinegar.  The other way to prevent it is by putting a few drops of olive oil in the ear before swimming. 

Swimmer’s ear is more likely to occur with swimming in lake, river, gulf or ocean and less if in swimming pool.  Also it is more common if prolong swimming rather than an hour or so.


Roger Knapp MD

p.s.  I do not recommend “swimming lessons” with babies below 1 year old.  Also watch out for low body temperature in small infants and children.  The minute the shiver, get out and warm them up.



Poison Ivy is around every summer.  If you are allergic to it then it will cause a blistery itchy rash a few days later.  If you get around it and come in right away, take a sudsy bath and put the clothes in the washer, then you will not break out much.  If you do get a rash, it is not contagious.  Studies ran experiments where we tried to spread it and could not.  We thought it spread because one area broke out in 1 day, another in 3days, and another 5 days later.  Or the person got out and came into contact with it again.  We thought we were spreading it but didn’t.   There are 10 plants out there that can give you the allergic rash but Poison Ivy is the most common.   Treat the rash with hydrocortisone.  If worse then get a stronger prescription steroid cream from the doctor.  If all over and on the face, then call to get oral steroids.  Swimming is OK with poison ivy rash and can help heal it.  Attached are pictures of the rash and the plant.


Raising children is so very difficult.  It requires hard decisions and lots of worry “are we doing it right?”  You will make decisions that you hope are the best and we always make them thinking what is the best for our child.  Sometimes we make one that did not turn out so good but we were trying to do the best for our child and not what is convenient for us.  Our parents also were not perfect and some of their actions did not turn out so good.  But they meant no evil… they were just trying the best they could to be a good parent.  If your mom &/or dad were decent parents and are still alive, write them a letter tonight.  Hand written.. not email.  Tell them how much you appreciate their love, sweat and efforts raising you.  Now that you have kids of your own you realize how hard it is.  And how much you love them and thank them.  You can’t tell them in person because you breakdown and cry.  If you can, then do it in person.  It is hard to do this when they are dying.  Do it tonight or you will forget.

Also think about writing a letter to your children when they graduate from high school or turn legal age of 21.  My Dad did and there is a copy at my web site.  It is a neat thing to do.



Well I diagnosed a case of Pertussis (or whooping cough) this week.  The vaccine has been out for decades.  First described in the 16th century, the organism was first isolated in 1906. Before 1900, 5 out of every 1000 children died of Pertussis.  From all diseases, 10% of all children died the first year and only half made it to adulthood.  The average life span was 35 years.  Before the availability of pertussis vaccine in the 1940s, more than 200,000 cases of pertussis were reported annually.  In America in 1976 vaccines had decreased the number of cases to 1,010 but now it is around 17,000 cases. 


Today Pertussis remains a major health problem among children in developing countries, with worldwide 300,000 deaths resulting from the disease yearly.  83% of the deaths are in infants less than 3 months old because it is more deadly below one year of age. 


The vaccine was developed in 1914 and the wide spread use of it in the 1940’s.  The first vaccine was called Whole Cell since the whole germ was used.  It contained 80 some odd protein antigens and had a lot of side effects.  The kids would run high fevers and not walk for a day with red swollen leg muscles.  Then in 1996 an acellular version of the vaccine was developed and it only contained 3-4 protein antigens.  Since then the reactions are minimal with no fever and minimal soreness.  But it did not stimulate very good and long lasting immunity like the whole cell vaccines.  That is why we are seeing an increase in the disease… plus the idiots out there that do not vaccinate their children. 


A recent study published in the Journal of Pediatrics reported the effectiveness of the new acellular vaccine given to 12 year olds.  It said it was 73% after 1 year and only 34% after 2-4 years from the booster TDaP.  (whole cell vaccine was called DPT and the acellular used the “a” before the P.)  I am not sure what the specialists are going to recommend in the future.  Maybe give some of the doses with the whole cell vaccine?   Who knows?  If your child has severe hard coughing and especially if rapid fire coughing 5-8 times, and sometimes vomit at the end of it, you might want to get tested for it.  Most patients do not make a whoop with it.  Croup is a seal bark cough outward.  Whooping cough sounds like a whoop breathing in after the rapid fire coughing.  Most will not have fever.  It is not very dangerous in older kids but we need to diagnose it to protect others.


Dr. Knapp  


Going to Disney world???? We love it.  Get two apps for your visit.

My Disney Experience

Magic Guide

Also go to Hoop Dee Doo Review show… lots of fun, songs, skits, jokes, and buckets of food and drinks.  Best thing there.



The Lyme disease bacterium, Borrelia burgdorferi, is spread through the bite of infected ticks. The blacklegged tick (or deer tick, Ixodes scapularis) spreads the disease in the northeastern, mid-Atlantic, and north-central United States. The western blacklegged tick (Ixodes pacificus) spreads the disease on the Pacific Coast.


Ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and scalp. In most cases, the tick must be attached for 36 to 48 hours or more before the Lyme disease bacterium can be transmitted.


Most humans are infected through the bites of immature ticks called nymphs. Nymphs are tiny (less than 2 mm) and difficult to see; they feed during the spring and summer months. Adult ticks can also transmit Lyme disease bacteria, but they are much larger and are more likely to be discovered and removed before they have had time to transmit the bacteria. Adult Ixodes ticks are most active during the cooler months of the year.

So check yourself and your kids after outdoors in weeds and forest.  Especially if you are in areas Northeast of here.


If you are really concerned there is a test kit where you can test the tick for Lyme disease called Lymenator Instant Tick Test for Lyme Disease


Here are pictures of the tick that carries lyme and the rash it can cause.


Roger Knapp MD


Also note:

SPF 15 blocks 93 percent of UVB rays while SPF 30 blocks 97 percent of UVB rays and above 30 is a sales gimmick.   Water-resistant sunscreen helps a little since regular sunscreen can rub off when the sun makes us sweat or while swimming. Water-resistant sunscreen means it will stays effective after 40 minutes but it is not water proof and you still need to put more on every few hours.




I am fairly conservative in mediations and surgery.  If  you need it I will tell you but to give medications and do surgery when not needed, it has complications.  Several studies have shown lower IQ and development with 1-3 surgeries below 4 years old.  Another study was just reported in the Pediatrics journal:  http://www.medicalnewstoday.com/articles/294966.php


Also another study came out showing how over-praising children can lead them to believe they are special people who deserve special treatment all the time.



We are starting to see swimmer’s ear.  You can tell because it hurts to touch or move the outer ear lobe.  See my web site on the treatment and prevention of swimmer’s ear. 



It’s tough to raise kids these days.  Do you send them to private school or public?  Do you let them watch which TV shows or movies?  Cell phones and when?  Do you spank or not?  There are too many gray areas  of decisions in raising kids.  Our parents had some but we have many more these days.  What you do is get as much information about these decisions as you can.  Talk to your mother, spouse, friends, doctor, and of course the internet (Yeow).   You will never know if it was the right decision.  You cannot go back and replay life.  You could think “maybe I should have married the other person” but how do you know …. They might have turned out horrible.  But the decision you make will be the best one based on the information you have.  Even though you may look back and wonder.  Sit back in an easy chair, close your eyes and do what you think is best for your child at that time.  That’s God telling you what to do if you would just listen.  The worst thing is when you get talked into what you did not want to do with your child and you kick yourself for years.  Just try to make the best choices and move on.  Don’t waste energy worrying about the past. You will never know if it was the best decision.



Excessive use of computer games among young people appears to be taking an alarming turn and may have particular relevance for American parents whose children spend many hours a day focused on electronic screens. The documentary “Web Junkie,” to be shown next Monday on PBS, highlights the tragic effects on teenagers who become hooked on video games, playing for dozens of hours at a time often without breaks to eat, sleep or even use the bathroom. Many come to view the real world as fake.


While Internet addiction is not yet considered a clinical diagnosis here, there’s no question that American youths(and adults!) are plugged in and tuned out of “live” action for many more hours of the day than experts consider healthy for normal development. And it starts early, often with preverbal toddlers handed their parents’ cellphones and tablets to entertain themselves when they should be observing the world around them and interacting with their caregivers.


In its 2013 policy statement on “Children, Adolescents, and the Media,” the American Academy of Pediatrics cited these shocking statistics: The average 8- to 10-year-old spends nearly eight hours a day with a variety of different media, and older children and teenagers spend more than 11 hours per day.” Television, long a popular “babysitter,” remains the dominant medium, but computers, tablets and cellphones are gradually taking over.


“Many parents seem to have few rules about use of media by their children and adolescents,” the academy stated, and two-thirds of those questioned in the Kaiser study said their parents had no rules about how much time the youngsters spent with media.  Parents, grateful for ways to calm disruptive children and keep them from interrupting their own screen activities, seem to be unaware of the potential harm from so much time spent in the virtual world.


Before age 2, children should not be exposed to any electronic media, the pediatrics academy maintains, because “a child’s brain develops rapidly during these first years, and young children learn best by interacting with people, not screens.” Older children and teenagers should spend no more than one or two hours a day with entertainment media, preferably with high-quality content, and spend more free time playing outdoors, reading, doing hobbies and “using their imaginations in free play,” the academy recommends.


Heavy use of electronic media can have significant negative effects on children’s behavior, health and school performance. Those who watch a lot of simulated violence, common in many popular video games, can become immune to it, more inclined to act violently themselves and less likely to behave empathetically, said Dimitri A. Christakis of the Seattle Children’s Research Institute.

Teenagers who spend a lot of time playing violent video games or watching violent shows on television have been found to be more aggressive and more likely to fight with their peers and argue with their teachers, according to a study in the Journal of Youth and Adolescence.


Schoolwork can suffer when media time infringes on reading and studying. And the sedentary nature of most electronic involvement — along with televised ads for high-calorie fare — can foster the unhealthy weights already epidemic among the nation’s youth.


A good rule to make: for every 2 minutes you read, you get 1 minute of screen time.  I had one mother turn the sound off the TV and turned on closed captions.  She said everyone’s reading became better. You can also purchase a Time's UP Automatic TV & Videogame Timer and it will automatically turn on any device for so many hours on certain days. 


Here are some teens having "fun" at DisneyWorld:  all on their phones!!!!!



Autism Spike Due Largely to Diagnosis Patterns, Not Increase in Prevalence

The results of the study were published this week in The American Journal of Medical Genetics

The rapid growth of autism diagnoses in the United States may not mean the condition is becoming more prevalent, according to a new study. Rather, the increase in autism rates appears to have more to do with changing diagnosis patterns. 


I have told many patients that Autism is not caused by vaccines and it is not increased.  There was an equal decrease in diagnoses of retardation (and other similar conditions) as there is an increase in the autism diagnosis.  Plus other conditions with decrease development (like downs syndrome) have been put into “autism spectrum”.  In addition many children slow reading have been labeled autistic to get extra help.  So most of us do not think it is truly increased.


Roger Knapp MD



Also: If you have flown much, you may have occasionally gotten a “precheck” status. Then you go through a short line, and do not have to take shoes off, or take liquids or laptops out.  Fast and easy and your kids can go with you.  You can get a permanent precheck by applying in Terminal D of DFW airport.  It is great and worth the money for the permanent precheck status.  Here are the facts:

An applicant must be a U.S. citizen or Lawful Permanent Resident (LPR) and cannot have been convicted of certain crimes. If an applicant has a record of any of the crimes identified in the eligibility requirements, they may choose not to apply, as the application fee is nonrefundable.  Interested applicants must visit an application center to provide biographic information that includes name, date of birth and address. An applicant will be fingerprinted and will be required to provide valid required identity and citizenship/immigration documentation. An applicant also has the option to pre-enroll online to provide basic information and make an appointment before visiting an application center. There is a nonrefundable application processing fee of $85.  After completing enrollment, successful applicants will receive a Known Traveler Number (KTN) via U.S. mail approximately 2-3 weeks following the visit to the application center. Once approved as eligible for TSA Pre®, the enrollee must enter the provided KTN in the ‘Known Traveler Number’ field when booking travel reservations on any of the ten participating airlines. The KTN also can be added when booking reservations online via a participating airline website, via phone call to the airline reservation center, or with the travel management company making reservations. Additionally, the KTN can be entered in participating airline frequent flyer profiles, where it will be stored for future reservations. Please make sure the name used when applying for the TSA Pre® application program matches the name used when booking travel.  TSA Pre® eligibility will be identified with a TSA Pre® indicator on the boarding pass.”



I love it when the internet disseminates false information. “Apple juice followed by olive oil to flush out your gall stones.” WHATEVER? Cures for memory and bald heads. Amazing what you read and most of it is a scam or just wrong. Use your common sense on most of this. Research it on Google’s Scholar search engine. So now Coke is the most horrible thing for your body…… “Coca-Cola Infographic”

Some whack-os talk about how bad coke is for our body.
Coke: 140 calories and Apple juice: 120. Get just as much sugar rush with both.
Caffeine in Coke: 23-35. Tea: 20-70. Coffee: 100-200.
Phosphoric acid “binds magnesium zinc and calcium”. Not enough to matter and it is in fruit juice also.

I agree that too much sugar is bad and does cause rebound low sugar if not taken with other foods. Everything in moderation…. Video games, sugar, sunlight etc.



Headlines this week:

Young picky eaters might have more mental health woes

Picky Eating Tied to Anxiety

Kids who are picky eaters might develop depression, anxiety




Well they started with 4520 children

3433 said they would allow their children’s eating to be screened

     944 screened high and 2490 were not picky

After more screening the researchers ended up with 693 normal 222 picky eaters.


The judgement of how picky was based only on what mom’s said their impression of how their child eats. And it was how the child eats for the mother and not for other people and daycare.


Statistics were based on few numbers.  For example:

Food refusal   normal 0.8%(N=2)  Moderate Picky 1.1%(N=6)  Severe Picky 3.5%(N=3)

So they were only able to show differences statistically by running statistics on the differences and not the actual numbers.


Then the Number of anxiety and emotional problems in the mothers “

Not picky= 16%     Picky = 32% had psychiatric problems

Not picky=21%     Picky = 42% had anxiety issues.

Not picky = 9%    Picky = 22% were drug users.

Many studies have shown emotional problems in moms rubs off on the child.


They looked at several psychiatric diagnoses in these normal and picky eaters:

1.    Depressive diagnoses

2.    Separation anxiety disorder

3.    Generalized anxiety disorder

4.    Social anxiety

5.    Oppositional defiant disorder

6.    ADHD

7.    Conduct disorder.

There was some statistical differences in the differences for 1,2, and 4.

But at the follow up 2 years later, there were no differences in any of these diagnoses.


So again researchers have an agenda for or against something and try to prove it in a very poor study.  Then the news reads the summary and broadcasts this.  I do think picky eaters tend to be a bit more stubborn.  See my web site on the article and video on picky eaters.



Football season is here and many kids are suiting up to play several sports.  The coaches as well as the players are wanting the kids to train hard and make more muscle.  There are many “natural” over the counter products promising more muscle, run faster, more energy, etc.  Most are usless, and some can be harmful.  The muscle milk and protein drinks DO NOT MAKE MORE MUSCLE.  But the coaches and some players are fooled into this propaganda.  The average diet has plenty of muscle and too much protein can have harmful effects.  The only product proven to help make more muscle and is safe is Creatine.  Keep at the recommended dosage of 5 gm a day …. more will not help and again cause side effects.  Just lift weights, take normal multiple vitamins, and eat healthy.  Beware of adds for products to make more muscle.  Most are lying and scams just like the products that claim to grow more hair, improve your memory, make you feel younger and stop aging, etc.


Remember my advice on injuries which is at my web site.  Fist wrap the injured area in tape and leave on for 24 hours.  Ice is the last thing you put on it.  The Dallas Cowboys wrap their joints in tape before they play knowing they will get hurt. When a player comes off the field in a lot of pain, immediately wrap the area with tape since it will swell in minutes. The recovery time in most cases is cut in half if you can keep it from swelling.



Earlier this year, the Dietary Guidelines Advisory Committee (DGAC) released a report stating that up to five cups of coffee per day, or up to 400 mg of caffeine, is not associated with long-term health risks. Not only that, they highlighted observational evidence that coffee consumption is associated with reduced risk for several diseases, including type 2 diabetes, cardiovascular disease (CVD), and neurodegenerative disorders. The body of data suggesting that moderate coffee—and, in all likelihood, tea—consumption is safe and beneficial in a variety of mental and medical conditions is growing fast.


A substance known to increase blood pressure might actually be good for the cardiovascular system. Caffeine consumption can cause a short-lived increase in blood pressure. However, when caffeine is ingested via coffee, enduring blood pressure elevations are small and cardiovascular risks may be balanced by protective properties. Coffee beans contain antioxidant compounds that reduce oxidation of low-density lipoprotein (LDL) cholesterol, and coffee consumption has been associated with reduced concentrations of inflammatory markers.  Moderate coffee intake is associated with a lower risk for coronary heart disease as far out as 10 years, and data suggest that an average of two cups per day protects against heart failure.  Finally, a study presented during a poster session at the Heart Rhythm Society 2015 Scientific Sessions counters the long-held dogma that patients with arrhythmias should avoid caffeine, finding no association between the compound and premature atrial or ventricular contractions.


According to a 2011 meta-analysis, consuming between one and six cups per day reportedly cut stroke risk by 17%.


The steamy brew appears to confer benefits to the "metabolic syndrome," the dangerous cluster of hypertension, hyperglycemia, abnormal lipid levels, and increased body fat. Numerous studies have linked regular coffee drinking with improved glucose metabolism, insulin secretion, and a significantly reduced risk for diabetes.


With so many foods thought to increase cancer risk—soda, alcohol, and grilled meats among them—at least we can rest easy when it comes to coffee according to recent data. Evidence suggests that moderate to heavy coffee consumption can reduce the risk for numerous cancers, including endometrial (> 4 cups/day), prostate (6 cups/day), head and neck (4 cups/day), basal cell carcinoma (> 3 cups/day), melanoma, and breast cancer (> 5 cups/day).


Beyond the short-term mental boost it provides, coffee also appears to benefit longer-term cognitive well-being. A 2012 study reported that patients with mild cognitive impairment and plasma caffeine levels of > 1200 ng/mL—courtesy of approximately three to five cups of coffee per day—avoided progression to dementia over the following 2-4 years.


A 2011 study suggests that a boost in coffee consumption might also benefit our mental health.  Women who drank two to three cups of coffee per day had a 15% decreased risk for depression compared with those who drank less than one cup per week. A 20% decreased risk was seen in those who drank four cups or more per day.


The liver might help break down coffee, but coffee might protect the liver in some cases. Evidence suggests that coffee consumption slows disease progression in patients with alcoholic cirrhosis and hepatitis C, and reduces the risk of developing liver carcinoma.


As is often the case, with benefits come risks, and coffee consumption certainly has negative medical and psychiatric effects to consider. Besides the aforementioned potential increase in blood pressure, coffee can incite or worsen anxiety, insomnia, and tremor and potentially elevate glaucoma risk.  Also, given the potential severity of symptoms, caffeine withdrawal syndrome is included as a diagnosis in the DSM-5.

One must assess and balance the potential benefits and drawbacks of coffee consumption. But mounting evidence suggests that going back for a second cup might not necessarily be a bad decision.

I would not have made it through Texas A&M without coffee.

See web site for caffeine content in drinks:




Halloween is a fun time of year to dress up and go around and get candy.  It is more of a costume party than any evil worship event.  And every one likes to be scared.  Look at the many movies with scare in them.  Monsters Inc.  How about Beauty and the Beast?  Around 41 million children trick or treat every year.  Most authorities recommend supervising your children until 12 years old.  But one study in 2011 found that 12% of the children under the age of 5 were not chaperoned and only 35% of the parents talked to their children about safety.  There are hazards to Halloween so let’s talk about them.


Tampered Candy:  The fear of candy that has been tampered with is media-driven(not surprising). Last poll showed 24% of parents of children below 12 yr old worried about poisoned treats. To date only 5 deaths have been linked to Halloween candy.  Two in the 1970s that later were attributed to the direct actions of family members.  One was a heroin stash that was hidden in the candy, and the other murdered his son with cyanide to get the insurance.  Other fatalities in 1978 and 1990 were determined to be caused by cardiac disease and natural causes.  In 2001 a 4 yr old died in Vancouver Canada the day after eating candy.  The police ordered everyone to throw away their candy but it was later found out he died of streptococcal disease and not the candy.  One child died of Halloween candy in California because a worker found marijuana-packed snickers bars in the post office and gave them out unknowingly. 


Then there are sharp objects in the candy.  80 such cases have been reported but almost all have been determined to be hoaxes.  The only valid case in 2000 when a teenage who bit into candy that had a needle in it.   Nothing became of that incident.  Towns who have x-rayed candy have not found any sharps in the packages.  Again a media scare.


Physical assaults: There are no increases in assaults on children reported on Halloween than any other time of year. 


What is the real danger on Halloween night?  It is pedestrian injuries.  Halloween is the number one day of the year for child pedestrian accidents with an average 5.5 deaths vs 2.6 for the rest of the year.  32% are 12-18yr and 23% are 5-8 yr old.  And not surprisingly the drivers of the vehicles were mostly 15-25 yr old.  Most accidents occurred between 5 and 9PM with the highest hour 6-7PM.  We give out glow sticks along with a piece of candy at our house and it really looks good when all the children on the side of the street leaving our house are lit up with glow sticks.  They love them and it is a good safety practice.  I also recommend letting them pig out on candy for 24 hours and then throw them in the trash.  Supervise children below 12 yr of age but that needs to be based on a case by case…. determined by  the child’s personality.  Have a safe and fun Halloween.  And parents… you can dress up too!!!!



HOMEWORK.  It drives kids and parents crazy.  One could also argue if it is even worthwhile in improving your child’s overall learning. But most schools will give homework so we are stuck with it.


Some kids just don’t want to do it and if asked whether or not they have homework, they will say NO and get a zero or low grade.  So the question is “does the parent find out what homework the child has and make them do it?”   Some would say let them fail and that will show them they need to do it.   I do not believe that.  You do not teach them to keep clean and have good hygiene by letting them go dirty and not bathe.  You make them bathe and that becomes a habit for life.  So I feel the parent should find out if the child has homework and make sure they do it.  Then that teaches them if they have things in life that they need to do…. Then get it done. 


I do not think the parent should go over their homework and correct mistakes.  (I think I was guilty of that when young). Then that is the parent’s A and not the child’s B or C.  The parent does not go into their class and correct their test papers to artificially increase their grade.  So I feel the parent should not correct the homework but just make sure it was done and completed.  If however the child missed almost all the homework, then the child may not understand how to do the homework.  Then the parent can “reteach” the lesson and show them how to do it.  Or the parent can make up extra papers for them to complete in order to make sure the child understands the lesson (Oh boy does that upset them…!  Do it right the first time or you get more work.  Yeow!)  Teach your child ways to memorize things… by making flash cards, lists, repeating over and over, etc.  And also the parent should encourage them to do their best and not just a minimal effort so it is enough to get a barely passing grade.


Have a home atmosphere where they can do their homework with minimal distractions.  Yes turn the TV, cell phones, and ipads OFF!  Record your programs for later.  I’m sure you parents have stuff you need to work on or need to read.


I thought I was a tough Dad but I had one parent who turned off the sound of the TV and turned on closed captions.  Everyone’s reading improved.  You also might have a house rule that so many minutes of reading earns you so many minutes of TV or screen time.  Have them get a good night’s sleep to help their school performance.  Have a bed time even though teens are not that sleepy.  And their cell phones go in a charger in the parent’s bedroom…. yes they have been found at 2AM under their covers texting. Keeping the total screen time down helps.  Most authorities recommend 2 hours a day when most kids are having 6 or more hours a day of screen time.  That should vary with the child and their performance in school and the type of programs. 


I know some of you will disagree with my views and that is OK.  We all raise our children differently.  It is just my opinion.  Thanks for listening.



It is that time of year when many families fly to relatives in other states.  A frequent question we get concerns ear pain in children when they fly.  It does not seem to hurt children’s ears to fly until school age.  You think it would but I can’t remember when a parent told me they cried on flying.  It is the descent when they plane lands that it can cause ear pressure to cause pain.  The infants usually cry because they missed their nap, are just tired, or want to get down and play.  So many people will tell the parent to give them to suck on, breast feed them, or chew gum but those actions are not needed. 


If a child has an ear infection, the middle ear is filled with fluid that is infected.  Water does not expand or contract under atmospheric pressure changes.  Air does and there are compressed air tanks.  You have not heard of compressed water tanks.  So it is OK to fly with ear infections in children.  If a person has normal ears and sinus/nasal congestion and fly, then they are in trouble with pressure change because they cannot “Yawn and pop” their ears equalizing pressure in that middle ear.


Dr. Knapp


App for smart phones and i-pads and tablets.  Search Roger Knapp. When searching on i-pads, change setting at top of screen to search phone only setting.


 I like the pumpkin patch in the Southlake area called Hall-Johnson Pumpkin patch just west of 121 on Hall-Johnson road. 


Speaking of pumpkin, here is the recipe for Pumpkin soup from Disney World:

Pumpkin Soup from Tony’s Restaurant in the Magic Kingdom

                        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.


Recent reports of processed meats causing cancer are true but you need to look at the picture.  If you are having too much of anything, it is bad for you.  Too much sun is bad but a little is good for you.  A little red wine is good but too much bad for you.   So too much processed meats… a hotdog every day is not healthy but you don’t need the news to tell you that.  Just go easy with red or processed meats.  Too much milk is even bad for you…. Leaches blood out of the intestines and cause anemia.  Too much screen time is doing more harm to our kids than hotdogs.  Just keep it 1 or maybe two processed meats a week.  



The family evening meal is very important.   We have moved away from that routine and eat in the front room with the TV.  Or going out too much.  You need to turn the phones, ipads, and TV off (yes off) and sit down together.  If you do, then later there is less divorce, less child obesity, less teen delinquency and pregnancy.  Sit down together and ask “How did your day go?”.  If one child is not hungry, then they can sip water and still sit with the rest of the family.  And no they should not have to finish their plate.  Use this time to express your morals on violence, sex, politics, and other important values.  The sage advice of my parents come back to me every week.  The values you express to your children actually go in them but you may not see it in their behaviors for 20 years.  But it is in them.


Many articles have shown the importance of family meals.


“Consistent inverse relationships were found between the frequency of family dinners and all high-risk behaviors measured (i.e., substance use, sexual activity, depression/suicide, antisocial behaviors, violence, school problems, binge eating/purging, and excessive weight loss)”



The majority of people who think they're allergic to penicillin, based on a doctor's opinion after an adverse reaction, are not actually allergic, according to a new study.  Most people never take penicillin again, and are treated with more dangerous antibiotics and exposed to unnecessary risk as doctors look to other treatment options. The Centers for Disease Control and Prevention estimates between three and 10 percent of Americans are labeled allergic to penicillin, however  about 90 percent of those people are not allergic. I had learned years ago it was 75% not allergic.  Anyone who has been told they are allergic to penicillin should be tested.  And just because a relative is allergic does not mean the child is allergic.  Hives are caused mostly by Medications, foods and most frequently an infection.  Many germs cause hives and especially strep.  The patient breaks out in hives from the infection and not the antibiotic we gave to treat the infection.   Interesting huh? 



One does not just develop bacterial bronchitis or pneumonia immediately.  Viral chest infections that can be diagnosed at pneumonia or bronchitis can come up quickly but generally not bacterial.

The lung and windpipes are damaged by smoking, asthma attack, or viral chest infection.  It takes a while for the bacteria to grow in it. The fever during the first 4 days of cough and cold is generally a virus. Fever after the 5th day and typically 7-10 days into the illness is when bronchitis or pneumonia develops.  Many people are diagnosed with bronchitis/pneumonia but are just having the viral flu.  See my article on reading chest x-rays at my web site.  The flu generally does not kill you unless you have a lot of other health issues.  The high risk groups are infants below 2 yr, pregnant women, and children with cancer, heart disease, lung diseases, diabetes, or immune troubles. So the average healthy child is not at high risk of dying of the flu.  But they can get pneumonia after the 5th day of cough/congestion. 

1.       So watch for fever after the fifth day.

2.       See my web site about treating the flu.  Tamiflu does not change the incidence of pneumonia complicating the flu. 

3.       I recommend the flu vaccine even though it only prevents it 2/3 of the time. 

4.       Some studies suggest there are less complications of the flu if you had the vaccine. 

5.       You are most contagious right as you develop symptoms so most people spread the flu when they do not realize they are sick.


Take care this weekend and have a good Thanksgiving.



The mosquito causing encephalitis illnesses are West Nile, Dengue fever, chikungunya disease, Japanese Encephalitis, Eastern Equine Encephalitis, and Western Equine Encephalitis.


Dengue Fever infects 200-400 million people yearly and 22,000 die every year in other countries of the world.  It has spread all over South and Central America and Mexico.  There was a big outbreak of Dengue fever in Hawaii this year.  Rare cases have been reported in South Florida and Texas.  A recent vaccine has been developed and is in trials now to see if effective. 


Chikungunya is spreading fast across the Americas.  In Latin America and the Caribbean the rate of infection is about a million people a year.  It’s name comes from African dialects meaning Bends Up because patients are often contorted in pain for weeks.  It arrived on St. Martin in 2013 and in just 2 years has spread all over Central and South Americas.  Death is very rare but you might wish you would die.


West Nile came here in the 1900s and now present in every state.  Last year there were 2,205 cases reported (but thousands of cases never diagnosed) with 858 brain infections and 97 deaths. These cases are adults with children almost never diagnosed because they are not seriously ill with it. (See my web site article on West Nile.)  With West Nile spreading all over America, the concern is will other mosquito-borne diseases like Dengue and Chikungunya  spread all over.  They have spread all over South and Central Americas, Mexico, and Caribbean islands.


Other encephalitis viruses are transferred through saliva and body fluids.  Common is Enterovirus infections that cause several different illnesses.  They are everything from chest colds, to meningitis, myocarditis, pleurisy, and Hand, Foot, and Mouth Disease.  Most of your children will get Hand, foot, and mouth but brain infection from that is rare.  Actually only 1/1000 people who were infected with polio were paralyzed and most people had NO symptoms.  Even Chickenpox can rarely cause brain damage.  And if your child developed one of these encephalitis infections at the same time they received their routine vaccines, we would of course blame the brain injury on the vaccine.


You may hear about these illnesses in the news.  I am not trying to scare you.  I just want you to be aware and protect yourself from mosquito bites here in America and especially when traveling South of our boarder. 



Well I recently wrote an article on Dengue and Ch viruses spread by mosquito. Now Zika virus is in the news.  This is a very mild form of Dengue and West Nile and in fact only 20% have any symptoms.  No deaths occur.  It is a rash and red eyes …. See picture below.  Zika was discovered in Africa in the 1940s and spread to South Asia countries.



Then it spread to the French Polynesian Islands (In The Pacific Ocean South of Hawaii) and then spread to South America mostly Brazil in 2013.  This summer it spread to most of that area.



Zika is now covering most of South and Central America and “heading this way” just like Dengue and Chikungunya.  Now this map looks like this in a very short 5 months!



This disease is very mild and no deaths from it.  The problem is that if infection occurs during pregnancy, it causes brain damage and microcephaly.  Brazil went from 147 cases of microcephaly to 2400 this year!  It is so bad that the Brazilian government has asked women to hold off getting pregnant for a few years.  And I huge concern will be the 2016 Olympics in Rio de Janeiro next year.

Most catch this from mosquito bites but there have been documented cases of blood transfusions, bedroom activities, and mothers in labor giving it to newborns. That does not cause microcephaly since the illness needs to be earlier in the pregnancy. 

Please use caution if traveling to South America, Central America, Caribbean Islands, or Mexico when pregnant.


Roger Knapp




·         About 1 in 5 people infected with Zika virus become ill (i.e., develop Zika).

·         The most common symptoms of Zika are fever, rash, joint pain, or red eyes.

·         Other symptoms include muscle pain, headache, pain behind the eyes, and vomiting.

·         The illness is usually mild with symptoms lasting for several days to a week.

·         Severe disease requiring hospitalization is uncommon.

·         Deaths due to Zika have not been reported.