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Newsymail sent out iin 2016


Jan 5, 2016

During the next 3 months we will have a lot of cases of Noro virus.  It causes vomiting, fever and diarrhea.  YUCK.  It is in most towns in America and these people then go get on cruise ships.  That spreads diseases worse than daycares.  It is the virus that causes cruise ships to have to come back to port with everyone sick.  There were a few cases last month at Chipotle Restaurants. The disease causes  2-3 days vomiting, 2-3 days fever, and up to 7 days of diarrhea.  In children we can’t give anti-diarrhea meds but we can call out some vomiting medication.  It takes thousands of Flu viruses to give you influenza illness but only 10-20 noroviruses to give you that disease.  And the virus is alive for many days on surfaces.  So it is very contagious. The virus is not killed by alcohol hand sanitizers and Lysol stuff.   It is only killed by dilute bleach.  So if someone in the family gets this, use soap and water for hands and dilute bleach for surfaces.  And what do they have all over cruise ships?  Hand sanitizer stations.  Duh!  Not good.  When I go on a cruise, I take paper towels soaked in dilute bleach in zip lock bags.

Roger Knapp MD


Jan 10, 2016

Anemia is low red blood cells.  The test is called Hemoglobin or Hematocrit. Children have smaller cells so we have normal values for children different than adults.  Some can have non-treatable congenital anemia like Thalassemia or Sickle Cell.  What we want to avoid is low iron anemia. We are born with iron stored up in our body but we get that the last month of pregnancy so premes do not have any iron for growth.  The newborn baby destroys all the red blood cells that they have at birth.  They are for exchanging oxygen through the placenta.  They then replace all their red blood cells over 6 months to air breathing red blood cells.  That’s crazy.  They give themselves a complete blood transfusion.  They need iron for this so we have iron in the formula and breast milk and give extra iron to premes.  We need iron for later growth using it for making more blood and muscle.  But also iron is needed for many other functions in our body and most important is brain metabolism.  Low iron causes poor neurological development and poor performance in school.  Too much cow’s milk after age one causes you not to absorb iron that you need.  Preschooler’s do not eat enough red meat and many older children do not eat as much meat as they need.  We tend to eat less red meat to help our heart.  So I recommend vitamins with iron from age 1 to 18.  When our body starts running low on iron, there has to be a big decrease in iron to start having anemia.  So you can have low iron that affects your function long before we see a decrease in red blood cells.  So a typical blood test for anemia does not test to see if you are low on iron.  Ferritin is the best test and also serum iron is good.  I don’t test for anemia every year since I have my patients take chewable vitamins with iron.  If they take them, then there is no low iron and no anemia so why cause pain.  Gummy vitamins do not have iron!!!! Sorry.  Take Flintstone Complete every day.  We adults should definitely take vitamins if you do not eat meat.  Adult men and women with no uterus who eat red meat should take a vitamin without iron since too much iron can damage your liver.  So the “men’s vitamin” in the stores do not have iron.  Moderation in everything.

Roger Knapp MD


Jan 12, 2016

News this week reported a recall of children’s cough med where the dosage cup is incorrectly labeled.  The cough medication has Guaifenesin which is an expectorant.  I don’t recommend cough medications with guaifenesin since it tastes terrible and studies showed a cup of water did just as good at loosening secretions as guaifenesin.  You can check the lot numbers of these cough medications on line but I recommend you throw out all medications with this.  The amount of medication error in these amounts would not cause much symptoms but do get rid of these dosage cups. 

Roger Knapp MD


Jan 20, 2016

The recent study reported in the news that women who ate more fish in pregnancy had higher IQ kids later in life.  This was not a fair study mainly because women who could afford more fish had higher intelligence and less smoking.  Also they had 5 different levels of fish intake.  1 was the lowest and 5 the highest amounts of fish consumed each week.  They had a difference statistically from level 1 to other levels but there was basically no difference between levels 2-5.  There are also risks of ingesting more mercury in larger fish: marlin, tuna, shark, swordfish, king mackerel, tilefish, and northern pike, contain higher concentrations of mercury than others. 


It can’t hurt to eat a little more fish or take fish oil capsules but I don’t think it helps much. 

Roger Knapp MD.


Also I reported the Zika virus and small heads and brains last month.  I had warned about traveling to those countries.  The cases so far had acquired the infection in South America but delivered the baby here.  I just hope the virus does not become wide spread here in our mosquitos.  Same thing with Dengue Fever and Chikungunya virus.


Feb 2, 2016

Frequently parents come into my office warning me that the child was exposed to a disease or that there are conditions that run in the family like scoliosis.  If you are a good doctor you check every child for scoliosis, heart conditions, diabetes, etc.  We check every child for everything.  If a child is exposed to a rare disease like brucellosis, Ebola, and other rare diseases, then let the doctor know.  But when you tell the doctor the child was exposed to common illnesses like strep throat, then the doctor tends to get “tunnel vision” and mostly thinks about strep throat and not ear infections, meningitis, pneumonia, and other causes of fever.  So it’s nice to know there is strep in the school or family but it is not helpful since we look for all causes of fever. 

 Roger Knapp MD


Feb10, 2016

Is the Zika responsible for all these microcephaly cases?????

Autosomal recessive primary microcephaly (MCPH) is a neurodevelopmental disorder that is characterised by microcephaly present at birth and non-progressive mental retardation.  MCPH is a nerve cell DNA defect when cells multiply.  Twelve MCPH DNA defects have been mapped to date from various populations around the world. Genetic counseling may help families with defective genes. Many conditions or factors can cause the break in the DNA. (Same thing in Autism which is from a damage to the DNA before birth.)

Brazil is enduring an extraordinary outbreak of microcephaly. Since last fall, more than 4,000 suspected cases have been reported, and authorities have blamed an unusual virus, Zika. But now it appears that a number of those cases may not in fact be microcephaly, or not linked to Zika.  The country is trying to find out which cases it could actually confirm by health secretariats in 26 states and one federal district spread across South America’s biggest country. After experts scrutinized many cases they found that more than half either weren’t microcephaly, or weren’t related to Zika.  Just 270 were confirmed as microcephaly that appears to be linked to Zika or other infectious diseases, according to the latest ministry bulletin.

It’s not yet clear whether the same pattern will emerge from all of the cases. And health experts say the huge number of cases is still very worrisome — as is the rapid spread of Zika through the Americas. The condition can also be caused by genetic factors, drug or alcohol abuse, during pregnancy.  It also can be caused by other infections such as CMV, Rubella, Coxsachie B, Toxoplasmosis, and even chickenpox.  Some scientists said the new data suggest that Brazil will have fewer cases of Zika-related microcephaly than originally feared. The country may have over-counted microcephaly cases because it initially asked doctors to report all births of babies with a head circumference of 33 centimeters or less — but some of those were simply children with normally small heads.

It is possible that the number of cases of microcephaly with suspected relationship to Zika will be much less.   Publicizing microcephaly on the news caused doctors to report more cases than in the years past.

Other specialists were wary of the new data, questioning the methodology that was being used since the badly affected areas, the northeastern state of Bahia, have used relatively cheaper transcranial ultrasound imaging — rather than CT brain imaging scans —  to try to confirm and discard cases of microcephaly.

In October, when the Brazilian government began requiring doctors to report suspected cases, they were instructed to notify the Health Ministry if the circumference of a newborn baby’s head was 33 centimeters or less.  In December, the ministry reduced the figure to 32 centimeters or less which is in line with WHO and USA guidelines. The ministry said many babies with the 33 cm heads were later found to be healthy. Using standard U.S. growth charts, the 33- centimeter guide would put 10 percent of American newborns in the category of suspected microcephaly — clearly way too high a percentage.

In northeastern Pernambuco state, authorities estimate that less than half of the 1,373 reported suspect cases are “possibly” related to microcephaly linked to Zika. Some children just have small heads. 



Concerning the recent outbreak of microcephaly, its cause, nor its clinical significance has yet been fully established. The Brazil health system database currently stores information on more than 100,000 neonates. A much higher than expected incidence of microcephaly was observed, varying from 2% to 8%. It normally is 1 in 6,000 babies. These findings raise questions about the condition’s diagnosis and its notification. However, the fluctuation of cases were documented since late 2012, before the entry of Zika Virus in Brazil, in mid-2014. Further questions are raised on both the surveillance of the Aedis mosquito infections, as well as the different possible causes for the outbreak.

 One study classified microcephaly on three different criteria, as follows:

1. Brazilian Health Ministry criteria, where microcephaly equals an OFC smaller than 32 cm for term neonates.

2. Fenton curves, where microcephaly equals an OFC less than -3 standard deviation (SD) for age and gender.

3. Proportionality criteria, where microcephaly equals an ratio of head to height.

Neonates were classified with microcephaly according to each one of the three criteria. A separate group was created for those who fulfilled all three criteria. Finally, those who fell into the lower third in each criterion were grouped as extreme cases of microcephaly. Depending on the criteria utilized, in this sample, 4% to 8% of kids born between 2012 and 2015 had microcephaly. Neonates fulfilling all three criteria accounted for nearly 2% of the sample. If, however, only the extreme cases filling all the criteria are considered, the rate of microcephaly becomes normal.

 The distribution of cases of microcephaly between 2012 and 2015 is observed in the chart. A variation through time is observed. The numbers are greater than expected since the end of 2012 and with its sharpest peak in mid-2014. If the Zika virus came to Brazil in summer of 2014, then 9 months later the cases would be elevated in 2015.  But the peak you see is in early 2014.


In 2000, Brazil reported that the prevalence of microcephaly in Brazilian newborns was 5.5 cases/ 100,000 live births and in 2010 it was 5.7 cases / 100,000 live births. Over the last three months it went up to 99 per 100.000 live births which corresponds to a twentyfold increase. In this study, independent of the classification criteria used, we demonstrated a much higher incidence of microcephaly between 2012 and 2015. Projecting our findings to the total number of live births in Paraíba area of Brazil, in 2014  the number of neonates born with microcephaly in that year would have been 4,652 by the Health Ministry proposed criteria, 2,442 by the Fenton curves and 2,907 by the proportionality criteria. Neonates classified with microcephaly by all three criteria would have been 1,105. These observations highlight the need to review the situation carefully. Many questions need to be answered prior to concluding what problem we are facing, how it came about and which consequences it is likely to bring to the Brazilian population in years to come. What is the real incidence of microcephaly in Brazil?

The numbers of very extreme cases of microcephaly, for instance, while significantly increasing over the last few months, are much smaller and until recently fell within the expected ranges for the worldwide reported incidence.


1.    Were only those extreme cases being notified?

2.    As the number of extreme cases increased over these past three or four months, did the awareness of health professionals increase and they started to notify milder forms which make up the majority of reported cases?

3.    Could a 31cm head circumference in a term newborn be within normal limits for this particular population?

4.    Could genetics or nutritional components explain these findings?

5.    Are we facing large numbers of a neurological disease or observing an anatomic variation of normality?

 Points to ponder:

1.    ZIKV has been identified in Africa over 50 years ago.  Increases in microcephaly have not been reported there or in other countries with outbreaks of Zika.

2.    Is there another cause of the increase microcephaly such as malnutrition, drugs, alcohol, and other viral infections? Most of the reported cases have occurred in low-income families.

3.    Mosquito controlling strategies will help many aspects of public health other than Zika. The scare will prevent many other diseases carried by mosquitoes.

4.    This is a challenging health problem that limited information brings questions to conclusions at this early stage.

 There have been outbreaks of other birth defects in the past in different countries.  Anencephaly is a condition where most of the brain is flat missing.  Estimates of the incidence of anencephaly in the United States during this century have varied from 0.3 to 7 per 1000 births.  In the United States each year there are about 1050 infants born with anencephaly.  Overall rates are highest in the Northeast and North Central regions and lowest in the Mountain and lower Plains states.   An anencephaly "epidemic" occured during the early 1930s in Boston and ProvidenceA mysterious cluster of anencephaly occurred in a three-county area of rural Washington State in 2013.  No cause was found. There were nearly two dozen cases of anencephaly in three years, a rate four times the national average.  They noted that small clusters of birth defects often turn out to be nothing more than sad coincidence. However it can be caused by diet, drugs, alcohol, and other viral infections that are hard to prove.

Texas has the Birth Defects Epidemiology and Surveillance Branch. BDES was established in 1993 as the result of an unusual cluster of anencephaly cases that occurred in Brownsville, Texas. Epidemiologic investigations revealed a higher than expected rate of neural tube defects among children born to Hispanic mothers living in South Texas. In recognition that epidemiologic resources are routinely needed to investigate birth defects clusters, the Texas State Legislature passed the Texas Birth Defects Act in 1993, which authorized the establishment of BDES.


So in conclusion, there are sometimes outbreaks of congenital defects of the brain, heart or kidneys that occur.  It is frequently just nature where there is a fluctuation in the frequency of these defects.  Some are caused by factors that we cannot discover nor prove.  The Zika virus may be causing some defects or just slightly increasing the incidence or may just be blamed for an increase that is either not real or caused by some other factor.  Time will tell.  But the news loves this scare and politicians (Obama) love to delegate 1.5 billion dollars to fix the problem. We need a vaccine for Dengue more than we need one for Zika.  Like the boy who took the “clock” to school, wait to judge this Zika thing until all the information is collected.

Roger Knapp MD


Feb 22, 2016

Gardasil, a vaccine introduced a decade ago to combat the sexually transmitted virus that causes cervical cancer has already reduced the virus’s prevalence in teenage girls by almost two-thirds, federal researchers said Monday.
Even for women in their early 20s, a group with lower vaccination rates, the most dangerous strains of human papillomavirus, or HPV, have still been reduced by more than a third.
“We’re seeing the impact of the vaccine as it marches down the line for age groups, and that’s incredibly exciting,” said Dr. Amy B. Middleman, the chief of adolescent medicine at the University of Oklahoma Health Sciences Center, who was not involved in the study. “A minority of females in this country have been immunized, but we’re seeing a public health impact that is quite expansive.”
The news is likely to serve as a welcome energizer in the tumultuous struggle to encourage HPV vaccination in the United States. Despite the vaccine’s proven effectiveness, immunization rates remain low — about 40 percent of girls and 20 percent of boys between the ages of 13 and 17. That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with its explicit purpose: cancer prevention. Only Virginia, Rhode Island and the District of Columbia require the HPV vaccine.
About 14 million Americans become infected with HPV each year, and the vast majority will clear the virus. But some strains persist and can cause genital warts, as well as cervical, anal, penile, and mouth and throat cancers. The American Cancer Society estimates that 4,120 women will die of cervical cancer this year.
The latest research, published in Pediatrics, examined HPV immunization and infection rates through 2012, but just in girls. The recommendation to vaccinate boys became widespread only in 2011; they will be included in subsequent studies.
By those later years, the prevalence of the four strains of HPV covered by the vaccine had decreased by 64 percent in girls ages 14 to 19. Among women ages 20 to 24, the prevalence of those strains had declined 34 percent. The rates of HPV in women 25 and older had not fallen.
There are several obstacles to greater coverage rates in the United States. In other countries, the vaccine is often given in two doses, particularly to girls younger than 15. In the United States, it is given in three doses. An immunization advisory committee to the C.D.C. will convene this week to learn more about the efficacy of the lower dose.
And in some countries, the vaccine is either mandatory or at least offered at school, its cost covered by a national health care system, making administration more streamlined and comprehensive. Such measures helped Rwanda achieve a 93 percent immunization rate in girls. Australia, where the vaccine is offered free to schoolgirls, accomplished a 92 percent reduction in genital warts in women under 21, a study showed.
But in the United States, the vaccine is largely optional.
I strongly recommend this safe vaccine to prevent cancers and warts. It is safe no matter what you read on the internet. I would want it if I was young.

Also we are checking vision as young as 1 year old with a new technology using a digital camera. These darn phones do everything but make coffee. lol

Roger Knapp MD.

 March 13, 2016

Teladoc and Memd and other online web internet virtual doctor visits are increasing in popularity.  They cost a monthly fee 5-15 dollars and average $40 a “visit”.  They can send in a prescription for you if needed.  They can’t treat complicated things, and most will not treat ADHD or depression.  They average 5-15% referral to emergency rooms to be seen.  Some have video but most are just over the phone.  More and more insurance companies are covering them and even Obamacare is starting to use it.  Texas has been last to join this movement thinking it is not very good quality medicine. 

 No studies have been done on their accuracy and cost effectiveness.  Many people will use this for such minor illnesses that they ordinarily would not have seen anyone for it.  But now they can just call.  So “over utilization” will occur driving up costs.  The doctors are afraid if missing something dangerous will over prescribe antibiotics like many urgent care centers perform.  Half the people leave my office with no antibiotics because it is viral or allergies.  A patient with cough and fever and sore throat comes in.  Without seeing the patient, how does the doctor know if it is the flu (with no tests performed), bronchitis, pneumonia, RSV, or a common cold.  Is it walking pneumonia that only needs one specific antibiotic?  Is it a viral cold but now has a sinus infection that may need a different antibiotic?  Is it the flu but now has other secondary infections?  Also if a patient has a sore throat and fever, how does the doctor know if it is strep and needs antibiotics without looking in there or running a strep test?  In essence he does not know and will over prescribe antibiotics just in case there might be a bacterial infection.  Then there will be too many antibiotics in that child and the germs will be increasing their resistance.  How does the doctor on the phone know if the child with stomach pain, fever, and vomiting has a viral illness or food poisoning or appendicitis?  Ninety percent of the girls who have burning when they urinate do not have an infection.  It usually is just irritation.  But every one of them will get antibiotics.  Does the 4 month old with fever and fussiness and decrease appetite have an ear infection, urinary tract infection, meningitis, or a viral illness?  Does the 4 month old with cough and fever have RSV with low oxygen and needs a hospitalization, or has influenza and needs Tamiflu, or has whooping cough and needs antibiotics and precautions for the family and daycare?  How is a doctor on the phone going to know any of this? 

 How about malpractice?  What if some damage is done by miss-diagnosis?  What are the chances of getting reimbursed for damages? 

 Insurance companies love this because it saves them the emergency room fee.  Less quality care for less money.  Some people will like this since they think they know what is wrong with their child and just want antibiotics.  The child gets better since the virus goes away and they think the antibiotic did it. 

 Anyway, I guess there will be a place for this service and especially for those in far rural areas with no doctors.  I will admit that I have called in some antibiotics for a few patients whom I know real well and trust their reliability and I have recently seen the child for a viral illness.  I think this virtual medicine is very low quality care and do not recommend it.  

 April 10, 2016

We are in full swing in the Spring allergies as I know you all are aware by your noses.  Trees are blooming.  Attached are the charts of the different pollens in North Texas and Central Texas.  The allergy symptoms of cough, runny nose, and congestion (CRC) are the same symptoms for a viral cold.  During your allergy season you will have CRC for months and hopefully an antihistamine will be helping.  You may develop a viral cold for a few weeks during the months of your allergy time of the year.  Then your CRC symptoms will increase.  The patient will think their allergy medication is not working because the symptoms will not be decreased by the antihistamines.  Then you call and say your antihistamines are not working.  Therefore you may have two causes of CRC at the same time.  On top of that you can develop bacterial bronchitis and then have 3 causes of your CRC.  Crazy huh?  There are no new pollens around now that have not been here for a month.  So if you are coughing and congested and your allergy medication is not working, you probably have a viral cold. If you are having CRC at this time and then have an increase in these symptoms and fever, is that fever from a viral cold or bacterial bronchitis?  It is sometimes difficult for the physician to figure it out.   Many just give antibiotics when there is an increase in CRC with fever even though the majority is viral.  Most of the “pink eye” we are seeing right now is not an infection but it is allergy.  You can use safely use some allergy products such as Zaditor eye drops and Nasocort nasal spray safely down to 3 years old.  What actually are your allergies?  It is your immune system saying you have a foreign protein in your body.   Whether it is pollen that is nothing, bacteria that will kill us, or a heart transplant that will save our lives, we will try to reject them all.   It is our defense immune system.   So we all have some allergies…. mild or severe.


April 26, 2016

Spanking a child leads to bad behaviors a new study suggests from researchers from the University of Texas at Austin and the University of Michigan. 


 Again I have talked about a correlation does not mean cause and effect.  Which caused which event? Did the spanking cause more bad behavior or did the kids with bad behavior cause the parent to spank more?  I think you are born with your personality and every parent with more than one child is surprised to see a different personality even though same parents and raised the same way.  A child who is defiant and obstinate and rebellious will be that way all their life.  They will get better through maturing and the parent’s guidance on proper behavior.  I do think rewarding good behavior is better than just spanking all the time for bad behavior.  I also do not have a problem with some spankings.  But unless we adults are not willing to drive one mile over the speed limit, do not criticize your kids for pushing the limits of your rules.  So we tend to punish the bad behavior and when they are being good, we tend to say “Shush!  Be quiet.  They are playing good together.  Instead go complement them for behaving well. All they need is a smile and a hug and a thank you. 

 Roger Knapp MD

p.s.  Also there is too much arsenic in the rice cereal and rice cakes.  Not sure if it is enough to harm the infants but I would stop the rice cereal for now until the government regulates lower amounts.  Give the infants oatmeal. 

 April 30, 2016

When you eat a fatty meal it does cause a high amount of fat to go through your arteries.  See picture of serum below.  So even though you can have a normal cholesterol and triglyceride value when fasting in the morning, it does not mean you do not have high amounts after every meal.  Just as comparison with  glucose.  You can have a normal fasting glucose but as most diabetics will tell you, your blood sugar can go way high after a meal.  So know that it affects our kids as well as us to eat fatty meals. 


Also back to Zika.  Many chemicals and viral infections can cause microcephaly.  I think Zika does cause some cases.  But it is not as horrible number as the news says. Columbia is now having a big outbreak of Zika in that country. 

 There are 14,000 cases in pregnant women getting Zika and 26 cases of microcephaly.

In the USA from 15,000 cases of pregnancy we have 16 cases of Microcephaly and we do not have Zika.

 There were 304 cases of Guillian Barre that they think were from Zika.   Many viral illnesses cause GB.

In the USA we have 8000 cases of GB every year. 

 Most of the cases of Microcephaly in Brazil are from one providence.  Some are caused by Zika but many are caused by something else… chemical hazards or other things.

 It is a viral illness that causes problems but I am trying to tell you it is just one more viral illness that causes birth defects that you did not know about.  Being a Doctor is hard because we know all the terrible diseases that can happen.  Every time the doctor feels your child’s tummy we are feeling for tumors.  Or finding cancer in the red reflex of the eye.  You do not want to know all these bad things that can happen because it drives you crazy.  Trust the doctor is looking for all these bad things.  Pray it does not happen or gets detected early.

 I worry a lot more about Dengue than Zika virus.

 Roger Knapp MD

 May 2, 2016

So the famous singer Prince who died suddenly did not leave a will. His $300million estate is now in the hands of the court and lawyers who will definitely take a large portion of the money. His brothers and sisters are now in court fighting over his assets and the judge will decide who gets what… not the family.

The renowned civil rights leader is another public figure who never created a will. In 1993, 25 years after his death, the family founded a for-profit company t...o control the licensing and use of King’s image and speeches. Unfortunately, that hasn’t been enough to prevent King’s children from engaging in legal squabbles. Over the years, King’s heirs have reportedly fought and sued each other for various reasons. The most recent disputes allegedly center around the King Center nonprofit’s right to use MLK’s intellectual property and whether the family should keep or sell King’s Nobel Peace Prize medal and personal Bible.

The former musician and U.S. Representative Sonny Bono passed away in 1998 following a skiing accident. The star, who was part of the pop group Sonny & Cher, failed to write a will before his death. His fourth wife Mary, who took over his congressional seat, became his estate’s administrator. Problems arose in 1999 when Sean Machu came forward saying that he was Bono’s illegitimate child. He reportedly wanted a piece of Bono’s estate and so did his ex-wife Cher, who alleged that he owed her alimony.

Rock icon James Marshall “Jimi” Hendrix did not draft a will before his untimely death in 1970. As a result, his father Al Hendrix had control over his $80 million estate until he died in 2002. At that point, family drama erupted. Since the majority of the estate went to Janie (Al’s adopted daughter), Leon Hendrix had no control over his late brother’s assets. The two relatives reportedly battled over trademark and copyright issues for years until they finally reached a settlement in 2015.

James Brown: The esteemed Godfather of Funk had a valid will in place when he died on December 25, 2006. But he failed to update it to reflect his marriage or to mention his youngest child, who just so happened to share his own name. Court clashes over the fate of his estate ate into his wealth. A 2009 settlement was supposed to give a quarter of Brown’s fortune to his wife, half to a charitable trust and the remaining assets to his kids. But since additional legal issues have come up, reportedly none of his heirs have received a single dime.

So do YOU have a will? Get one since death can come quickly and unexpectedly. Protect your children and spouse from lifelong pain and suffering. Your estate is not that large but fighting among relatives generally occurs. GET A WILL !!!!

May 6, 2016

Many of you have not heard of tonsil stones.  Here is a picture of one.   Google images and you will see thousands and more huge ones.  There are many theories of their formation and I think it is food that gets caught in the crevices and coagulates and decays.  They smell bad and give the bad breath of tonsils. They are hard and about the consistency of peanuts.  Sometimes when someone clears their throat a chunk will come into their mouth.  Or they get knocked off when you swallow food.  Teenagers and adults can use a long Qtip and flashlight in a mirror and “flick” it off.  Then your throat is not sore and your breath is better.  Just don’t touch your tongue where your gag reflex is located.  Stay on the sides where the tonsils are and you won’t gag…. too much.  LOL.  Notice they are off white and have a sharp boarder.  Almost look like a piece of plastic.  Pus oozes out and does not have a sharp boarder.  So if you see this with a sore throat and no fever, it is not infection with pus.  Save your money and don’t see the doctor.  And remember 5% of people carry strep in their throat all year without infection.  So I’m sure some doctor thought it was infection and you tested positive for strep when you did not have fever.  Then you were given antibiotics when you did not need them.  So now you have heard of tonsil stones. 

 Roger Knapp

 A study of mothers and their teen children was reported in the Archives of Disease in Childhood. Analyses showed a mother who was overweight prior to pregnancy more than doubled the risk that her child would be overweight or obese at age 11.  There was also an increase if mother smoked and had lower education.  There are some families and some children who are overweight because of some kind of “metabolism” defect that they are born with and frequently inherited.  They can eat less calories and still gain weight where other children eat twice as many calories and are thin.  Same with some adults with obesity.  Our metabolism also slows down as we get older and we gain more weight with fewer calories.  There is some hormone or chemical imbalance in some people that causes obesity that cannot be controlled unless they move to the desert and there is no food.  80% of the contestants who were on The Biggest Loser TV show have regained most of their lost weight.  Some day doctors will figure out what is wrong.  But until then I have not been able to get obese children to become thin.  However there are some families and children who eat too much and it is not their “metabolism”.  I had one teen girl who was way over weight who came back the next year and looked great.  I asked her what happened and she said she started running three times a week.  She started burning more calories.  So it can be done but few will be able to lose weight and keep it off.  Let’s all eat healthy and use portion control. Most fad diets do not help.

For more on Obesity, see my web site:  http://www.rogerknapp.com/medical/Obsity.htm

Roger Knapp MD

May 17, 2016

Kids love to swim all day long. That makes their hands and feet get white and wrinkled. The skin is then very soft. When they try to get out of the pool, they scrape their hands and fingers on the cement causing them to scrape the skin off. This is sore and you can bandage them with antibiotic ointment.


June 3, 2016

Zika continues to be big news.  It has been connected with birth defects in South America and now one case of microcephaly in mother who became infected in South America and delivered here in North America.  Over 20,000 cases of microcephaly occurs in America every year.  It is caused by many problems during pregnancy:


1. Certain infections during pregnancy, such as rubella, toxoplasmosis, or cytomegalovirus

2. Severe malnutrition, meaning a lack of nutrients or not getting enough food

3. Exposure to harmful substances, such as alcohol, certain drugs, or toxic chemicals

4. Interruption of the blood supply to the baby’s brain during development

5. And now Zika.


All these conditions occur in South America and other developing countries at a higher incidence than here in the States.  The Zika virus is new to South America so many people are being infected.  There are normally no or mild symptoms from the illness. The children who are getting infected are then immune to it and will not have the illness when an adult who gets pregnant.  So they should want their children to get the illness to protect them.  It works like a vaccine to prevent birth defects later in life. There are a lot of cases of microcephaly now from Zika but when the children who are immune grow up, then the number of cases will be extremely rare.  They estimate 1% of pregnant women will have a damaged newborn with Zika but many cases are not reported since there are such mild symptoms.  The damage rate is probably far less.  America will spend big dollars to develop a vaccine since the disease may eventually come here.  (I mentioned before I worry more about Dengue Fever.)  Many people will want the vaccine and especially adults in child bearing years should get it.   (Interesting how many people who are against the MMR will want this vaccine yet we give Rubella vaccine to prevent such problems.)  Before the chicken pox vaccine, we used to have chicken pox parties where the parent would expose their kids to it.  Then get the disease as a child instead of as an adult when it would be more dangerous.

 Some diseases are less dangerous in children than adults and some are more dangerous as kids like Dengue.  You do not hear much about West Nile like we did years ago.  It came to America in 1999 and there are outbreaks in different states in different years.   In Texas the yearly rate of West Nile was 27-260 cases every year from 2001 to 2011.  Then in 2012 there were 1868 reported cases.  There were a lot of susceptible people in the population and more mosquitos with the virus that year.  The next year there were 183 cases. West Nile is dangerous for the elderly although severe disease is only 1%.  Children hardly ever are hospitalized with it.  But I see 20-30 cases of probable West Nile every year but they never get diagnosed since it is mild and require expensive yucky tests for a disease I cannot treat.  I tell parents it is not a bad thing since they are then immune to it and will not get it when older and more deadly.  Also there was a lot on the news about West Nile so doctors were testing more patients for the infection.  There sometimes is an increase in disease because the doctors and population are looking harder for the disease and not an actual increase the number of cases.  The West Nile story sounds similar to Zika situation huh?

 Protect your children from mosquito bites and especially when traveling to South America, Central America, Mexico, and other countries with high numbers of mosquitos.  Not to prevent Zika but to prevent Dengue, malaria, and other worse diseases. 

 Here is a not-so-complete list of diseases from Mosquitos.

 Banna Fever

Bunyamwera fever

Bwamba Fever


Dengue fever,

Eastern Equine Encephalitis

Jamestown Canyon fever

Japanese encephalitis

La Cross encephalitis


Mayaro virus disease

Pogosta disease

Rift Valley Fever,

Ross River fever

Saint Louis encephalitis

sleeping sickness

Tropical eosinophilia

Venezuelan equine encephalitis,

West Nile Fever,

Western Equine Encephalitis,

Yellow Fever,

Zika fever


June 25, 2016

The Nasal Flu Vaccine “Flumist” was not very good.  It was only 17% effective.  The shot is 67% effective most years.  So the CDC and AMA and American Academy of Pediatrics recommends only the shot this year.  There probably will be a shortage of injectable shots for flu since everyone should be getting shots and not nasal vaccine.  I recommend the vaccine and I would suggest getting it as early as you can since I think there will be a shortage.


July 19, 2016

Child Identity Theft.


Data about the prevalence of child identity theft victims is limited, in part because children don't become aware that their personal data has been stolen until they are old enough to apply for a driver's license or a credit card. The Child Identity Fraud Report found that 1 in 40 households with minor children had at least one child whose personal information was stolen.  The survey also revealed that 27 percent of identity thefts in the U.S. are committed by people that the children know.  Friends or relatives.  As for the 73 percent of identity thieves who don't know your child, criminals may gather your children's personal information from forms from school, tax office, or even doctor's office.  Our office and Cook’s system are very careful in protecting your child’s private information. 


The problem with the freeze, however, is that you need to have a credit report in the first place before you can put it in cold storage. Because most children don’t, it’s usually been nearly impossible to freeze a child’s credit file. In the last few years, though, that’s been changing. According to Heather Morton, a program principal with the National Conference of State Legislatures, 19 states now require the credit agencies to help parents and guardians create a new credit report for a minor child for the express purpose of immediately freezing it. Those states are Arizona, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Louisiana, Maryland, Michigan, Montana, Nebraska, New York, Oregon, South Carolina, Texas, Utah, Virginia and Wisconsin. If your state doesn't allow a child credit freeze, you have to petition hard to get that changed.

·                     Info on freezing a child's credit with TransUnion can be found here.

·                     Info on freezing a child's credit with Equifax can be found here.

·                     Info on freezing a child's credit with Experian can be found here.




You can have a company freeze it for you like “Life Lock” but they charge you every month to freeze your credit.  You can do that with a onetime fee.  You can unfreeze it when you need it with a one time fee $10 to unfreeze it for a week or so when applying for something.  I recommend everyone in the family freeze their credit.


Roger Knapp MD


July 23, 2016

The family evening meal is very important.   We have moved away from that habit 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.


July 28, 2016

We all develop breast tissue at different ages. The hormones in the mother’s breast milk can make the breasts grow in infant males and females. This occurs in a few weeks of life. These breasts can actually make milk that the grandmas used to call “witch’s milk”. They go down in a few months. Then the breasts can grow again around one year of age in females and is called premature thelarche. It lasts for several years. This is normal if there are no other signs of puberty. Then of course girls develop breasts at puberty. The hormones in cow’s milk have not affected puberty. The age of menarche has been decreasing for the last 300 years and is more related to better health and nutrition. Boys can develop breast buds at puberty around 11 – 13 years old. It is a hard tender knot usually quarter size below one or both nipples. It is just the hormones starting and will generally go away after a few years. It is not abnormal and they do not need to see the doctor. If they continue to get big then it is gynecomastia and needs to be evaluated. And then we old men get man-boobs. LOL. So there are several ages when breasts occur and can be very normal.

Aug 8, 2016

I have tried many gates in our home for stairs and doorways to keep pets and children from harm.  I think this is the best one. We have an adaptor to keep from putting holes in our stair post.


Dr. Knapp

Aug 22, 2016

All of doctors have finished back to school and sports physicals and vaccines.  We get swamped this time of year and especially for sports physicals.  Many school districts started requiring a physical after April or May.  I personally have 8000 patients and cannot see the athletes in 2 ½ months.  Please write your school board to let them have physicals after Jan 1 of that year.  Their heart or kidneys are not going to change in that short time period. 

 Speaking of sports, I have sent information in the past and told patients in my office about treating injuries with four things and they spell the word RICE.  Rest, Ice, Compression, and Elevate.  When you injure your joint and come off the field in lot of pain, it will bleed into the joint or muscles.  That damages the body.  Of the four things we do, compression is the most important to keep it from bleeding.  Then later you put ice on it. So wrap painful injuries with tape. An Ace Wrap will stretch and still let it swell.  Watch the pro football players wrap their fingers and joints in tape before they play. 

also see my website on the four misconceptions of head injuries.

 Aug 24, 2016

Where do you search for medical information?  The regular google search brings up advertisements, and biased conspiracy prejudiced websites, and some good ones like webMD.  If you want good medical evidence and research papers with mostly unbiased medical studies, then go to Google Scholar.  Here is a short video on how to get there.


 Aug 29, 2016


There are many studies that have shown that insecticides cause microcephaly, spina bifida, hypospadius, autism, gastroschisis, and other birth defects.  Now many cities are spraying for mosquitoes to prevent Zika and West Nile.  This is very likely harming as many people as the diseases.  It is also killing bees and butterflies that are needed for our flowers and crops.  The news media loves to scare us about one thing or another.  They scared us about AIDs when it first came out many years ago and people would not come close to patients with that disease.  They cause general anxiety or even panic in the general population so people get upset something is not done by our wise and omnipotent government. Then the national and city leaders feel pressure to “fix” whatever problem arises.  Some times that is important like the lead in the water system in the Northeast.  They were criticized for not reacting more quickly. Hopefully we can get a vaccine and not spray toxins all over our cities. How about wearing more clothes and using insect repellent which is safe down to 6 months old? And then people will be talking about Neurological disorders like Guillain-Barré syndrome that can follow infections like Zika and also vaccines.  Rare…. 1/100,000!!  It seems like it never ends. It is hard to stay calm and think straight when everyone else is panicking.  “It is hard to remember your main objective was to drain the swamp when you are up to your neck in alligators.” Then one community decided to only spray the mile around cases of zika.  At least that is better than they whole town.  But how many people come back from South America infected with Zika who have no symptoms?  Most patients with Zika have no symptoms.  Oh well.  What do we do?  I personally am against spraying all these chemicals all over our communities. 

 Sept 6, 2016

Let’s clarify the recent FDA ruling on hand sanitizers and washes(hand soaps).  They outlawed the use of certain antibacterial chemicals in hand washes.  Those are antibacterial soaps with chemicals like triclosan and triclocarban.  Hand sanitizers are the alcohol containing products in a bottle you squirt on hands.  The washes are used with water to wash hands like regular soap and water.  These antibacterial soaps are not more effective than just plain soap and water.  The alcohol hand sanitizers are good and safe if you do not have soap and water as long as you do not do your hands 50 times a day. One hospital in the area I was working in tried to start washing newborn babies in antibacterial washes 4 years ago.  I gave them evidence of the toxicity of them and insisted they use just plain soap and water which they did.  Many times the simple things without a lot of chemicals are the best. It is OK to use the alcohol hand sanitizers that we have used for years. 

 Sept 14, 2016

Swallowing something that we cannot digest can cause problems.  Common to have children swallow a coin and it usually passes.  More dangerous is a small button battery that needs removal immediately.  But also hair and fibers can cause a “hairball” called a Bezoar in the stomach.  Here is a picture of a fleece blanket bezoar of the stomach that had to be surgically removed.  The child had a habit of chewing the blanket all the time. There are also cat hairballs and Owl pellets.  Don’t let your child chew their hair or blankets that have loose fibers of this could happen.

Roger Knapp MD



Oct 7, 2016

In the News: http://people.com/human-interest/polio-like-disease-is-on-the-rise-in-the-u-s-causing-paralysis-in-children/

 Oct 2016:    Some enteroviruses are very common and cause only mild illness. Ailments can range from common cold symptoms, but it can cause stronger effects in younger immune systems.

 Enteroviruses affect millions of people worldwide each year, and are often found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person. Historically, poliomyelitis was the most significant disease caused by an enterovirus, poliovirus. There are 64 non-polio enteroviruses that can cause disease in humans: 23 Coxsackie A viruses, 6 Coxsackie B viruses, 28 echoviruses, and 5 other enteroviruses. Poliovirus, as well as coxsackie and echovirus are spread through the fecal-oral route. Infection can result in a wide variety of symptoms ranging from mild respiratory illness (common cold), hand, foot and mouth disease, acute hemorrhagic conjunctivitis, aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, and acute flaccid paralysis.

 The rare condition of paralysis similar to polio has been documented in 24 states, with the majority of cases (90 percent) affecting children, according to the Center for Disease Control and Prevention (CDC), which has been monitoring cases of Acute Flaccid Myelitis (AFM) since 2014.

 According to a report by the CDC, 120 AFM cases were reported across 34 states in 2014. The following year, 21 cases were reported and as of August 2016, 50 people in 24 states were confirmed to have this serious illness.  As for the severity of paralysis, doctors are unsure. In the cases from 2014, some children have completely recovered — but many did not.

 Enterovirus has been around a long time.  From 1974: An Apparently New Enterovirus Isolated from Patients with Disease of the Central Nervous System.  J. of Infectious Diseases.  1974  20 Patients in California.

 Report from Spain June 2016.  This localized outbreak of neurological symptoms associated with enterovirus A71 (EV-A71)

It's rare, but acute flaccid myelitis (AFM) is under close watch by the Centers for Disease Control and Prevention. Because the upswing in AFM cases occurred in tandem with a nationwide outbreak of enterovirus D68, some physicians felt the two could be linked; a relationship remains unproven. The CDC's website also indicates that AFM reporting is both voluntary and only a few years old; it's difficult to determine whether there is a statistically-significant growth in the number of cases or just in the number of cases reported.

Getting AFM is unlikely, but it's critical for parents to know what symptoms to watch for. According to CBS News, 90 percent of this year's reported AFM cases occurred in children. Often, the illness begins with the same mild to moderate fever and respiratory symptoms common to respiratory illness. Within days, fairly common side effects may be supplemented by sudden limb weakness, loss of reflexes, loss of muscle tone, difficulty moving their eyes, drooping facial muscles and eyelids, difficulty swallowing and slurred speech.  AFM is far from being an epidemic, but it is dangerous enough to warrant ongoing CDC monitoring and continuing interest from the medical research community.

 Roger Knapp MD

 Oct 15, 2016

Protein drinks and muscle milk products make a lot of money convencing athletes to get more protein and many coaches and trainers have bought in to it.  Studies show most teen athletes get plenty of healthy protein.  Below is an example of protein in diets and shows it is easy to eat plenty of high protein food to help.  Also studies show most of these protein supplements are contaminated with cadmium, lead, and mercury.  Large amounts can give the body more lead/mercury than the tolerance level. Also studies show too much protein can harm the body.  Most of these supplements contain whey protein reported to do better than casein proteins.  But as one study said:  one might speculate that if the protein dose or intake is sufficiently high, it may not matter what that particular protein source may be.”

 I do not recommend the protein supplements unless you are a vegetarian or just don’t have time or money to eat correctly.

Grams of protein in typical teenage servings of food:

Yogurt 23

3 eggs 18

Glass milk 16

6 oz steak 70

Hamburger 40

Pork chops 70

Chicken or turkey 65

Tuna or salmon 65

Tilapia 60

Navy Beans 30

Bacon 40

Jerky 26

Peanut Butter sandwich 12

Nuts 12


Menus and protein intake:

Breakfast: Eggs bacon and milk 132

Lunch: Hamburger, Milk 86

Snack jerky X2 52

Dinner:   Steak(or other meat), beans, milk  146

Snack jerky  52

Total intake 468gms of protein. 

Recommended protein intake: 2 gm/lb X 180lb = 360



 Roger Knapp MD

 Oct 25, 2016

 New study shows that the 3 shot Gardasil for HPV prevention can work better in kids below 15 yr old.  So now the recommendation is to give only 2 shots if the child is below 15 and 3 shots if older than 15 yr old.   Good news for less pain and cost.  The HPV vaccine is very important and safe.  

 Nov 6, 2016

In the U.S. the death rate of newborns are most often caused from labor and delivery complications, birth defects or infections, a recent study reported in the Journal of Perinatal Medicine,  October 18, 2016.

 Infant mortality in the U.S. is rare. The death rate for midwife-attended home births was the highest, though, with almost 13 fatalities for every 10,000 deliveries, the study found…. 1/770 deliveries.  That compares with roughly 6 deaths for every 10,000 hospital deliveries by a doctor and about 3.5 deaths for each midwife-attended hospital birth. The study looked at full term normal weight babies.  The cases were lower in hospital midwife deliveries because cases that developed problems were turned over to the doctors. 

 In home deliveries, the most frequent causes of labor and delivery issues that contributed to neonatal deaths at home were situations that caused brain damage such as oxygen deprivation to the brain or suffocation.  These happened in 2.3 of 10,000 births at home versus 0.21 per 10,000 in hospital midwife deliveries.

 The study commented that they felt the home midwives may not have the same level of training or properly screen women to ensure they are unlikely to require medical interventions available only in a hospital.

 The study did not have the data on neonatal deaths for situations when women started delivery at home but transferred to a hospital due to complications.  Those would have been counted as hospital fatalities. 

 Several other studies in the past have found the same results as this study. Midwife deliveries in the hospital are safer for the baby.  Like vaccines, the rare complications do not outweigh the benefits of regular medical care.

 Roger Knapp MD

 Nov 18, 2016

In Canada “medical marijuana was legalized but with loopholes in the law, many can grow it privately without punishment.  So by 2006 it was widely used with almost half (44%) of Canadians say they have used marijuana.  Just over one-quarter (26.5%) of Ontario students (grades 7–12) said they had used marijuana. By the time they have reached Grade 12, and nearly half (46%) of Ontario students use marijuana and about one in eight students (12%) use it every day.

 Now since 2007 over the last 10 years since marijuana was widely used, there has been a huge increase in addiction to hard drugs like opioids.  There was an increase of 62% in hospitalizations in 15-24 year olds.  There was a 30% increase overall ages in hospitalizations for opioid poisoning.  That is just the statistics for hospitalizations but it reflects a massive increase in the population using hard drugs. Now Canada is in Crisis mode to get control of the epidemic.

 Nov 30, 2016

Boy howdy are the many cough cold preparations in the stores confusing. They also have a lot of false advertising on TV and on their product labels.

 A popular prescription cough/cold medication is Bromfed.

 Bromfed® DM Cough Syrup

5 mL (1 teaspoonful) contains:

Brompheniramine Maleate,   2 mg  An antihistamine

Pseudoephedrine Hydrochloride,  30 mg  A decongestant.

Dextromethorphan Hydrobromide, 10 mg A weak cough suppressant.


Children 12 years and over: 10 mL (2 teaspoonfuls) every 4 hours.

Children 6 to under 12 years of age: 5 mL (1 teaspoonful) every 4 hours.

Children 2 to under 6 years of age: 2.5 mL (½ teaspoonful) every 4 hours.

Infants 6 months to under 2 years of age: Not recommend but can be used

by a physician dosage.  CDC and I do not recommend it below 2 yr old.


Other cold medications that are similar but use a very weak or useless decongestant Phenylephrine.  Many companies have changed decongestants from Pseudoephedrine to Phenylephrine.  But Phenylephrine is not very effective and some studies showed it did not help any more than placebo.  The problem is that Pseudoephedrine is prescription or you have to sign for it from the pharmacist because of Met. Labs. 

The Dosage of Pseudoephedrine

3 to 5 years:15 mg orally every 4 to 6 hours as needed
6 to 12 years:30 mg orally every 4 to 6 hours as needed
12 years or older:30 to 60 mg orally every 4 to 6 hours as needed


Children's Dimetapp DM Elixir Cold & Cough active ingredients.

Children 12 years and over: 4 tsp every 4‑6 hours.

Children 6 to under 12 years: 2 tsp every 4‑6 hours.

Children 4 to under 6 years: do not use unless directed by a doctor.

Children under 4 years: do not use.

5 ml Teaspoonful:

Brompheniramine Maleate, 1 mg,

Dextromethorphan HBr,  5 mg,

Phenylephrine HCI USP 2.5 mg.


Walgreens Cough and cold

Children 12 years and over: 4 tsp every 4-6 hours

Children 6 to under 12 years: 2 tsp ever 4-6 hours

Children 4 to under 6 years: do not use unless directed by a doctor

Children under 4 years: do not use

Contains: 5ml

Brompheniramine Maleate 1mg

Dextromethorphan HBr,   5 mg

Phenylephrine HCl USP 2.5 mg


Zicam is “zincum” which basically zinc.  Zinc helps your immune system and many studies have proven it.  That is why I recommend multiple vitamins with zinc all year.  Studies comparing Zicam showed 1-2 days less viral colds but only in cough and congestion.  It did not make a difference in fever, muscle aches, or sore throat.  It did make 80 % of the patients nauseated and foods tasted different.  I don’t think it will help you if you take a multiple vitamin every day all year.  The studies showing it helped the cold is because the patients were not taking a vitamin all year with zinc.

 Vitamin C …. DOES NOT HELP ILLNESSES OR COLDS.  There always is a placebo effect so if you think it helps you… go for it.  I don’t recommend it.  It also is in multiple vitamins in an adequate dose.

 Airborne: major ingredients are:

Echinacea … Many studies have been done.  Half of the studies showed slight improvement with colds and half of the studies showed NO difference from placebo. I don’t recommend it but again not hurting anything but your wallet.

Glutamine and Lysine …. Amino Acids.  Yes they help the immune system but you have to have a significant deficiency to matter.   We make plenty of them inside our own bodies and if you need more, there are massive amounts in our diet from meats, dairy, and vegetables.  Hurting nothing but your wallet but if you think it helps (placebo) then take it.   I don’t recommend it.

 Guaifenesin …. This is an expectorant to loosen mucous.  Some studies showed it helped colds but only helped one out of 12 symptoms.  Some studies showed a cup of water worked just as good.  I guess grandma’s advice for colds to take Tylenol and drink fluids is good today as back then.  Guaifenesin tastes terrible.  So I don’t push Mucinex or other products with it. 

 Dextromethorphan.   This is a cough suppressant.  Some studies showed it did not help and others showed a decrease in cough.  I does not make you drowsy so it is worth a try during school hours.  Watch your teenagers.  Many teens take huge amounts of it in order to get high.  Large amounts are hallucinogenic.

 Honey.  Several studies showed honey helped.  ½ tsp for 1-2 yr, 1 tsp for 2-5 yr, and 1 ½ tsp for over 5yr old given three times a day. Of course we don’t recommend a hot toddy and no honey for infants below one yr old.

 So in summary:

I recommend something for cough (Dextromethorphan) and something for congestion (pseudoephedrine).  The antihistamines (Brompheniramine) that some products contain can make you drowsy but not help a viral cold. It can’t hurt either. Drowsy is good at night.

 I like Delsym(Dextromethorphan) in the morning for school age and older. Dosage:

Chldren 12 years of age and over …  10 mL every 12 hours,
children 6 to under 12 years of age … 5 mL every 12 hours,
children 4 to under 6 years of age …  2.5 mL every 12 hours,
children under 4 years of age … do not use

 I like NyQuil at night.  It has Dextromethorphan, Tylenol, and an antihistamine. It does not have anything for congested nose so you could take “Sudafed” along with it. Then you basically have the same stuff as Bromfed. NyQuil D Cold and Flu Nighttime contains all four of these ingredients including Sudafed. (D stands for Decongestant) Dosage 10ml 6-12 yr old and 20ml for 12-17 yr old. Adults 30ml.

 And of course Honey … since I have two bee hives.

Roger Knapp MD


Dec 16, 2016

You may have heard about the increase in cases of Mumps recently in the news.

The MMR vaccine is very safe and fairly effective. The mumps component of the MMR vaccine is about 78 % effective with one dose and 88% effective with two doses.

 There's been a huge drop in how many people have been affected by the disease since the U.S. mumps vaccination program first started in 1967, according to CDC data. At the time, about 186,000 cases were reported each year. Since the pre-vaccine era, the CDC notes, there has been a more than 99 percent decrease in the number of people with mumps in the U.S. This year there is a large number of cases in Oklahoma, Iowa, Illinois, Indiana, Pennsylvania, Massachusetts, and Arkansas. (There is a rumor that Pres. Bill Clinton had Mumps as child and is sterile.)

 Most years, the entire state of Texas reports about 20 cases of mumps, but an outbreak in Johnson County has affected almost 30 people, mainly children, in recent weeks. 


In recent U.S. mumps outbreaks, orchitis occurred in 3.3 to 10% of adolescent and adult males. In 60% to 83% of males with orchitis caused by mumps, one testis is affected. Such orchitis can rarely cause sterility. Other rare complications of mumps include pancreatitis, deafness, meningitis, and encephalitis, which have occurred in less than 1% of cases in recent U.S. outbreaks. There have been no mumps related deaths reported in the United States during recent mumps outbreaks.

 Many outbreaks occur in children like here in Texas and many are children who have not been vaccinated for MMR. Mostly from false claims of autism or fear of mercury. 

 Mercury is a naturally occurring element found in the earth's crust, air, soil, and water.  The two types of mercury to which people may be exposed -- methylmercury and ethylmercury -- are very different.

 Methylmercury is the type of mercury found in certain kinds of fish. At high exposure levels methylmercury can be toxic to people. In the United States, federal guidelines keep as much methylmercury as possible out of the environment and food, but over a lifetime, everyone is exposed to some methylmercury.

 Thimerosal contains ethylmercury and is added to vials of vaccine that contain more than one dose to prevent growth of germs. Thimerosal does not stay in the body a long time so it does not build up and reach harmful levels. When thimerosal enters the body, it breaks down to ethylmercury and thiosalicylate, which are quickly eliminated.

Roger Knapp MD