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Newsymail 2003


A new vaccine combination was approved by the FDA on December 16, 2002 for GlaxoSmithKline by the name of  Pediarix™.   It contians Diphtheria, Tetanus, Pertussis, Hepatitis B, Polio Vaccines.  and can be given to infants at 2, 4 and 6 months of age.  It will be months before it is manufactured and distributed to our offices but it will cut down the number of pokes for the babies.  It still hurts us more than it does them.  Like our Dad said "This spanking is going to hurt me more than you."  and now that we have children we understand what he was saying.


Because dietary supplements can vary in their contents and quality, supplement manufacturers will begin distributing products bearing the United States Pharmacopeia's Dietary Supplement Verification Program mark, a guarantee that the bottle contains exactly the ingredients that the label claims. Not that it does what it says .... but just that it contains that amount of the material. USP’s program is voluntary. Supplements meeting these standards will be labeled with the DSVP-certification mark and the following statement: "USP has tested and verified the ingredients, product and manufacturing process. USP sets official standards for dietary supplements." Northridge, Calif.-based Pharmavite Corp.'s Nature Made Vitamin E will be the first product with the DSVP-certification seal to hit shelves.

The U.S. Pharmacopeia (USP) plans to formally launch a national certification program for dietary supplements. All U.S. dietary supplement manufacturers are invited to participate. The USP program includes:

Quality control and manufacturing data review 
Laboratory evaluation of product samples
Evaluation of manufacturers’ quality systems through GMP audits
Granting of a USP verification mark Surveillance of products bearing the USP verification mark

The USP verification mark will indicate that the product will:
Contain the declared ingredients on the product label
Contain the amount or strength of ingredients declared on the product label
Meet requirements for limits on contaminants Comply with the United States Pharmacopeia.

U.S. Pharmacopeia’s (USP) new Dietary Supplement Verification Program (DSVP) is confusing and could be misleading. The USP certification mark means that it vouches for the presence, quantity, and purity of a supplement’s ingredients—and not the supplement’s safety or possible benefits. The concern is that some consumers will assume that the USP mark means the product is safe and beneficial. It does not mean that it has been shown to do what it claims to do. If you are going to trust your body and health to these dietary supplements, at least get quality stuff with this seal.


The cream to numb up the skin for blood drawing and such is called EMLA in the doctors office.  You can get it over the counter in ELA-Max which is just as effective and safer.  You can get the "glue" with which the doctor puts minor cuts together now over the counter.  So we are gradually trying to get things over the counter that you can do safely so you can avoid a trip to the doctor or ER.  You might consider taking the skin glue on camping trips in case of minor little cuts.

Date: Sun, 26 Jan 2003 22:42:08 -0600

Circumcision debate:

Diseases Prevented:

>7,000 cases of Aids

>10,000 cases of syphilis

>20,000 episodes of kidney infection

>1,000 cases of penile cancer

200,000 cases of phimosis (foreskin scared closed)

250,000 cases of balanoposthitis (infected foreskin)



2,000 cases of bleeding that can be stopped.

2,000 cases of infection.

300 shaft injury that needs repairing.

1 case of entire penis lost. (same result with cancer)


I recommend it.

Dr. Knapp


Date: Sat, 22 Feb 2003 23:28:59 -0600

The rivers in West Africa had black flies that carried parasites which caused blindness.  River Blindness was so rampant in the 1970’s that 10% of the population were totally blind and 30% had severe visual impairment.  People moved out of the area.  The World Health Organization started giving medication and insect control measures until it has been virtually irradiated.  Now farmers are moving back into the fertile river land, reclaiming 25 million hectares of land that will feed 17 million people.  This was done completely with donated money. 


We are going to send billions of dollars to Africa for treatment of Aids when more important is to stop the spread.  It is simple: don’t have sex with anyone except your spouse.  Be faithful.  It doesn’t cost a dime.


Dr. Knapp



p.s.:  I think they should restart the blood tests for marriage license.  Tests for Hepatitis B and C and for Aids.

Date: Sun, 9 Mar 2003 22:05:18 -0600

Polycystic ovarian syndrome (PCOS) was originally described in 1905 by Stein and Leventhal as a syndrome consisting of amenorrhea, hirsutism (facial &/or chest hair in women), and obesity in association with enlarged polycystic ovaries.

Findings in this disorder are:

  • Irregular or absent menses
  • Numerous cysts on the ovaries in many, but not all, cases
  • High blood pressure
  • Acne
  • Elevated insulin levels, Insulin Resistance, or Diabetes
  • Infertility
  • Excess hair on the face and body
  • Thinning of the scalp hair (alopecia)
  • Weight Problems or obesity

In fact, earlier studies of PCOS have focused on ovarian morphological findings and were considered to be an important diagnostic criteria. However, it was found that polycystic changes of the ovaries were observed in some normally cycling women and some women with PCOS have normal ovaries.  The ovaries are really a secondary effect of the hormone imbalance. Thus some authors refer to it as a syndrome of hyperandrogenic chronic anovulation.

There are irregular heavy periods from puberty.  Increased hormones cause resistant acne, not responding to conventional treatments.  Affected areas are the facial and suprapubic region of the body plus the chest, inner thigh, and perineum. Another sign is acanthosis nigricans which is characterized by velvet-like, grey-brown hyperpigmentation of the skin in the nape of the neck, axillae and groin. Many women with this syndrome have mild degrees of hyperinsulinism and insulin resistance resulting in diabetes.

Occasionally, spontaneous ovulation and pregnancy may occur.

The incidence of PCOS is about 3% in both adolescents and adults and it is not inherited. PCOS is an endocrine disorder of undetermined cause characterized by elevated levels of luteinizing hormone (LH), but not of follicle-stimulating hormone (FSH), and   increased circulatory levels of androgens. 

This needs to be treated even though it can’t be cured.

Dr. Knapp

Date: Sun, 23 Mar 2003 16:38:57 -0600

The hair loss that many women have after giving birth is common and known as “telogen effluvium”.  It can be more than a nuisance--occasionally, those shed hairs can get wrapped around baby's toes, creating a "tourniquet" that cuts off the circulation.  The condition is not very common, and the exact incidence is not known. The condition, referred to as toe tourniquet syndrome, occurs when a loose hair or thread becomes so tightly wrapped around a baby's toes that pain, swelling and discoloration occur. A finger or penis (Ouch!) can also get wrapped up, but the toes are most often the victim. It can occur from 1 to 15 months of age but usually occurs at an age when their mothers' post-delivery hair loss is at its peak--around four months old.   The only symptom is fussiness and one of the toes are swollen, purple and tender to the touch. Look for a fine line indention and blue or red toe past it.

Treatment is to soak the toe in “Nair” or other hair dissolving solution.  Sometimes the surgeon has to cut down in the skin to release the tourniquet.

So watch the hairs and toes.  J

Dr. Knapp

Date: Mon, 24 Mar 2003 21:59:39 -0600

Foods high in nitrates can cause what is called Methemoglobinemia where the hemoglobin in the blood does not hold oxygen and the baby is blue. It is more common in infants below 6 months old. This chemical is in vegetables and especially in spinach and beets. That is why we do not want to give any vegetables below 6 months old. But a large volume of many vegetables that are home pureed and stored in the refrigerator for days can contain allot of nitrates and has caused the problem in 6-12 month olds. If you prepare vegetables at home (which I prefer you do) just grind them up and feed it that day. Don’t try to keep it. Or freeze it immediately. It brings up a new meaning of our mother’s advice to "eat all your vegetables." J

Dr. Knapp

Date: Sun, 30 Mar 2003 06:37:53 -0600

There was a report of a patient whose dog sniffed at a mole on her leg. On 1 occasion, the dog even tried to bite the lesion off.  Although the patient was not concerned about the lesion, the constant attention from the dog prompted her to seek medical advice. The lesion was excised and histology showed the lesion to be a malignant melanoma measuring 1.86 mm in thickness. Since that time the patient has remained well with no sign of recurrence. Even more recently reported is a man aged 66 who developed a patch of eczema on the outer side of his left thigh, It grew slowly to about 1‑2 cm in diameter. When dry, the lesion would become scabby, and cause occasional itching. It was treated with several topical agents, including steroids and antifungals  without effect. When a pet Labrador called Parker came into this fellow's home in 1994, the dog began to persistently push his nose up against the owner's trouser leg, as if sniffing the lesion beneath it. This prompted the patient to return to his family physician for examination. The lesion was excised and histological assessment of the lesion showed it to be a basal cell carcinoma. In both cases, the dog could smell the lesions through clothing and showed no further interest once the lesions were excised. Having heard of these 2 cases, a dermatologist from Florida has teamed up with a retired police dog handler with 33 years experience in training dogs, including service in Vietnam, leading the K‑9 bomb unit. They used conventional sniffer‑dog techniques to train George, a Schnauzer, to recognize in‑vitro malignant melanoma samples. Subsequently, George was introduced to a patient with several moles thought to be cancer‑free. One mole caused George to go crazy. An excision of that lesion confirmed an early diagnosis of malignant melanoma.


I don't know if this is true or just accidental that the dogs found the cancer but it would not hurt to get it checked out if your dog is bothered by your skin spot. Pretty interesting. If the dog is sniffing your luggage at the airport and goes crazy about your leg, pay attention.  The dog proves again that he is truly man's best friend.
Dr. Knapp
p.s.: good pet health advice from:
Date: Tue, 1 Apr 2003 22:07:44 -0600
Our wonder government has made some major changes to our medical offices.  We "love" their regulations. (cough, cough).  These changes deal with privacy.  Most are probably good but many areas it goes into too much stuff.  We can not fax allot of forms.  We cannot talk in the halls.  And there are many more regulations.  One is that patients will have to read and sign a privacy acknowledgement form that you have received a privacy statement.  We will hand you a copy and you will have to sign a paper that you were given it.  There is a copy at my web site of this statement and the form you have to sign. You will only have to sign it once for every child and you will be doing it at your adult doctors offices also.  Sorry about the future inconveniences but it is beyond our control.
Thanks for your patience and your patients.  (pediatricians are doctors with little patience. ha.)
Dr. Knapp

April 6, 2003

Mercury in the vaccines was miniscule and we could not measure an increase in the infants’ blood or urine.  Mercury does not cause Autism.  There are creams from foreign countries, especially Mexico, that contain large amounts of Mercury.  Of a study of 330 adults using creams from Mexico showed 146 micrograms of Mercury in the urine (normal 0-20).  As much as 5% of the population there use “Crema da Belleza-Manning”.  Mercury causes tremors, unsteadiness, mental deterioration, and even coma and death. 


Of course there are other heavy metal poisonings like lead.  We took the lead out of paint and there is no lead in the “lead” of pencils… it is graphite.  (Don’t fret if your child pokes their hand with pencil “lead”.)  The concern was that lead in shotgun pellets was causing lead to increase in food and the environment.  Iron pellets are too light and Bismuth metal is more poisonous than lead.  Gold is not toxic and would work great as shotgun pellets.  But then who could afford hunting with that.  J


Dr. Knapp

April 13th, 2003

CNN Reports:


GUANGZHOU, China (Reuters) -- A new and often deadly virus which is sweeping the globe has infected thousands, with no apparent regard for race, gender or nationality. But one group has so far come through virtually untouched -- children.

Doctors are trying to explain why a virus that moves with relative ease through the adult population, so far infecting 3,000 worldwide with more than 100 dead, has come up against something of an immunological wall when it comes to youngsters.

In the south China city of Guangzhou, just miles from where the outbreak began, Guangzhou Children's Hospital has yet to see its first patient with Severe Acute Respiratory Syndrome (SARS), officials said this week.

"We haven't had any cases of SARS," said Yu Minghua, chief of paediatrics at south China's largest hospital for children.

Viral illnesses are usually worse in adults and less severe in children.  Children are not immune to SARS (in my opinion) but they only have a mild cough and not much fever.  They never get diagnosed.  Mild cases in adults does not get diagnosed.  The incidence of SARS is probably much higher (I bet more likely 30,000 rather than 3,000.) but the true total amount of cases just never gets known.   SARS is a nasty chest “flu” but may not be any deadlier than the flu every winter.  As you can see for this report from the CDC:

In the United States, influenza epidemics occur nearly every winter and are responsible for substantial morbidity and mortality, including an average of approximately 114,000 hospitalizations and 20,000 deaths/year.  During influenza epidemics, hospitalization rates among older adults and persons with underlying chronic health problems can increase twofold to fivefold above rates in nonepidemic periods. From 1972--73 through 1994--95, >20,000 influenza-associated deaths/year were estimated to occur during 11 U.S. epidemics, with >40,000 influenza-associated deaths estimated for 6 of these 11 epidemics (unpublished data, National Center for Infectious Diseases, CDC, 1998). In each of the 3 influenza seasons from 1997--98 through 1999--00, P&I mortality exceeded epidemic threshold values for >10 consecutive weeks. The peak proportion of P&I deaths was 9.7% during 1997--98, 9.8% during 1998--99, and 11.2% during the 1999--00 season.


We worry about a new strain of flu going through and killing many people … mostly adults, elderly, and rarely small babies.  The flu however is not as severe in children. 


To compare, think about Hepatitis A.   It is such a mild illness in children that they hardly ever even get jaundiced.  They have a 7 day stomach flu and the main reason I want to diagnose them is so that I can give the family shots to prevent it in them.  Hepatitis in adults is bad and 100 every year die, which equals 1/500 cases.  In children it is not severe and most parents do not know that their child had Hepatitis and usually do not even bring them to the doctor.  Also if we compare the child with chicken pox and the adult with chicken pox.  It is more severe in adults. We give the chicken pox vaccine since rarely these viruses can kill a child, therefore we recommend the chicken pox vaccine and the Flu shot.


The flu can kill just as bad as SARS:


The 1918 Spanish Flu Pandemic, and the Hong Kong Incident

Mankind’s most devastating recorded global epidemic and its latest close call

By Leonard Crane, author of Ninth Day of Creation.



As their lungs filled … the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business.

--Isaac Starr, 3rd year medical student, University of Pennsylvania, 1918.


By the fall of 1918 a strain of influenza seemingly no different from that of previous years suddenly turned so deadly, and engendered such a state of panic and chaos in communities across the globe, that many people believed the world was coming to an end. It struck with amazing speed, often killing its victims within just hours of the first signs of infection. So fast did the 1918 strain overwhelm the body's natural defenses, that the usual cause of death in influenza patients---a secondary infection of lethal pneumonia---oftentimes never had a chance to establish itself. Instead, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients would drown in their own body fluids.


Not only was the Spanish Flu strikingly virulent, but it displayed an unusual preference in its choice of victims---tending to select young healthy adults over those with weakened immune systems, as in the very young, the very old, and the infirm. The normal age distribution for flu mortality was completely reversed, and had the effect of gouging from society's infrastructure the bulk of those responsible for its day to day maintenance. No wonder people thought the social order was breaking down. It very nearly did.

But at the close of the First World War, when Spanish Flu appeared, the world was a very different place. Since then, outstanding advances in our knowledge of the germ world have been made, adding dramatically to our repertoire of medical wizardry. Surely what happened back then couldn't happen again.

Or could it?

During the 1918-1919 fall period the number of Americans who died from influenza is estimated at 675,000. Of those, almost 200,000 deaths were recorded in the month of October 1918 alone. Worldwide, the mortality figure for the full pandemic is believed to stand somewhere between 30 to 40 million. So, with the world population today having more than tripled in the intervening years, what is to stop a modern flu pandemic from claiming upwards of 100 million lives? The answer, it seems, is nothing at all.

Today, of course, we have vaccines and antiviral drugs. But in the Third World, at least, these combatants are in very short supply. In India, where the Spanish Flu is thought to have culled more than 10 million from the population, public health care is still notoriously deficient. In China, with a population one third larger again, the situation is not much better. Even for developed countries, where vaccines are readily available, the fraction of the population that routinely subjects itself to inoculation generally hovers around 10 percent. In the event that the public were to receive adequate warnings of an impending pandemic, it's likely of course that this number could be significantly increased. But even then, it may not matter. By their nature pandemics tend to take us by surprise. The next influenza strain that ravages the human population will probably not be the one we were planning to encounter.

If all this seems a little alarmist in nature, consider for a moment the recent controversy surrounding what Robert Webster, chairman of the Department of Virology and Molecular Biology at Saint Jude Children's Research Hospital in Memphis, Tennessee, has called The Hong Kong Incident.

In 1997 epidemiologists and public health officials from around the world got their first glimpse¹ of an entirely new variety of human influenza. Known as subtype H5N1 for the surface proteins which the virus carries, the new strain had only ever previously been observed in birds. Ominously, the effect of H5N1 on poultry had earned it the evocative title of "Chicken Ebola." And when it surfaced in the human population of Hong Kong last year it proved to be almost as deadly.


How deadly? Even with the advantages of intensive-care treatment, fully one third of the first 18 confirmed cases never recovered. They died. The numbers are suggestive of the death tolls suffered by immunologically-isolated Alaskan villages in 1918, where, in some cases, half the population was lost to the disease. In Hong Kong, bird-to-human contact is believed to have been the transmission route. Fearing a public health crisis, city officials in December of 1997 ordered the slaughter of Hong Kong's entire poultry population. All ducks, geese, and chickens in the city were killed. Fortunately it appears the H5N1 subtype lacks the ability to transmit itself through the air from one human host to the next potential victim.

On the surface, HK97 shows the hallmarks of what might be described as a "near miss" for our species. In other words, a biological catastrophe. Or it could be a false alarm. It's too early to say. Either way, it's hard to argue that we didn't just receive a wake-up call of sorts. Maybe what happened in 1918 has today merely the substance of a tenuous memory, but it also marks a lesson that clearly would be dangerous to forget. On the scale of a human life span, pandemic influenza is a rarity, but no-one seriously doubts that it will be back.


As Webster reminds² us, "All the genes of all influenza viruses in the world are being maintained in aquatic birds, and periodically they transmit to other species... The 1918 viruses are still being maintained in the bird reservoir. So even though these viruses are very ancient, they still have the capacity to evolve, to acquire new genes, new hosts. The potential is still there for the catastrophe of 1918 to happen again."


So what I am saying is that SARS is a new strain of the “cold” virus called coronavirus and we will need to get a vaccine for it.  Soon the majority of people will become immune to it since most cases will not be severe enough to diagnose and will not get it the next year.  This illness will come to the USA like most diseases and I worry about you adults out there.  I am not concerned for your children and I suggest you not loose sleep either.  Actually they are better off getting immune now when their body can fight it off better.  I would not go to the orient now as an adult.  Hopefully since they now have the DNA mapped out for the virus that a vaccine can be rushed quickly. 


The World Health Organization is appropriately trying to identify it and quarantine it until more is known and a vaccine produced.  The news media has of course taken this and used the good old fear and scare tactic to get viewers as usual.  Stay calm about the SARS but don’t travel to Hong Kong this year.


I guess I am allowed to get tacky here:   Those parents who are paranoid about vaccines and how they are terrible for our children and they do not get their children vaccinated against the common childhood diseases …… please continue your ignorant ways and don’t get vaccinated against SARS either.  


Sorry this is so long.

Dr. Knapp


May 11, 2003

This is a summary of these articles:

  1. 25% of cases of H. Pilori is acquired by adulthood.
  2. The best test now for diagnosis and determining if it is cured is a new stool test.  It is run on a 2-3 inch stool frozen and sent to the lab.
  3. H Pilori relates to stomach cancer and should be treated.

Read these summaries of three medical studies.

Also see: http://www.helico.com/


Dr. Knapp



Age at Acquisition of Helicobacter pylori Infection:

Malaty HM, El‑Kasabany A, Graham DY, et al         Lancet 359:931‑935, 2002  


Helicobacter pylori infection is common worldwide. The age at which the acquisition rate of H pylori infection is highest was examined, and the effects of race and sex on the acquisition of the infection were determined.  224 children were followed up from 1975 when they were 1 to 3 years of age, to 1995. Eight percent of the children had H pylori antibodies at 1 to 3 years of age. By 18 to 23 years of age, the prevalence of the infection was 24.5% overall.  Nineteen percent of the 206 participants uninfected at baseline became infected by 21 to 23 years of age. Overall, the crude incidence rate per year was 1.4%, ranging from 2.1 % at 4 years of age and 1.5% at the ages of 7years.



The Stool Antigen Test for Detection of Helicobacter pylori After Eradication Therapy

Vaira D, Vakil N, Menegatti M, et al       Ann Intern Med 136:280‑287, 2002  


Patients underwent endoscopy with histologic assessment, rapid urease test and culture, urea breath test, and a stool antigen test at baseline and on day 35 after completing triple eradication treatment. In addition, the stool antigen test was done on days 3, 7, 15, 21, 28, and.35 after treatment completion. A positive result on stool antigen testing 7 days after treatment completion identifies patients in whom H pylori eradication was unsuccessful.  Current guidelines therefore recommend the use of the urea breath test 4 weeks after completion of therapy to determine whether the organism has truly been eradicated.  The fecal antigen test is a relatively new noninvasive test for detection of H pylori. The test detects the presence of infection by measuring the fecal excretion of H pylori antigens.



Helicobacter Pylori lnfection and the Development of Gastric Cancer

Uemura N, Okamoto S, Yamamoto S, et al      N Engl J Med345:784‑789, 2001     


Many researchers have documented an association between Helicobacter pylori infection and the development of gastric cancer.  A prospective study included 1526 Japanese patients with duodenal ulcers, gastric ulcers, gastric hyperplasia, or non‑ulcer‑related dyspepsia. Of these patients, 1246 had H pylori infection; 280 did not. Patients were followed up for a mean 7.8 years. Endoscopy with biopsy was performed at enrollment and 1 to 3 years later.  Gastric cancer developed in 2.9% of infected patients and in none of the uninfected patients.  Worldwide, gastric cancer is the second most frequent cancer, and is also the second leading cause of death from cancer. Since the discovery of Hpylori just 20 years ago, an association between this bacterium and gastric cancer has been suspected. Whether better anti‑H pylori therapy will reduce the long‑term risk for gastric cancer remains unknown.  Many of these doubts about the link between Hpylori and gastric cancer can now be put to rest. The question of who should actually undergo complete H pylori eradication still remains largely unresolved. Most patients with chronic H pylori infection have no symptoms. Previous studies have indicated that screening for and treating Hpylori infection to prevent gastric cancer is potentially cost‑effective if it prevents at least 30% of cancers attributable to H pylori. Evidence is rapidly accumulating that anti‑H pylori therapy is effective, and gastric cancer may in the future be viewed, like colon cancer, as largely preventable.


Also be aware that H pylori infection can trigger apparently unrelated problems. For example, some think that H pylori is a causal factor in various dermatologic disorders. Wedi et al have shown that Helicobacter infection can be a causal factor for such diverse dermatologic disorders as rosacea, urticaria, angioneurotic edema, and atopic dermatitiS.2  Recently, investigators in Budapest studied 65 patients with hereditary angioneurotic edema and found that approximately one‑third had H pylori infection. When this was eradicated, the episodes of periodic edema were virtually eliminated in the majority of treated subjects.  This is an interesting link between the gastrointestinal tract and the skin. You may recall that President Clinton had rosacea, which somewhat miraculous disappeared during his presidency. One wonders if someone slipped him a little ampicillin and Pepto‑Bismol.


Dr. Knapp

May 22, 2003

The recent Federal Trade Commission report that was critical of diet ads and exercise equipment that promised easy, quick and miraculous results, will hopefully educate more people that offers that seem to good to be true usually are.

The FTC says to be wary of ads that include the following claims:

  • No Diet! No Exercise!
  • Eat Your Favorite Foods and Still Lose Weight
  • Scientists Announce Incredible Discovery!
  • Revolutionary European Method! Ancient Chinese Secret!
  • Absorbs Fat
  • New Scientific/Medical Breakthrough

And any ad that describes the product as 'incredible,' 'a miracle cure,' or 'a breakthrough' should be viewed with suspicion.

In addition to targeting people who want to lose weight, there are many products targeted at other common medical problems in children, such as acne, ADHD, snoring, learning disabilities and depression.

These ads can be tempting. They often describe incredible results. And that you can get these results yourself without much or any effort.

How do you know if these products, including biofeedback devices, optometric visual training, special diets, vitamins, and minerals, really work?

It can help to be skeptical of special offers or miracle cures. Also, learn to read the fine print of an offer. If they mention that 'results may vary' or that the 'results are not typical' then you can feel fairly confident that it is a scam.

You should be especially suspicious of treatments that can be used for multiple disorders, such as ADD, ADHD, anger, anxiety, alcoholism, behavior problems, depression, manic depression, panic attacks, PTSD, sleep problems, and stress.

Alternative miracle treatments for ADHD seem to be especially popular. This is likely because it is a condition that is difficult to treat and the conventional treatment, stimulants like Ritalin, receive a lot of negative press.

In the past few years, the FTC has taken action against many ADHD treatments which were shown to be making unproven claims, including:

  • Pedi-Active A.D.D promoted by Natural Organics, Inc or Nature's Plus
  • Efalex and Efalex Focus, marketed by Efamol Nutraceuticals, Inc
  • Pycnogenol, sold by J & R Research, Inc
  • God's Recipe, distributed by New Vision International, Inc.

But just because a company or product hasn't been disciplined by the FDA or FTC doesn't mean that it is effective or safe.

When considering an alternative treatment, do some research before spending your money and giving it to your child. Don't be mislead by ads saying that they are 'proven' or 'doctor recommended.' If they have really been proven to work, find the research study that substantiates, hopefully from a reputable medical journal, the claim and show it to your Pediatrician.

Also remember that:
all natural does not always mean safe

anyone can put up a website. Just because a company or product has a fancy website doesn't mean that it is not a scam.
money back guarantee does not always mean that you will get your money back. Before buying the product, call the company and act like you have already bought it and want your money back. Do they help you? Can you even get someone on the phone? If not, you will likely not get your money back if you are not satisfied.
If the treatment really worked, why wouldn't they do a real research study to prove it?

Adapted from   http://www.keepkidshealthy.com


Dr. Knapp

June 4, 2003

Poison ivy is in full bloom.  There are actually 10 different plants that will cause similar contact dermatitis.  And some people are not allergic to poison ivy but allergic to one of the others.  The plant material can be on your clothing, skin or the coat of the dog that runs in it.  Some one can be mowing or burning it down the block and it go through the air to you.  We used to think that you scratch your rash and spread it to other places on your body but we could not transmit it on purpose.  It is not spread.  But one area breaks out in 1 day, another breaks out in 3 days, and another in 5 days.  It looked like you are spreading it but you do not.  Or you come in contact with more plant but you do not spread it.  If, after you work out in the yard or play in the weeds, you will come in and shower with lots of soap, you will avoid the rash.  Once you break out, you should put steroid cream Hydrocortisone on it.  If it is severe and/or around the face, see the doctor for a stronger cream and/or oral steroids.  Swimming in a chlorine pool helps it also and it won’t go to others in the pool.  Have a great summer and watch out for the three leaves.

Dr. Knapp


June 22, 2003

This is a fun email about cigarettes.

Dr. Knapp




"Medical books espoused the curative powers of tobacco for everything from flatulence to rabies, as an antiseptic, and as a cure for headaches. Pity the poor asthmatics of the time‑doctors recommended tobacco smoke as the cure. For pearly whites, rub teeth with tobacco ashes, A bad memory? Sixteenth‑century physicians suggested tobacco smoke because it 'rose to the brain, the seat of recollection.' The plague? Smoking, the medical establishment believed, would keep it at bay, prompting widespread smoking during the Great Plague of 1665. During the plague years, boys at England's Eton College were whipped if they tried to skip their daily smoke."


Parker‑Pope T. Cigarettes. New York, NY: New Press; 2001



"In the 1950s, the first news reports that smoking might cause health problems began to appear. But the bad news seemed to enhance, rather than diminish, the cigarette's role in popular culture. The fact that there was growing unease about cigarettes affirmed the cigarette's role as seductive right of passage for rebellious teenagers. The leather‑clad, cigarette‑smoking outsider, immortalized by James Dean in Rebel Without a Cause, appealed to a generation that had grown disillusioned with cookie‑cutter suburbs and the Ozzie and Harriet lifestyle."


Parker‑Pope T. Cigarettes. New York, NY: New Press; 2001



Smokers are more likely to take risks, act defiantly, and rebel against cultural norms than are nonsmokers. Smokers, for instance, are less likely to wear seat belts and more likely to be divorced. They are even said to have higher sex drives. So while government health warnings and growing antitobacco sentiments certainly scared many smokers off the habit, those very prohibitions also served to solidify many smokers' loyalties, partly because the more smoking was vilified, the more rebellious and appealing it seemed. 'Smoking has always been somewhat daring and has become much more so since the 1960s/ writes David Krogh in Smoking: The Artificial Passion (repr. 1992). 'There's a commercially approved way of being daring, and it's called smoking cigarettes."'


Parker‑Pope T. Cigarettes. New York, NY: New Press; 2001



1999 Tobacco Sales: $23.4 Million (Estimate)

"This state‑controlled tobacco monopoly caters to more smokers than any other cigarette company in the world. One of every 3 cigarettes is smoked in China. But the CNTC is more of a government agency than a business. It controls virtually every aspect of China's tobacco market, from the buying of tobacco leaf to the licensing of cigarette retailers. CNTC sells more than 900 cigarette brands, the biggest of which is Hong Ta Shan, which accounts for just 4% of sales. Although China accounts for one third of the world's cigarette consumption by volume, it represents only 8% of world tobacco sales because of the low price of cigarettes sold there."


Parker‑Pope T. Cigarettes. New York, NY: New Press; 2001

June 29, 2003

Malaria.  Several cases have been seen in the northeast around Virginia.  Two teenagers have come down with it.  They had not traveled outside America.  Immigrants and visitors from S. America, Asia, and Africa have the malaria in them but the fever comes and goes.  They may feel OK when coming here but caring the germ.  Just like West Nile Virus that was seen if a few cases up North many years ago and spread over the country, Malaria probably will spread to this area.  The mosquito only goes 1 mile from its breading ground.  People traveling with the disease spread it.  Expect to see more cases in the news this summer or next.  So keep protecting your kids from mosquito bites this next summer.


Also while we are talking about these type diseases, the West Nile virus, which has been transmitted threw organ donation, now has been shown to be transmitted threw breast milk. 


Infants over 9 months who are going to areas of Yellow Fever should be vaccinated.  That is in certain parts of Africa and S. America.  The attack rate is as high as 33% getting the illness, 5% having severe illness, and of those 20% die.  Complication rate of the vaccine is 1/million.  Check with the local state health department to find out if you need this vaccine for the area to which you might be traveling.


Wow… just more to worry about.  Not really.  Just try to avoid mosquito bites and check with the health department when traveling abroad.  Deet is safe and OK for children in the usual amounts of sprays.



Dr. Knapp

July 16, 2003

We are still seeing too many swimmer's ear infections that are preventable.  The best thing is to put 2-3 drops of olive oil in their ears before swimming.  You can put alcohol in afterwards and actually the ENT docs recommend a solution of 1/2 alcohol and 1/2 white vinegar.  That is what is in the drops like Swim-Ear that you buy but it is cheaper to make your own.  Also the olive oil will stop ear pain from an infection in the night or from landing in a plane from the pressure.  (It does not hurt their ears until 4 yr old or older.).
Dr. Knapp

July 16, 2003

Last email correction.  Don't use olive oil in ears that have PE tubes.  Also the oil can go in the ears after 6 months old.  The statement: (It does not hurt their ears until 4 yr old or older.). was pertaining to flying in airplanes, not the oil.

The new flu vaccine that is taken by a mist in the nose will be out this Fall and you will see advertisements for it.  It is a new live virus vaccine for 5yr to 49yr olds.  It is not recommended for heart patients, asthma patients or pregnancy in the second or third trimester ….. those are the patients who really need it. 


The rate of illness showed 15% in the control placebo group

v.s. 13.7 % in the vaccine treated group.

This was a minimal decrease in disease.


The side effects in adults showed 10% more had cough, sore throat, runny nose, chills, and weakness. 


Most insurances will not cover it this first year and it will cost around $80.


At this time I do not personally recommend this live virus vaccine but strongly recommend the usual flu shot in the arm for adults, children 6 months or older with asthma, and children in middle and high school. It is tough to miss a week of school and catch up.  It is a killed protein shot and does not make you ill.

Dr. Knapp

July 27, 2003

We screen children for this curvature of the spine and so do the schools in Jr. High Middle school.  Only 20% of adolescents have a straight spine but if they have a curve over 10 degrees it is "scoliosis" and over 20 degrees, then it needs referral to orthopedics or Scottish Rite.  This is an unequal growth and is not caused by posture (although good posture is a good thing to work on), or diet.  Studies have not shown exercise, or chiropractic care of any help.  They may go ahead and live normal lives and participate in sports.  Treatment varies with age and severity.
They best test is have them bend over and touch their knees and look at the rib humps on the sides of the spine.
For more info:
Dr. Knapp

Aug 7, 2003

Croup season is almost here.  Every Fall we have a chest cold that causes a "seal bark" honk of a cough.  Many older people call the croupy cough that is mucousy congested cough but that is wrong.  It is the seal bark that is croup.  We need to see them the first day to give a mild steroid so they do not get into severe respiratory distress and end up in the ER or Hospital.  Bring them in for it the first day because by the third day they are in trouble. 
Also if asthmatics are using their inhalers once or more per week, then they need a preventive type inhaler to use every day so they stay out of trouble. 
Plus be sure to get their flu shots in Oct for asthmatics and kids in Jr. high or high school.  You adults need it too.
Dr. Knapp

Aug 16, 2003

When teens have sex, it’s often right under their parents’ noses, according to a survey by the nonpartisan research group Child Trends.   Of the 46% of the American high school teenagers who have had sex at least once, 34% reported first doing it in their teen partner’s family home, 22% in their own home, and 12 % at a friend’s house.  Only 4% did it in a car, 3% in a park or elsewhere outdoors, and 3% in a motel.  And contrary to the popular belief that teens are having their first sexual experience right after school, the  most common time frame cited was 42% between  10 p.m. and 7 a.m. and 28% between 6p.m. and 10 p.m.
Roger Knapp MD

Aug 24, 2003

The definition of metabolic syndrome recently proposed by the National Cholesterol Education Program (NCEP) incorporates thresholds for five easily measured variables linked to insulin resistance. Individuals with values exceeding the predefined thresholds for any three variables are considered to be at increased risk for CHD and type 2 diabetes.

The researchers classified the men on the basis of whether or not they had metabolic syndrome using the NCEP defined criteria, Substituting body mass index (BMI) for waist circumference. 
Threshold values were as follows:
triglycerides 150 mg/dL or greater;
high-density lipoprotein cholesterol 40 mg/dL or less;
fasting plasma glucose concentration 110 mg/dL or greater, systolic blood pressure 130 mm Hg or greater; or diastolic blood pressure 85 mm Hg or greater;
BMI greater than 28.8 kg/m2.
To calculate your BMI: see http://nhlbisupport.com/bmi/bmicalc.htm

Sept 1, 2003

There have been recent news reports about Rickets in babies and teens because of Vit D deficiency.  That is why I recommend vitamins in all children growing up.  (Plus it helps keep up their zinc.)  Also plenty of milk (or calcium supplement) when growing up ..... 12-24 oz in growing children and 1000-1500 mg calcium in teens. That loads up their bones so they do not get Osteoporosis as frequently in the declining years.  The reports of decrease bone and Vit D troubles is really in the dark pigmented races since the sun rays on the skin converts inactive Vit D we eat to the active form of the vitamin.  Increase intake may not help as much as increase sun for those individuals.  So I do not push more Vit D but push for more sun exposure in the dark skin races.  I don't think sun screen hurts your Vit D metabolism in the light skin races so keep up the protection.
Roger Knapp MD

Oct 18, 2003

We behave worse for the people we love the most.  That is a sad fact but true.  Your teenager tries to be nice all day to people and teachers that they do not like and then come home and blow up at you.  And thank goodness there is a place where we can let it out.  If they can’t let it out at home or with others, then they load up a gun and go to school.  We are the release valve for the pressure cooker.   So bear with it when they are ill tempered.  Our ability to keep calm in a heated confrontation gets better every 10 years.  Have you ever seen a 20 year old at your work get all upset about something and you are saying “Chill and lets see how to work this out.”?  That is why we elect the president of the United States a 50 yr old gomer that does not get ticked off some day and push the button.  So 20 yr olds can’t stay calm and for sure teens and 6 year olds can’t. 


Actually we adults do the same.  You would not talk to your friends or co-workers the way you do your spouse.  If you did they would not talk to you again.   So we let it out at home on our spouse and hopefully not our children.  And that causes some divorces.  “My wife is such a gripe and that lady at work is so nice.”   So we divorce one and marry the other and guess what… same thing.  We behave worse for the ones we love the most.  It is because we have to let out the frustrations somewhere and our family will tolerate it.  They love us, understand us, and are stuck with us…. kind of.  Notice how you treat other children better than you do your own…. how you treat other women/men better than your wife/husband?  So your kids get upset and yell because they are trying to learn to be calm in a heated discussion.  We shouldn’t yell back at them because we are not setting a good example and are lowering ourselves to their level. 


Lets all try to be nicer to our family members and treat our kids and spouses more like we do our friends and co-workers.  Try to discipline your children like you would correct a co-worker.  Use a firm and “I-mean-it” tone but not hateful tone.  If your boss is hateful to you, you would actually slow down or make more mistakes just to get back at him.  That is why when you really ball out your kids harshly they sometimes get worse. 


Hang in there! …. All this parenting will yield a wonderful child in 20 years and yes it is worth it.

Dr. Knapp