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Newsymail 2005

1/3/2005

The National Institute of Health (NIH) studied programs to stop repeat teen violence.  The get tough programs like boot camps and detention centers did not help.  There were two that were shown by external studies to help.  They were Functional Family Therapy (duh!... you mean the dysfunctional family has an affect on kids?)  and the other is Multisystemic Therapy.  There were six other programs that were not proven by outside studies to be effective but they have numbers that suggest that they might help.  They are Big Brothers/Sisters, Multidimensional Treatment Foster Care, Nurse-Family Partnership, Project Towards No Drug Abuse, Promoting Alternative Thinking Strategies, and Brief Strategic Family Therapy.  See:  http://consensus.nih.gov/ta/023/023youthviolencepostconfintro.htm
 
Dr. Knapp

1/19/2005

There is a new way to remove tonsils.  Instead of an electric cautery, there is a new device called coblation.  The temperature the old way is 300 degrees while the new coblation is only 30 degrees.   So less damage to surrounding tissues.  The recovery time goes from an average 4 days to 1.5 days.  Less pain is a good thing.  This instrument will be coming to the local hospitals for the ENT doctors to use in the next few months.  Yeah!
 
Dr. Knapp

1/22/2005

Things just keep getting younger and younger.  There was a 14% increase in cosmetic surgery in children below 18 last year.  Ears, nose and breast jobs.  There were 3700 breast augmentation in teenage girls and just as many breast reduction in teen boys.  (I guess we really are just a vain.)  There are rare exceptions that a defect you have make you repulsive ugly, then have it fixed.  An important thing we parents do is teach our children to accept what God gave them like a bald head like mine.  When you start down the road of having this perfect body, then it is a sad road and you are never happy with your body.  Accept what you have.  Everything will eventually sag (darn gravity). 
 
Dr. Knapp

1/27/2005

They just reported the first ever patient with Rabies living through this terrible disease.  They put the teenager into a coma, gave antiviral drugs and vaccinations.  The patient thought the bat just brushed against her leg.  And she thought sick bats would not fly.  In fact you cannot feel the bite of the bat so anyone coming in close contact with a bat should get shots.  It is better to prevent the disease rather than trying to treat it, which is improving but you probably will have some residual harm.  So watch out for bats.
 
Dr. Knapp

2/6/2005

If you are thinking of government run health care, look to the North.  Canada's government-run health care reports that averaging 12 specialties in 10 provinces it takes 4 months to get a patient into the hospital.  It takes 1 year to get a hip replacement for example.  It has private clinics for the Mounted Police, workman's comp cases, and prison inmates.  There was a joke in the newspaper up there about two prisoners talking.  One prisoner asks the cellmate "What are you in for?"  Answer: "Hip replacement....."  Our system of healthcare in America is not perfect nor equal but it is still the best in the world.  
 
A friend of ours sat 5 rows behind Pres. Bush at the inauguration.  They passed the plate for donations at the prayer.  It is common knowledge that Pres. Bush does not carry any cash money.  So he whispered for some cash to put into the plate.  V.P. Chaney passed him some money and so did his father first Pres. Bush.  He took the money from his father and put the money into the offering plate.  The morals of this event are two: you never get too old to ask for help from friends,  and no matter how high in society, your children never stop asking for money.... !!!!!!!!!  

Dr. Roger Knapp

2/10/2005

It is vogue and cool to teach your infant/toddler sign language when you are teaching them to talk.  I worry about how good that is for them.  Ten years ago we started teaching the first graders “finger math” so that they could quickly figure addition and multiplication problems easily using their fingers.  But then they did not memorize their math facts and were delayed in their ability to do regular math problems on paper.  So we quit it.  I just worry that the infant will rely on the hand language instead of learning to talk better.  In fact if the 2 year old is not talking well and getting everything he wants by grunting and pointing, then I tell the parent to play like you do not understand what he wants and don’t give it to him until he says it.  It will frustrate him but he will eventually understand that he is not going to get what he wants until he communicates in the language that everyone understands.  There are quite a few children that learn both sign language and verbal language but there are some that it slows them down.

 

Dr. Knapp

3/10/2005

Everyone has heard of the formulas with "Lipil".  This is an essential fatty acid called docosahexaenoic acid (DHA).  This DHA is needed in the development of the brain and retina of the eye.  Studies show improved development when there is higher intake of DHA in the diet of infants.  Also there is improvement if the mother takes in more DHA in her diet the last trimester of the pregnancy.  DHA you can get from fish oil and fish but the risk of Mercury is too much.  So pure extracts of DHA is safer.  The product Expecta is DHA that the pregnant mother can take every day.  Also if she takes it while breastfeeding her breast milk will have more DHA and will be giving her infant "lipil breast milk".  (You can make a sticker and put it on your breast.. ha)  The oriental mothers who eat alot of fish have much more DHA than American mothers.  Maybe that is why there are many oriental children in the top of graduating high school classes.  Formulas have DHA added but Enfamil has the most.  Good Start has less and Similac has the least. 
 
Iron is also needed for good brain development.  There is very little iron in breast milk compared with formula but we did not see any anemic breast fed babies.  But in studies coming out now show if you compare breast fed babies who are given extra iron with those who are not, the babies with iron developed better.  So it would be better to give breast fed infants vitamins with iron like Poly-Vi-Sol with iron or Tri-Vi-Sol with iron. 

Dr. Knapp

3/17/2005

The bacteria Neisseria meningitides causes blood infections and meningitis.  This meningococcal disease occurs at any age but is most common 15 to 24 yr old.  The 3000 cases that occur each year has an overall 10% mortality but the 15-24 has a mortality of 22% and 1/3 have major damage.  We have been recommending a meningococcal vaccine for many years for the seniors who are going to college, but there is now a brand new meningococcal vaccine called Menactra that is approved for 11-12 yr olds.  At that age it will protect them during high school as well as college, and also it eliminates many carriers of the germ.  Most insurance policies will not pay for it since it is not required by high schools even though many colleges require it.  It is about $90 but I think it is worth it.  It is a nasty germ and even though not very frequent, it is a rapid and deadly infection. 

 

http://www.menactra.com/

http://www.drugs.com/NDA/menactra_040922.html

 

Dr. Knapp

4/6/2005

Acid stomach and ulcers are mostly caused by a bacterial infection of the lining of the stomach by a germ called H. pylori.  Adults who were on antacids for years were treated with medication to eradicate it from the stomach and then threw away their antacids.  It cured them (although it can relapse).  China and Japan have a much higher incidence of this problem and a higher incidence of stomach cancer.  A study just came out looking at 1500 patients.   After 7 years there was 3% stomach cancer in the infected group and none in the uninfected group.  In another study those that were treated had 37% less cancers.  So there is not only a comfort issue in treating this but also a health and longevity issue.  Children can also have this infection and sometimes is the cause of constant stomach aches in school children.  This germ can be detected by aspirating the stomach with a tube down the throat (Ugh) or from a frozen stool specimen (less traumatic but more smelly!) or blood test. (stool was the more accurate.)  So if you are eating a lot of antacids, get it checked out.

 

Dr. Knapp

4/17/2005

Diarrhea kills 600,000 children every year in the world.  It is not number one killer.  Unsanitary drinking water kills 3,900 children every day.  The most important thing we could do for the underdeveloped countries is to get them a water treatment system.  Rotovirus is one of the more common causes of severe vomiting and diarrhea around the world and here in America.  We should have a vaccine for it next year. 
 
No S*%#....
Dr. Knapp

4/20/2005

There will be 132,000 cases of Milignant Melanoma yearly and 66,000 deaths.  Keep sunscreen on you and your children.  Exposure to UV rays below 18 yr old is worse and below 30 is bad.  Tanning beds are just as dangerous as sunbathing.  Keep at least 20 SPF sunscreen or higher on them when outdoors in the mid day.  If the teens just have to have the dark skin then use the tanning oils that are safe.  I thought shirts stopped most of the UV rays but they say they do not and they recommend sunscreen below the shirts!! 
 
Children are not born with most of their moles so don't be worried that they start popping up with a lot of moles between 4 yr old and teens. 
 
Take photos with your digital cameras of the big moles on you and your children so you know what they looked like last year and you can show the dermatologist what they looked like.  Make a file in your documents for mole pictures.
 
Dr. Knapp 

5/1/2005

Contact allergic reactions can occur with just about anything.  Every one knows about poison ivy.  Whereas laundry detergents are very rare.  Actually what is very common is an allergy to Nickel.  It is in many kinds of jewelry and in snaps of clothing.  Nichel allergies can be as high as 14% of the population.  That can be seen in pierced earrings, snaps, coins before 65, deys, sools, school chairs, orthodonic braces, and even foods. 
 
Also antibiotic ointments can cause an allergic reaction.  Some are: Bacitracin, Neomycin Polysporin, and triple antibiotic Ointment.  Another allergen is fragrences like perfumes, personal care and household products, opys, cosmetics, medications, diaper wipes. 
 
Then there was the baby that was allergic to the plastic in the pacifier and had a rash around the mouth all the time.  Lanolin can cause a reaction and that is in cosmetics, lotions, medications, leather, furs, and also Eucerin and Aquaphor.
 
I guess anything can cause it so watch the rashes and watch what they get around and watch for a coorelation.
 
You treat it with hydrocortisone cream or call us for a stornger steroid cream.
 
Dr. Knapp

5/11/2005

The rapid strep test that comes back in 4-5 minutes is fairly accruate.  A follow up culture was only positive 2% of the time when there is a negative rapid test.  So the rapid test is adequate. 
 
Studies also showed that 5 days of Cephalosporin like Keflex had only 8% failures where Penicillin had 16% failures.  They did not compare Amoxacillin but probably is similar.  Sometimes we prefer Amoxacillin since it helps sinus green mucous better than Keflex. 
 
To make things more confusing, 4% of the population carry strep around all the time in their throat so they have a sore throat from allergies or something else then they do a culture and it is positive for strep that has been in there all year.  Plus the culture is only accurate 90-95% of the time so you could have honest to goodnest Strep throat and have a negative culture and not get antibiotics.  So the culture is not as accurate as you think. 
 
There is a rare condition after strep infection where the child has sudden onset of Obsessive Compulsive Disorder and nervous tics.   It is called Pandas and is a weird neurological condition after a strep infection.  Strange!!
 
Kinda strange huh?
Dr. Knapp

5/20/2005

The most common source that infants get Whooping Cough is from the adults that are in the house.  In adults it is just a bad cough that lasts for 3 months.  But it can be dangerous for the infant.  We give DPT (P is for Pertussis or Whopping Cough) and the last time they get it is at 4 years old.  Then the immunity wears off and they get it as a late teen or adult.  There will be a vaccine this summer for the 14 year olds that instead of just dT it will be a Tdap with some pertussis in it.   That way the adult will not cough for 3 months and they will not give it to some infant.
 
Dr. Knapp

6/8/2005

The complications of Circum. is rare and the benefits out weigh them:

 

Complications of Circ:

2000 infections or bleeding which are treated.

300 shaft repairs which are not bad.

2 loss of falus which is horrible.

 

Illnesses that are prevented with Circ:

7000+ cases of HIV that cannot be cured.

10,000+ cases of Syphilis that usually can be treated.

20,000 cases of kidney infections that can be treated but leave scars.

1000 cases of falus cancer and loss of falus which is horrible.

200,000 cases of phimosis (stricture) which can be treated buy painful.

500,000 cases of infected foreskin that can be treated but is painful

 

Dr. Knapp

6/16/2005

The statin drugs like Lipitor are very important advances in lowering cholesterol and are important to use if you have high levels at any age.  We are sometimes even testing 14-18 yr olds to treat if they have high levels. These statin drugs can cause birth defects up to 40% of the babies and it is very important not to take them when getting pregnant.  The ones with Cerivstatin, Simvastatin, Lovastatin and Atorvastatin are very bad.  But one that does not go to the baby and not cause birth defects is Pravastatin.  I would not take any of them if I were getting pregnant (?) but if one just has to take one, then take the pravastatin. 

 

Dr. Knapp

6/21/05

Ten ways for Parents to help their teens avoid Substance Abuse:
1. Set a good example.
2. Know your child's whereabouts, activities, and friends.
3. Eat dinner together regularly
4. Set fair rules and hold your child to them.
5. Be caring, supportive and maintain open lines of communication.
6. Have a strict dress code and don't let them wear clothes that the "bad" kids wear.
7. Surround your child with positive role models.
8. Incorporate religion or spirituality into family life.
9. Learn the signs and symptoms of teen substance abuse and conditions that increase risk.
10. If problems occur, get help sooner rather than later.

6/23/05

Bug spray and Sunscreen

 

Use of Deet has been shown to be safe and effective in preventing insect bites.  It can be used down to 2 months of age in concentrations of up to 25%.  I prefer to keep it at 10-15% preparations and more start it’s use at 4-6 months old.  All concentrations are just as effective but the higher ones last longer time.  The 10% deet repels just as good as the 50% but they last a different length of time.  I like to put less on the skin but apply it more frequently.  10% lasts 2 hours, 30% lasts 5 hours, and 50% lasts 10 hours.  Older kids can use the higher concentrations and teens can use the 50% deet without worry.  Do not apply to the hands of infants and small children.  You can spray your hand and apply it to the face of infants.  Careful about applications of deet.  It can harm plastics (eyeglass frames) synthetic fibers like rayon and spandex, leather, some watch crystals.  It does not harm cotton or wool.

 

There are two other repellants without deet.  One is Picaridin is a synthetic safe repellant that does not harm fabrics like deet and it only lasts 2 hours.  It is available in 7% concentrations (Cutter Advanced) The other product is Oil of lemon eucalyptus which is a plant based repellent and lasts 90 minutes of protection. 

 

Sunscreen products are variable and act differently.  The SPF is confusing.  The higher number only lasts longer but does not protect any better.(Just like the deet.)  The SPF 15 will protect even very sensitive skin but only lasts 2 hours.  The SPF 30 would last 4 hours.  The mistake is not putting enough on the skin to get the full effect and less SPF 15 would result in an effect of SPF 7.  So put plenty on the skin.  So many people recommend 20-30 SPF because they figure you will not put enough on the skin.  You should use a sunscreen that protects both UVA and UVB rays.  Apply it 30 minutes before going out and apply it before you put Deet repellents on the same areas.  Do not use the combined products that have sunscreen and repellents in it.  Apply sunscreen every 2 hours.  The water resistant or sweat resistant products only last 40 minutes and the “very water resistant” products only last 80 minutes.  So you need to apply them when swimming very frequently.  Consider putting a small T-shirt on them when swimming a long time.  They are also starting to manufacture “wet suit” type tops for children to wear.  One study from Europe showed children whose parents always kept shirts on their children had far less moles as adults than those who did not wear shirts.  Tanning beds are worse than the sun so use the tanning chemicals, which are safer.

 

We still see sunburns in children even though we warn that 2 sunburns will double your chance of Melanoma later.  80% of our lifetime sun exposure occurs before 18 yr of age.  So keep them covered with this stuff.  Just like buckling up in the car, think before you go and keep them safe.
 
Dr. Knapp

6/25/05

I raced into the grocery store, 8‑month‑old in my arms and 3‑year‑old in hand, to pick up Tylenol, a prescription and a few groceries. I was on my way home from the pediatrician's office, and my to‑do list was nowhere near done. There was dinner to cook as well as housework and dirty diapers waiting for me at home, and a meeting to attend that night.

 

I gathered up the things we needed and hit the checkout counter, impatiently waiting to get my change so I could dash out the door, when all of a sudden an older woman came up behind me. She stopped me and said, "Slow down and enjoy your boys while they're little. The time will go so fast! My two sons are grown and live on different coasts. How I miss them and wish I could see them and spend the day with them!"

 

The time didn't seem to be going fast. Those were the days when I could barely see over the stacks of dirty diapers, when I was cooped up with my children's bouts of bronchitis or ear infections, spilled milk and whines of "Mommy!" On those days, it seemed like I hadn't talked to an adult in what seemed like weeks. It didn't help that my husband worked long hours. Because we were newcomers to the city, I didn't know any other moms.

 

Yet I knew the woman was right. When I went home that day and days afterward, I slowed down enough to make Lego forts and castles with my boys and then stroll with them to the park to play.

 

Perhaps you've received similar advice from an older mom, too, but it bears pondering again. The truth is, your kids' childhood will pass so quickly. As Dorothy Evslin said, "It will be gone before you know it. The fingerprints on the wall will appear higher and higher, and then suddenly they disappear."

 

In the twinkling of an eye, they'll be taking off for college or career. Try this little exercise: Close your eyes and picture your child strolling down the aisle with his graduating class. Decked in cap and gown, he walks across the stage when his name is called and grasps his diploma. Then a few short months later, he piles all his stuff in his car and heads across the country for college. Graduation photos on the piano; Little League baseball trophies and GI Joes stored in the attic. No music blaring from his room.

 

When that happens, you won't be thinking, I wish I’d spent more time at the office or polishing the floors.
 
 From: Focus on the Family by Cheri Fuller

 

Oatmeal Kisses

The baby is teething-the children are fighting. My husband just called and said to eat dinner without him. Okay, one of these days you'll shout: "Why don't you grow up and act your age!" and they will, or "You guys get outside and find yourselves something to do...and don't slam the door!"...and they won't.

You'll straighten up their rooms neat and tidy...bumper stickers discarded...spreads tucked and smooth ... toys displayed on the shelves...hangars in the closet...animals caged, and you'll say outloud: "Now I want it to stay that way!" and it will...You'll prepare a perfect dinner with a salad that hasn't been picked to death and a cake with no finger traces in it and you'll say, "Now there's a meal for a company." and you'll eat it alone.

You'll say, "I want complete privacy on the phone. No dancing around, no pantomimes, no demolition crews. Silence! Do you hear?"...and you'll have it. No more plastic tablecloths stained with spaghetti, no more anxious nights under a vaporizer tent, no more dandelion bouquets, no more iron-on patches, knotted shoestrings, or tight moots.

Imagine, a lipstick with a point, no babysitter for New Year's Eve, washing clothes only once a week, no P.T.A. meetings, carpools, blaring radios, Christmas presents out of toothpicks and paste. No more "Wet Oatmeal Kisses". No more toothfairy giggles in the dark, or knees to heal.

Only a voice crying..."Why don't you grow up?"... and the silence echoing ......."I did."

7/9/05

Not to scare you but just so you can put things into perspective:
In the whole world newborn deaths:
3 % Diarrhea
7 % Other
7% Tetanus
8 % Congenital
23% Asphyxia (Not breathing)
26% Infection
28% Preterm (preme)
 
The death rate in the world in children less than 5 yrs:
3% aids
3% injuries
4% Measles
8% Malaria
10% Other
17% Diarrhea
19% Pneumonia
 
Justs reminds us how lucky we are to live in the USA.
Dr. Knapp

7/17/05

For a long time conventional wisdom has been that it is good for teenagers to work after school.  There are more than 5 million teens less than 18 working in America.  Two different organizations studying this found teens working more than 20 hours a week, had lowers grades, higher alcohol use, and too little time with their parents and families.  Between 16 and 19 yrs. old, the percent teens working are: 53% Americans, 30% Germany, and 18% Japan.  But then how can they pay for their car and stuff.  You might think about limiting the hours they work!
 Dr. Knapp
 

7/19/05

Well the new Harry Potter Book came out and I have had several patients who have already read it.  One 11 yr old said she read it in 24 hours!!!  Kids are starting to read and this book has inspired many children to read more.  It has improved their reading skills.  In 2001 75% of children 11-13 yr old and 20% of adults said that they had read at least one of the books.  But there has been a decline in reading over the last several decades.  The number of 17 year olds who reported never or hardly ever reading for fun rose from 9% in 1984 to 19% in 2004.  Hopefully these books will begin a new trend in children reading novels for fun and we will see an improvement in the future.  I personally do not think these books are "bad" because it deals with Magic and witches.  It is not any worse than star wars that has more violence in it and they use magic light swords.  What about sleeping beauty with the witch and the apple.  Harry Potter deals with good over evil.  And it helps children want to read more.  60% of UK children say that the books have made them a better reader.  If you have not read them, get the potter books on CD.  The man who reads it is wonderful and it sure does make the trip to work go quick.  They are great books for adults too.
 
Roger Knapp MD
 
You also might get the series of books: Artemis Fowl .  They are just as good but no witches.

7/28/05

Well we are doing better in some areas and not so good in others:
                                                                    1950                        2002
Unintentional Injuries:    1-4 yr old:                  36.8                        10.7            per 100,000
                                    5-14yr                       22.7                        6.7
                                    15-24 yr                    54.8                        38
 
Homicide:                       1-4 yr                        0.6                        2.7
                                    5-14 yr                        0.5                        0.9
                                    15-24 yr                      6.3                        13.1
 
Suicide:                        1-4 yr                          __                        __
                                    5-14 yr                        0.2                        0.6
                                    15-24                          4.5                        9.9
 
So we get hung up in the stress of making our children perfect that we loose sight of the end goal.  Note this:
 

"He didn't look like much at first. He was too fat and his head was so big his mother feared it was misshapen or damaged. He didn't speak until he was well past 2, and even then with a strange echolalia that reinforced his parents' fears. He threw a small bowling ball at his little sister and chased his first violin teacher from the house by throwing a chair at her. There was in short, no sign, other than the patience to build card houses 14 stories high, that little Albert Einstein would grow up to be 'the new Copernicus,' proclaiming a new theory of nature, in which matter and energy swapped faces, light beams bent, the stars danced and space and time were as flexible and elastic as bubblegum. No clue to suggest that he would help send humanity lurching down the road to the atomic age, with all its promise and dread, with the stroke of his pen on a letter to President Franklin D. Roosevelt in 1939, certainly no reason to suspect that his image would be on T‑shirts, coffee mugs, posters and dolls."

 

I think my main complaint of our education system is that we put huge amounts of money and effort into our weaknesses and very little into our strengths and talents.  But that is where we will end up as far as our jobs and hobbies.  So Michael Angelo could not go to art class because he was slow in reading.  Albert Einstein could not go to Physics because he was Dyslexic and could barely read.  He failed his college admission test.  And look at his hand writing... Oh my God!!  The loop did not go up to the line!!!  So keep the big picture in mind when raising our kids and work on their strengths.... and it is amazing how some of the most troublesome kids turn out good.  Keep on "Keeping on".  Yea for Helen Keller who kept on trying.... and Mrs. Sullivan who probably wondered every day how the end result would be.

 

Dr. Knapp

7/31/05

There are some changes in the vaccine recommendations. 
1. Instead of giving the 12-14 yr olds the Td (tetanus and diptheria) it will be replaced this next week with TdP which includes pertussis (Whooping Cough).  The reasoning:
 
In the United States, from 1934 through 1943 an annual average of 192,752 pertussis cases and 4,034 pertussis-related deaths were reported. Following the introduction of childhood pertussis vaccination during the 1940s, the number of reported pertussis cases declined dramatically to a historic low of 1,010 in 1976. However, since the 1980s the number of reported pertussis cases has been steadily increasing (see figure), especially among adolescents and adults. Reported cases in adolescents ages 11 to 18 years have increased from less than 200 cases per year in the early 1980s (incidence less than 1/100,000) to 4,144 cases in 2003 (incidence 12/100,000).

In 2004, provisional data show more than 18,000 reported cases. Numerous school and community outbreaks have occurred across multiple states. A repeating theme is that source cases and highest attack rate often are in middle schools (frequently in classrooms or gatherings related to school activities) with rapid spread throughout the school and into families and the community.

Reasons for the changing epidemiology of pertussis include waning immunity from a parenteral vaccine given in childhood against a mucosal respiratory tract disease years later, fewer natural boosts in immunity because of partial control of pertussis, an aging cohort who may have received less effective pertussis vaccine or no pertussis vaccine, and increased awareness of pertussis in older individuals.

The Whooping cough in adults does not kill you but you can give it to infants less than 6 months old and it is real bad for them.  Also you cough for 3 months as an adult and that is not fun.

2. The other change is the requirement of Hep A vaccine for preschool kids 2 and older.  We cannot give it until 2 yr so we will be giving the shots to 2 yr olds.  There is a second booster of Hep A that is given 6-12 months later also.  The Hep A is recommend for school age children but not required at this time.  I really don't push this vaccine for school kids unless they are going to live in foreign countries that have poor sanitation or live along the Mexico border.

We will be giving the TdP to teens 11-14 yr old and with the meningitis vaccine Menatra (Meningococcal Meningitis vaccine that is needed before College but can affect high school kids too). 

PS:  There is a really cool site for underwater pictures and even a live cam.
http://www.oceanexplorer.noaa.gov/explorations/05lostcity/welcome.html

8/2/05

Breath holding spells:
This occurs in children starting 1-2 yrs old and usually gone by 4 yr old.  It is where the child is usually hurt physically or emotionally and when crying they hold their breath, turn blue and pass out.  When they pass out they start breathing again and get up OK and the follow up in these children are normal.  It is associated in many children with iron deficiency anemia and when treated with iron the spells stop.  It is quite frightening to the parents and must not be confused with a seizure.  There also can be a very few children who have a pale episode of passing out without holding their breath and not turning blue.  They are pale and white.  There is a minor head trauma that triggers a brief stopping of the heart with a temporary drop in blood pressure.  There is no crying and not holding their breath. They need to be tested with an ECG to see if they have a short QT Interval Syndrome.  These are not as common.I recommend iron and vitamins and Zinc to all children at 1 yr old and I hardly ever see this problem.  Give your kids vitamins with iron and zinc the whole time you have them with you ...until 19 yr ...(or 29).
 
Dr. Knapp
 

8/25/05

Sever's Disease

 

What is it?

Sever's disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones. As a result, the tension the heel-cord applies to the heel bone at its insertion is very great. Moreover, the heel cord is attached to a portion of the calcaneus (heel bone) that is still immature, consisting of a mixture of bone and growing cartilage, called the calcaneal apophysis, which is prone to injury. Compounding to this is the fact that all these changes are happening in a very active child, prone to overuse. The end result is therefore an overuse syndrome of injury and inflammation at the heel where the heel cord (Achilles Tendonitis) inserts into the heel bone (Calcaneal apophysitis).

What are the symptoms?

The typical patient is a child between 10 and 13 years of age, complaining of pain in one or both heels with running and walking. The pain is localized to the point of the heel where the tendo-Achilles inserts into the calcaneus, and is tender to deep pressure at that site. Walking on his toes relieves the pain.

What does your doctor do about it?

X-rays are normal in Sever's disease, but your doctor will probably get X-rays to rule out other problems. Treatment consists of non-steroidal anti-inflammatory medications and use of a heel lift to relieve tension on the calcaneal apophysis. In more severe cases, phycical therapy consisting of modalities to relieve the pain, and stretching exercises may be helpful. In extreme cases, castings have been used.

What can be expected of the future?

Sever's disease is an overuse syndrome involving an immature part of the skeleton. Pain goes away when the overuse is over, or when the growing is done. Hence, the disease is self-limited, in that the pain goes away eventually when growth in the heel bone is complete at about age 13. Even if the child is hurting, as long as he can tolerate it, he may continue to take part in sports. No long term disability is expected from this problem.

 
Dr. Knapp

9/12/05

Calcium requirements for age are:

0-6 months old             200-400

6-12 months old       300-600

1-3 years old                500-800

4-8 years old                800

8-10 years old              800-1200

11-18 years old       1200-1500   

 

Food

Amount

Calcium

Yogurt, plain, low fat

8 oz

415

Collards, frozen, boiled

1 cup

357

Skim milk

1 cup

306

Spinach, frozen, boiled

1 cup

291

Yogurt, plain, whole milk

8 oz

275

Cheese food, pasteurized American

1 oz

162

Cottage cheese, 1% milk fat

1 cup

138

Baked beans, canned

1 cup

154

Iceberg lettuce

1 head

97

Canned salmon

3 oz

181

Oranges

1 cup

72

Trail mix (nuts, seeds, chocolate chips)

1 cup

159

Almonds

1 oz (24 nuts)

70

Blackeye peas, boiled

1 cup

211

Green peas, boiled

1 cup

94

 

So milk intake should be 12-24 oz a day by one year old and stay there for many

years.  By 8-10 years it increases if they are not taking in much other calcium. 

When they go into puberty, they recommend 1500 mg of calcium for females and

1200 for males.  That is a lot of milk so I recommend calcium for most teens.  Usually

500-1000 mg a day plus the milk and ice cream that they do eat. Then they will have less

Osteoporosis as an older adult.

 

Dr. Knapp

www.rogerknapp.com

 

Plus give vitamins to children at all ages.  We just do not eat right most days.

9/26/05

Focus on the Family

by Cheri Fuller

 

I raced into the grocery store, 8‑month‑old in my arms and 3‑year‑old in hand, to pick up Tylenol, a prescription and a few groceries. I was on my way home from the pediatrician's office, and my to‑do list was nowhere near done. There was dinner to cook as well as housework and dirty diapers waiting for me at home, and a meeting to attend that night.

 

I gathered up the things we needed and hit the checkout counter, impatiently waiting to get my change so I could dash out the door, when all of a sudden an older woman came up behind me. She stopped me and said, "Slow down and enjoy your boys while they're little. The time will go so fast! My two sons are grown and live on different coasts. How I miss them and wish I could see them and spend the day with them!"

 

The time didn't seem to be going fast. Those were the days when I could barely see over the stacks of dirty diapers, when I was cooped up with my children's bouts of bronchitis or ear infections, spilled milk and whines of "Mommy!" On those days, it seemed like I hadn't talked to an adult in what seemed like weeks. It didn't help that my husband worked long hours. Because we were newcomers to the city, I didn't know any other moms.

 

Yet I knew the woman was right. When I went home that day and days afterward, I slowed down enough to make Lego forts and castles with my boys and then stroll with them to the park to play.

 

Perhaps you've received similar advice from an older mom, too, but it bears pondering again. The truth is, your kids' childhood will pass so quickly. As Dorothy Evslin said, "It will be gone before you know it. The fingerprints on the wall will appear higher and higher, and then suddenly they disappear."

 

In the twinkling of an eye, they'll be taking off for college or career. Try this little exercise: Close your eyes and picture your child strolling down the aisle with his graduating class. Decked in cap and gown, he walks across the stage when his name is called and grasps his diploma. Then a few short months later, he piles all his stuff in his car and heads across the country for college. Graduation photos on the piano; Little League baseball trophies and GI Joes stored in the attic. No music blaring from his room.

 

When that happens, you won't be thinking, I wish I’d spent more time at the office or polishing the floors.

 

Perhaps your home is still filled with the footsteps of little or big kids that run, skip or jump but rarely walk. Lucky you! Or you're on the verge of your kids flying from the nest. As my friend Melina told me one summer, "In two years Tim will be gone to college! I wish I could make time stop! It's moving too fast!"

 

While we can't make time stop as life proceeds and our children grow, what can we do to savor and enjoy the time we do have together? How can a mother make the most of those fleeting and sometimes exhausting yet sweet years of childrearing?

 

Don't put off joy. "When my little girl gets potty trained, when I lose the extra weight I gained in pregnancy, I'm going to be so much happier," a young mom told me recently. When our finances aren't so tight, if my husband’s not so stressed, if I get my house redecorated, when my prodigal teen starts loving God and makes better choices.... If we stake our joy on the “whens and ifs," we'll miss out on the joys and blessings God has for us in each season of parenting, even those that are difficult and filled with unfinished projects, toddlers resisting potty training or challenging teens.

 

Instead we can focus on living life fully today and realize there is something in every season to enjoy: Picking strawberries and camping out in the backyard in summer, baking gingerbread cookies and drinking hot chocolate in winter, having a "color walk" in the spring as you walk around the block and have them name all the red (or green or yellow) things they see. You can even see sick days as a time to fill up your kids' emotional tanks, a time to hug, sip hot apple juice, cuddle up and read books together. Every day there are miracles and things to celebrate: a purple‑and‑rose sunset, your child's first sentence, a sticky kiss or even a goldfinch at your bird feeder.

 

Find your own "Slowdown spots of time" together. As moms, we can get so focused on getting everything done that we begin to look at our children as interruptions instead of our priority. We get so busy and overcommitted; we and our kids continually rush from one place to another. When you take time to lie on a quilt and look up at the stars in the night sky, time slows down a little. And moments to sit on the edge of your child's bed to listen and pray for her, to fly a kite or blow bubbles in the spring breeze are precious.  (Go on a Scout Campout.)

 

Make time for what really matters. Whatever the most important things in your life‑the love of husband, kids, friends; the joy of knowing God; helping a friend in the hospital; opening your door in hospitality; or teaching your kids about Jesus‑ask yourself, Am I using my time to do these things? Talk with your family about the one thing you don't want to miss doing this spring or summer and then just do it.

 

Life is a gift. Our children are a gift, and each day together is a gift. As we give our time to God each day, don't put off joy, and keep in mind what's most important.

10/5/05

Head lice crops it's "head" up each year.  There were some recent studies that showed that many head lice are becoming resistant to antibiotic shampoos like Rid and such.  In the past we have talked about smothering the lice with olive oil on the hair.  Recent studies have shown that using a rinse conditioner in the hair and combing with a "nit" comb would remove most lice.  But you have to get them as they hatch and repeat the conditioner and combing once every 3 days for 2 weeks.  If you combined that with soaking the hair in olive oil the next day and the third day use the Rid rinse, then we should be able to get them all and cure it without bad chemicals.
 
Or you could shave your head bald like me... ha ha! 
 
Dr. Knapp

10/13/05

Although childhood malignant melanomas are rare, physicians and parents must keep an eye out for them.  About 2% of all melanomas appear in children, but the types that commonly oc­cur in children are different from those found in adults. Melanomas in children arise from three things: 1. congenital nevi (moles that are there at birth),  2. de novo nodu­lar nevi (moles that come up new as they grow older), and 3. superficial spreading melanomas that are sun induced from moles that have been there for years.

 

Although 70% of melanomas in adults are sun induced and are superficial spreading melanomas, about 80% in children arise from congenital moles or de novo nodular lesions. There are very dif­ferent concepts of melanoma in child­hood.

 

1. Congenital moles that occur in 2% of children arise during the first 4 months of life. Most are small, less than 1.5 cm.  Excision of congenital moles is not nec­essary in infancy.  It is suggested that children with these moles be followed close­ly by parents and physicians. In children, these are more important than the other moles.  Melanomas in small congenital moles usually occur at or after puberty so they should be removed before puberty, espe­cially if the mole is on the scalp, face, or trunk.  Giant moles in children and those over 6 cm in a newborn, have a 5%-8% chance of melanoma risk. Many of these nevi are too large to totally excise.

 

2. The second most common type in chil­dren is nodular melanoma, constituting 40% of the melanomas in childhood. The nodules are rapidly growing and a red, bluish purple in color. They often ulcerate and, at times, bleed.  This is a highly fatal type.  The nodules are thick at the time of diagnosis.

 

3. And, in third place are the superficial spreading malignant melanomas. Here the ABCD rule applies: asymmetry, border irregularity, color variation, and diameter over 6 mm. However, the idea that the le­sion in a child has to be more than 6 mm is not reality.  This type is increasing because of the sun exposure of kids.

 

In adults, melanomas start out as a speck, and only 20%-40% start in preexisting moles. About 60%-80% start in de novo moles (new moles that are just beginning).  It's the new kid on the block, the new mole that can get you into trouble.  All moles have some potential to develop melanoma, but it is very low.  Congenital nevi have the most potential.

 

If a person has more than 100 moles, a family history of melanoma, and several large atypical nevi, there is a 50% chance of melanoma.  These individuals have to be followed carefully. Teenagers that fit this category should be fol­lowed like a hawk.

 

Early recognition and referral is essen­tial, followed by biopsy and surgical exci­sion. Adjunctive therapies have marginal additional value. The depth of the lesion is extremely important, with a depth of less than 1 mm being 95% cur­able and up to 3 mm being 40% curable.

 

There has been a 20-fold increase in the incidence of melanoma since 1930. This was  about the time that people decided to get silly and take off their clothes for recreational sun.

 

Dr. Knapp

10/30/05

A study came out showing lower birth weight of children of mothers who had dental x-rays during their pregnancy.  Even small amounts of radiation can cause small babies.  Wait 9 months to get the x-rays if they really are needed.  I would not get them anyway unless there are compelling reasons.  X-rays should not be a routine part of the routine visit to the dentist or emergency room.

 

Dr. Knapp

11/09/05

From the Wall Street Journal, July 2005:
We are a nation of take-outers and drive-throughers, eating our meals on the go, dining by ourselves and laughing alone. The family dinner has become an endangered species. .. . These days, fewer than one-third of all children sit down to eat dinner with both parents on any given night. The statistics are worse if both parents are working and the family is Caucasian (Latino families have the highest rate of sharing a meal). The decline in the family dinner has been blamed for the rise in obesity, drug abuse, behavioral problems, promiscuity, poor school performance, illegal file sharing and a host of other ills. A recent study at the Harvard Medical School, for example, concluded that the odds of being overweight were 15% lower among those who ate dinner with their family on 'most days' or 'every day' compared with those who ate with their family 'never' or on 'some days.' The National Center on Addiction and Substance Abuse at Columbia University found that teens from families that almost never eat dinner together are 72% more likely to use illegal drugs, cigarettes and alcohol than the average teen.
 
Roger Knapp MD

11/16/05

Here are the American Pediatric Recommendations for decreasing SIDS.

Have a great Thanksgiving..... Dr. Knapp

 

RECOMMENDATIONS to Prevent SIDS

 

The recommendations outlined here were developed to reduce the risk of SIDS in the general population. As it is defined by epidemiologists, risk refers to the probability that an outcome will occur given the presence of a particular factor or set of factors. Scientifically identified associations between risk factors (eg, socioeconomic characteristics, behaviors, or environmental exposures) and outcomes such as SIDS do not necessarily denote causality. Furthermore, the best current working model of SIDS suggests that more than 1 scenario of preexisting conditions and initiating events may lead to SIDS. Therefore, when considering the recommendations in this report, it is fundamentally misguided to focus on a single risk factor or to attempt to quantify risk for an individual infant. Individual medical conditions may warrant a physician to recommend otherwise after weighing the relative risks and benefits.

 

1.  Back to sleep: Infants should be placed for sleep in a supine position (wholly on the back) for every sleep. Side sleeping is not as safe as supine sleeping and is not advised.

 

2.  Use a firm sleep surface: Soft materials or objects such as pillows, quilts, comforters, or sheepskins should not be placed under a sleeping infant. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.

 

3.     Keep soft objects and loose bedding out of the crib: Soft objects such as pillows, quilts, comforters, sheepskins, stuffed toys, and other soft objects should be kept out of an infant's sleeping environment. If bumper pads are used in cribs, they should be thin, firm, well secured, and not “pillow like.”  In addition, loose bedding such as blankets and sheets may be hazardous.  If blankets are to be used, they should be tucked in around the crib mattress so that the infant's face is less likely to become covered by bedding. One strategy is to make up the bedding so that the infant's feet are able to reach the foot of the crib (feet to foot), with the blankets tucked in around the crib mattress and reaching only to the level of the infant's chest. Another strategy is to use sleep clothing with no other covering over the infant or infant sleep sacks that are designed to keep the infant warm without the possible hazard of head covering.

 

4.  Do not smoke during pregnancy: Maternal smoking during pregnancy has emerged as a major risk factor in almost every epidemiologic study of SIDS. Smoke in the infant's environment after birth has emerged as a separate risk factor in a few studies, although separating this variable from maternal smoking before birth is problematic. Avoiding an infant's exposure to second‑hand smoke is advisable for numerous reasons in addition to SIDS risk.

 

5.  A separate but proximate sleeping environment is recommended: The risk of SIDS has been shown to be reduced when the infant sleeps 'in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission and ASTM (formerly the American Society for Testing and Materials) is recommended. "Cosleepers" (infant beds that attach to the mother's bed) provide easy access for the mother to the infant, especially for breastfeeding, but safety standards for these devices have not yet been established by the Consumer Product Safety Commission.

 

Although bed‑sharing rates are increasing in the United States for a number of reasons, including facilitation of breastfeeding, the task force concludes that the evidence is growing that bed sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleep surface and, therefore, recommends that infants not bed share during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep. The infant should not be brought into bed when the parent is excessively tired or using medications or substances that could impair his or her alertness. The task force recommends that the infant's crib or bassinet be placed in the parents' bedroom, which, when placed close to their bed, will allow for more convenient breastfeeding and contact. Infants should not bed share with other children. Because it is very dangerous to sleep with an infant on a couch or armchair, no one should sleep with an infant on these surfaces.

 

6.  Consider offering a pacifier at nap time and bedtime: Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling, and the evidence that pacifier use inhibits breastfeeding or causes later dental complications is not. Until evidence dictates otherwise, the task force recommends use of a pacifier throughout the first year of life according to the following procedures:

 

·      The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.

 

·      Pacifiers should not be coated in any sweet solution.

 

·      Pacifiers should be cleaned often and replaced regularly.

 

·      For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.

 

7. Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult. Overbundling should be avoided, and the infant should not feel hot to the touch.

 

8. Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or to reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.

 

9. Do not use home monitors as a strategy to reduce the risk of SIDS: Electronic respiratory and cardiac monitors are available to detect cardiorespiratory arrest and may be of value for home monitoring of selected infants who are deemed to have extreme cardiorespiratory instability. However, there is no evidence that use of such home monitors decreases the incidence of SIDS. Furthermore, there is no evidence that infants at increased risk of SIDS can be identified by inhospital respiratory or cardiac monitoring.

 

10. Avoid development of positional plagiocephaly:

 

·      Encourage "tummy time" when the infant is awake and observed. This will also enhance motor development.

 

·      Avoid having the infant spend excessive time in car‑seat carriers and "bouncers," in which pressure is applied to the occiput. Upright "cuddle time" should be encouraged.

 

·      Alter the supine head position during sleep. Techniques for accomplishing this include placing the infant to sleep with the head to one side for a week and then changing to the other and periodically changing the orientation of the infant to outside activity (eg, the door of the room).

 

·      Particular care should be taken to implement the aforementioned recommendations for infants with neurologic injury or suspected developmental delay.

 

·      Consideration should be given to early referral of infants with plagiocephaly when it is evident that conservative measures have been ineffective. In some cases, orthotic devices may help avoid the need for surgery.

 

11. Continue the Back to Sleep campaign: Public education should be intensified for secondary caregivers (child care providers, grandparents, foster parents, and babysitters). The campaign should continue to have a special focus on the black and American Indian/Alaska Native populations. Health care professionals in intensive care nurseries, as well as those in well‑infant nurseries, should implement these recommendations well before an anticipated discharge.

11/28/05

Calcium requirements for age are:

0-6 months old             200-400

6-12 months old       300-600

1-3 years old                500-800

4-8 years old                800

8-10 years old              800-1200

11-18 years old       1200-1500   

 

Food

Amount

Calcium

Yogurt, plain, low fat

8 oz

415

Collards, frozen, boiled

1 cup

357

Skim milk

12 oz

500

Spinach, frozen, boiled

1 cup

291

Yogurt, plain, whole milk

8 oz

275

Cheese food, pasteurized American

1 oz

162

Cottage cheese, 1% milk fat

1 cup

138

Baked beans, canned

1 cup

154

Iceberg lettuce

1 head

97

Canned salmon

3 oz

181

Oranges

1 cup

72

Trail mix (nuts, seeds, chocolate chips)

1 cup

159

Almonds

1 oz (24 nuts)

70

Blackeye peas, boiled

1 cup

211

Green peas, boiled

1 cup

94

 

So milk intake should be 12-24 oz a day by one year old and stay there for many years.  Too much milk

 and they get anemic and will not eat a proper solid food diet.  The children usually are in that range of 12-24 oz

where their height/weight is on the growth curves.  For example if they are at the 50% then they would usually

take in about 18oz a day.  If they are big and at the 90% height/weight, then they would be taking in 24 oz a day.

  Then they get the few hundred mg of Calcium from cheese, ice cream, and other foods that have calcium. 

IF they are allergic to milk then they can drink SILK (non-dairy milk) or the Orange Juice with calcium. 

Or they can take a 500 mg chewable calcium from the stores.

 

By 8-10 years requirements increase and it goes higher at puberty.  When they go into puberty, the

recommendations are 1500 mg of calcium for females and 1200 for males.  That is a lot of milk

(three 8 oz glasses) so I recommend calcium supplements (and multiple vitamins) for most teens….usually

1000 mg supplement a day plus the milk and ice cream that they do eat.  The average teen only gets

300 mg a day.

 

We can load up their bones with calcium during their rapid growing years and prevent Osteoporosis

in their later years.

 

Dr. Knapp

www.rogerknapp.com

 

Plus give vitamins to children at all ages past one year.  We just do not eat right most days.  Plus we eat less red meat.  Any vitamin that has Iron and Zinc.

12/23/05

Dental Caries by Michele Sullivan

 

Altering the oral flora by dietary management and dental in-tervention can alter the cariogenic process in young children, lessening the chance of decay in primary and permanent teeth, Kevin Hale, D.D.S., said at the annual meeting of the American Academy of Pediatrics.

"We can address this as preventive medicine," said Dr. Hale, a pediatric dentist in Brighton, Mich., and a member of AAP's executive committee on pediatric dentistry. "Don't wait until kids have a problem."

Managing the population of oral bacteria, both in the child and the mother, is the key to preventing caries in children. "We want to decrease the percentage of cariogenic bacteria, and increase the noncariogenic strains," Dr. Hale said.

Humans don't have an established oral bacteria population until they get a tooth, Dr. Hale said. Mothers are the primary source of bacterial colonization for their infants. If a mother has active decay, she also has many cariogenic and few non-cariogenic strains. This is the ratio she will pass on to her infant.

There are several steps to managing maternal oral flora: removing active decay, changing diet, and improving dental hygiene. All of these will decrease the amount of cariogenic bacteria," he said. "This is important because the longer these bacteria sit on the teeth, the more acid they produce, which inhibits the growth of noncariogenic flora."

Xylitol gum can be an important part of this strategy, he said. The sugar doesn't promote bacterial growth because bacteria can't process it. The action of chewing increases salivary production and helps remove plaque.

A 2000 Finnish study looked at the effect of xylitol gum on maternal and child levels of Streptococcus mutans, compared with women who chewed fluoride or chlorhexidine gum. None of the children received any of the treatments. By 5 years, children whose mothers chewed xylitol gum had 70% fewer cavities than those in the other groups (J. Dent. Res. 2000;79:1885-9).

These strategies are useful for children as well, Dr. Hale said, with diet of primary importance. "The main problem is carbonated beverages. You should be counseling your patients to drink milk and water between meals, and only 4-6 ounces of undiluted fruit juice per day, [and] only with meals."

Remind parents that bottles of milk or juice at bedtime promote decay-causing bacteria. Children who cruise with "sippy cups" of juice throughout the day also are at risk. Older children who chew gum should chew the xylitol variety.

Children's teeth should be brushed twice a day and flossed once a day (yea … Right!), even if they only have one or two teeth (How do you floss one tooth?). Fluoride supplements can be useful in remineralizing the teeth and reducing bacteria, but it's important to do a very thorough history before prescribing these, he stressed.

"Even if they have fluoride in the water, the kids may be drinking bottled water without fluoride," Dr. Hale said. Conversely, children may live in an area without fluoridated water but attend day care in an area that has it, or be drinking bottled beverages made with fluoridated water. Over dosages of fluoride can cause brown spots on developing teeth, he said.

Pediatricians should be checking the teeth at every visit. Sometimes an exam will reveal chalky-looking white marks near the gum line. "Using an otoscope to examine the teeth can help you see this." The white areas are acid-etched enamel, a sign of impending decay, Dr. Hale said.

Check the teeth for plaque accumulation and the gums for inflammation. To check for inflammation, wiggle the bristles of a soft toothbrush between the teeth; if the gums are inflamed, blood will ooze a few seconds after brushing stops.

If there is no plaque and no inflammation, patients are doing a good job with hygiene. If you see inflammation without plaque, you are looking at a case of "performance brushing," Dr Hale said. "These are the kids who get their teeth brushed real well before they come in to see you, but who don't do it regularly otherwise."

If you see plaque without inflammation, the child probably has poor dietary habits and is drinking a lot of sugary liquids. Restrict the amounts of juice to only with meals.

 

So Mommys... keep your teeth in good condition.

Happy Holidays.

Dr. Knapp