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Egg allergies

 A study looked at children who were allergic to eggs.  55% could tolerate eggs in cooked food, and over half out grew their allergy by 7 years old.  45% outgrew their allergy to milk.  Very few outgrew their allergy to shellfish or tree nuts. (Peanuts are not a nut.  They are a legume in the roots of plants.  Allergy to nuts does not automatically mean they are allergic to peanuts and visa versa.)  There is no reason to delay giving certain foods to children when the parent is allergic to it.  There are more allergies to these foods the later you introduce them into their diet.

 Some vaccines contain eggs.  But they are duct eggs and processed in the production of the vaccine.  Almost never is there an allergic reaction to vaccines in persons allergic to eggs.  In persons who allergic reaction to eggs was only hives, then the CDC recommends giving the vaccine to the patient and observe them for 20-30 minutes.  


 Dr. Knapp


Outbreaks of acute gastroenteritis (AGE) often occur in closed populations, such as institutionalized persons or cruise ship passengers as well and the general community. Recent epidemiologic investigations of outbreaks of AGE have confirmed that >95% of cruise ship AGE outbreaks and 50% of children’s stomach bugs are caused by norovirus (NoV).  Although the use of alcohol-based hand rub has been promoted to limit the spread of NoV, alcohol has limited effectiveness in killing calciviruses, suggesting this approach has limitations.

NoV survives on stainless steel surfaces for weeks at ambient temperatures.  Recent studies in health care settings have documented opportunities to improve environmental disinfection cleaning of toilet area surfaces that are believed to play a role in the transmission of enteric pathogens. In light of these considerations, we undertook a covert evaluation of environmental hygiene practices related to public restrooms on commercial cruise ships and in many public areas.

The thoroughness of environmental disinfection cleaning (TDC) of public restrooms was evaluated in 56 large cruise ships.  A transparent solution that dries on surfaces rapidly and fluoresces when exposed to ultraviolet light was used to evaluate the TDC. The standardized objects were toilet seat, flush handle or button, toilet stall inner handhold, toilet stall inner door handle or latching device,  the baby changing table surface and the restroom inner door handle.  Twenty-four hours later, each object was evaluated to determine whether the target had been removed.

Conclusions. An objective evaluation of public restroom environmental hygiene on 56 cruise ships found that only 37% of selected toilet area objects were cleaned on a daily basis. It is probably less in stores and restaurant’s restrooms.   The effective solution for flu virus is the normal alcohol hand sanitizers.  But that does not stop or destroy the norovirus and it needs bleach solutions to clean surfaces and soap and water for the hands.  So dilute bleach is better for vomiting and diarrhea viruses. 

 Roger Knapp MD
Also there is a very good web site for behavior in children called Empowering Parents.


The age of puberty has been decreasing for 100s of years.  It is not from the hormones in the food or milk.  Studies showed no effect of Soy Formula.  We evolve as an animal race.  We are faster and smarter with every generation.  The decrease in the age of puberty is more likely the health of the population.  Obesity seams to bring it on sooner also.  Boys usually start puberty age 11 to 13 and may grow way into college.  Girls stop growing when they start their cycles. The hormones in the males may cause some boys to develop quarter size tender breast buds under one or both breasts.  This is common so do not bring them in for a doctor’s visit.  Certain chemicals and “natural” herbs can cause large breasts in the male (gynecomastia).  Lavender creams on the skin are a common cause.  What goes on the skin does go inside the body.  What is natural does not mean it is healthy for us.  I do not recommend a lot of herbal remedies since they can have side effects and frequently only have a placebo effect.  There are hundreds of chemicals in plants.  Most are innert and have no effect.  Some are good for us but in such low and variable concentrations that they are not much help.  Some of the chemicals in herbs are not good for our health and can cause long term problems (cancer?). I have not seen any reports of problems with melatonin.  The most natural approach is let God do it.  The body will naturally heal itself.  My favorite question is “Is this bothering the child or the parent?”.  If the mild symptoms such as clear runny nose or dry skin are not bothering the child, then leave it alone.

 Dr. Roger Knapp


A recent study showed that exercise does not help obesity.  Exercise makes you feel better and you have a better heart.  I strongly recommend exercise and sports for many reasons.  But you can play 2 hours of soccer and burn up 200 calories but that is canceled by 1 chocolate donut. 

 See:   http://pediatrics.aappublications.org/content/early/2013/01/08/peds.2012-1092.abstract?sid=58949f65-7342-4256-8e7a-2fc48a911a29

 Eating healthy definitely comes from the home and parents.  We set the example.   When our children are 2 years old we stop cussing because they will repeat it.   And in grade school they look over at the speedometer to see if you are driving the speed limit.  And when in high school we don’t drink in front of them.  We start looking at the example we set for our children.  So kids are good for us because they clean up our act.   So eat healthy for your sake… and your child’s sake.

 Start “brainwashing” your children into your morals starting at 5 yr old.  You do not wait until 14 since it goes in one ear and out the other.  Make editorial statements about the bad things in life that you see.  Instead of hoping they did not see the bad event, turn it around into what not to do.  If you see someone speeding and cutting in and out of traffic, say: “I hate people who drink and drive drunk.  Isn’t that bad.  They are not nice people.”  Your children do not get your morals out of the air.   You have to express them.  Then by the time they are teens and also as adults they will hopefully have some of your morals.

 Dr. Knapp

Using an AED to shock the heart into beating again is very important and time imperative.   See video on use of the AED:


There are a couple of things I want to mention about the function of the family.


The family evening meal is very important.   We have moved away from that habit and eat in the front room with the TV.  Or going out too much.  You need to turn the phones, ipads, and TV off (yes off) and sit down together.  If you do, then later there is less divorce, less child obesity, less teen delinquency and pregnancy.  Sit down together and ask “How did your day go?”.  If one child is not hungry, then they can sip water and still sit with the rest of the family.  And no they should not have to finish their plate.


How to help your child with homework: Get to know your child's teacher. Attend school events, such as parent-teacher conferences, to meet your child's teacher. Ask about his or her homework policy and how you should be involved. Set up a homework-friendly area. Make sure your child has a well-lit place to complete homework. Place supplies - paper, pencils, glue, scissors - within reach. Schedule a regular study time. Some children work best in the afternoon, following a snack and play period; others may prefer to wait until after dinner.  Keep the distractions to a minimum. This means no television, no loud music, and no phone calls. (Occasionally, though, a phone call to a classmate about an assignment could prove helpful.) Make sure your child does his own work. Children will not learn if they don't think for themselves and make their own mistakes. Parents can make suggestions and help children with directions. We want to each year have your child do more of the learning on their own. Set a good homework example. Does your child see you reading the newspaper, writing letters, or reading a book? Children are more likely to follow their parents' examples than their advice. A good rule is to have the child do an assignment that they did not do or turn in.   Even if it is not for credit, it is the learning that is important.   That way the child will have to do it some day so they might as well go ahead and do it on time and get credit for it.  I don’t believe in reviewing your child’s homework and correcting mistakes to improve their grade.  I think the parent should make sure they get it done.  If you correct their mistakes, that is you’re “A” and not their “B”.  You do not sit by them at school during a test and correct their mistakes.  If they obviously do not know how to do the paper or problem, then it is OK to “re-teach” the material so they know it.   And also show them how to memorize facts.

 The husband and wife will most of the time have different opinions about many things are run in the family.  For example one likes to party more than the other. The one that likes to get out more probably should not go so much and the one that likes to stay at home should get out more often. The appropriate amount is between the two opinions.  If both partners spend too much money, then they will go broke. So the one who spends too much should decrease their spending and the one that is miserly should spend more. Neither one is right. The proper amount is the compromise in between. And the parents will not agree on the discipline of their children. One will be harder and the other softer on the child. Neither one is right. The proper balance is the middle. That is not the problems of the marriage but the checks and balances of the marriage.  Don’t look at these differences as a problem of your marriage.  It is the good thing that you are different and both bring something special to the table to have a balanced child. "Neither one of you are right… find that happy middle between you two."

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

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

 Dr. Roger Knapp


Sleep apnea is a common problem and the most common indication for tonsillectomy and adenoidectomy.  The other indication for removal is the child has 6 strep throats or tonsillitis in 12 months, then they need them out also. You do not need fancy tests because if your child has severe noisy breathing and pauses his breathing for even 5 seconds, you need to video it and take it to your local ENT.

See example of it:https://www.youtube.com/watch?v=IjUeIwSb5aM

 They are starting to do in home testing for sleep apnea: http://www.usatoday.com/story/news/nation/2013/02/15/home-sleep-apnea-tests-momentum/1922335/

 There is now a home pulse oximeter to measure blood oxygen at $30-$100.  The price has come way down…. here is a good one on Amazon.


 This is also good for kids with asthma and having trouble.  Our oxygen is usually above 95%.  If it is 85-95% then that is not good but not life or death.  We increase our heart rate and blood flow to compensate for less oxygen.  Below 85% bad and head in to the ER if it does not come up quickly.

 Roger Knapp MD

p.s.  The Dallas Perot Museum is Awesome.    http://www.perotmuseum.org/

It is very reasonable and they only allow a certain number of people in so it does not get overwhelmed with too many attending.  Get your tickets ahead of time online.  Birthday parties are great also and only  costs $200 for 15 kids plus 15 adults.


There are a lot of companies advertising testing your DNA for diseases.  Examples:

 Make Informed Decisions About Your Health w/ Genetic Testing. Only $99”
A DNA Predisposition test will reveal your genetic predisposition for 25 diseases and conditions.”
“Establish a legal chain of custody with our $230 paternity test.”

These are not very accurate and can give more worry about what might happen and frequently does not.  It also labels the child as a potential to have a disease and will affect them getting jobs, insurance, or even possible marriage.  The American Academy of Pediatrics and the American College of Medical Genetics and Genomics have made an official statement that does not recommending random testing. 


 If a child has an illness that might be diagnosed with genetic testing then test for just that disease.  Or if a certain disease is in the family and it is a disease that can be addressed early to save the child, then test for that disease. 

 Also it is not recommended to save your babies cord blood.  In most cases it will not be used. 

 Roger Knapp MD
p.s.  The weather is starting to get better.  But remember sunscreen even when it is cold.  Snow skiers can even sunburn.  Babies can sunburn even in the shade.  At least SPF of 20.


Two things I added to Miscellaneous section of my web site.

 One is a very good person for hair cuts in Southlake if you are in my area.

Homaira is kind, quick, and reassuring to kids who are scared.

Here is a coupon for $3 off the first visit.

She only works on Fridays and Saturdays.

It is in Southlake at 114 and 1709 between Kohls and Old Navy


 The other is a musical medley of old TV theme songs. 

Can you name them?

There are two groups. Don’t peak at the answser until you guess.


Dr. Knapp


There is a large increase in Whooping Cough in school age children.

The Centers for Disease Control and Prevention (CDC) recommends a booster shot for tetanus and whooping cough at age 11 or 12. But researchers found that slightly younger kids may be at risk of developing whooping cough before then, as their original immunity declines.

What has become apparent is there's an increase in pertussis in children in the 7-10 year old age group.  Meissner and other researchers think that trend results from a change in the 1990s to a new type of pertussis vaccine, called an acellular vaccine, which comes with fewer side effects than the original whole-cell version.  Although the acellular vaccine works well, experts said it might end up providing shorter lasting protection.

Kids born between 1998 and 2003 and received the recommended series of five DTaP shots, the last of which is given at ages four to six.  Over the following six years, 458 kids from Minnesota came down with whooping cough. The rate of new cases rose from 16 per 100,000 children in the first year after their most recent DTaP shot to 138 per 100,000 in year six. That is only an increase from approximately 1/10,000 to 1/1000.  That is a 10 fold increase but still uncommon.  We do need a better vaccine.

Two options that are on the table are:

1.    Switching back to the whole-cell pertussis vaccine, at least for the first shot or two, could improve protection as kids get older …. but there is no evidence that it would make a difference.

2.    The CDC could also move up the booster shot to ages 8-10, but it's harder to get kids into the office at that point. 

Researchers agree the best thing to do is follow the CDC's current vaccine schedule.  Kids who do receive all five doses on time generally have milder whooping cough than those who are under-vaccinated, but the problem is that they expose infants below 1 yr of age who are more seriously affected.

I will let you know what the “experts” agree on what change if any is needed.

Roger Knapp MD


David Bloom.   He was a news reporter in Iraq that died from a blood clot and pulmonary embolus.  This is his 10 yr anniversary of his death and his wife continues to put out the word about Deep Vein Thrombosis.  There are many factors that increase your chances of getting DVT.  Watch out for long airplane trips.  Get up and stretch every 30-60 minutes.  See this article about the condition:


 There is an inherited condition that makes people prone to this.  It is called Factor V Leiden Thrombophilia. (Thrombophilia is increase clotting.)  Many specialists feel it increases (two to three times) miscarriages or possibly some pregnancy loss in the second trimester.  Factor V Leiden is the most common inherited form of thrombophilia. Between 3 and 8 percent of people with European ancestry carry one copy of the factor V Leiden mutation in each cell, and about 1 in 5,000 people have two copies of the mutation. The mutation is less common in other populations.

 The chance of developing an abnormal blood clot depends on whether a person has one or two copies of the factor V Leiden mutation in each cell. People who inherit two copies of the mutation, one from each parent, have a higher risk of developing a clot than people who inherit one copy of the mutation. Considering that about 1 in 1,000 people per year in the general population will develop an abnormal blood clot, the presence of one copy of the factor V Leiden mutation increases that risk to 3 to 8 in 1,000, and having two copies of the mutation may raise the risk to as high as 80 in 1,000 (8 percent!).

 If you have a family or parent with increase clots, consider having them checked for this condition and then have the children checked to see if they inherited it. 

 Dr. Knapp MD

p.s. In the news: the FDA is starting to regulate AEDs that restart your heart.  That is good since there are 45,000 reports of AEDs failing to work.  Yieks!  Especially with baseball season starting and the rare incidence of commotio cordis about which I have sent newsymails in the past.  http://www.medscape.com/viewarticle/555448


The news came out this week saying the American Academy of Pediatrics does not recommend any foods and only milk for the first six months of life.  But we still recommend a few things.  Rice Cereal for reflux or if not satisfied by just liquids in the evenings.  They actually make a formula with cereal in it.... Enfamil AR.  AR stands for added rice!   And also we give fruit or juice that is non-citric acid for constipation.  And if they do not need cereal or juice, then don’t give it.  I do recommend waiting on vegetables and meats until 6 months.

 The AAP recommends no TV until 2 yrs old.  I think one or maybe two hours a day below 2 yrs old is OK but they just don’t want 8 hours a day.  But the AAP does not trust parents to regulate it so they say NO TV until 2 yrs old.  Same with the bottle and pacifier.  If you keep it restricted to less use, the it is not hurting the toddler.  A sippy cup is a bottle with a hard nipple.  Same thing.  We just don’t want them going to bed with it and mess up their teeth or walking around all day sipping juice and causing cavities.  But using the rubber nipple bottle past 1 yr is OK as long as we do not over use it.  So same with starting foods below 6 months old.  It is OK but keep it limited.

 Actually the American Academy of Pediatrics recommends cereal and juice at their web site.

AAP recommends giving infants fruit juice for constipation.

AAP recommends giving infants cereal for Gastric Reflux.

So does Boston Children’s Hospital, Mayo Clinic for Children, and  WebMD.  And me too!

Wait on the vegetables and meats until 6 months. 

Most of the media has it wrong as usual.

 Roger Knapp MD


The news reported a large increase this year of Valley Fever.


What the heck is that!!!!

It is a fungus Coccidioidomycosis that causes fever and body aches.  Actually most people have no symptoms since 50% of people living in the southwest have positive antibodies to it. I lived in Arizona 3 years in the Army and saw some cases.  It starts after a few weeks of staying in or passing through those states and if you have fever, it is usually only a few weeks.  There are some severe cases in those people who have a weakened immune system, are of African-American or Filipino descent, or are pregnant in their third trimester.  If you are traveling through Arizona or California where 97% of the cases occur, and you start having fever and aches a few weeks later, remind your doctor you were in those states.  The number of cases climbed from less than 2,300 in 1998 to more than 22,000 in 2011. 

We also see “Spring Fever” during the next two months.  There are some Enterovirus viral fevers here every spring.  3-4 days of fever and aches.  No cough or sore throat.  The kids with this were tired and did not do their school work.  Through the years the term was converted to not caring about school in the spring, but it came from the spring fevers.  Grandma also blamed these fevers on the hay growing and called it Hay Fever.  Through the years that term was converted to your hay fever allergies but it originally was the “Hay Fevers”. 

 Be sure to use Deet bug repellants soon and they are safe down to 6 months old.  We had a big increase of West Nile illnesses last year. I think we will see fewer cases this year since so many people are now immune to it.  See my article on West Nile:


 Roger Knapp MD

No!  Fever does not harm the body.  It is the disease that damages it.  I do not recommend alternating Tylenol with ibuprofen because that is too many chemicals to your liver and it can be damaged by that.


Recently the news was talking about Skin Cancer Melanoma has a 2% increase each year over the last few decades.  See article in USNews.  But Melanoma is only 1 per million children.  Do not be frightened by the news media since it is still extremely rare in kids.  However the sun damage over many years causes cancers more in adults.  So protect your kids with sunscreen and swimming shirts to block sun damage.  It only takes a few sunburns to double your chance of cancer.  Another study showed 25% of adults with melanoma continued to not use sunscreen and even used tanning beds.  No we do not recommend tanning beds for children… much less adults.  Still another study showed less melanoma in adult women who took aspirin daily.  Cover up your kids this summer. Many a farmer is out working in the fields with long pants and long sleeves.  Watch the highway construction crews this summer with long pants and sleeves. 

 All cancers are rare in kids with a rate of around 15 per 100,000.  Survival of all kinds of Cancer in kids is improving.  In the 1970s it was 58% survival and now it is 80% survival. Here is a chart of the causes of death by age group.


Roger Knapp MD


Recent reports talk about too many antibiotics being prescribed by doctors. 

 I know some of my patients hate to hear the words “it’s a virus” but it is true.  You bring in your child to see what is causing the fever and there is pressure on the doctor to give you something for spending the time and money to make an appointment.  I think most of my patients understand we and they do not want to over use antibiotics.  Quick clinics like CareNow and other after-hour clinics tend to give more antibiotics since they do not know the patients as well.  They also tend to run more tests like x-rays and blood tests.  If the clinic or doctor owns the lab and x-ray, then there is financial incentive to order more tests.

Some kids have more illnesses than others.  Giving a lot of antibiotics to a child does not weaken their immune system.  Kids who are born with weaker immune systems get more illnesses and are therefore given more antibiotics. 

 Dr. Knapp


The news came out and announced that the FDA will allow girls down to 15 yr old buy Emergency Contraception pills over the counter without a parent.  I don’t think that is good but everyone has an opinion.  There is a slight decrease in pregnancies but a huge increase in venereal diseases.  HPV is a large portion of them.  See for amazing numbers: http://www.cdc.gov/std/stats/STI-Estimates-Fact-Sheet-Feb-2013.pdf

 This “morning after” pill prevents the egg release and not “abortion” causing fertilized egg loss.  But it only works before ovulation.  It does not work at all if the egg has been released so it does not work the second two weeks of the cycle.  Too many people think it works anytime.

 Roger Knapp MD



 A new paper in the journal Pediatrics has found that early limited formula feeding actually increases the rate of long term exclusive breastfeeding. The difference was quite dramatic. 79 % of 3 month old infants who received early supplementation were being breastfed exclusively, while only 42% of babies who received no supplements were still being exclusively breastfed at 3 months. The study involved only a small number of infants but it certainly did not hurt breast feeding.  I think in many cases it helps so that the breasts are less painful from a lot of nursing on an empty breast. 

 Breast-feeding activists have long argued that supplemention is detrimental to breast-feeding. What’s interesting to note is the fact that many other cultures in India, China, Nigeria and Saudi Arabia, some with much higher breast-feeding rates than ours, infants are given other liquids until a mother’s milk comes in.

 Let us stop making women feel guilty about combining breastfeeding and supplementation if that’s what works for her baby and herself.
Roger Knapp MD


Angelina Jolie's stunning announcement that she had a preventive double mastectomy raised both awareness and questions about the gene that led to her decision -- BRCA1.  She is 37 yr old but had her breasts removed before cancer developed.  Many women have chosen that road who have this cancer gene.

 BRCA1 and BRCA 2 (stands for BReast CAncer genes) are types of tumor-suppressing genes that  help stabilize the cell's DNA and help prevent uncontrollable cell growth. http://i.cdn.turner.com/cnn/.e/img/3.0/mosaic/bttn_close.gif

 About 12% of all women will develop breast cancer sometime in their lives.  But for women with a harmful BRCA mutation, the risk of breast cancer quintuples to 60% and some say as high as 87%.

 As for ovarian cancer, about 1.4% of women will have the disease sometime in their lives, according to the National Cancer Institute. But the risk for women with a harmful BRCA mutation increases to 15% to 40%. 

 Only 3 to 5% of women who develop breast cancer have a BRCA mutation, and about 10% to 15% of women with ovarian cancer have a BRCA mutation.  It is higher if these cancers were in very young patients. 

 Adults with these cancers can be screened for the genes.  Then their daughters can be screened if they are positive.  It is not a concern for teens and children but some parents want their daughters tested.  I think that is a good idea when older but labeling the child at a young age that would worry parents and the child themselves is not a good idea to do in my opinion.   I would think of testing them in their young 20s.  It complicates future spouse choices, their pregnancy choices, and insurance availability.  There are pros and cons to testing kids.

 Roger Knapp MD

Further genetic risk assessment is recommended for women who have more than a 20%-25% chance of having an inherited predisposition to breast or ovarian cancer. These women include:

  • Women with a personal history of both breast cancer and ovarian cancer
  • Women with ovarian cancer and a close relative—defined as mother, sister, daughter, grandmother, granddaughter, aunt—with ovarian cancer, premenopausal breast cancer, or both
  • Women of Ashkenazi Jewish decent with breast cancer who were diagnosed at age 40 or younger or who have ovarian cancer
  • Women with breast cancer at 50 or younger and who have a close relative with ovarian cancer or male breast cancer at any age
  • Women with a close relative with a known BRCA mutation

Genetic risk assessment may also be appropriate for women with a 5%-10% chance of having hereditary risk, including:

  • Women with breast cancer by age 40
  • Women with ovarian cancer, primary peritoneal cancer, or fallopian tube cancer or high grade, serous histology at any age
  • Women with cancer in both breasts (particularly if the first cancer was diagnosed by age 50)
  • Women with breast cancer by age 50 and a close relative with breast cancer by age 50
  • Women with breast cancer at any age and two or more close relatives with breast cancer at any age (particularly if at least one case of breast cancer was diagnosed by age 50)
  • Unaffected women with a close relative that meets one of the previous criteria


U.S. researchers looked at 9,424 children and teens who were taken to an emergency department for abdominal pain and found that nearly 20% of them were diagnosed with constipation.  Sometimes stomach pain can be severe and the parent is  not sure about appendicitis.  The best trick to test them for appendicitis is what we call rebound pain.  Anything that giggles the stomach will cause pain…. Kind of like after an operation. If you notice a person after an operation cough, they have a grimace on their face and bend over a little.  You do not have to ask them if it hurts since you can see how they react.  So ask you kid to cough big or jump and if you do not see any reaction, then it is hardly ever appendicitis.  But the parent usually pushes on their stomach and the child says ouch.  And where it hurts will generally not help you since early on it may be sore in the middle.  So use the cough trick to assess the need for an emergency visit.

 Also in the news was a report of the pertussis vaccine.  We have been watching this for several years and it turns out more cases of whooping cough are from the “acellular” DaPT.  The old whole cell DPT was harsh with severe pain and high fever.  But the milder DaPT did not cause antibodies for very many years.  Overall, the effectiveness of the vaccine fell from 98.1 percent within a year of finishing it to 71.2 percent five or more years later, according to the Centers for Disease Control.  So there is discussion about moving the 12 yr  old TdaP down to 8-9 years old.  The experts are still debating and we will let you know when the new recommendations come out.  We promised a bunch of kids the next shot was not until 12 years old…. Sorry.  So don’t promise no-vaccine when coming in to your checkups about then.

 Have a safe Memorial Weekend.  
Roger Knapp MD


Sunscreen for the summer.   I recommend covering your body with clothing.  Many farmers in the fields wear long blue jeans and long sleeve shirts.  Same with the men on the highway construction.  Kids with long pants have less rashes from grass, less skinned knees, less bug bites, and less sun.  If you put sunscreen on, using a SPF higher than  20 does not give much more protection.  But since the actual SPF in the products are frequently less than the label, and because you do not put a thick enough layer of sunscreen on the skin, a higher SPF is recommended…. 30-50.  Tests by Consumer Reports showed inexpensive store brands just as effective and cheaper:

Six got recommended ratings:

  • Target's Up & Up Sport, at the top spot, costs $1.16 an ounce.
  • Walmart's Equate Ultra Protection SPF 50, is just 47 cents an ounce. It won the CR Best Buy award of the dozen.
  • Coppertone Water Babies SPF 50, at $1.38 an ounce.
  • Walgreens Continuous Spray Sport SPF 50, at $1.33 an ounce. 
  • Hawaiian Tropic Sheer Touch SPF 30, at $1.38 an ounce.
  • Coppertone Sport High Performance SPF 30, at $1.67 an ounce.

The six that didn't get recommended ratings include:

  • California Baby SPF 30+, at $6.90 an ounce (discontinued, but may still be available).
  • No-Ad with Avobenzone, Aloe, and Vitamin E SPF 45, at 63 cents an ounce.
  • Neutrogena Wet Skin SPF 45+, at $3.67 an ounce.
  • Kiss My Face with Hydresia SPF 40, at $5.33 an ounce.
  • Badger Unscented SPF 34, at $5.52 an ounce (discontinued, but may still be available).
  • All Terrain AquaSport SPF 30, at $4.33 an ounce

Adults who used sunscreen every morning had less melanoma and less wrinkled skin.  There are rumors of side effects of sunscreens but no actual reports of harm from them.  The benefits outweigh any possible harm.  Plus the less you use stuff then the less it affects you.  So cover with cloth.  Look at my left hand where I wear a golf glove and the right hand where I use sunscreen.  More sun spots on the right.  Put swim shirts on the kids.  Have a safe fun summer.

 Dr. Knapp


We are already seeing some swimmer’s ear infection.  It is very tender ear and it hurts when you move the ear lobe.  It occurs more often after swimming in lake or ocean water.  To prevent it you put 2 drops of olive oil in their ears before swimming or put 2 drops of a solution of ½ alcohol and ½ white vinegar.  The products in stores like “ear dry” do not have the vinegar to keep the normal acid state of the ear canal. 

 Roger Knapp MD

 p.s. Remember, the day goes by slowly and the years go by fast!

 10 ways to raise children to use drugs.

 Teach them to be persistent…. to keep trying.  Let them make mistakes and encourage them to do better next time. By having choices and taking risks is that sometimes your child is bound to make mistakes. These are valuable lessons to build your child's confidence.  We certainly made mistakes.  If your child is trying to tell you something, stop and listen to what he has to say.  The best is to face them eye to eye and really listen.  It is important to them even though it may seem silly to you.


There has been an increase in penile injuries from toilet seats… No this is no joke.

See article:


 (Reuters Health) - Ouch: Boys know that toilet seats are an occupational hazard of potty training, but a new study suggests the number of genital injuries caused by falling toilet toppers is growing.  Researchers found the number of emergency room visits for toilet-related injuries to the penis, while still rare, increased by about 100 visits each year between 2002 and 2010.

Usually, the injuries happen when boys are learning how to urinate into the toilet while standing up and the seat falls unexpectedly - although a few adults did get snagged by the seat, too.  Breyer's team was "pretty surprised" to learn that one in 30 genitourinary injuries showing up to the ER involved toilets.

Using a national database of injuries caused by household products that were treated by U.S. ERs between 2002 and 2010, the researchers found 13,175 genital injuries related to the toilet seat.

About 68 percent were so-called crush injuries, which is when the penis gets trapped between the seat and the bowl. Of those, about 97 percent were in children seven years old and younger. Only five adults were caught by falling lids.  What!!!

Fortunately, it doesn't look like falling toilet seats lead to too much physical damage, but there may be some lingering mental trauma.  But parents of boys going through potty training may choose more male-friendly options, Breyer added.  For example, parents may want to invest in a U-shaped or "slow close" models. Those, however, can be more expensive than traditional lids.




 One model has an insert for small toddlers learning to be potty trained.

 A child is considered toilet-trained when he or she knows that it is time to go to the bathroom, is able to hold it until they get to the toilet, and is able to climb onto and use the toilet when they want to let it go.  In a study of children who started training between 22 and 30 months of age, boys were fully trained at an average age of 38 months, while girls were trained slightly earlier.  Just wait. They understand what to do by watching others, we have to wait until they have neurologic control.   And who cares… when were you or I or President Obama potty trained?????   It does not really matter.  It is more important to work on Language, vocabulary, behavior, and discipline.

 Dr. Knapp

Get the Disney I-Phone App if you are going to Disney World... it is great.   I recommend the "Disney Magic Guide" but there are several different Apps. 


The American Academy of Otolaryngology came out with some recommendations on who should get PE tubes in their ears for fluid or infections in the middle ears.  They mention that many children get tubes who do not need them.   Around 670,000 PE tube surgeries are done each year.  By age 3 yrs. old around one in 15 children have had this surgery.  I am conservative in medications, X-rays and surgery.  Many children get tubes who have only had a few infections.   If we average ear infections, they typically have 3-4 the first winter,  1-2 the second winter, and rarely have them the third winter.   Around 2-3 years of age their immune system matures and their muscles in their throat are able to “yawn and pop open their ears” letting the fluid out.  Parents do not cause the infections.  The fluid does not decrease the hearing significantly in most children and does not slow down their speech.  But around 18-36 months of age many kids start talking and the parents think it is because they put tubes in their ears.  My opinion is that if the infant is having ear infections in the summer when they should have stopped, or if we are not able to clear up the infections at all, then put in  tubes. 


 See article: http://www.usatoday.com/story/news/nation/2013/07/01/ear-tubes-surgery-guidelines/2465303/

 Roger Knapp MD


In a new finding the researchers at the University of Nevada Las Vegas on 25 different brands of hot sauces from Mexico and South America, they noticed some brands carried excessive lead content. The four brands are Salsa Picante de, El Pato Salsa Picante, Salsa Habanera, Chile Habanero and Bufalo Salsa Clasica.  The new investigation revealed that the four brands had shocking levels of lead that surpass the current FDS standard of 0.1 parts per million.  Work by UNLV researchers and the Southern Nevada Health District led to the removal of imported candies from local store shelves in 2006. In 2010, the FDA issued an alert for lead in candy in 39 types of candies from China, Mexico, and the Philippines.


 They closed down a national park in California this week because they found the plague in a squirrel.   The squirrel carries fleas which actually have the plague.  Not to worry since it is easy to treat it if you get a sore on your arm from playing with a wild squirrel… like you are going to catch one.   Plague is endemic and all year round in wild rodents mostly in the southwest states.  West Texas ranchers do not like prairie dog villages because the horse will hurt his leg if he steps in the hole.  So if the rancher finds a dead prairie dog he throws in down a hole.  Then when more dead ones show up he throws them down holes to eventually wipe out the group from plague.  But sometimes the flea gets on him and bites his arm and he comes down with a sore.  It is easily treated with antibiotics. So the plague lives on but not a concern. There are many diseases you can catch from dead or dying animals or birds.  In our compassion we try to save them but  most of the time you cannot save them and we put our family’s health at risk. Leave them alone.


 Roger Knapp MD


Good advice I could not say better.... Dr. Knapp

7 Tasks Kids Should Do for Themselves



Fewer people in America's largest cities are being murdered by guns, but the rate of suicide by gun has increased in recent years, U.S. health officials said Thursday.

 The rate of gun murders at the hands of teenagers accounted for nearly 3,400 firearm killings in 2009-2010. More than 1,500 teens and preteens took their own lives by gun in that time period, according to the findings from the CDC. But in 2009 the total for all ages, there were 22,500 gun murders and 38,000 gun suicides were recorded. 


 Keep the guns locked up since there are more suicides.

 Roger Knapp MD


Now they are coming up with something interesting and sad to say necessary.  A glass or straw that can detect if there is a date rape drug in you drink.   It will be coming out in 2014 and looks interesting.  A good idea especially if you are a young female in the college prep scene. 

 See for more info: http://www.nydailynews.com/life-style/health/drinksavvy-launches-date-rape-drug-detcting-glassware-article-1.1424854 or www.drinksavvyinc.com

 I still recommend the HPV vaccine and as Michael Douglas was on the news lately about his throat cancer, it is for the guys also.

 Roger Knapp MD

also some good parenting advice, see:  http://www.education.com/slideshow/tasks-kids-do-themselves/avoid-helicopter-tendencies/


The outbreak of Measles in Tarrant County totals 15 now.  Measles is a bad disease and 1 out of 20 get pneumonia and 1 per 500 die.   All but one of these cases are members of the 1500 member Eagle Mountain International Church.  An adult brought the disease from overseas and exposed everyone since it is highly contagious.  There are many in the church who do not believe in vaccinations and trust their faith to protect them.  Now 200 of them have gotten the Measles Vaccine.  It is not a worry for adults born before 1957 and those who have been vaccinated.  There were a few cases in people who were vaccinated but they either received only one vaccine or falsified their shot records.  It is a reminder for parents to give their children the MMR and not delay it.  It does not cause Autism.  I worry about children less than 1 yr old who have not received their vaccine yet.  There is no cause for panic for infants below 1 year old but just be careful of people in public places with a bad cough and runny nose during the next several weeks until this blows over. 

 Roger Knapp MD


As parents we have to make some difficult decisions raising our children.   Some decisions are black and white but many are confusing gray areas.  Do we send them to public or private schools?  Do we let them have a phone at what age?  Do let them go to a sleep over at another’s house and at what age?  What I recommend is to get as much information as you can, sit back in a recliner, close your eyes, and do what your heart feels is the best choice for that child.  You cannot go back and replay life.  You will never know if it was the best decision.  You can look back in your life and wonder “maybe I should have married that other person or taken a different job.”  But how do you know that other person or job might have turned out horrible.   We never know.  If you follow your heart, that is God telling you what to do.  Women are better at this than men… sorry guys.  That decision was the best one at that time with that information.   What you don’t want to do is have someone talk you into a choice that you do not feel was right and you kick yourself for years.  Follow your heart and don’t look back since we never know if it was the best choice. 

 Roger Knapp MD

P.S.:  The introduction of a hepatitis B vaccination program for babies in Taiwan in 1984 was linked to a 90% decline in the number of hepatitis B-related deaths, a study showed. Among individuals born between 1977 and 2004, the overall number of liver cancer cases dropped by 80%, while the proportion of deaths caused by chronic liver disease and liver cancer declined by more than 90%.   HPV now out for 7 years has already caused a 50% decrease in those infections and long term will dramatically decrease cancer of the cervix and throat.   Some vaccines are actually vaccines against cancer.   Hopefully we will have more of them in the future. Not getting vaccines is like driving without a seat belt for you and your children.  Yes the seat belt will rarely cause a death but it will save you 99+% of the time. 


We see “croup” every year at this time.   It is a viral cough cold with head congestion.   Some will have a low fever with it.   The throat hurts a little with swallowing but hurts more the windpipe below the vocal cords when you cough.  In small children it causes a croup seal bark sounding cough and we treat it with steroids.  Older children and adults can get it but they do not make the seal bark sound.  It also causes hoarseness to the voice.  It is viral and we can’t cure it.   Give ibuprofen and maybe cough medication.  The kids below 3  yr old we treat with steroids so it does not cause breathing problems.  Humidity helps so run a vaporizer.   We are happy to see the older kids with this but we can’t treat it.   Save money and stay home till no fever.   Strep throat generally does not have a cough with it.  If there is severe sore throat with swallowing and no cough, then we need to  see them.  Watch for sinus or ear infections the week after croup.

 Roger Knapp MD


Again the news likes to scare us and a good example is the most recent case of the recent death of the 4 yr old in Louisiana from the Naegleria fowleri amoeba in the brain.   He acquired it while playing on a slip and slide at a birthday.   The water was untreated.  Chlorine kills the amoeba but many water systems in Louisiana are not treated.  It is very rare…. only 31 cases were reported in the last 10 years in America.  Six of them were in Arizona where the well water is not treated with chlorine and it is warm.  10% of the well waters in Arizona contain them.  There is no risk if your water system is from the city that treats it with chlorine.  I would rather have too much chlorine (you can smell it) rather than not enough.  There are a lot more germs that the chlorine prevents.  The majority of the cases are from summertime freshwater ponds and lakes.  You have to get the contaminated water way up in your nose and a few cases were from people irrigating their sinuses with untreated water.  You CANNOT get it from drinking water containing the amoeba and you cannot get it from bathing as long as you do not get it way up in your nose.  There is no reason for panic.  Wear a nose clip when swimming in small ponds and see your doctor if there is fever, headache, and stiff neck. (Duh!)


Roger Knapp MD
P.S. With football and other sports getting into full swing, remember to wrap injuries immediately with tape and then later on put ice on it. See


George Nissen, a competitive gymnast, patented the modern trampoline as a “tumbling device” in 1945. Nissen initially designed the trampoline as a training tool for acrobats and gymnasts and subsequently promoted it for military aviator training. Recreational use of trampolines is a more recent phenomenon, driven primarily by the increased availability of relatively inexpensive trampolines marketed for home use.

 The concern is not only falls off the trampoline to the ground but also the force created in the trampoline.  There is just as much Gs of force on the body and joints at the bottom of the spring as there are if you fell off the roof.  It is not a sudden impact but the ligaments and bones can still tear or break.  Approximately 1/1000 children are injured on them every tear… but that is the total population of children.  It is more realistically 1/50 kids who use trampolines.  The problem is that just jumping straight up and down by yourself is boring fast.  The injuries are when they summersault, flip, or jump with more than one child on the trampoline.  The fence around the trampoline to prevent falling off helps some.  The padding has not been shown to decrease injuries.

 The injuries are ankle sprain or fracture, fracture of the arms, head and/or neck injuries (accounted for 15%  of all injuries, and 0.5% resulted in permanent neurologic damage), cervical spine injuries, back strains with constant back pain, breast bone fracture or dislocation, vertebral artery dissections, and fracture of the tibia bone. 

 There are now trampoline parks which are not regulated at all.  There is no fence around them as you can see in this web site.  http://altitudetrampolinepa1.reachlocal.net/page.cfm?pageid=31967

The AAP and myself do not recommend any use of the trampoline.


 Roger Knapp MD
Want a fun calculator on how tall your child will become…. Not super accurate but interesting.
  About as accurate as doubling their height at 2 yr.


Oh my goodness my grandkids love chicken nuggets.  But what about healthy diets?

We want children to take in 20-35% of their diet in fat.  I am not going to address the kinds of fats that are best in this email.  Most Pizzas have 25% fat but most fast food places have 36% fat in their chicken nuggets.  Chick-fil-e nuggets have 26% fat and their grilled nuggets have only 6% fat.  I love their cool wraps and it has 12% fat and more fiber.  So actually pizza is better than MacDonald’s nuggets. 

 Now they have a study that came out showing most fast food nuggets have only 40-50% chicken meat.  The rest is ground up skin, nerves and blood vessels.   Yuck!  See report here.  That is why I recommend Chick-fil-e and especially their grilled chicken nuggets.

 The biggest problem with overweight is the amount of food and calories.  Teach you kids to not finish their plates.  Keep desert in proportion the amount of proper food eaten.  Many times kids and we have heart burn and translate that into hungry.  We neutralize the acid with food.  Try an antacid and glass of water instead of snack.  Sugars stimulate insulin and it increases hunger, and drives the calories into the fat cells.  So cut out the sweets and sugar drinks, eat more at home or take a sack meal from home with you, and split a meal at the restaurant.   See obesity article at my web site.

 Roger Knapp MD


A study came out looking at visits where immunizations were given at a sick visit.  Many years ago they did not recommend vaccines if the patient was ill.  We proved that was wrong 25 years ago and you will still hear it today from your friends.   Unless there is major illness like pneumonia, then it is recommended we give vaccines in spite of colds, ear infections, or even fever.  I don’t give vaccines if there is fever 101 or more since it confuses the picture but we are allowed to give them.  The CDC even came out and said if you have a parent that does not bring them in for well checkups to get vaccines, then give them the vaccine while you have them in the office for an ear infection.  That resulted in the parents coming in even less frequently for well checkups as shown in this article.

Sick-Visit Immunizations and Delayed Well-Baby Visits  in Pediatrics. 2013;132:44-48

 If your doctor wants to give the vaccine at checkups and your child has a cold…. Go ahead and give the vaccine. 

 Roger Knapp MD

p.s.  Parents should monitor their children to make sure they are not playing the Knockout Challenge.  The game, commonly played by middle-school-age youths, entails taking several quick breaths to become dizzy and then being pressed in the chest for a few seconds by a peer to temporarily lose consciousness. "A student who does this risks his or her health and could die from the challenge or the fall."


Autism increase?????

This study from the Institute of Child Health in London, United Kingdom, looked at how rates of autism diagnosis have changed in the UK over the past few decades compared it to the data released last year by the US CDC.  The researchers calculated how many new children had been diagnosed each year with autism when the children were between the ages of 2 and 8.  The number who had autism in the UK had not changed much from the 1990s up through 2004 to 2010…. 4 autistic boys out of every 1,000 boys and 1 autistic girl out of every 1,000 girls.

These numbers contrast with the US CDC numbers in 2012 that found one in 88 children had autism …. Approximately 12 per 1000.  That is more than 1 percent.

We certainly are not seeing that number of autistic kids.  The increase in autism in America is greatly exaggerated.  Disorders like Downs syndrome have been added to Autism spectrum and any child with reading problems are labeled autistic to get extra help. 


A recent study showed children who received iron supplements demonstrated significant improvement in IQ scores and other cognitive tests. Other differences included being slightly taller for their age, as well as improved weight for age.

That is why I recommend Flintstone Complete with iron and zinc instead of gummy vit without Iron.


 Roger Knapp MD

p.s.   Shopping for Christmas Gifts?  Here are a few suggestions.

 For teenager: The Lego Minecraft Village


 For gradeschool age: Magic Jinn Game


 and Boom Boom Balloon


 For preschool age: Princess Sofia Surprise Slides





We have been sleeping babies on their backs for many years now and the incidence of crib death has dramatically decreased. 

But we also stopped most pigeon toed… toeing in.   When we slept the kids on the stomach their feet were curled in and under as in this picture.

This twisted their lower leg Tibia bone in ward and bent the front half of the foot inward.  The terms for these are Tibia Torsion and Metatarsus Adductus.  These conditions had to be treated and we had to put them in a splints as shown.




    You can tell if it is Tibial Torsion from another condition that is Femoral Antiversion because the outside ankle bone is in front of the inside ankle bone. 


The kids tend to sit on the floor legs outward with Femoral Antiversion.  Encourage them  to sit cross legged.  

We don’t treat the Femoral antiversion but they used to put them in this contraption to make it look better. 


They will generally grow out of it and these devises did not make a difference.           

We almost never have to treat these conditions since the mild forms will go away through the years of running and playing. 

We hardly ever see severe forms since we sleep them on their backs. 

Roger Knapp MD

p.s.  The HPV virus is so correlated to cervical cancer (and other cancers) that it is more accurate to test for HPV than to do pap smears. 

A recent article said:  Detection of the most dangerous HPV-16 and HPV-18 types predicted high-grade cervical intraepithelial neoplasia with 92% sensitivity compared with cytology's 53.3%.  "HPV testing with separate HPV-16 and HPV-18 detection could provide an alternative, more sensitive, and efficient strategy for cervical cancer screening than do methods based solely on cytology," the group concluded in the paper.  Combining HPV testing with liquid-based cytology held little advantage over HPV testing alone, according to the results of the ATHENA trial published in the September issue of the Lancet Oncology.



Katie Couric Promotes Anticancer Vaccine Alarmism

 It is unfortunate that someone like Ms. Couric, who did so much to promote awareness of colon cancer, did a show last week  that scares people away from a cancer preventing vaccine.   

 Cancers, plural, actually, given that, according to University of California law professor Dorit Reiss, HPV is responsible for nearly all the cervical cancers in the United States and for “90% of anal cancers, 40% of vulvar, vaginal, or penile cancers, and 12% of oral and pharyngeal cancers.”

  A study published in the British Medical Journal in October evaluated 997,000 girls, 296,000 of whom had received at least one dose of the HPV vaccine. More than 150,000 of those girls received all three doses. The results show  absolutely no link to short- or long-term health problems. 

 If HPV didn’t carry the dual emotional and cultural baggage of being a vaccine that prevents a sexually transmitted viral infection and being initially rolled out for tweenage girls, we wouldn’t be having this discussion.

 Her husband died of colon cancer at a terribly young age. If this discussion were about a vaccine that prevented colon cancer, Couric’s segment would have been very different.

 The episode focused on anecdote and emotion and failed to highlight what the evidence shows in favor of the safety and effectiveness of the HPV vaccine.


 New study shows HPV vaccine helping lower HPV infection rates in teen girls

A new study looking at the prevalence of human papillomavirus (HPV) infections in girls and women before and after the introduction of the HPV vaccine shows a significant reduction in vaccine-type HPV in U.S. teens. The study, published in [the June issue of] The Journal of Infectious Diseases  reveals that since the vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56 percent among female teenagers 14-19 years of age.

 About 79 million Americans, most in their late teens and early 20s, are infected with HPV. Each year, about 14 million people become newly infected.

 Unfortunately only one third of girls aged 13-17 have been fully vaccinated with HPV vaccine.  Countries such as Rwanda have vaccinated more than 80 percent of their teen girls. Our low vaccination rates represent 50,000 preventable tragedies – 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates.  For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes.

 According to CDC, each year in the United States, about 19,000 cancers caused by HPV occur in women, and cervical cancer is the most common.  About 8,000 cancers caused by HPV occur each year in men in the United States, and oropharyngeal (throat) cancers are the most common.


 Other vaccines have been developed for cancer.   Liver cancer has decreased 80% in many Asian countries after the Hep B vaccine was started in the 1980s. 

I recommend the HPV vaccine.  It is safe and I would want it if I were a teenager.

Roger Knapp MD


The news came out this week saying don’t take vitamins.


 “The first article reported the results of vitamin supplements for disease prevention in adults with no nutritional deficiency. The second evaluated the efficacy of multivitamins in preventing cognitive decline in men over 65. The third measured the effects of a high-dose multivitamin on people with a previous cardiac event. Each concluded that there were no benefits from the supplements on those populations, and the editorial said: "The message is simple. Most supplements do not prevent chronic disease or death, their use is not justified and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deficiencies, who represent most supplement users in the United States and in other countries." It wasn't the first time it has been suggested that vitamins and supplements are not helpful. "This is not new information if anyone follows this," said nutritionist Heidi Skolnik, who runs Nutrition Conditioning, which has an office Englewood Cliffs Not new, but once again studies create debate instead of a definitive answer. While Skolnik largely agrees with the editorial — particularly that healthy people don't need supplements — others find flaws in the method and message. “

 I recommend vitamins in most people.  We eat healthier and eat less red meat.  Then we do not get enough Zinc and Iron.  The news came out this week saying vitamins should not be taken since studies show they do not prevent chronic disease, cognitive decline, or cardiac events.   But they do help keep us healthy.  I disagree with their statement that you should not take vitamins.  Many studies show it helps:

See: http://ajcn.nutrition.org/content/86/4/1167.short

 If you want to research medical stuff on the internet, use Google’s scholar …. Click on the list of search engines, then click the bottom where it says “more”.   Then at the bottom of that list, click on the “even more” and you will have all the search engines of Google.  In the lower right area is “scholar”.   Click on it and search for actual medical articles.  You may not have the full article but you will have the abstract.  Many internet sites have some whacko who has an agenda against any authoritative group.

 Another news article this week talking about the government making the makers of antibacterial soaps prove they were better than just plain soap.  We wash with just soap in the hospital.  I never recommended antibacterial soaps and the chemicals they have in them.  Even if they kill bacteria, the chemical is not in contact with the germs long enough to kill them.  And the chemicals are being absorbed into your body.  Just use soap (I like Dove and Oil of Olay).  And if there is a vomiting and diarrhea bug in the house, the hand sanitizers do not help.  Use soap and water for hands during those illnesses in the house.

 Have a Merry Christmas… Hanukkah,  …or whatever your religion celebrates.

Roger Knapp MD.


Here is another disease the news media will probably scare you about this coming year.   It is Chikungunya.   I don’t know how to pronounce it!  It is a virus like West Nile that is from mosquitos.  It normally is restricted to Africa and Asia but now has been detected for the first time in the Western Hemisphere, with 10 confirmed cases in the Caribbean island of St. Martin.  The CDC has issued a travel advisory for this tourist playground.

 The chikungunya virus in spread by the bite of infected mosquitoes and can cause a severe  illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash and joint pain but is rarely deadly.  Chikungunya means "that which bends up" in the Kimakonde language of Mozambique.

 It has the potential to spread in the Caribbean, South and Central America, and Southern United States, but this could take years or possibly quicker.  The St. Martin authorities are already fighting an outbreak of Dengue fever, spread by the same Aedes aegypti mosquito that carries the chikungunya virus.  Dengue fever is spreading North from Central America and Mexico and has been reported in Southern Florida and Texas.  Dengue Hemorrhagic Fever is more severe than Chikungunya and 1-2 % die.  I mentioned Dengue before in my West Nile article.  So there are many diseases spread by mosquitoes so try to use the normal precautions  this coming year.


 Speaking of viral infections, we are starting to see some cases of the Flu.  The vaccine only prevents it 65% of the time.  High fever and head ache in every patient.  Some with cough and some with vomiting.  Not every person should be treated with Tamiflu and the test misses 50% of cases.  Read my article on the Flu at my web site. 

 Have a happy and safe holiday

Roger Knapp MD