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Newsymail 2002

5/20/02

Recall.  find more info at http://www.djgusa.com/services/productrecall/recalls.html

In cooperation with the U.S. Consumer Product Safety Commission (CPSC) and the National Highway Traffic Safety Administration (NHTSA), Dorel Juvenile Group Inc., of Columbus, Ind., is voluntarily recalling about 26,000 Safety 1st and Beatrix Potter "Designer 22" infant car seats/carriers. When the seat is used as a carrier, the plastic handle can unexpectedly release from the carrying position.

5/21/02

Here is the answer from Children’s Medical Center in response to the TV program May 2002 slamming Vaccines. It seems we have these shows every Sweeps week during ratings. There is no mercury in Enfanrix DtaP, Prevnar, IPV (Polio), MMR, HIB, Varicella (Chickenpox). There is miniscule amount in the Tripedia DtaP <.0002% . Actually far more mercury is transmitted to the baby by the mother ingesting fish with mercury when pregnany or when nursing. I sent a Newsymail last year on this and is copied at the bottom of this article.

Dr. Knapp

Recent media reports indicate dozens of lawsuits have been filed across the country charging that vaccine mercury poisoning leads to neurodevelopmental disorders in children, including autism. Additionally, recent publications have raised the question concerning a relationship between MMR and autism.

A Channel 8 investigative report beginning tonight (Monday, May 20) will examine this issue, as well.

The following informatio n indicates that autism is not linked to these vaccines:

Etiology of Autism - Three groups of studies support the fact that autism results from an event or exposure that occurs during development of the central nervous system early in utero: genetic studies of monozygotic and dizygotic twins, in-utero events and timing of onset of autism. Home video studies demonstrate abnormalities of movement and behavior in children later diagnosed with autism as early as 2-3 months of age and 12 months of age before exposure to MMR vaccine.

Studies of MMR vaccine and autism - The Immunization Safety Review Committee of the Institute of Medicine reviewed all published and unpublished data and released a report in April 2001 (www.nap.edu/catalo,g/10101.html). The committee concluded that "a consistent body of epidemiological evidence shows no association at the population level between MMR vaccine and autistic spectrum disorders." A causal relationship and biological plausibility were rejected since there have been no proven biological mechanisms that would explain a casual relationship.

Large epidemiological studies have been performed in the United Kingdom, Sweden and California; all failed to demonstrate any association between MMR vaccine and autism.

Published data does not support the Wakefield hypothesis that MMR vaccine causes intestinal inflammation, loss of intestinal barrier function, entrance into the bloodstream of encephalopathic proteins and consequent development of autism.

The Institute of Medicine, the American Academy of Pediatrics (AA-P) and the ACIP support the continued use of MMR vaccine according to current recommendations. Recent decreases in the use of the MMR vaccine in the United Kingdom and Germany have been associated with measles outbreaks similar to those in the United States in 1989-9 1.

Summarized information by Paul Offit, M.D., for the AAP is available at www.cispimmunize.or0fam/mmr/a main.html. A set of Frequently Asked Questions (FAQ) also is available for parents at www.cisl)immunize.ors~/fani/mnir/a niain.htnil

Studies of thimerosal-containing vaccines and neurodevelopmental disorders - Thimerosal contains ethyl mercury and has been used as a preservative in multi-dose vials since the 1930s to prevent bacterial contamination. In response to the concern that the cumulative intake of mercury from vaccines administered in the first six months of life could exceed the guidelines for methyl mercury intake set by the EPA, (but still within the safe limit according to the guidelines set by the FDA, ATSDR and the World Health Organization) (MMWR 1999; 48:563), a thimerosal-free hepatitis B vaccine was licensed in August 1999. As of March 2001, all routinely recommended licensed pediatric vaccines manufactured for the United States are thimerosal-free.

The Immunization Safety Review Committee of the Institute of Medicine reviewed all available data and published a report in October 2001 (www.flap.edu/cataloiz/10208.htm]). The committee concluded "the evidence is inadequate to accept or reject a causal relationship between thimerosal exposures from childhood vaccines and the neurodevelopmental disorders of autism, ADHD and speech or language delay." Thimerosal-free vaccines are recommended for routine immunizations, but if the only choice is a thimerosal-containing vaccine, the committee recommends using it rather than not immunizing.

Specific evidence supporting the absence of a causal relationship includes:

•  No association between postnatal exposures to low doses of methyl mercury and neurodevelop mental disorders has been found (Pediatrics 2001; 108: 197).
•  Signs and symptoms of mercury poisonings are not identical to autism, ADHD or speech -language delays.
•  There is only limited toxicological information regarding ethyl Mercury.
•  There are only two epidemiological analyses of the association of neu rode velop mental disorders with thimerosal-containing vaccines - both are unpublished. When reviewed by the IOM, no significant associations were found in either study. One study, the CDC Vaccine

Safety Datalink (VSD) project, included >130,000 children with 169 cases of autism.

Preliminary results from ongoing studies of mercury metabolism at the NIAID of NIH indicate the half-life of ethyl mercury in infants who received thimerosal-containing vaccines is only 68 days and eliminated in stool, compared with a half-life of 45 days for methyl mercury. The only vaccine in the United Kingdom containing thimerosal is DTP; however, the autism case rate increased rapidly during the 1980s with no change in thimerosal exposure, since all added vaccines were thimerosal free.

It is important to assure parents that the current U.S. supply of routinely recommended vaccines is thimerosal-free and the AAP does not recommend testing children who have received thimerosal-containing vaccines for mercury.

The Influenza vaccine contains thimerosal, but this vaccine is not used prior to 6 months of age and there is no longer any cumulative effect from other vaccines.

If the U.S. Court of Federal Claims rules that thimerosal is one of the components that comprise vaccines rather than a contaminant, then allegations that thimerosal in the vaccine caused injury or death must be filed with the Vaccine Injury Compensation Program (VICP) before any civil litigation can be pursued for a VICP-covered vaccine. (www.hrsa.gov/osp/vicp/qanda.htm.)

Helpful, frequently asked questions can be found at www.cdc.gov/nip/vacsafe/concems/tbimerosal/faqs-thimerosal.htm.

For more information, contact Jane Siegel, M.D., at 214-648-3561 or e-mail Jane.Siegel@UTSouthwestem.edu.

Date sent: Sun, 10 Mar 2002 21:58:20 -0600

Save for your children's education. ..... Dr. Knapp www.rogerknapp.com

A "529 Plan" is a tax-advantaged program, established under Section 529 Of the Internal Revenue Code, that helps families and individuals prepare for the future costs of a college education. Plan participants contribute to an account or purchase tuition credits or certificates on behalf of a beneficiary -- a parent for a child or grandparent for grandchild, for example -- that has certain federal and state tax advantages. These plans are known as Qualified Tuition Programs. All 50 states have passed legislation authorizing a 529 plan, and most Have a plan in operation. Two types of 529 Plans There are two kinds of 529 Plans -- college savings plans and pre-paid tuition plans. Some states offer one or the other, while others offer both. Why choose a 529 Savings Plan? First, there are the tax advantages. . . .

Federal taxes: Your investment grows tax-free for as long as your money stays in the plan. In addition, beginning in January 1, 2002 withdrawals to pay for the beneficiary's qualified college costs will be federal income tax free.

State taxes: Some state programs offer additional tax advantages in addition to those offered by the federal government. Depending upon the state in which you live, program advantages could include a state income tax deduction for contributions and an income tax exemption for qualified

withdrawals. Other Advantages The plan beneficiary can use the money at virtually any accredited college, university or other institution of higher education -- not just in-state schools, which is a common misconception -- and at some institutions abroad. 529 Plans are professionally managed. When you invest in a 529 program you generally have the ability to invest in one or more professionally managed portfolios. TIAA-CREF Tuition Financing, Inc. currently serves as program manager for 12 states. For more information about plans available from TIAA-CREF, please call 1 888 381-8283. Estate Planning Benefits. You, the account owner maintain control of how the funds are distributed and to whom -- deciding when withdrawals are taken and for what purpose. When you contribute to a Section 529 plan and become the owner of that account, you always retain control of that account's accumulations, even though contributions are treated as completed gifts. As a result, your contribution qualifies for the $10,000 annual gift tax exclusion, so you can make fairly large contributions without incurring the gift tax. The funds accumulated in your account are generally not considered

part of your estate for federal estate tax purposes, but you remain in control of the funds. You may also decide to transfer the account balance to another eligible beneficiary or to reclaim the funds for yourself at any time. However, some transfers could be subject to gift tax and withdrawals that are not used for qualified expenses will be subject to taxes and penalties. Anyone is eligible. Generally, there are no income limitations or age restrictions. And you can name anyone as a beneficiary -- your child, your grandchild, niece, nephew; or -- if you're thinking about going back to college -- yourself. Flexibility. You're not limited to investing in your own state's plan, but can take advantage of plans in nearly all of the states that offer these

programs.

High contribution limits. You can invest substantial amounts of money in most programs; in some programs you can make contributions until as much as $240,000 has been set aside for your beneficiary. Contribution limits for Section 529 plans are considerably higher than the limits for other types of investments typically associated with funding higher education.

Funds transfer flexibility. Parents can transfer balances to siblings or certain other family members. So, if one child decides to not go to college, his or her sibling can benefit from the plan. In addition, beginning on January 1, 2002, account owners can rollover the accumulation from one 529 to another 529 without changing the beneficiary once every 12 months.

Withdrawals for non-college related expenses. Effective January 1, 2002, the new federal tax law imposes an "Additional Tax" of 10% on the earnings portion of non-qualified withdrawals. The Additional Tax eliminates and replaces the federal income tax law requirement that each qualified tuition program impose a penalty that is "more than de minimis" on non-qualified withdrawals (i.e., the currently 10% state penalty on earnings). This Additional Tax will have similar consequences to the account owner as the current tax, however, account owners will now be responsible for paying the Additional Tax to the United States Treasury through their federal

Income tax return.

Date sent: Sun, 3 Mar 2002 10:24:37 -0600

Fluoride is important for stronger teeth but an excess of anything is bad. We used to push fluoride in the first year of life but damaged permanent teeth with too much fluoride. We now want to be sure they have fluoride in their diet after 1 year of age to have stronger permanent teeth at school age. The children swallow tooth paste so the recent recommendations is To not use fluoride tooth paste until 3 years old and some say 6 years old. Swallowing too much fluoride tooth paste is bad. On the contrary, if the 1+ year old children are not drinking any city fluoridated water, then ask the doctor for fluoride containing vitamins. p.s. Children do not have to see the dentist until 3 unless you see problems before then.

Dr. Knapp

www.rogerknapp.com

What time should you go see the dentist? At tooth-herty!

Date sent: Wed, 20 Feb 2002 20:37:22 -0600

Latest study showed that children who get allot of infections in the first 4 years had less infections during grade school and visa versa. So it looks like kids will have to get these infections and develop immunity to the germs eventually. They will either get them during preschool or get them later during grade school. I would just as soon have them get these infections when they are older and better able to handle them. But if your toddler is getting frequent infections, the side benefit is that they will miss less school later. Hummmmmm.

It is kind of interesting that when we Pediatricians first go into pediatrics, we are sick every week for two years. Then we hardly ever get sick since one develops immunity to all the germs. It is a rough first two years though.

Dr. Knapp

www.rogerknapp.com

Date sent: Fri, 15 Feb 2002 16:18:25 -0600

I strongly recommend you fix a Family Disaster Kit, not only for terrorist stuff but also tornados and such.  Dr. Knapp www.rogerknapp.com This is attached as a .doc file if you want it.

There are many things you may need in an emergency or during a disaster. These things should be in a duffle bag, backpack, or plastic storage container so you can take them with you easily if you have to leave your house. Here is a list of some of the most important things:

• a.. Mess kits, or plates, cups and spoons made of paper or plastic
• b.. Radio (plenty of batteries or wind up kind that does not need
• batteries.)
• c.. Flashlight and extra batteries
• d.. Manual can opener and utility knife (like a Swiss Army knife)
• e.. Fire extinguisher (ABC type)
• f.. Pliers, plain and Phillips screw drivers, hammer
• g.. Tape
• h.. Compass
• i.. Matches in a waterproof container (film canister)
• j.. Aluminum foil
• k.. Signal flares (like you use for road hazard)
• l.. Paper and pencils
• m.. Needle and thread
• n.. Shut-off wrench to turn off the gas and water to your house
• o.. Plastic sheeting
• p.. Whistle and small mirror
• q.. Toilet paper
• r.. Soap
• s.. Household chlorine bleach
• t.. Plastic bucket with a tight lid
• u.. Plastic garbage bags

You will need a three-day supply of non-perishable food. Non-perishable means food that can stay good for a long time without needing to be in the refrigerator. It is also good if the food doesn't need to be cooked. Here are some suggestions:

• a.. Ready-to-eat canned meats, spaghetti, chili, fruits and vegetables
• b.. Canned juice, or milk
• c.. Sugar, salt and pepper
• d.. High energy foods, like peanut butter, jelly, crackers, granola bars, trail mix
• e.. Fun foods! Like cookies, hard candy, lollipops, instant coffee and tea
• f.. Special food for babies or older people
• g.. Dehydrated foods like soups from the grocery store.
• h.. Beef Jerky

The food should be kept dry and cool. Cookies and crackers and other items should be put in plastic bags.

Storing water is one of the most important things you can do. In an emergency, pipes may be broken or the water contaminated. (Contaminated means it is not safe to drink.) Store water in plastic containers. Plastic soft drink bottles are good! Don't use milk cartons or glass bottles.

You should have a three-day supply of water.

You will need at least two quarts of water for each person in your house for each day. You will also need two quarts per person per day for cooking and hygiene (like brushing your teeth). That means you will need four quarts for each person -- which is one whole gallon! And don't forget extra water for your pets!

You need to multiply one gallon times the number of people in your house and then multiply that number by three to get the total gallons you'll need. Stored water needs to be treated to make sure it will be safe to drink when you need it. You can do this by adding four drops of bleach per quart of water. Have an adult do this for you. The liquid bleach should have 5.25 percent sodium hypochlorite and NO SOAP! Seal all bottles tightly so they don't leak.

Everyone in your house should have a complete change of clothes and a pair of sturdy shoes or boots stored in the disaster kit. You should also have rain gear, thermal underwear and blankets or sleeping bags.

Restock or create your family first aid kit. These are the things your first aid kit should have:

• a.. Sterile adhesive bandages of different sizes
• b.. Sterile gauze pads
• c.. Hypoallergenic adhesive tape
• d.. Triangular bandages
• e.. Scissors
• f.. Tweezers
• g.. Sewing needle
• h.. Moistened towellettes
• i.. Antiseptic
• j.. Thermometer
• k.. Tube of petroleum jelly
• l.. Safety pins
• m.. Soap
• n.. Latex gloves
• o.. Sunscreen
• p.. Aspirin or other pain reliever
• q.. Anti-diarrhea medicine
• r.. Paint Stir sticks for splints
• s.. 5 days of medication that you take regularly for asthma or heart or BP.

Date sent: Wed, 13 Feb 2002 05:45:13 -0600

It soon will be pollen and allergy season. Some people have allergies year round and there are winter allergies to Mountain Cedar (Cedar fever).. Ala Cedar Hill. The eyes can be treated with allergy eye drops. There are over the counter drops like Opticon (The generic is good too) or the doctor can prescribe Patanol eye allergy drops. It helps the eyes without Drowsiness

and safe to use long term. There are nasal sprays for allergy that you probably heard of that help nasal allergies (Nasalcort, Flonase, Nasonex, etc.) They are safe long term and can be used down to 3-4 years old. The problem is that some kids and adults would rather take an oral medicine rather than spray something up their nose. The eye drops can be used as needed but the nasal sprays have to be used every day to work. Achew

Dr. Knapp

www.rogerknapp.com

Happy Lent.. "He became what we are, to make us what He is" -Unknown

Date sent: Sat, 9 Feb 2002 20:30:36 -0600

Federal Health Officials announced their smallpox bioterrorism plan. It is the same plan in effect for 30 years. If there is an outbreak, then contacts and people in the area will be vaccinated. This was effective in eliminating the world of smallpox. There is a common misperception that

An infected person who travels during the incubation period will spread the disease to new areas. Patients will only transmit the disease after onset of fever. Plans for outbreaks are in place and will be implemented if there is an outbreak. I would not bet on any outbreak of smallpox.

Dr. Knapp

www.rogerknapp.com

Date sent: Sun, 3 Feb 2002 23:15:32 -0600

There have been now 25,000 cases of Hepatitis B prevented by vaccinating infants for it. That translates into 3,000 deaths due to live cancer or liver failure. I wish there was a vaccine for AIDS since there are over 1 million still in America with aids. There is not much publicity about

It with the terrorism thing taking center stage but the problem is still there. I have not seen bacterial meningitis in 10 years because of the vaccines. There is a vaccination for a less common meningitis that the teens need before college. Vaccines are still extremely safe with only a few hundred injured by them. But they save millions.

Dr. Knapp

www.rogerknapp.com

Date sent: Wed, 30 Jan 2002 23:38:21 -0600

Advice on handling adolescent using drugs published in a journal:

• 1.. Require immediate cessation of alcohol and illicit drugs.
• 2.. Require immediate and permanent cessation of contact with drug using friends.
• 3.. Allow attendance at concerts only under mature adult supervision.
• 4.. Do not allow attendance at parties unless supervised by a mature responsible adult.
• 5.. Set an appropriate curfew unless accompanied by a responsible adult. The adolescent's whereabouts should be known my parents at all times.
• 6.. Do not allow use of a car for at least 3 months unless the parents know where the teen is going and the parent checks on them. Tell the teen that if that contract is broken, the state motor vehicle bureau will be notified of the drug problem and asked to suspend the teen's license
• until he or she has been drug free for at least 6 months.
• 7.. Give the teen only a limited amount of spending money. Paychecks should be deposited and withdrawals should be approved by parent. Consider changing or stopping the job because of the money used inappropriately and the influence by other at the work place to use drugs.
• 8.. Restitution should be made for any stolen items or destroyed property.
• 9.. Do not allow verbal or physical abuse.
• 10.. Initially require urinalysis on a random weekly basis.
• 11.. Lock up all alcoholic beverages and remove tranquilizers, amphetamines, barbiturates, and sleeping pills from medicine cabinets.
• 12.. Your teen is a minor in your house. They have not attained full adult privileges. So the parent has the right to search their room and even tap and record phone lines. They have lost the right of privacy. No phone in their room is a good plan. What should they be saying to their friends that you should not be hearing?

Dr. Knapp

www.rogerknapp.com

Three quickies:

1. If you have a hard time pulling the kitchen trash bag out of the kitchen trash can, it is because of the air lock between the bag and can. Cut a small hole the size of your finger tip 1 inch about the bottom in the side of the trash can. Then the bag will come out easily.

2. Wonder if the gimmick they are selling is a hoax for medial ailments? See http://www.quackwatch.com/

3. Is this a cute picture or what? See attachment.

Dr. Knapp

www.rogerknapp.com

Here is an interesting disease that is not talked about much. Celiac Disease (or Celiac Sprue) is a reaction of the intestines with a protein called gluten found in grains like wheat, barley, rye, and

oats. This causes the last part of the small intestines to loose it's absorption surface and the person cannot absorb fats, iron, certain vitamins and lactose. On biopsy of the lining of the intestine there are no finger-like projections that help absorb nutrients. The patient is under weight, large tummy, and loose stools. This condition completely goes away when taken

off grain containing foods for several months. It was described as early as 1888 but shown to be caused by gluten in 1952-54. It is diagnosed in 1 in 2000 people but the real incidence is 1 in 300 of the population. It gets diagnosed anywhere from 1 year old to 50 years old patients. There are recent reports of teenagers with no symptoms having persistent iron deficiency anemia caused by Celiac Sprue. There is a blood test for it that is 95% accurate and then the small bowel biopsy (no it is not dangerous) is very good at diagnosing it. Now there is a camera in a capsule that adults can swallow to photograph your intestines. (Is that wild or what???)

And the treatment is avoiding gluten containing foods for the rest of your life.

For more info see: http://www.csaceliacs.org

Dr. Knapp

Date sent: Tue, 1 Jan 2002 17:32:09 -0600

We recommend taking folate during pregnancy to decrease birth defects. According to a study in the Dec. 8 issue of The Lancet, iron and folate supplementation during pregnancy reduces the risk of acute lymphoblastic leukemia (ALL) later on in childhood. The researchers found a 63% risk reduction for childhood leukemia with iron or folate supplementation during pregnancy. The risk reduction was 25% for iron and 60% for folate supplementation. Another reason to take it when pregnant.

Dr. Knapp

6/7/02

Diaper rashes are one of the biggest problems in the infant until potty trained.  Wipes are the most common cause and that is why I recommend cleaning them up with water and paper.(We wipe with just dry paper and we don't have a rash.)  Keep some Vaseline on them all the time to prevent the wetness from chaffing them.  Some times there can be a Strep infection of the skin around the anus.  It is painful and the 1-3 year olds will not want to go to the bathroom.  See a picture at the web site under diaper rashes.  http://www.rogerknapp.com/medical/diaper_rashes.htm  It will not go away with creams and has to be treated with antibiotics.  It looks painful!  Parents think it is a "rash" when it really is an infection.

7/1/02

This year Texas started the Graduated Driver’s Licensing program (GLD). See: http://www.txdps.state.tx.us/director_staff/public_information/pr122101.htm . Michigan and N. Carolina implemented it in 1997. In both states there was a decline of 25-27% in crashes involving 16 year olds and a 57% decline in fatal crashes in N. Carolina. Car crashes are the leading cause of death in teens and it is due to their lack of driving experience and risk taking behavior. The American Academy of Pediatrics has been lobbying for this law for years. Certainly the Kennedys would be alive today if he had more practice driving more sophisticated airplane.

8/2/02

When trauma causes swelling in your body, holding pressure on the area will decrease the swelling and improve the healing.  It is true for head bumps and getting a goose egg.  Now it turns out that a spranged ankle is helped by pressure around the ankle.  Less swelling means shorter healing time and quicker function.  I guess you need to have an ace wrap handy at the baseball field.  (A stat wrap??? Oh well. :)  You are ready for sports after a sprang if you can hop on the foot 10 times without pain.   

8/10/02

Croup This is a viral infection like a chest cold that occurs in the spring and fall (coming soon in Sept.). The cough has a "seal bark" sound. Some people think the croupy cough is the mucousy or congested cough (like a smoker’s cough). The seal barky croup cough is treated by humidity so run a vaporizer or take them into the bathroom and steam it up. Or take them out into the cool night air. If they have severe retractions on breathing and every breath sounds barky like the cough, then take the child to the ER and they can give a breathing treatment. Make an appointment to the doctor the first day of the cough and get a prescription of a few days of steroids. It will stop the bark (but does not cure the cold) and will keep them from getting into severe respiratory distress.

8/13/02

Ulcers and heartburn is an infection. It is not just an acid thing. Helicobacter pylori is a spiral shaped bacterium that can live in the stomach and duodenum. The inside of the stomach is bathed in about half a gallon of gastric juice every day. Gastric juice is composed of digestive enzymes and concentrated hydrochloric acid, which can readily tear apart the toughest food or microorganism. Bacteria, viruses, and yesterdays steak dinner are all consumed in this deadly bath of chemicals. The stomach is protected from its own gastric juice by a thick layer of mucus. H. pylori can safely live in the mucus by secreting chemicals that neutralize the acid and enzymes of the stomach. This creates a cloud of acid neutralizing chemicals around the H. pylori, protecting it. The reaction of this urea hydrolysis is used in the breath test for diagnosing the H.pylori.

Tests to diagnose it:
1. C14-urea breath test (see http://www.meretek.com )
2. Blood test for antibodies …. Does not work very well.
3. Biopsy of the stomach lining usually through endoscopy.

Diseases:
1. Duodenal and Stomach ulcers. When treated, 80% can throw their antacids away.
2. Stomach cancer. 6 times more likely to have cancer is H pylori present.

You contract the germ by swallowing it from contaminated water, food, or someone’s vomitus (YUCK!) It is treated with usually three medications. Some on the list are amoxycillin, clarithromycin, tetracycline, metronidazole and peptobismol. Your doctor can tell you which he/she prefers.
Children can get this infection and may be a common cause of chronic stomach pains in children. Also when I council parents on obesity I mention than some people have chronic acid stomach problems and neutralize the burning with food. They are not as much hungry as they have burning and think it is hunger.
For more info:
http://www.faseb.org/opar/pylori/pylori.html
http://www.aap.org/policy/helicpylori.html http://www.niddk.nih.gov/health/digest/pubs/hpylori/hpylori.htm http://www.rogerknapp.com/medical/ulcers.htm

8/16/02

Small Pox and the vaccine. This has been my recommendation all along and now recommended by the major medical organizations. Here are the facts.

Case fatality rates of 30% or higher were observed during epidemics of smallpox. Death, when it occurred, was usually a result of viral toxemia associated with circulating immune complexes. Four forms of smallpox are recognized. In addition to typical smallpox (more than 90% of cases), there are 2 forms of variola major, hemorrhagic and malignant or flat type. Each variant occurred in 5% of cases and was associated with a 90% to 100% mortality rate. Variola minor, or alastrim, is associated with a longer incubation period, a milder prodromal period, fewer skin lesions, and a lower mortality rate than variola major or typical smallpox.

A major reason not to initiate universal immunization in the absence of actual cases of smallpox, besides the limited availability of vaccine, is the risk of serious complications of immunization. Severe complications of immunization include death, postvaccinal encephalitis, progressive vaccinia, eczema vaccinatum, generalized rash, and accidental inoculation to the face, eye, or other sites. Smallpox vaccine has been known for decades to produce significant adverse effects, especially in immunocompromised persons. In patients with chronic skin conditions, smallpox vaccine can cause a severe, sometimes fatal dermatologic involvement termed "eczema vaccinatum." The list of conditions that place patients at risk of eczema vaccinatum is long and includes most disorders that disrupt epidermal integrity. Atopic dermatitis is the most common disorder associated with severe eczema vaccinatum, and people with this disorder may be susceptible even if the skin disorder is in remission. Even unimmunized susceptible individuals can have such reactions if the virus spreads to them from those who have been immunized. Studies from the 1960s indicate an overall rate of complications of 1254 per million primary immunized individuals (that is around 1/1000).

American Academy of Pediatrics announces recommendations for Vaccine:

See http://www.aap.org/policy/s040209.html

RECOMMENDED STRATEGY: RING VACCINATION (SURVEILLANCE AND CONTAINMENT)

The AAP supports the strategy known as ring vaccination, also referred to as surveillance and containment, and is the current CDC recommendation. Using this approach, if smallpox were introduced in an act of terrorism, infected patients would be isolated. Contacts of infected individuals as well as their contacts would then be identified and immunized by specially trained teams of health care professionals. This strategy can control a localized outbreak with minimal exposure of vulnerable populations to the complications of immunization. The ring strategy is based on the knowledge that vaccination can prevent or ameliorate disease severity if given within 3 to 4 days of initial exposure and can decrease symptoms if given within the first week of exposure. Immunizing and monitoring a ring of people around each infected individual and his or her contacts would help protect those at the greatest risk of contracting the disease and form a buffer of immune individuals to prevent the spread of disease. This strategy would be more desirable than a preevent mass immunization campaign for the following reasons¹⁷:

Focused contact tracing and immunization combined with extensive surveillance and isolation of cases was the strategy used to eradicate smallpox in the successful worldwide program in the 1960s and 1970s.

In a universal immunization campaign, the number of adverse events would be expected to be higher than in the past because of the number of persons with contraindications, some of which might be undiagnosed or unrecognized at the time of immunization or exposure to individuals who have recently been immunized (eg, undiagnosed immunosuppressive disorders such as HIV infection or receiving cytotoxic or immunosuppressive agents for cancer, transplantation, or autoimmune or inflammatory disorders). Severe vaccinia infections may occur in such vulnerable individuals and in persons with skin conditions, including atopic dermatitis, if they come in close contact with immunized immunocompetent persons who are shedding vaccinia virus.

In the past, individuals with complications of immunization were treated with VIG. Current supplies of VIG are not sufficient to treat the number of patients expected to experience adverse effects with a universal immunization campaign.

In the past, immunization focused on young children. Senescence of the immune system could make the elderly more susceptible to vaccine-related complications, but there is little information available regarding the immune response and complication rate in older individuals. There is some experimental evidence to suggest that they may have a higher rate of certain complications from smallpox immunization.18

Current supplies of smallpox vaccine would be exhausted quickly if a universal campaign were initiated, potentially leaving no vaccine for use if smallpox cases occurred.

Mass preevent immunization would require large numbers of health care and public health professionals to perform immunization and to monitor for and deal with the high number of adverse events.

Should an outbreak of smallpox occur, initiation of mass immunization may lead to improper reliance on this strategy to control the outbreak with less focus on other essential outbreak control measures, such as careful surveillance, contact tracing, and isolation of cases. If an outbreak occurred in a locale where there had not been preemptive immunization, there could be inadequate supplies of vaccine for areas with the greatest need, and that potentially could prolong the epidemic instead of controlling it.

9/14/02

Anencephaly and Spina Bifida are two conditions that are markedly decreased with the pregnant woman taking in 400 micrograms of folic acid a day. The USDA started requiring cereal grain products to contain 100 / gram of grain in 1998. There was a decrease of 23% in these birth defects. Spina Bifida is a hole in the back where the spinal cord opens up and the nerves are exposed. There is frequently decrease use of the lower legs, no bladder or bowel control, and hydrocephalus (water on the brain). Anencephaly is where the baby is born with most of the brain missing and they die shortly. So be sure you take the vitamins with folate in them where trying to get pregnant or if you could possible become pregnant.

9/22/02

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

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

And any ad that describes the product as 'incredible,' 'a miracle cure,' or 'a breakthrough' should be viewed with suspicion. In addition to targeting people who want to lose weight, there are many products targeted at other common medical problems in children, such as acne, ADHD, snoring, learning disabilities and depression. These ads can be tempting. They often describe incredible results. And that you can get these results yourself without much or any effort. How do you know if these products, including biofeedback devices, optometric visual training, special diets, vitamins, and minerals, really work? It can help to be skeptical of special offers or miracle cures. Also, learn to read the fine print of an offer. If they mention that 'results may vary' or that the 'results are not typical' then you can feel fairly confident that it is a scam. You should be especially suspicious of treatments that can be used for multiple disorders, such as ADD, ADHD, anger, anxiety, alcoholism, behavior problems, depression, manic depression, panic attacks, PTSD, sleep problems, and stress. Alternative miracle treatments for ADHD seem to be especially popular. This is likely because it is a condition that is difficult to treat and the conventional treatment, stimulants like Ritalin, receive a lot of negative press. In the past few years, the FTC has taken action against many ADHD treatments which were shown to be making unproven claims, including:

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

But just because a company or product hasn't been disciplined by the FDA or FTC doesn't mean that it is effective or safe. When considering an alternative treatment, do some research before spending your money and giving it to your child. Don't be mislead by ads saying that they are 'proven' or 'doctor recommended.' If they have really been proven to work, find the research study that substantiates, hopefully from a reputable medical journal, the claim and show it to your Pediatrician.

Also remember that:

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

Adapted from http://www.keepkidshealthy.com

10/3/02

Ever heard of Commotio Cordis

Has been documented in over 128 cases in the four years since the formation of the United States Commotio Cordis Registry in Minneapolis, Minnesota in 1998, although the true number of deaths is unknown because of underreporting and misclassification. 128 cases/4 yrs = 62 per year!

Occurs most often in baseball. But aside from baseball and lacrosse (three deaths of players from New York in two years; one near death of a player at a Massachusetts prep school), commotio cordis has stricken those playing hockey, softball, soccer and karate. In the fall of 2000, two football players died from blows to the sternum delivered by a helmet. In one case, a young boy reportedly died after his father poked him in the chest.

Is largely the result not of the force of the blow but from an incredibly timely blow contacting the chest directly over the heart at just the wrong time -- the precise millisecond between heart contractions that throws the heart into a lethal abnormal heart rhythm called "ventricular fibrillation" or VF, which causes a useless quivering of the heart that results in a complete cessation of circulation instantly depriving the brain and other vital organs without circulation and oxygen. The blows usually causes no identifiable structural injury to the ribs, sternum or to the heart itself.

Occurs most often in healthy young athletes, who are especially at risk because the pliability of their chest walls. In a study of 55 cases of sudden cardiac arrest, 90% were 16 years of age or younger, 25 were playing in organized athletic events such as baseball, softball, and ice hockey. The remaining 30 children were playing informal sports at home, school or on the playground. None of the children showed evidence of any heart defect or diseases.

It Cannot be completely eliminated through the use of protective equipment. Chest protectors do not appear to protect against it: athletes have died wearing chest protectors while playing baseball, lacrosse, hockey and softball. Studies have shown that the use of softer, lighter baseballs may reduce the risk of commotio cordis. Softer, heavier (so-called Reduction In Force or "RIF") baseballs may actually increase the risk of commotio cordis.

Has a survival rate that declines by approximately 7 to 10% for every additional minute that passes without defibrillation. After 12 minutes, the time Emergency Medical Service (EMS) paramedics typically arrive, it is usually too late (the national survival rate from sudden cardiac arrest (SCA) is a dismal 5%. In some cities it is as low as 1 to 2%.

Requires community-based programs using automated external defibrillators (AEDs) if the survival rate is to be increased. When defibrillation is delivered in one minute, the reported survival rates can be as high as 90%. For defibrillation within 5 minutes, the survival rate can be as high as 50%.

This is not to scare you but make you aware so you can take action quickly should you see such an event. For more info see: http://www.emedicine.com/ped/topic3019.htm

10/9/02

WinWhatWhere Investigator from WinWhatWhere Corporation
One-click download link
(note: clicking this link will begin the download)

To keep an eye on that and where you kids are on the internet, get this program.  It will collect window titles, urls, keystrokes, time, date, and more. You get the information in a report.  It is free for a 14 day trial. Then you will have to pay $100 for the full version.  You don't have to pay if you don't want to use it.  If your teens are having problems, this is good.

Don't be afraid to keep an eye on your teens if they are giving you trouble.  Know what they are saying to their friends and which friends are influencing them.  I have no problem with parents putting a recorder on the phone to see what they  are saying.  You can get the kind of phone recorder that comes on when someone is on the phone anywhere in the house. Parents have found out their teen was going to sneak out Sat night after every one had gone to bed.  One found out that their teen was considering suicide.  Some have found out their teen was sexually active or pregnant.  Teens do not have the right to privacy.  They are a minor.  I would only do these steps if they were having allot of problems. 

Also have a dress code.  If your teen wears the type of clothes that the "bad" kids wear, then expect them to hang with that crowd and start acting bad. 

10/18/02

Tooth knocked out or loosened.

• If tooth is traumatized and not loose, just watch it.
• If the tooth is loose but in socket and not chipped, then give liquids only and see the dentist the next day to "splint" it.
• If the tooth is chipped badly, see the dentist the next day.
• If the tooth is knocked out, rinse it but do not scrub.
• Best is to put it into the socket and push in till it is in position.
• Next best is to put it into milk and see the Dentist in the next 2 hours.
• Next best is to keep it in saliva in the mouth and see the Dentist in 2 hours.

Nice article:

TOOTH INJURY

Injury Definition
· Injuries to the teeth

Types of Teeth Injuries
· Loosened Tooth: If mild, it usually tightens up on its own (may bleed a little from the gums).
· Displaced Tooth: Any tooth that has been pushed out of normal position (displaced) needs to be seen by a dentist to assess the damage. Displaced teeth that interfere with biting, chewing, or closing of the mouth need to be repositioned within 4 hours for reasons of comfort and function. Mild displacement can wait for 24 hours for assessment.
· Knocked-out Tooth: This is a dental emergency. The knocked-out tooth needs to be placed back in its socket at soon as possible, ideally within one hour.
· Chipped or Fractured Tooth: All need to seen by a dentist. A fracture that enters into the pulp (center) of a tooth is referred to as complicated; the tooth is usually painful or sensitive to hot and cold. You may be able to identify a complicated tooth fracture by noticing a small red dot or pink blush (the pulp) in the fractured area. To prevent permanent tooth damage, fractures into the pulp need to be treated within 3-4 hours.

FIRST AID for Knocked-out Tooth
· To save the tooth, it must be put back in its socket as soon as possible (2 hours is the outer limit for survival). Use the following technique:
 - Rinse off the tooth with saliva or water. Do not scrub the tooth.
 - Replace it in the socket facing the correct way.  
 - Press down on the tooth with your thumb until the crown is level with the adjacent tooth.
 - Lastly, bite down on a wad of cloth to stabilize the tooth until you can be seen by a dentist.

Transporting a Knocked-out Tooth
· Follow these instructions if you are not able to put the tooth back in its socket.
 - It is very important to keep the tooth moist. Do not let it dry out.
 - Transport the tooth in saliva or milk.

WHEN TO CALL YOUR DOCTOR FOR TOOTH INJURY
Call 911 Now (your child may need an ambulance) If
· Knocked out (unconscious)
· Major bleeding that can't be stopped

Call Your Dentist Now (night or day) If
· You think you have a serious injury
· Knocked-out tooth (see First Aid and Transport information)
· Tooth is almost falling out
· Tooth is greatly pushed out of its normal position
· Tooth that's pushed out of its normal position interferes with normal bite
· Chipped tooth is missing a large piece, or a red dot is visible inside the chipped area
· Bleeding won't stop after 10 minutes of direct pressure  
· Severe pain  

Call Your Dentist Within 24 Hours (between 9 am and 4 pm) If
· You think you need to be seen
· Tooth is slightly pushed out of its normal position
· Can see a chip or fracture line in the tooth
· Tooth sensitive to cold fluids  
· Tooth feels very loose when you try to move it

Call Your Dentist During Weekday Office Hours If
· You have other questions or concerns

Self Care at Home If
· Minor tooth injury and you don't think you need to be seen

HOME CARE ADVICE FOR MINOR DENTAL INJURIES
1. Local Cold: For pain, apply a piece of ice or a Popsicle to the injured gum area for 20 minutes.  
2. Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
· Do not take ibuprofen if you have stomach problems, kidney disease, or other contraindications to using this type of anti-inflammatory drug. Do not use if pregnant. Do not use ibuprofen for longer than 7 days without consulting your PCP.
· Do not take acetaminophen if you have liver disease.
· Read the package instructions thoroughly on all medications that you take.
3. Soft Diet: If you have any loose teeth, eat a soft diet for 3 days. After 3 days, they should be tightening up.
4. Call Your Dentist If:
· Pain becomes severe
· Tooth becomes sensitive to hot or cold fluids
· Tooth becomes a darker color
· You become worse or develop any of the "Call Your Doctor" symptoms.

From: David Thompson, MD, FACEP

10/26/02

Studies of children 15-17 years old showed that more were turned off to sex and drugs than were influenced to change their moral attitudes.  33% said it caused them to discuss it with their parents.  I think they see in movies what their morals are really inside.  If they are brought up with proper attitudes, then they see how immoral behavior is bad for kids as seen in movies.  If their morals are of that persuasion then the movies moved them farther in that direction.  Just as there are many authors who feel that children who have better morals choose better friends that have the same morals.  The children with bad morals did not make other kids bad.  They had bad morals to begin with and they chose to hang with those kids who also had bad morals.  

All that said, I do think kids can be influenced by TV and music.  Be very careful about the media that your children are exposed to and when there are bad things happening on TV or in real life, then point out how it is bad and how you do not approve of it.  "Brain wash" your children into your moral values. 

Also, the clothes do make a difference.  If your children want to wear the baggy black clothes that the "bad" kids wear, then they will hang with them and be influenced by them.  Have your dress code at home and enforce it.

10/29/02

WHAT THE BICYCLE HATH WROUGHT (written in 1900)

"The bicycle, with its recently invented brakes and pneumatic tires, was seen by doomsayers as just another nail in the coffin of civilization. Women were riding bicycles, contributing to the decline of morals and accelerating the collapse of social harmony. Newfangled sports, rambling, and cycling threatened rank, order, and culture …..

Newly obtrusive and newly mobile criminals, robbers, bag-snatchers, muggers, gangsters, and hooligans ... use bikes to rob and stab and make their getaway. Juvenile delinquency is rife. Indeed, a lot of activities are publicized and a lot of notions are bandied about that come to us with a familiar sound: aggression, perversion, homosexuality, incest, drugs, immigrants, nerves, neurasthenia, depravity, unemployment, loneliness, isolation, transgression, anomie, and urbanization. Urban predators run wild in the streets, children brandish knives and pistols, parents are indifferent to the moral and physical well being of their offspring, and the uncouth masses gain access to the precincts of their betters."

Even Socrates complained about the youth and how they were so disrespectful and how they are lazy and terrible.  He said the society is crumbling and the future is bleak.  Sound familiar?  Most of us worry about the future of our nation and the youth of our country.  I think it is going to be OK because of the many "good" kids out there that you do not hear about.  I worry about the general decline of our morals as adults and the example we set.  Lets all try not to do the Enron thing. 

11/6/02

MMR Vaccination Not Associated With Autism in Large Danish Study

By Steven Reinberg

NEW YORK (Reuters Health) Nov 06 - The results of a large population-based study provide "strong evidence" that the measles, mumps and rubella (MMR) vaccine is not a cause of autism.

"There was a lack of association between MMR vaccination and autism no matter how we looked at our data," lead researcher Dr. Kreesten Meldgaard Madsen told Reuters Health.

The risk of autism remained similar in vaccinated and unvaccinated children after taking into account factors such as birth weight, gestational age, socioeconomic status, mother's education and gender, Dr. Madsen added.

Dr. Madsen from the Danish Epidemiology Science Center, Arhus, and colleagues collected data on 537,303 children born in Denmark between January 1, 1991 and December 31, 1998. Among these children, 440,655 had received the MMR vaccine.

After adjusting for confounding factors, the relative risk of autism was less among vaccinated children compared with unvaccinated children.

"Few studies, if any, can be said to be conclusive. But I think this is as close as we can get, at least with the Danish population-based registries," Dr. Madsen stressed. "There is no reason to believe that MMR vaccination causes autism."

The findings by Madsen et al. support those of another recent study by Finnish researchers, which appeared in the November issue of Pediatrics. In their cohort of 535,544 children, the Finnish team found that MMR vaccination was not associated with the incidence of autism, encephalitis or aseptic meningitis (see Reuters Health report November 4, 2002).

N Engl J Med 2002;347:1477-1482.

11/20/02

It is interesting how we make correlations and put the cause on what we want it to be. There was a statement about how walkers and exersaucers caused the infants to be late in walking and slowed their development. But actually the infants with delayed walking had to use the walker longer rather than it causing the delay. We thought that ear infections and fluid caused delayed speech but it turns out it doesn’t. Many children have delayed speech with normal ears and visa versa. We just liked to blame it on the ears rather than it was just a child with delayed speech. Many orthodontists say now that thumb sucking did not cause over bite. We see many children who have an overbite that did not suck their thumb and many kids who suck their thumb whose teeth are fine. We just love to blame it on something. So teething does not cause fever, wind blowing in the ear does not cause ear infections, and the black cat did not cause the bad luck. Come on people, think critically …. Think what else could cause this?

Most great discoveries were not associated with the expression "Eureka! I found it!" but was started with "Hey… that’s weird. What is that?"

12/10/02

There now is very good anti-cheat detection software. Some high schools and many colleges are using this to detect plagiarism. A leading company of anti-plagiarism software called Turnitin has seen a 25% increase in business this year. Around 150,000 students in America are under its beady electronic eye. This software chops each paper submitted for scrutiny into small pieces and gets a "digital fingerprint". It then searches for cheats. It is interesting that good universities such as Duke, Reuters, and Cornell employ it and those that think of themselves as top-notch, such as Princeton, Yale, and Stanford, do not.

12/15/02

If we could shrink the earth's population to a village of precisely 100 people, with all the existing human ratios remaining the same, it would look something like the following.

There would be:

57 Asians

21 Europeans

14 from the Western Hemisphere, both north and south

8 would be Africans

52 would be female

48 would be male

70 would be non-white
30 would be white

70 would be non-Christian
30 would be Christian

89 would be heterosexual
11 would be homosexual

6 people would possess 59% of the entire world's wealth and all 6 would be from the United States.

80 would live in substandard housing

70 would be unable to read

50 would suffer from malnutrition

(ONE)1 would be near death;

(ONE)1 would be near birth;

(ONE)1 (yes, only 1) would have a college education;

(ONE)1 (yes, only 1) would own a computer.

When one considers our world from such a compressed perspective, the need for acceptance, understanding and education becomes glaringly apparent.

And, therefore . . .

If you have food in the refrigerator, clothes on your back, a roof overhead and a place to sleep, you are richer than 75% of this world.

If you have money in the bank, in your wallet, and spare change in a dish someplace, you are among the top 8% of the world's wealthy.

If you can attend a church meeting without fear of harassment, arrest, torture, or death, you are more blessed than three billion people in the world.

If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture, or the pangs of starvation, you are ahead of 500 million people in the world.

If you hold up your head with a smile on your face and are truly thankful, you are blessed because the majority can, but most do not.

If you can read this message, you are more blessed than over two billion people in the world who cannot read at all.

If you woke up this morning with more health than illness,

you are more blessed than the million who will not survive this week.

Here in the most prosperous and generous nation this is the time of the year we are the most charitable. Happy Holiday Seasons to everyone.

12/22/02

Strabismus is where the eyes do not line up straight.  If the turn in they are called crossed eyed. If they do that transiently then it is a sign of lazy eye and the doctor needs to know it.  If they are stuck that way all the time, it is from birth and they need surgery.  But the skin fold of the eye can cover the white of the eye and it appears to be crossed and it is not really turned in.  The first picture is a patient with true crossed eyes and the light reflects off the center of one pupil but off center of the other pupil.  In the second and third pictures you will see that the eyes may looked crossed but the light reflects off the center of both eyes.  The eyes are therefore straight and nothing needs to be done.

12/24/02

RUDOLPH THE Red-Nosed REINDEER

In 1938, as the Great Depression Wound down and even as the prospect of better times loomed on the horizon, Bob May was looking toward another bleak Christmas. An advertising copywriter for Montgomery Wards, living on a meager salary, May was on the brink of bankruptcy and exhaustion. After fighting cancer for two long years, his wife, Evelyn, was losing the battle. Staring in to each other's eyes, they both knew she wouldn't last long. Their daughter knew something was wrong too.

On a cold December night, after visiting her bedridden, emaciated mother, their four-year-old Barbara, climbed up into her father's lap. "Why isn't my mommy just like everybody else's mommy?" she solemnly asked.

How could he explain to a small child that her critically ill mother wanted to play with Barbara, read her stories and more than anything in the world-be with her for every important moment in life? Flow could he tell an innocent-girl that illness and death were a part of life? That Evelyn wanted to believe other mothers, but illness had excluded her from all the activities that children and their mothers normally enjoyed? How could he give her the answers she needed without breaking little Barbara's heart in the process?

In their drafty, two-room Chicago apartment, with the cold north wind rattling the windows, Bob May held his daughter in his arms and struggled to answer the child's simple question. He recalled the pain he had always felt growing up because he had been considered different. May had been a small, thin child, constantly picked-on by other children, called "sissy" and other names he didn't want to remember. Even in college he was so slightly built that he was often mistaken for a boy.

Despite having a college degree, the country's sorry financial state had made it almost impossible for May to find any other job than the position at Wards that was far beneath his skill level. Yet when he found Evelyn and they fell in love and married, Bob suddenly felt like a king. For the first time he had a place in the world where it was all right to not fit the mold. Their daughter's birth seemed to assure the man that good times were just around the corner. But then Evelyn got sick and the cost of fighting the cancer stole not only his wife's energy but the family's savings as well. Bob sold everything of value and they lived in what amounted to a Slum.

But on that cold, windy night, even with every reason to cry and complain, Bob wanted his daughter to somehow understand that there was hope ... and that being different didn't mean you had to be ashamed. Most of all, he wanted her to know she was loved. Drawing from his own life experiences, the copywriter made up a story about a reindeer with a large, bright red nose. And as little Barbara listened, May described in story form not only the pain felt by those who were different but also the joy that can be found when someone discovers his special place in the world.

The tale was a big hit with Barbara, and thereafter she demanded that her father tell it to her each night. With every new telling the plot grew more elaborate, and the reindeer, Rudolph, became less a fictional character and more a member of the May family.

Unable to purchase a gift for Barbara that Christmas, Bob decided to carefully craft his story about Rudolph into a homemade book, drawing on his own abilities as an artist for the pictures, Many evenings after his wife and daughter had gone to sleep, Bob carefully worked to finish his unique present. But tragedy struck the May family before Christmas could arrive: Evelyn lost her battle with cancer.

Though the last few pages of his gift book were stained with tears, Bob Would not give up on Rudolph. He knew that his daughter needed the uplifting story now more than ever. He prayed for the strength to finish the project. His efforts were rewarded when a thrilled Barbara found a completed copy of Rudolph the Red-Nosed Reindeer waiting for her on Christmas morning.

Though he hardly felt like celebrating, a few days later Bob was forced to attend a Montgomery Wards' employee party. His coworkers in the ad department asked May to share his children's story that night. Though he didn't feel like it, he took his book and, at the appointed moment, climbed before the crowd and read the story. After the scores of holiday revelers laughed, they stood and gave May and his children's tale a thunderous ovation, they all loved Rudolph and wanted copies of their own.

The head of the company felt that Wards could benefit from Bob's gift to his daughter. For a modest sum, Stewell Avery, the chairman of the board of Montgomery Wards, bought all rights from the cash-strapped and debt-ridden May. Avery then had tens of thousands of copies of Rudolph printed and shipped to Wards stores across the nation in time for Christmas 1939. The response was so positive that for the next six years, each child who visited a Santa in a company store got a copy of May's book.

By 1946 Wards had given away six million copies of Rudolph and Stewell Avery was being besieged by offers from every major publishing house wanting to print a new version of the story. in one of the most generous decisions ever made by the head of a large company, the CEO gave all rights back to Bob May. A year later the mass-market release of the book made the Wards copywriter a rich man.

With the book a best-seller, numerous toy and product deals were soon cut and May's entire life revolved around a story he had told to comfort a worried daughter. Remarried, and with a growing family, Bob couldn't imagine anything else that could improve his wonderful life. Then his brother-in-law, Johnny Marks, decided to adapt the story into a song.

Marks, who had written music for a number of major recording stars, hoped that the "Voice of Christmas," Bing Crosby, would record the song "Rudolph the Red-Nosed Reindeer." When Crosby passed, Marks offered the song to Dinah Shore. She wasn't interested either. Other artists were given the demo, but none of them wanted it. Finally cowboy star Gene Autry was approached. Marks figured that Autry might be looking for a follow-up to his earlier Christmas hit, "Here Comes Santa Claus." Besides, Gene, unlike Bing and Dinah, often sang kids' songs. Children were his main audience.

Like Crosby, Shore, and the other artists, Autry was unimpressed. He had already discovered a song he felt would become a seasonal children's classic in "if It Doesn't Snow This Christmas." There was no doubt that the favored title was a great song and a perfect children's single, but Marks begged Gene to give "Rudolph" a second listen. The writer figured that Autry might find a place for the misunderstood reindeer on the "B" side of the record.

Gene took Marks's demo home and played it for his wife, Ina. As they listened, Autry scoffed that there were already too many songs about reindeer, Ina thought differently. When she heard the line "they wouldn't let poor Rudolph play in any reindeer games," it broke her heart. She insisted that her husband cut the song,

Columbia Records wanted Autry to record four sides (songs) for a Christmas release. "Rudolph" was the last song chosen and cut. A few weeks later, when Autry sang "Rudolph" at the Madison Square Garden rodeo, the crowd went wild. As the cowboy's fans rose to their feet, the underdog deer flew past the other three new Christmas cuts and became the singer's holiday release for 1949. While Bing Crosby and Dinah Shore looked on, Gene Autry's "Rudolph the Red-Nosed Reindeer" streaked to number one on the charts. it would soon become the second best-selling Christmas song of all time, just behind "White Christmas."

Through books, records, television specials, and movies, for tens of millions of children of all ages, Rudolph has become as much a symbol for the secular wonder of the Christmas season as Santa Claus. While there are many lessons to be learned from this magical story-including that while it takes courage to be different, being different can be a blessing-there is an even greater lesson from this story and song that is now all but forgotten: When You give a sincere gift of love from the heart, that gift will come back to you magnified beyond all expectations and measures. It is a lesson that the fictional Rudolph and the very real may family are still living more than six decades after the story was first told.

Interesting story from Ace Collins book "Stories behind the Best Loved Songs of Christmas. Many great books and other works have started as a personal act toward our own children. Thomas the Train started when a father made up stories of a train to tell his boy who was laid up for weeks with the measles in the 1940s. His wife encouraged him to print them up and the rest is history. So when your wife says you should produce your handywork… trust her!