March 12th, 2009 by Stacy Stryer, M.D. in Health Policy
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By Stacy Beller Stryer, M.D.
I vividly remember my firsts in medical school – my first patient with cystic fibrosis who was so air hungry that he couldn’t even speak, my first teen who was constantly admitted to the hospital with an infection due to a genetic disorder that would eventually kill him, and my first 3 year-old patient with sickle cell anemia who almost died because her spleen decided to sequester many of her red cells. They were my firsts, but they certainly won’t be my lasts.
On March 9th, however, President Obama took a major step toward helping these children and so many others just like them. It gives me hope that someday there will be a few lasts. On Monday, he signed an executive order which relaxed restrictions on embryonic stem cell research and allowed federal funding for such projects. This is big. It reverses an almost 8 year policy that severely restricted such funding and the ability to use embryonic stem cells.
Embryonic stem cell research will open up the doors for potential cures and treatments for diseases such as Parkinson’s and Alzheimer’s, and for traumatic injuries, such as those that involve the brain and spinal cord. But the potential benefit of stem cells isn’t just for adults. Discoveries from embryonic stem cell research could save many lives and significantly reduce the suffering of children with a whole variety of diseases. Many medical centers, such as the University of Cincinnati, are or will soon be greatly expanding their stem cell research programs because of this policy change.
Why are embryonic stem cells so important for research? These cells are truly amazing because they have the ability to turn into any other cell in the body, such as blood cells, nerve cells, islet cells (which make insulin in the pancreas), or even entire organs. Plus, these cells can continue to duplicate, or make more of themselves, which is wonderful for both research and eventual treatment. Think about a newborn, that starts out as a single cell which then continues to replicate and differentiate until it becomes a fetus. It is truly a miracle and is the reason embryonic stem cells are so important.
Researchers at the University of Cincinnati want, through new research, to successfully treat fatal and other serious genetic disorders. Other medical centers will use embryonic stem cells to search for treatments for illnesses such as cancer, cystic fibrosis, diabetes, muscular dystrophy, and traumatic injury. The list goes on and on. Results will not occur overnight. It will be a long, expensive time intensive process. Through this process, researchers hope to learn how cells differentiate into specific types of cells and how genes turn certain cells on and off. The ultimate goal is to successfully repair or even replace ineffective, damaged and abnormal cells.
Some people are against the use of embryonic stem cells in research and treatment because they believe that, even though it can save lives, it also ends a life. This is an issue everybody has to think about on a personal and individual level. Currently, federal guidelines require embryo stem cells to come from extra embryos that were made when a couple underwent in vitro fertilization but were not used and, if not used for research, would simply be thrown away.
March 5th, 2009 by Stacy Stryer, M.D. in News
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By Stacy Beller Stryer, M.D.
Between seeing the hoards of patients with multiple days of high fever and sore throat; taking care of my own daughter who was sick almost an entire week; and trying to allay the fears of countless parents who read about the deaths of two teens in our community due to influenza, I am exhausted. There is no doubt that the influenza virus has arrived and is wreaking havoc in our community. According to the Washington Post, our region has just begun to see an increase in the virus but has not yet reached its peak. Each year, the virus peaks at a different time, usually between December and March, although we only know after-the-fact when the peak incidence occurred.
According to the Centers for Disease Control, approximately 5% to 20% of the United States population develops the flu, over 200,000 are hospitalized, and about 36,000 people die. This includes children, particularly those with chronic illnesses such as asthma and heart disease.
There are many different strains of influenza virus and each year the strain changes. Researchers try to determine which type will be most prevalent for that particular year and, based on this information, develop a flu vaccine with the three most likely types of influenza A and B. Even if scientists aren’t 100% correct, antibodies which are made against one strain can provide protection against different strains if they are closely related. In addition, it is possible that a related strain, while not entirely preventing an illness, can still decrease its severity and prevent flu-related complications. For this reason, the CDC recommends that everybody get the flu vaccine each year.
So, how do you know if your child has the flu and not another virus? Often it is difficult to tell the difference. People use the word “flu” liberally and often, when someone says they have the flu, they actually don’t. You must actually be tested for it to know if you truly have the influenza virus. However, if you followed me in my office for one day, even four hours, you would get pretty good at picking out who probably has the flu. The specific symptoms can vary somewhat from year to year but they tend to be much more severe than other viruses. In general, they include several days of high fevers, headache, dry cough, sore throat, runny or stuffy nose, extreme tiredness and sore muscles. The cough is usually the last symptom to go away.
The flu is spread from respiratory droplets, meaning people who cough and sneeze can spread the virus to others nearby. People are usually infectious about one day before they get sick until about five days after they become sick, although the infectious period can vary.
What can you do for your child? First of all, you can try to prevent them from getting the flu in the first place by getting the flu vaccine in the fall (or even in January or February if the peak hasn’t occurred), and by teaching good hygiene and hand washing techniques. You can also remind your children to stay away from others who are sick and to keep their hands away from their own faces.
If your child does get the flu, antiviral medications are sometimes an option to help decrease the severity and length of the illness, and to prevent potential complications. In order to be effective, however, it must be given within the first 48 hours of symptoms or before symptoms even develop. Each year, the Centers for Disease Control tests the flu virus in different regions throughout the country to see if the particular strains are resistant to the antiviral medications available. This year they have found that the influenza A is highly resistant to Tamiflu, one of the more common antiviral medications prescribed. Data so far shows that most of the circulating viruses this year are the “A” type. Tamiflu helps children feel better, on average, about 1.5 days before someone who has not taken it.
As a physician, I must watch for evidence of bacterial infections that have developed along with influenza virus in my patients. More common bacterial co- infections include pneumonia, ear infections, and sinusitis. Dehydration and worsening of chronic medical problems, such as asthma, can also occur. In 2006-2007, the CDC documented an increased incidence of staphylococcus aureus infections and methicillin-resistant staphylococcus aureus (MRSA) in patients who were hospitalized for influenza or who eventually died. If your child has symptoms that continue to worsen or that don’t begin to resolve after several days, or if your child has shortness of breath, blue lips, cannot speak full sentences or other signs of breathing problems, you should see a doctor immediately.
January 15th, 2009 by Stacy Stryer, M.D. in News, Uncategorized
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By Dr. Stacy Beller Stryer, M.D.
Reflecting on the past year’s successes and failures as a parent is an important and worthwhile exercise to do each January. In previous January blogs, I have published my own list of resolutions for the New Year to help you get your own creative juices flowing. This year, however, I have decided to talk about the top five news stories related to pediatrics in 2008.
The top news story in 2008 is the election of Barack Obama as our next President. President-elect Obama wants affordable, comprehensive and portable health care for everybody . His goal is for all uninsured children to be able to sign up for healthcare plans. He wants to expand Medicaid and state health insurance programs, and to develop a government-funded health insurance plan that will compete with other companies. President-elect Obama also wants comprehensive health education taught in schools.
A second important pediatric-related news story is the recall of cough and cold medicines, including decongestants, expectorants and antitussives, for children, particularly those ages 2 years and less. The reason for the recall is because studies have found that the risks of dangerous side-effects far outweigh the benefits. A study which came out last year from the Centers from Disease Control found that over 1500 children under age 2 visited the emergency room for serious side effects due to taking cold medicines in 2004 and 2005, and that 3 children died. In addition, insufficient studies have evaluated the efficacy and side effects in children. Actually, these medicines were previously developed based on studies done with adults.
Another important finding concerns the use of cigarettes. If you smoke and light up that cigarette only when you are outside your house or when your children aren’t home, you may still be harming them (OK – this was reported in the January issue of Pediatrics but I heard about it December 31st!). According to a recent study published in Pediatrics , this “third-hand smoke” causes toxins to remain everywhere, such as on clothes, hair, couch cushions, and carpets, for extended periods of time. The toxins include heavy metals, carcinogens, and radioactive materials that children may ingest, especially if they are crawling on the carpets. If this isn’t enough of a reason to quit smoking, I don’t know what is!
Unlike some other fatal illnesses, researchers have been able to decrease the risk of sudden infant death syndrome (SIDS) significantly over the years when they discovered that placing an infant to sleep on his back significantly reduced the risk. Another study published last October in the Archives of Pediatrics and Adolescent Medicine that placing a fan in an infant’s room during sleep decreased the risk of SIDS by 72%.
The last news story which made significant changes in pediatric practice this past year concerns the identification and treatment of elevated cholesterol levels in toddlers and children. In July, the journal Pediatrics published revised guidelines for pediatricians, including initiation of lipid screening in children, beginning at age 2 years, in those who have a family history of high cholesterol or early heart disease, or in those who are overweight, have diabetes, or smoke. The American Academy of Pediatrics has also begun to recommend a decrease in the fat content of milk in overweight children beginning at age 1 year. Finally, they now recommend medication as early as age 10 years in certain children with elevated lipid levels despite exercise and diet change.
There are many other important findings from 2008, but I thought that these were among the most important. Now stop reading and get back to your New Year’s Resolutions for 2009!
January 9th, 2009 by Dr. Val Jones in Uncategorized
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Can you think of a really good caption for this medical cartoon? The winner will receive a Better Health t-shirt, effusive praise, and bragging rights. The winning caption will be chosen on the basis of subjective criteria by a panel of 3 judges of variable wit. List your captions in the comments section. Enjoy!
