Does your body become immune to antibiotics?

This is a question I hear daily in my office.  The answer is- sort of.  Your body does not become immune to the antibiotic but what does happen is that the bacteria in your body can ve selected to be antibiotic resistent.

Think of it this way:  Imagine you have a yard filled with rats.  Imagine that one out of 10 rats will not be killed by a particular rat poison.  Imagine also that the children of these 1 out of 10 rats  will also be immune to the poison.  Imagine now that you leave rat poison in your yard every day for a year.  Finally imagine that your house gets invaded after a year by several rats.  If you try to use rat poison to kill the rats the poison will have no effect.

Let's look at a different scenario.  Imagine that you still have 1 out of 10 rats immune to your poison and the offspring of these surviving rats will also be immune to rat poison.  Imagine now that your house if infested with fatal disease carrying rats.  What do you do?  You lay down rat poison, of course.  You take the chance that you may select for resistent rats because what other choice do you have.

This is how physicians think about antibiotics.  We certainly hope that we don't have to use antibiotics but when the risks of the disease outweigh the risks of the aintibiotics and the risks of future resistance we do what we have to in order to protect our patients and preserve the life of our patients.

I hope that this helps.

Till next time.

Chicken soup for the Common cold.

So, what can we do about his cold, Doctor? 

I hear this regularly regarding the care of young children.  For children under 6 years of age there is not alot of medication approved for use.  The meds that used to be available didn't really do much anyway.  Currently the best options include elevating the head of the bed, using a humidifier or vaporizor, and using nasal saline drops with or without suctioning for nose congestion.  If your child has a fever and is above 2 months of age, you can use tylenol or motrin.  I don't recommend alternating tylenol and motrin, however, because this has been associated with a high risk of medication overdose.

We would like to see your child if he has difficulty breathing, is turning blue, is using the muscles of her neck to breathe, has fever for more than 3-5 days or has cough more than 2 weeks or is a known asthmatic.

Good luck, this is frustrating.

Anemia- what is it?

Anemia describes any of many disorders that decrease your red blood cell quantity (referred to as hematocrit or packed red cell volume).  In toddlers this is most commonly due to insufficient iron in the diet.  Commonly this iron deficience occurs because of too much cow's milk in the diet (we recommend limiting your child's cow's milk to 16 ounces daily in order to supply sufficient calcium without pushing iron out of the diet).

We routinely screen all children at 1 year of age for anemia.  This is a common age for anemia to develop.  If undiagnosed and untreated, at this age, it can lead to permenant learning disability, mental retardation or even heart failure.  Anemia is screened with a simple complete blood count (CBC) or even a hemoglobin or hematocrit which can be done in your doctor's office.

I typically also screen at 2 years of age because I find too many children who were missed at 1 year of age.

Realize that not all anemia's are due to low iron and that ONLY iron deficient anemia's should be treated with iron.  Overdoses of iron need to be avoided at all costs because of the risk of a complication of iron overload called hemosiderosis which is potentially fatal.  Iron replacement needs to be monitored carefully with frequent checks of hemoglobin and serum iron and feratin (a measure of total body iron stores) levels.

Iron deficient infants need to be carefully examined to rule out signs of heart failure as well.

What is this Mycoplasma thing?

Mycoplasma pneumonia is the most commom cause of walking pneumonia, a very common form of pneumonia for school aged children. Normally this does not make you too sick but rarely can really nock a kid for a loop. It tends to be responsive to erythromycin, azithromycin (zithromax) and clarithromycin (biaxin) and for older kids to doxycycline. Usually 5 days of zithromax or 14 days of biaxin or doxy is all you need. Rarely the kids don't respond well and will need 1-3 months of medication (I get about 1 of these nonresponsive cases each year). Close followup is always important but these kids usually do very well and have complete resolution after a time.


Mycoplasma many times will mimic asthma.  This can delay diagnosis for quite a while, unfortunately.  Mycoplasma may or may not be associated with a fever and occasionally results in a rash.  We are seeing several cases per day of this bug right now.  Call us if you are concerned.

Recommendations for the overweight child

Here are some simple tips if you are concerned regarding your child's weight.

1.  Limit TV to 90 minutes daily
2. Encourage exercise to be 90 minutes daily regardless of the weather.  It is never too cold, here in Reno, to go outside to play.

If you do these 2 things then your child will do well.  Here are some additional suggestions:
1.  Limit to 16 oz of 2% milk
2. Eliminate juice and soda from diet.
3.  Limit Fast food to one time per week.
4.  Bring your lunch to school at least 4 days per week (school lunches tend to be high fat and high calorie.

If you are concerned regarding your child's weight please see us.

Choking Hazards

We recommend that children under 6 years of age not be given nuts, whole grapes or slices of hot dogs (unless they are cut up into pieces small enough to swallow whole).  Children younger than 6 years of age lack the molar teeth necessary to grind up these foods.  This then leads the child to increased risk of aspiration (inhalation of food).  If your child aspirates food the only solution is to surgically remove the food through a scope in the opperating room.  Needless to say, this is something we hope to avoid for your child.

The "Mono" monster

One of the most common causes of sore throat is Epstein Bar Virus.  This is one of the 3 major causes for the syndrome known as acute mononucleosis or mono.  Today I want to dispell mono's undeserved reputation.

By 18 years of age most people have already contracted mono.  It was just one of those flu syndromes that were suffered through as a child with no particular name.  Unlike the typical flu, after your immune system kicks in and tries to kill the infection, the virus causing this one goes into hiding until some time in the future.  In college under the influence of no sleep and the stress of being away from home people can have a reactivation of the virus.  Like any virus most people get better in a few days, but if you don't rest (like most college students with classes, jobs and social lives) it can take a long time to get better.

As you see it isn't the monster it is cracked up to be.  You don't need to drop out of school or quit all your activities if you get mono (again) but you do need to rest or you won't get better.

Till next time.

Strep- won't jump out and get you.

Most cases of "strep throat" turn out to be viral syndromes like mononucleosis and adenovirus.  You cannot really tell strep from a viral syndrome without either a culture or rapid test.  Most of the day care epidemics are due to people whe were never accurately diagnosed resulting in alot of unnecessary antibiotic use.

As a result of this, many dangerous kidney infections are missed resulting in kidney scarring and failure.  My recommendation is to insist that your doctor perform some sort of test before diagnosing your child with "strep throat"

Asthma preventers- a daily medicine

we use asthma preventers to Prevent asthma attacks.  These preventers include oral singulair (pill), and inhaled steroids including pulmicort, flovent, advair and asmanex.  These drugs are intended to be used every day whether you are having symptoms or not.

This is not to be confused with resuce medicines like xopenex, proair, ventolin or proventil.  these are rescue drugs and intended to be used only when having troubble- unlike the preventers which are supposed to be used every day whether you need it or not.

Hope that this helps

Asthma in Young Children

welcome back. 

Did you know that young children with asthma often times don't wheeze.  I hear time and time again patients who were told by the ER or some other doc that since their infant wasn't wheezing they could not have asthma.  Young children (under 2-4 years of age in particular) have floppy air ways that often collapse when they try to move air across an obstruction.  This means that they are not capable of generating the sound known as a wheeze.  Instead they cough.

If your child has had chonic cough- greater than 1-2 months or has a cough or bronchitis with every cold they get this could, in fact, be asthma.  Ask your health care provider to evaluate for asthma or request a referral to a pulmonologist (lung doctor) if you have concerns.

Eczema the itch that rashes

okay, I vowed to post weekly and I know that this one is a little early but hey, who cares.

Lets talk about eczema.  Now eczema is in reality, a wastebasket diagnosis.  Most eczema is either atopic dermatitis or sebhorrheic dermatitis.  I want to focus on atopic derm since this is most common to my patients here in the desert.

Atopic derm usually starts as dry skin that then becomes red and itchy, and occasionally flaky.  It can appear on the cheeks but typically appears in the inner folds to the elbows and the back of the knee.  In severe cases the entire body is involved.

First and foremost the skin must be hydrated.  This is best accomplished with vaseline 4-5 times per day.  If this is to greasy then aquaphore or eucerin cream (not the lotion) can often accomplish this for us.  If this step is skipped the eczema will never get any better.

For red itchy spots, steroid creams can be applied but these have significant side effects and should be used as little as possible.

Bathing should be limited to every other day.  After a bath the cream/vaseline should be applied immediately to the still wet skin.

If the eczema persists then infectious processes should be considered.  This includes staph which, as a localized infection, can produece the so called "stap superantigen" which can insite an immune response which casues eczema to flare across the body.  This can be treated with topical or oral antibiotics as appropriate.

Finally if all else fails consider allergies as a cause.  As the skin breaks down it becomes sensitized to many things and food items can be among them.  Certain blood tests to look at allergic response (called RAST or Immunocap tests) or scratch tests at the allergist's office can be helpful here.

If you are afraid that your child has eczema know that this is a very common occurance especially here in the desert.  Call us to look at your child if you are concerned- (775)- 395-7111

Inhalers and spacers

Did you know that without a spacing tube over 85% of the medication in an inhlaer is swallowed.  For patients who have asthma and require the use of a metered dose inhaler, a spacer is a must.  By preventing the swallowing of the medication we can result in better lung deposition and better efficacy of the medication while minimizing the bad taste and side effects.  Spacers are recommended for all patients regardless of age by most pulmonologists (lung doctors).

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