KNOW your history! ASK questions! PROTECT your children! IMMUNIZE!

By Dena Pepple, R.N. for Lee’s Summit Physicians Group

I love to read, and historical fiction is my favorite subject. For Christmas, my wonderful sister-in-law gave me a Barnes & Noble Nook. Since then, I’ve probably read three books a week about wars, orphan trains, politics, and more. Oddly, in several of these books disease epidemics, that we now have vaccines for, were an integral part of the story. As a pediatric nurse who talks to parents daily about immunizations, I found this very interesting.

Many of these diseases I’ve never seen personally, yet statistics and history tell me of their toll on human life.

In the 1920’s, 10,000+ lives were lost for several years in a row due to diphtheria. Polio paralyzed or killed thousands in the 1940’s and 1950’s. At the height of the measles outbreak, prior to vaccination, an estimated half a million children per year got the disease, with many progressing to pneumonia, encephalitis, and death.   These, and many other diseases, were tragedies that today’s vaccines have saved us from.  Vaccines have protected us so much that most people, like me, have not witnessed the death and destruction that many of these diseases have caused.

Knowing this disease/vaccine history and having the lives-saved statistics of vaccines at our fingertips:

…I wonder why some parents choose not to immunize.

I think there are three main reasons.

ImmunizationFirst, we in the vaccine world are “victims of our own success”. Most of the diseases we vaccinate for have seen a 90%+ decrease in reported cases. We rarely hear about or see these diseases and think it won’t happen to us, or it’s only in other countries.

Second, some parents have had no information about vaccines, and have genuine fear.

Lastly, there’s a HUGE amount of partial/mis-information easily available to us, and touted as the whole truth.

Of course, we don’t want to fix the first reason listed above, vaccine success. Keeping children healthy is what we are all about.

We can, however, work on the information problem. I tell parents, the most important thing for them to learn/do is: ASK QUESTIONS!!! If you have a worry, ASK!  If something does not make sense, ASK! If you have a sixth sense about something, ASK!

The second thing I advise is consider the source and check facts. A children’s hospital is most likely more thorough and reliable than your neighbor, or a random web site. Below is a list of some partial or mis-information statements I’ve heard, followed by factual clarification.

SERIOUS DISEASES LIKE POLIO ARE GONE, SO WE DON’T NEED TO VACCINATE AGAINST THEM.

While many diseases have been wiped out or rarely occur in our country, they are still present around the world and are only a plane ride away. If an unvaccinated or under vaccinated person travels and contracts the disease from an infected person, then brings it back home, he/she may infect others. This opens us up for further spread of the once thought to be gone infection.

This is happening now with measles. We have already had 5 outbreaks of measles here in the United States this year. If this rate continues, we will have 3 times more cases this year than last year.

Polio is prevalent in other countries as well, so it is only a plane ride away. My dad had polio in 1951. He “saw black” for 4 days, was in the hospital for over a week, had severe muscle ache/pain and was very weak for about a month. He was lucky. In 1952 >3,000 people died from polio, and >21,000 were paralyzed. Until the disease is eradicated worldwide, we NEED to vaccinate.

BABIES IMMUNE SYSTEMS CAN’T HANDLE THE NUMBER OF VACCINES GIVEN TODAY.

The infant is already exposed to thousands of germs on a daily basis, whether they are in child care or not. Even if he/she got 11 vaccines at the same time, he/she would only use 0.1 % of his/her immune system to respond. Therefore, they can easily handle the number of vaccines given at any one time.

The goal is to protect them as early as possible when they’re most vulnerable to these diseases. Also, even though the number of vaccines has risen over the years, the antigen (substance that induces an immune response) load has gone down due to the refinements in the vaccines. This means we can protect our little ones from more diseases, while having an overall lower antigen load than previous generations received in their vaccines.

DELAYED IMMUNIZATION SCHEDULES ARE SAFER THAN STANDARD ONES.

Some parents believe that too many vaccines at once can cause problems, including developmental issues. Study after study denies this. In fact, by delaying immunizations, their children are at greater risk of contracting these diseases. These diseases can cause numerous health problems, up to and including death.

NATURAL IMMUNITY IS BETTER THAN IMMUNITY FROM VACCINES.

Natural immunity may last longer than vaccine derived immunity, but that is why there are booster shots. The risks, symptoms, and complications associated with getting the disease (to get that “natural immunity”) can be far worse. When my children got chickenpox 25 years ago, it was a breeze. Their main issue was itching and I had a week off of work, but many aren’t so lucky.

One of my little 6 month old patients was admitted to the hospital with so many blisters he looked like he had 3rd degree burns. One of our nurse practitioners took care of an 8 year old with chickenpox encephalitis. This child had brain damage, and spent months in the hospital and rehab. Pneumonia, cancer, and death can and does occur as a consequence of this “natural immunity”. In addition, there are some diseases, like tetanus, that don’t provide natural immunity.

THERE IS FORMALDEHYDE IN IMMUNIZATIONS, AND THAT IS A POISON.

Yes, there is a small amount of formaldehyde used in the production of vaccines to prevent contamination. Most of it is removed at the end of processing, before packaging. Some are concerned that it is used at all, but formaldehyde naturally occurs in the human body. Our bodies are continually producing/processing/eliminating formaldehyde, with about 1.5 mg always circulating in a 15 lb baby. One banana has 20 times more formaldehyde and one pear has 600 times more formaldehyde than a single vaccine.

THERE IS NO SUCH THING AS HERD IMMUNITY AND IT DOES NOT HURT YOUR CHILD IF MY CHILD IS NOT IMMUNIZED.

Yes there is, and yes it does! Herd immunity is a form of immunity that occurs when a significant number of the “herd” (you and me) are vaccinated, which then provides protection for those in the “herd” who do not have immunity (newborns, immune-compromised, elderly, etc). This is usually achieved with an 85-95% vaccination rate.

The higher the percentage of vaccinated persons does two things: there are less people in the first place who are susceptible to the disease, and if you don’t get the disease-you can’t give it. The “herd” then cocoons those who are still vulnerable to the disease. If less children are vaccinated, it weakens the herd, leaves the unvaccinated vulnerable to disease, which they can then spread to those who are not immune.

Sir Winston Churchill once said, “Those who fail to learn from history are doomed to repeat it.”  The statistics and stories are in our history books.  I’ve read about them on my Nook. Let’s learn from our “history” and NOT repeat it.

KNOW your history! ASK questions! PROTECT your children! IMMUNIZE!

Prescriptions can be expensive. Here are some tips that could save you a lot of money.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

PrescriptionsOne problem we run into as health care providers and as patients is what to do if medications are too expensive. There are several options that you can check into to either get discounts or to get medication changed to something that is more affordable.

Know Your Insurance

First, know your insurance and how to look up what medications are on “formulary”. A formulary is what medications the drug companies have agreed to cover based on your plan. This can be dictated by your employer or by the insurance company that contracts with other drug companies. The list can change every 6 months or yearly, so check back frequently.

Just because technology helps us with our medical charting, it doesn’t magically know what your insurance plan covers because each employer can be unique.

Patient Assistance Programs

There are also patient assistance programs ran by drug companies. Your pharmacy should be able to help you with this or you can look up the company that makes the medication and ask for customer service.

An organized, easier way to look this information up is to go to needymeds.org. This has all of the drug company discount programs linked by simply looking up the drug name. You will have to fill out paperwork and possibly provide financial information to qualify, but often some assistance can be given especially to low income households.

There are some state and local medical assistance programs, ask around in your area for more information. There’s also a lot of information you can find on Google.com by searching “medication assistance”.

There are websites to look at, savings cards, and assistance that can be applied for.

Prescription Cost Savings Apps

Have you ever considered downloading free apps on your phone to compare costs? These apps can provide lots of cost saving information.

GoodRx is one that I reference frequently.

Sometimes, mail order or online pharmacies will save you more money than getting it filled at a local pharmacy. Also not all pharmacies have the same costs, so check pricing at more than one local pharmacy, especially for expensive prescriptions. The pharmacist or pharmacy staff can look up if taking #2 500mg tablets is cheaper than a single 1,000mg tablet for instance. Again, knowing your formulary can help with this.

Samples and Savings Cards

One last tip: Don’t forget to ask for samples or a savings card at your appointment or when you’re prescribed something. Medical offices often get discounts that can’t be found on websites. But then others are the same online as in your doctors office.

The bottom line is that there is no reason to stop taking medications or to go without. Work with your provider on what can be done for your particular situation, don’t just assume that we know what the situations is. We don’t know unless you communicate with us about these situations, and we want to give you the best care possible!

A Coronary Calcium Scan Could Save Your Life

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group

Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men. Coronary heart disease (CHD) is the most common type of heart disease, killing over 370,000 people annually, per the American Heart Association. Alarming statistics, but with the Coronary Calcium Scan physicians are able to catch the beginning stages of heart disease and then refer you to a cardiologist if necessary.

On a personal note…

The reason I felt the need to write about Coronary Calcium Scans, is that I lost my husband in January due to unknown heart issues. I wanted to make sure everyone knows about this simple test that could possibly save your life. Or at least make you are aware there’s a chance you could have heart  disease.

My husband had a very physical job and he was an avid golfer. He rarely went to the doctor and didn’t present with any heart issues other than family history of heart disease. He did have normal cholesterol and triglycerides, normal EKG, no shortness of breath or chest pain prior to his death.

My husband was only 56 years old. Due to his age, an autopsy was performed. This is how I learned of his heart disease.

I felt compelled to tell my story so I could spread awareness that this test is available. I recommend you to talk with your provider to see if you would be a good candidate for the Coronary Calcium Scan. I feel that if my husband would have had this test done just because of his family history, we would have known he had heart disease and been more proactive. We could have been referred to a cardiologist for additional treatment.

So, how can we be proactive in our own heart health?

Artery ComparisonFirst, ask your physician if you are a good candidate for the Coronary Calcium Scan. Your physician will order the scan based on risk factors, family history, age, cholesterol levels, blood pressure, diabetes and smoking history. Men, age 35-70, and women, age 40-70 should ask their physician or make appointment especially if they any of these risk factors as mentioned above.

A heart computerized tomography (CT) scan, also called a calcium-score screening heart scan, is used to find calcium deposits in plaque of people with heart disease.  They are the most effective way to spot atherosclerosis before symptoms develop. They look for the plaque inside the arteries of your heart that can eventually grow and restrict or block the flow of blood to the muscles of the heart. The measurement of calcified plaque with a heart scan may enable your doctor to identify possible coronary artery disease before you have signs and symptoms.

The doctor will decide if you are low or intermediate risk for heart disease. If low or intermediate risk, the cardio scan can determine presence and degree of calcium, indicating probable cholesterol build up. (See scoring chart)

The outcome of the test may indicate the need for medication or lifestyle changes to reduce the risk of heart attack other heart problems. If you are high risk, the best test is a cardiac catheterization-dye test as it will give more detail and ordered by a cardiologist.

Coronary Artery Calcium ScoresSome imaging centers and hospitals in the Kansas City area are offering these scans for as low as $50 (out of pocket cost) and a written order from your doctor. Little preparation is involved, no caffeine 4 hours prior, no antihistamines 24 hours prior, and no vigorous exercise 2 hours prior to the exam. This of course may vary depending on where you schedule your exam.

I have my scan scheduled in about a week, and I encourage everyone that has a family history, or any symptoms listed above, please take this step and be proactive. Talk to your physician to ensure your heart is healthy… not only for yourself but for your family.

For more details of the CT scan go to www.heart.org and as always, if you are experiencing any symptoms: chest pain, tightness, pressure, shortness of breath, numbness in legs and arms, weakness, pain in the neck, jaw or throat, call 9-1-1 or go to the nearest emergency facility.

The Epidemic of Kids and Technology – Part One: Ages 1-5

By Daniel E. Gershon, D.O. and Laura Salitros, D.O. – Lee’s Summit Physicians Group

This is the first in a series of blogs about children and technology.

Child with Cell PhoneWe’ve wanted to write about this subject for the past two years. It has become painfully clear to us that electronics/screen time (TVs, computers, tablets, and smart phones) has become a major concern as pediatricians. The effect it’s having on kids and adolescents is staggering. A typical day in our office will involve evaluations for ADHD, learning difficulties, anxiety, depression, sleeping problems, and extreme behaviors.

We’ll go ahead and call it an EPIDEMIC.

Most parents today grew up with electronics, including smart phones while they were in high school. It is a big part of who they are and their way of life. Consequently, they introduce screens to their children at young ages. Kids will often see their parents in front of screens. No one is to blame. Technology moves lightning fast. It moved so fast that science got a late start and is now telling us there are inherent dangers in what we are doing.

Let’s start with some science first:

When every finger swipe brings about a response of colors and shapes and sounds, a child’s brain responds gleefully with the neurotransmitter dopamine, the key component in our reward system that is associated with feelings of pleasure. Dopamine hits in the brain can feel almost addictive, and when a child gets too used to an immediate stimuli response, he/she will learn to always prefer smartphone-style interaction – that is, immediate gratification and response over real world connection. This is a mild version of the dangerous cycle psychologists and physicians see in patients with drug and alcohol addictions.

The Critical Period

Toddler and ComputerBetween birth and age three, our brains develop quickly and are particularly sensitive to the environment around us. This is called the critical period in some circles because the changes that happen become the permanent foundation upon which all later brain function is built.

A child needs specific stimuli from the outside environment for the brains neural network to develop normally. Spend too much time in front of a screen and development becomes stunted. Their social skills (frontal lobe) can be effected as well. Empathy, the near-instinctive way you and I read situations, get a feel for other people, can be dulled, possibly permanently. Heavy parent use of mobile devices is associated with fewer verbal and nonverbal interactions between parents and children.

AAP recommendations for children younger than 2 years were based on research on TV and videos, which showed that in-person interactions with parents are much more effective than video for learning of new verbal or nonverbal problem- solving skills.[1] Before 2 years of age, children are still developing cognitive, language, sensorimotor, and social-emotional skills, which require hands-on exploration and social interaction with trusted caregivers for successful maturation. Therefore, adult interaction remains crucial for toddlers to learn effectively from digital media.

For example, from 12 to 24 months of age, toddlers can begin to learn novel words from commercially available “word learning” videos, but only if their parents watch with them and reteach the words, essentially using the videos as a learning scaffold to build the language skills.[2]  In fact, recent reviews of hundreds of toddler/preschooler apps labeled as educational have demonstrated that most apps show low educational potential, target only rote academic skills (eg, ABCs, colors), are not based on established curricula, and include almost no input from developmental specialists or educators.

An additional concern is that the formal features (ie, bells and whistles) that are designed to engage the child in an interactive experience may actually decrease the child’s comprehension or distract from social interaction between caregivers and children during use.[3]

Here are some troubling numbers:

In 2011, 52% of children zero to eight years of age had access to a mobile device. By 2013, this access had increased to 75% of 0- to 8-year-olds.[4]

A large international study (2013) with almost 300,000 children and adolescents found that watching between 1 and 3 hours of TV a day led to a 10% to 27% increase in risk of obesity.[5]
(It should be noted that TV viewing in children has decreased dramatically in the past two years with content moving to smart phones and tablets)

Here are some frequently heard comments from our parents:

“Sometimes I just need to get things done.”

YES! Sometimes we parents need to get stuff done and cannot supervise our kids like we would like to. We like to think of these as worst case scenarios, not something we do regularly. Don’t forget that engaging even our youngest toddlers in household responsibilities early on results in benefits for the entire family in the long run. Yes, it requires a lot of work up front, but it will be worth it

“He focuses better on the TV or tablet than on anything else.”

Boy and TVDigital content can be very stimulating. However, evidence shows that digital media is likely harmful to attention and executive function.  See this article about a study that was published in Pediatrics in 2011. This may be one of the factors as to why ADHD numbers have significantly risen over the past decade.

As a child spends more time in front of a screen, their frontal lobe has a harder time turning on when acknowledging a spoken voice, looking at books, or picking up visual clues. It prefers the digital or electronic format.

“I don’t really have a strict limit because we only use educational media.”

Even the AAP distinguishes between quality digital media and media that should be avoided, such as violent or fast-paced media. This doesn’t mean that “educational” shows/apps don’t count. Kids need time to engage in unstructured play. They need to be read to, talked to, and engaged with. They also need regular physical activity and adequate sleep.

“My kids can’t settle down for the night without having the TV on.”  

Results from one study show a relationship between screen time and poor sleep, especially when screens are used in the evening hours.[6]  As mentioned above, we are seeing a lot of kids with sleep issues. Some are due to common, age appropriate reasons, but many are due to screen time.

“It helps my child calm down when she gets upset.”

Distraction can be helpful in distressing or painful situations. This is why many children’s hospitals have child life departments available to help during painful or otherwise anxiety provoking procedures.  We use virtual reality in our office for vaccines and blood work.  However – Using screens to alleviate the discomfort of everyday disappointments or frustrations interferes with our children learning healthy emotional regulation without reaching for an external device.

One reason that children may be less socially engaged during digital play is that gaming design involves behavioral reinforcement meant to achieve a maximum duration of engagement, which may explain why interrupting children’s digital play leads to tantrums.[7]

“The TV is on in the background all day, but they’re not actually watching it.”

However, having the TV on in the background distracts children from their play, interferes with good language exposure, and decreases parent-child interaction, all things that can have an effect on their development. It is amazing what kids pick up from background TV. Yes, my son, at 4 years old, asked me if my heart was healthy enough for sex!

Here are our recommendations for ages 1-5:

1) No screen time for anyone under 24 months of age
Exceptions are video chatting (Facetime) or worst case scenarios (DMV, illness/doctor’s visit, etc.)

2) No screens in bedroom
Having screens in the bedroom was an independent factor associated with obesity. As kids get older, the temptation and addiction will only get worse. This is a place for quiet time, music, drawing, reading, sleeping, etc.

Limit Screen Time3) For ages 2 through 5 years old: No more than 1 hour a day of quality content.
Use sources like Common Sense Media to help you determine what is quality and what is not. Most evidence now suggests that long amounts of time in front of a screens is more damaging than short exposure (30-45 minutes).

We recommend teaching your kid that screens are an earned privilege not an expectation. It should never be a part of your everyday routine. Kids can look out the window while in the car. They can eat their meal or they can be hangry by their next one.

4) Find apps and games that you can play with your child.
Studies show that retention is much better when educational apps/games are played with a parent vs. alone with a device.

5) Develop a Family Media Use Plan
www.healthychildren.org/MediaUsePlan

6) Watch the time YOU spend in front of screens
Try your best to wait until the kids are asleep. If it is work related, let them know.

Finally, we know parenting is the hardest job there is. There is no perfect parent. It is our goal to let you know electronics can be harmful and potentially damaging to a child’s developing brain through the age of 5. Hopefully we have given you some tips on how to safely raise your kids in an electronic/digital world.


References:

[1] Brown A; Council on Communications and Media. Media use by children younger than 2 years. Pediatrics. 2011;128(5):1040–1045

[2] . DeLoache JS, Chiong C, Sherman K, et al. “Facetime doesn’t count”: video

Do babies learn from baby media? chat as an exception to media Psychol Sci. 2010;21(11):1570–1574 restrictions for infants and toddlers.  Richert RA, Robb MB, Fender JG, Wartella E. Word learning from baby videos. Arch Pediatr Adolesc Med. 2010;164(5):432–437

[3] Vaala S, Ly A, Levine M. Getting a Read on the App Stores: A Market Scan and Analysis of Children’s Literacy Apps. New York: The Joan Ganz Cooney Center at Sesame Workshop; 2015. Available at www.joanganzcooneycen ter.org/wp-content/uploads/2015/12/.  Guernsey L, Levine MH. Tap Click toddlers learn language. Child Dev. Read: Growing Readers in a World of

2014;85(3):956–970 Screens. San Francisco, CA: Jossey-Bass; 2015

[4] Rideout V. Zero to Eight: Children’s Media Use in America. San Francisco, CA: Common Sense Media; 2013

[5] Braithwaite I, Stewart AW, Hancox RJ, Beasley R, Murphy R, Mitchell EA; ISAAC Phase Three Study Group. The worldwide association between television viewing and obesity in children and adolescents: cross sectional study. PLoS One. 2013;8(9):e74263

[6] Michelle M. Garrison, Kimberly Liekweg, Dimitri A. Christakis Pediatrics July 2011, VOLUME 128 / ISSUE 1

Article Media Use and Child Sleep: The Impact of Content, Timing, and Environment

[7] Hiniker A, Suh H, Cao S, Kientz JA. Screen time tantrums: how families manage screen media experiences for toddlers and preschoolers. In: CHI’16. Proceedings of the 2016 CHI Conference on Human Factors in Computing Systems; May 7–12, 2016; New York, NY. 648–660. Available at: http:// dl. acm. org/ citation. cfm? doid= 2858036.2858278. Accessed May 9, 2016

LSPG loves keeping GREEN and helping others in the community including Hope House.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Did you know we are GREEN here at LSPG? Not too many people know this. Our office is always looking for ways to help our community and to be GREEN.

Dr. Trites, Julie Gramlich and others help us recycle and stay earth friendly. Often, employees bring clothing/toys/books in for other employees to pick up to use so that they continue to get use and not just thrown away.

Hope House

Hope HouseAnother thing we do, is support Hope House with surplus lunch supplies. Darlene Barnard, Dr. Barnard’s wife, is always eager to come pick up extra and take it to our local Hope House. I asked Darlene one time, How did you get involved with hope house?

“When our youngest was in 5th grade (15 years ago), we had a Thanksgiving dinner at his school. We had a couple of extra roasted turkeys, and all the trimmings as leftovers. We had enough for over 30 meals. One of the parents had lost a friend to a domestic violence incident that year and had a connection at Hope House in Lee’s Summit.

She contacted the staff at Hope House and three car loads later-they had food for their clients. I’ve taken food and donations there ever since. I’m part of the Summer Lunch Program that delivers a sack lunch to school age children throughout Lee’s Summit, Greenwood and Raymore in areas of need. On Fridays I take the surplus sandwiches and food supplies to Hope House.”

LSPG is GREENDarlene and others at Lee’s Summit Physicians Group set a good example by donating time, items, food, clothing, etc. so that those in need can put those things to good use. When we donate, that allows organizations to spend their limited budget on other needs so that our community can truly benefit.

Darlene added that “Anyone can help by donating time to Uplift to deliver food to the homeless, sorting clothes or  food donations at LSSS, donating time at the local dog shelter or non-profit of their choice. Sharing a little of yourself to those in need is something I find worthwhile.”

Dental Health: Would you kiss a donkey if you had a toothache?

Dental Health Month

By Dena Pepple

Would you kiss a donkey if you had a toothache? Do you go to the barber when you tooth hurts? Do you chew on chili peppers for your tooth pain? Would you have your tooth pulled in the town square by a traveling salesman?

These are just a few of the “old time” treatments for tooth pain, and actually the milder and less grotesque ones that I’ve come across. Now, why am I asking? Well, it’s because February is National Dental Month. Luckily, we’ve come a long way since those old time remedies were used. That said, we have some work to do.

Tooth Decay

Tooth decay is the number one chronic illness among children in the United States of America. It’s the second most common disease in general, coming in right behind the common cold. 10% of two-year-olds already have one or more cavities, and almost 50% of children have tooth decay by the time they go to school.   Children endure pain, miss school days and more in relation to this poor dental health.

Tooth DecayThis early occurrence of disease in our children spills over into the adult population as it’s the number one risk factor for poor oral health into adulthood. Daily, we’re learning new information that links adult tooth decay to many illnesses, such as diabetes, heart health, cancer and more. It’s estimated that 90% of system diseases have oral health connections.

According to the CDC, our nation spends about 124 billion dollars a year on dental care. So, that’s the bad news.

The Good News

The good news is this disease, tooth decay, is preventable. As parents, there are many things you can do to slow/stop potential tooth decay in your children. Start early with good dental habits.

With the very first tooth, you should start brushing your baby’s teeth with a tiny (rice grain size) bit of fluoride toothpaste on a soft bristle brush at least twice a day. Did you know some of the earlier tooth brushes were made from hog, horse and badger hair?  Flossing can also be an important part of this early routine. The website Healthychildren.org has some great information on the specifics of this and how to progress as your baby grows.

Healthy eating is a big part of dental health.

Decrease the sugar in your kiddos diet. This of course includes cookies/candy/pop, but also, even the sticky nutritious fruit like raisins or prunes. Did you know the cotton candy machine was invented by a dentist? Talk about sticky food! If they do have these sweets, have them brush afterwards. We often suggest honey for cough treatment in our kids over one year old, and brushing is necessary after this as well. A baby bottle should only have milk/formula (or rarely per doctor water or juice) but NEVER pop, Kool-Aid, or other sweetened drinks, and NEVER before going to bed.

Fluoride is a huge part of tooth health.

Fluoride is added to the water supply of many cities in the United States. Check with your city, and if it doesn’t add fluoride, talk with your doctor/dentist for other sources.  I repeat: this is HUGE!

It’s very important that your child have a “Dental Home.” 

Healthy Habits for Dental CareJust as we are your medical home, (for general health, growth and development, illnesses, etc.) your child needs a dental home where it’s recommended that your baby see a dentist within 6 months of her first tooth, or around 1 year of age. The American Academy of Pediatrics recommends this early start so the dentist can then follow the baby and help guide further specifics of dental health.

We are here to help as well. Checking oral health is part of our well child care procedure.  We share our office monthly with Hope Dental, who serves our under-insured patients with accessible dental care. We follow the American Academy of Pediatrics guidelines for dental care, and keep up-to date information on local pediatric dentists. And we have display information at all of our offices about dental health this month!

I’ve seen first-hand that this process works.

I have two grandsons (age 2 and 4) who started very early with a dental care routine. They know where their toothbrushes are at my house and remind me when it’s time to use them. (Of course it could be the “Spiderman” electric toothbrush that reminds them!) They know what floss is for, and already see a dentist regularly.  And they’ve already beaten the stats… no cavities!

Working together, parents, kiddos, and dentists can definitely impact future health by helping us take care of our teeth. Let’s do it!

Juuling and Vaping: The nitty-gritty on E-cigarettes.

Sarah Dedrick, C-P.N.P.By Sarah Dedrick, PNP

It’s hard as a parent of an adolescent to know what the latest trend is and what all the kids are doing.

Being the mother of four children, two of those being teenagers, along with being a Pediatric Nurse Practitioner, I try to stay in tune with what is the newest and “coolest”’ thing to do as a teenager. The most recent hype the past few years has been with E-cigarettes.

E-cigarettes: Vape and Juul

There are many different types of E-cigarettes. I will be giving you some quick facts about the two most popular among teenagers: the ‘’Vape’’ (medium to large tank device) and the Juul.

Vape

The ‘’Vape’’, as my teenagers and others call it, can be either a medium or large tank metal device. It’s used by having a separate bottle of liquid that you pour into the holding tank on the device. The liquid is heated up as you smoke. This is where the ‘’vape’’ gets tricky. The liquid that is being put into the device may or may not contain nicotine. There are liquids that vary in nicotine concentrations from 0 mg/ml to as high as 36 mg/ml. A normal cigarette contains an average of 12mg per cigarette.

The only way you will know, as a parent, is by seeing the bottle containing the liquid and knowing this is for sure the liquid that was used. A big trend with these type of devices is doing ‘’tricks’’ with the smoke that is produced. They may not be smoking for the nicotine but using the device to make ‘’donuts’’, ‘’jellyfish’’, ‘’tornados’’, or a ‘’waterfall’’ to name a few with the smoke that’s exhaled. Even though they’re not inhaling nicotine, they’re still inhaling toxic chemicals and metals produced with the device when it heats up and the smoke is inhaled.

Juul

E-cigarettesThe Juul is the newest and, likely, most popular among the teenagers. It’s also one that most parents are not aware of. Many have no knowledge regarding this device.

The Juul is another form of an E-cigarette. It looks like a flash drive and is even charged using a USB port. It’s very discrete and does not resemble a typical cigarette or other larger vaping device (like the one mentioned above). It has very few parts and is uncomplicated (again unlike the one mentioned above). Due to this, it can be very easily hidden. It can be hidden in a hand while the adolescent is smoking it. Which makes it easy to smoke at school, in the classroom or bathroom, and at home. It operates by heating up a ‘’pod’’ that is filled with the nicotine containing liquid. You buy the pods and change them out when the liquid is done.

Besides charging it, this is as easy as it gets. The one small ‘’pod’’ contains as much nicotine as a pack of cigarettes, making it highly concentrated and addicting.

For all E-cigarettes, the fear in the medical community is increasing regarding the potential harm to the teenagers.

E-cigarettes are not only popular because of their discreetness, but also the appealing flavors that are possible: mango, crème, cucumber, mint, fruit, etc. The smoke has a sweet scent and doesn’t make the adolescent smell. Their clothes, car, room, breath, etc, don’t smell like a traditional cigarette.

The nicotine in these devices is a highly addictive drug.

E-cigaretteWhen the concentration of nicotine is even higher, teenagers are getting more of a ‘’high’’ from it. They get an energetic boost or a calming experience from smoking/vaping. Even if they’re smoking a vape device that has no nicotine… just developing the habit of smoking can lead to smoking traditional cigarettes or  engaging in other drug use.

Besides developing the habit and/or addiction, there’s worry of the damage to an adolescents developing brain.

The adolescent brain is not developed like the adult brain. When they’re exposed to nicotine, it affects the ‘’reward’’ system in the brain which leads to addiction. The nicotine can also affect the brain circuits that control attention and learning along with mood and impulse control. These, along with the obvious harms of smoking and inhaling foreign substances into your lungs, are becoming a real concern for parents and the medical community.

We recently visited a Cardiologist for my husband. The Cardiologist briefly mentioned nicotine, specifically with the Juul, stating how bad the nicotine is on the heart muscle. In the years to come, it will be interesting to see how many young people end up having heart issues related to nicotine use.

Parenting is hard.

There’s no right way or wrong way to parent. It’s easy to point fingers or say that a child is doing this because of their home life or the type of parents they have. I think I’m a decent parent =) And yet I’ve caught my teenage daughters Juuling.

Educating ourselves and being aware is what we can do as parents. This is not only with smoking/vaping but with all aspects of teenage life: drinking, texting and driving, speeding, drugs, sex, social media, etc. We need to know what the newest trends are so we can know what signs to watch for…  and how to, hopefully, dissuade them from taking chances with their health. They are teenagers, and we should expect mistakes and curiosity. Mistakes are part of their journey and how they learn. Even as adults, we’re still making mistakes and learning from them.

Loving your teenager, accepting their mistakes, educating them and encouraging them are the some of the most valuable aspects of parenting (in my opinion).

Happy New Year from LSPG! [Office Holiday Party Pics!]

Happy New Year! Can you believe it’s 2019?

To finish out 2018, we wanted to share some photos of our office holiday party with you. We played games, exchanged gifts and had a great time celebrating the holidays.

We hope your year is off to a good start! It’s a great time to consider some healthy resolutions!

Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year Happy New Year

Festive, Spooky and More – Darlene Makes it Happen

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Ever wonder how the decorations get changed at LSPG?

DarleneThere’s someone that does a lot of work around LSPG, but never gets paid! Darlene Barnard, Dr. Barnard’s wife, was gracious enough to answer a few questions for me. She has been helping our office and the community for many years. She is one of the silent, necessary components that keep LSPG running smoothly. When questioning her about the things she does and enjoys, I learned a great deal!

“I enjoy meeting all of the staff at LSPG. I also like the office building and grounds to be welcoming to the clients & staff of LSPG. Pretty flowers and trees always make me smile, so I like to add some color around the office.

I try to maintain the flower pots at the entry doors festive and inviting. I enjoy the positive comments from kids and adults as they walk in the doors to LSPG.  I offer my input (usually only when asked) about the landscaping of the green areas around the office parking lots!”

Anyone that knows Darlene, knows she likes to garden. She brings her bounty in to share with staff when the season is good.

But holidays would not be the same here without her help!

“I decorate the front desk and waiting areas for Halloween, fall and Christmas. The receptionists and patients enjoy the decor. The decor is inviting and comments on the ghosts, pumpkins, snowmen and Santa are a nice diversion for the clients and families of LSPG. “

DarleneDarlene loves flowers and trees and doesn’t want LSPG to look “institutional” so she loves to add color around the office. She enjoys interacting and watching the children look at the decorations. Often, the decorations open communication with our staff like what they’re going to wear for Halloween, what presents they got for Christmas, and what they like about the holiday season.

And we couldn’t make this an article about her without mentioning her love to walk her two golden retrievers every day. She brought them to meet the staff when they were little and now they’re too big to come inside to say hello. But once in a while, you might see them outside in the car as happy as can be to get some attention!

Photography, loving on her grandkids and being outside (particularly on the BEACH) are some of her other favorite things!

Thank you Darlene for being such a great part of our daily life at LSPG!

Marijuana and CBD – Legal Status, Treatment and Risks

By Dr. Andrew Huss

Marijuana and CBDA drive down I-35 and I-70 just before the midterm elections in November 2018 showed me that change was coming. Billboards for two different CBD oil dispensaries and two separate medical marijuana bills greeted me during my morning commute. With the passage of Amendment 2 legalizing medical marijuana in Missouri and with the Hemp Farming Act of 2018 set to legalize CBD oil nationally, now is a good time to review both the legal status and medical risks and benefits of marijuana, CBD, and similar products.

What’s the difference between marijuana and hemp?

Marijuana and hemp are actually two different varieties of the same plant species called Cannabis sativa. Just like dachshunds and greyhounds are both from the Canis species but were bred for different leg lengths, marijuana and hemp were also bred to emphasize different properties. Marijuana plants are cultivated for their flowers and THC content, while hemp is typically grown for its fibers and oils (and more recently, for its CBD content).

But wait, what are THC and CBD?

  • THC (tetrahydrocannabinol) is the psychoactive compound found in cannabis plants that causes the ‘high’ that users associate with marijuana. For a plant or plant product to be defined as hemp (and not marijuana) the THC concentration has to be less than 0.3%.
  • CBD (cannabidiol) is another chemical found in cannabis plants that has found use as a treatment for certain seizure disorders in children and has been suggested as a treatment for chronic pain and several other chronic conditions.

So what is the legal status of CBD and medical marijuana in Missouri?

  • Medical MarijuanaSimply put, possession and use of marijuana for recreational purposes remains illegal.
  • CBD oil is currently in an a legal no-man’s-land in Missouri.
  • Hemp production is legal in several states, but law enforcement interference in the transport between states and sale was essentially restricted by Congress in 2016 (The pending 2018 farm bill is expected to formally legalize hemp production nationally.)
  • Amendment 2 legalized medical marijuana use in Missouri in several forms (such as capsules, oils, smoking, ointments, patches, or edible products) under supervision of a physician for a “qualifying medical condition.” That definition under the law is very broad.

 A “qualifying medical condition” includes:

  1. Cancer
  2. Epilepsy
  3. Glaucoma
  4. Intractible migraines
  5. A chronic medical condition causing persistent pain or muscle spasms (such as Multiple sclerosis, Parkinson’s)
  6. Debilitating psychiatric disorders including PTSD (needs diagnosis by psychiatrist)
  7. HIV/AIDS
  8. A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication
  9. Any terminal illness [aka end-stage or incurable disease]
  10. In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to, hepatitis C, amyotrophic lateral sclerosis, inflammatory bowel disease, Crohn’s disease, Huntington’s disease, autism, neuropathies, sickle cell anemia, agitation of Alzheimer’s disease, cachexia, and wasting syndrome.

As you can see, that leaves a lot of leeway for interpretation by a physician. Some might feel comfortable prescribing it for pain or other chronic illnesses, but others might leave that prescribing up to the specialist managing their patient’s condition (such as a neurologist managing epilepsy or Parkinson’s or their cancer doctor managing their cancer pain). Furthermore, with the availability of a few prescription medications that mimic the effects of CBD or THC and allow controlled dosing, some physicians might be more comfortable using a product with standardized and consistent dosing and FDA approval.

So what is the evidence for treatment with CBD and marijuana and what prescription alternatives exist?

Headlines such as “Research Shows CBD Benefits 50+ Conditions” are difficult to ignore. However, a closer look at many of the medical conditions listed show only a few studies performed on rats or mice or cells on petri dishes – not enough evidence to make any conclusions on how CBD treatment will affect humans. Other studies don’t include a placebo group or have a very small amount of people in the study which limit how useful the results are. A few areas that actually have been studied in-depth are seizures, nausea and poor appetite in cancer patients, and chronic pain.

Seizures (specifically the rare conditions Dravet Syndrome and Lennox Gastaut Syndrome) are one area in which CBD has been shown to provide some benefit. In fact, it has shown enough benefit for the FDA to approve cannabidiol for the treatment of this and a prescription form of CBD (Epidolex) has been approved. However, experts still recommend further research to determine the long-term side effects of this treatment and Epidolex/CBD is not recommended as a first-line treatment.

Marijuana and synthetic THC have also been evaluated as a treatment for nausea associated with chemotherapy as well as with poor appetite and weight loss associated with cancer or chronic disease. Two synthetic forms of THC (nabilone and dronabinol) have FDA approval for use in certain patient populations. Although these medications have been shown to have benefit similar to other anti-nausea medications, there is an increased risk of adverse events when compared to traditional anti-nausea medications. While dronabinol has been shown to help with weight loss associated with AIDS, studies show that both synthetic THC medications are less effective than another appetite stimulant (Megace) or placebo in cancer patients.

Some weak evidence exists that smoked or ingested cannabis can help with chronic neuropathic pain, although studies have yet to show evidence that this helps with other types of chronic pain. The use of cannabinoids wasn’t shown to provide a significant benefit over placebo in treating disease progression in multiple sclerosis but did show a small benefit in muscle stiffness and very small benefits in treating spasticity and pain.

What risks are associated with marijuana or CBD treatment?

RiskAlthough there is evidence of benefit from marijuana or CBD in some conditions, any benefits need to be weighed against the risks of treatment.

  • Short-term side effects of smoked marijuana include dizziness, dry mouth, paranoia, hallucination, and sleepiness.
  • Long-term marijuana smoking is associated with cough, wheezing, and increased mucus production.
  • The most common side effect of CBD is drowsiness, with fever, decreased appetite, diarrhea, vomiting, and elevation of the liver markers AST and ALT also reported.
  • A potentially dangerous side-effect of CBD is how it interferes with the body’s enzymes that process certain medications, especially anti-seizure medications.
    • For example, some children on anti-seizure medications given CBD in a research trial were found to have higher levels of the seizure medicine in their blood (despite no change in their dose of medicine) and more side effects from their medicine.

It is important to let your doctor know if you are taking CBD as it could require adjustment of medication doses or closer monitoring.

What do we know about cannabis use in kids?

The effects of marijuana on children’s developing brains are also very important to consider when discussing treatment with marijuana or CBD products.

  • Regular cannabis use during the teenage years is associated with a lower IQ in adulthood.
  • Some studies show a link between increased risk of psychosis or depression in teenage marijuana users.
  • MRI scans of the brains of people who used marijuana regularly in the teen years show decreased brain volume in the parts of the brain responsible for memory, motivation, and emotional processing.

These findings show that the long-term risks of marijuana use in children need to be weighed against the possible benefits of that treatment (and also compared to risks and benefits of different treatments as well).

What does the passage of Missouri Amendment 2 mean for me?

Legalized medical marijuana is coming to Missouri, although the rollout will take several months to set up state-approved distributors and to finalize rules and regulations. This new law gives physicians much leeway in terms of which conditions they can recommend the use of medical marijuana for, but science is lagging behind the law.

There’s little to no quality scientific evidence of benefit for many of the conditions medical marijuana can be prescribed for. Similarly, there is little to no quality scientific evidence that CBD benefits many of the diseases that it is claimed to treat. Even in diseases in which CBD and marijuana have been more closely studied, often the studies don’t show much benefit compared to existing treatments, and medical marijuana and CBD are not recommended as first-line treatments.

It will be interesting to see what knowledge is gained in the coming years, but in the meantime, we must carefully consider the risks and benefits of CBD and marijuana and remain skeptical of many of the claimed benefits for certain diseases until more research is performed.

Additional Resources