Mystery virus causing paralysis? What parents need to know.

By Danielle Leivian, M.D.

Danielle Leivian, M.D.Another day, another disease to worry about, right? In between “reasons my child is crying” memes, there’s a good chance that your news feed has been highlighting a scary type of childhood paralysis called Acute Flaccid Myelitis.

What is Acute Flaccid Myelitis?

There we go with the med-speak again. Acute Flaccid Myelitis, or AFM, is a descriptive term for a medical condition that is still shrouded in mystery. Acute simply means sudden in onset. Flaccid refers to the “limp muscle” type of paralysis that we see in diseases that affect the spinal cords or motor nerves exiting the spinal cord. Myelitis refers to inflammation in the spinal cord.

AFM is a curious disease. There were rare reports of it before this decade, but in 2014, it sprang onto the scene and numbers have flared up every 2 years since. We aren’t sure what causes it yet, but it seems to cycle with peak occurrence during late summer and early autumn. It happens almost exclusively in children and teens.

The vast majority of afflicted kids have had cold symptoms (cough, runny nose, fever) during the prior week and some AFM patients test positive for viruses in their spinal fluid. This suggests that certain viral infections may trigger AFM. The CDC has some leads, but is casting a wide net and has not ruled out the possibility of an environmental or toxic cause.

When should I worry?

While AFM cases are increasing, it’s very important to understand that this is still an incredibly rare disease. There have been 430 confirmed cases in the US since 2014 and 106 confirmed cases this year. This disease happens to fewer than 1 out of 1 million children.

Here’s what to watch for:

  • Sudden onset of weakness in an arm and/or leg on one side of the body.
  • Facial droop, difficulty with eye movement, drooping eyelids, swallowing difficulty, or slurred speech may also occur.
  • Numbness and tingling is rare, although some patients report limb pain.
  • In rare and severe cases, AFM may affect the respiratory muscles and cause breathing problems.

If your child has any of these symptoms, they should be seen in clinic (or the ER if they are having breathing problems). Workup typically involves blood work, spinal cord imaging, and possibly a lumbar puncture (spinal tap). Treatment is typically determined on a case-by-case basis and would likely be led by a pediatric neurologist.

Can AFM be prevented?

We do not yet have a sure-fire way to prevent AFM, but for now, wash your hands well and frequently, protect your family from influenza with yearly flu vaccines, and try to share holiday meals rather than winter germs. Rest easy by remembering that while virtually all kids will get a cold (or 10 of them) this fall and winter, exceedingly few will get AFM. Let us know if you have questions!

Pediatric Walk-In Flu Shots Now Available

By Jennifer M. Sauer, M.D.

Walk-In Flu ShotsWe strongly believe in the importance of giving the flu vaccine to our patients. Therefore, we allow our patients to walk in for flu vaccines while we’re open with the hours listed on our website. Staffing has even been increased while kids are out of school to make it quick and convenient for our patients and families to get their flu shot at all three of offices.

Influenza Cases Reported in Missouri

Influenza is already in the area with the CDC report showing 147 lab confirmed cases in Missouri during the week of October 7th – October 13th. There’s also been the death of a child because of influenza this year in Florida. (Per the Florida Health Department where the CDC reports sporadic activity of influenza currently.)

Per the American Academy of Pediatrics in September 2018, excluding the 2009 pandemic, the 179 pediatric deaths reported through August 18th, 2018, during the 2017–2018 season (approximately half of which occurred in otherwise healthy children) are the highest reported since influenza-associated pediatric mortality became a nationally notifiable condition in 2004.

As of October 6, 2018, a total of 183 pediatric deaths had been reported to CDC during the 2017-2018 season. This number exceeds the previously highest number of flu-associated deaths in children reported during a regular flu season (171 during the 2012-2013 season). Approximately 80% of these deaths occurred in children who had not received a flu vaccination this season.

Source: CDC.gov

Some sources estimate the total death toll from influenza nationwide last year to be 80,000 people. But only flu deaths in children are directly reported to the CDC.

American Academy of Pediatrics (AAP) Recommendations

The American Academy of Pediatrics (AAP) recommends annual influenza vaccination for everyone 6 months and older, including children and adolescents, during the 2018–2019 influenza season.

Special effort should be made to vaccinate individuals in the following groups:

  • all children, including infants born preterm, 6 months and older (based on chronologic age) with chronic medical conditions that increase the risk of complications from influenza, such as pulmonary diseases (eg, asthma), metabolic diseases (eg, diabetes mellitus), hemoglobinopathies (eg, sickle cell disease), hemodynamically significant cardiac disease, immunosuppression, renal and hepatic disorders, or neurologic and neurodevelopmental disorders;
  • all household contacts and out-of-home care providers of children with high-risk conditions or younger than 5 years, especially infants younger than 6 months;
  • children and adolescents (6 months–18 years of age) receiving an aspirin- or salicylate-containing medication, which places them at risk for Reye syndrome after influenza virus infection;
  • children who are American Indians and/or Alaskan natives;
  • all health care personnel (HCP);
  • all child care providers and staff; and
  • all women who are pregnant, are considering pregnancy, are in the postpartum period, or are breastfeeding during the influenza season.

Also per the AAP, those patients with history of egg allergy can safely receive an influenza vaccine as long as there are no other contraindications to the vaccine.

Be sure to visit our contact page for office hours so you can plan a good time to get your flu vaccine.

Provider Spotlight: Dr. Andrew Huss

Interview of Dr. Huss by Matthew Hornung, Director of Information Technology for Lee’s Summit Physicians Group

Dr. HussDr. Huss is a board certified pediatrician who joined our practice in 2015. He graduated from University of Nebraska College of Medicine in 2012, and completed his pediatric residency training at Children’s Mercy Hospital in 2015. Dr. Huss chose pediatrics as it combines the science of medicine with the opportunity to educate and have fun, rewarding interactions with families. Outside of work he enjoys soccer, travel, and home improvement projects.

The following is a Q&A session we had with Dr. Huss.

If you could learn to do anything, what would it be?
It would be cool to learn to fly a helicopter or land a passenger plane.

What’s your favorite indoor/outdoor activity?
I love hiking, whether ‘hiking’ around town or real hiking at state/national parks!

What is your favorite thing about working at LSPG?
I love coming in to work every day. Seeing kids learn new things and grow and develop is a joy, and it’s also great seeing parents grow and learn to deal with all of the curve balls their little ones learn how to throw.

What drew you to LSPG originally? And how has LSPG changed since?
I was drawn to LSPG because I loved the great attitude of the group and the staff – when I saw the clinic in action I knew I wanted to be a part of it. Although some small things have changed in the 3 years since I arrived (such as new evening hours) the overall atmosphere remains the same.

What is your least favorite food? And your favorite?
Least favorite? Gummy bears.
Favorite? Dark chocolate.

We are so glad to have Dr. Huss on our team!

Provider Spotlight: Valerie Monroy

Valerie Monroy, C-P.N.P.One of the things we plan to share with you every month is a provider or employee spotlight. This month, we asked provider Valerie Monroy some questions that hopefully give you a little more insight into what makes Valerie tick.

What was the last experience that made you a stronger person?

Becoming a mother has been an amazing experience. My husband and I welcomed Anna into our family three years ago, and she has made me a better person and a better provider. Being a parent has been challenging, humbling and the most rewarding experience thus far. We welcomed our second child, a son, a year ago. Since becoming a parent, I am able to better understand parent’s concerns about my patients and my own experiences provide me with better understanding outside the medical realm.

What’s your favorite indoor/outdoor activity?

Indoor; I love to cook and try new things in the kitchen. Outdoor; I love to travel and learn new cultures.

I guess I was bitten by the travel bug early in life. During college I was fortunate enough to study abroad for a semester in Sevilla, Spain. While there, I took the opportunity to visit neighboring countries. I have traveled to most of the continents but one of my favorite trips was to South America to meet my husband’s family. We hope to return and take our whole family soon. In the meantime, we practice Spanish at home and are raising our children bilingual so they will be familiar with this part of their heritage and be able to communicate with all of their family members.

What would you do (for a career) if you weren’t doing this?

I would have my own food truck! That way I can travel and cook.

How do you define success?

Success for me starts at home. No professional or personal achievements can compensate for a lack of meaningful relationships in my life. If I am able to succeed as a wife and mother the rest seems to fall into place.

What is your favorite thing about working at Lee’s Summit Physicians Group?

Lee’s Summit Physicians Group is very family oriented. We provide great care and I am always proud to tell people about where I work.

What drew you to LSPG originally? And how has LSPG changed since?

LSPG has an outstanding reputation in the community. As a Neonatal Intensive Care Unit nurse at Children’s Mercy for over 6 years, I always knew I wanted to continue my career in a clinic that was well regarded and known for the good care provided to their patients. That is how I found LSPG. Many things have changed and will change in the future, but I believe our reputation will remain the same; a welcoming office that provides outstanding care to all.

What is your role at LSPG. What does that really mean you do on a daily basis?

As a Nurse Practitioner I see patients in the urgent care or in clinic during scheduled appointments. One of my favorite things about this job is being able to see my patients grow and watching families grow over the years. It is always exciting to see the newest member of the family.

What is one thing that the rest of the staff at LSPG doesn’t know about you?

I played the saxophone for many years and I plan to join a jazz band when I retire. (Well, only the first part is true!)

The Magic of Disney, Mickey and the Carousel of Progress

Jennifer M. Sauer, M.D.By Jennifer M. Sauer, M.D.

Where is Your Happy Place?

If anyone were to ask me “Where is your happy place?” my immediate answer is Disney World, The Happiest Place on Earth.

My obsession with anything Mickey Mouse began in 1989 when my family was able to take our first planned vacation. I happened to turn 16 while we were there, but the trip was NOT for my 16th birthday. It just happened to occur while we were there since my birthday is around spring break.

My mom has had Multiple Sclerosis for as long as I can remember. Anyone can tell you that living with, or caring for someone with a chronic illness isn’t easy. But for those four days in Disney World, my Mom wasn’t sick. Disney took care of everything. Mickey mouse shaped ice cream bars, a birthday cake with my name on it, fixing the door in our hotel room and then leaving a porcelain Mickey as a gift for the inconvenience. I just remember a sense of calm and pure joy!

Lees Summit Physicians Group: Disney Lees Summit Physicians Group: Disney

 

Some of my most precious memories have happened at Disney World.

Lees Summit Physicians Group: DisneyI’m blessed with a husband that takes all of my Disney passion and embraces it. We went to Disney World for our honeymoon, and on the first night we had a nice table overlooking the water. But as soon as Mickey came in the dining room, I was jumping up and waving him down. The waiter had to come reassure me that Mickey would be over in a minute.

I’ve been able to watch my kids light up when seeing the characters and run to hug them as young children. And then taking pictures in the same places many years later, but no longer being held on my hip. Within Disney World, they’ve watched many firework shows and parades, have overcome their fear of roller coasters, and continue to eat Mickey shaped food items and wear Mickey ears.

A recent visit to Magic Kingdom was like getting a history lesson.

Carousel of Progress is my all-time favorite attraction due to its sentimental/nostalgia value to me. Walt was intimately involved in this exhibit, and it is the only ride in Disney World that he actually rode. The exhibit was originally developed for the 1964-65 New York World’s Fair,. It was originally in Disneyland and then moved to Disney World in 1975. (Walt died approximately five years before Walt Disney World opened.)

While riding the Carousel of Progress, the song “It’s a Great Big Beautiful Tomorrow” plays between the scenes. Our tour guide said if you change the word “Man” in the lyrics to Walt, it has a new meaning:

Man (Walt) has a dream and that’s the start.
He follows his dream with mind and heart.
And when it becomes a reality,
It’s a dream come true for you and me.

Walt Disney was a visionary and a dreamer. He believed “If you can dream it, you can do it.” I was inspired to be able to follow my dream of becoming a doctor. Naturally, I needed to be a pediatrician so that I never had to grow up and can still wear Mickey Mouse shoes to work.

Provider Spotlight: Kailey Wilson

By Kailey Wilson, D.O. with Lee’s Summit Physicians Group

Kailey Wilson, D.O.I knew I loved science growing up, so I chose biology for my major in college. I didn’t know what to do with it until I went on a medical mission trip with my church to Peru my junior year of college. We set up shop in a community orphanage and I knew this was where my gifts and passions collided. It’s an awesome feeling to get to do what you love on a daily basis, and I feel so blessed and fortunate to get to do just that.

Family

My husband and I got married right before I started medical school, and he has supported me all the way through. I couldn’t have made it without his love and support! We had our first child Tucker during my intern year of residency – it was a little crazy, but I wouldn’t have had it any other way! He is a joy to our family. After starting with Lee’s Summit Physicians Group last fall, we welcomed our daughter Eeva just before Christmas. She loves watching her big brother and he loves to make her laugh! I love that having kids gives me insight and experience that can hopefully help make me a better pediatrician!

Fun

One of our favorite things to do as a family is go on walks. We love to be outside together. We also like to go to the lake and enjoy water skiing and swimming. And, we love to cook food for our family and friends. We lived away from our families during my residency, so we’re thrilled to be back closer to them and we enjoy getting to see them often.

Advice for Aspiring Medical Students

Advice I would give anyone who is thinking of pursuing medicine: be 100% sure that is what you want to do. It’s a long road and it takes all of your commitment. But if you are sure, the discipline will follow and when you reach your goal, you will be in such a rewarding place every day. There are hard days, especially with balancing a family and a career, but I cherish my role as both a mom and a pediatrician. I feel so lucky to get to be both!

It’s truly an honor that other parents would entrust their children’s health to me. I understand the weight of that gift as a parent. I pray that I will always have that perspective… of what a privilege it is to care for their precious little ones. I think that perspective will make me a better pediatrician!

Kailey and Family

LSPG Uses Virtual Reality to Reduce Anxiety During Pediatric Care

By Daniel E. Gershon, DO – Lee’s Summit Physicians Group

I remember one or two years ago watching a news report that showed how the military was using sophisticated virtual reality (VR) to help soldiers, who were burn victims, reduce the need for or strength of narcotics during long and painful medical procedures. Soldiers were put into immersive VR (blocking out all surrounding reality) and then used a program called SnowWorld 3D.

SnowWorld 3D

In this game, soldiers were taken through an ice and snow environment where they had to focus on throwing snowballs at snowmen. One hit would freeze them, but a second hit would shatter them. The blue and white colors were intended to create the opposite emotion of the burns that injured their bodies.

Studies have clearly shown that VR can reduce the pain and anxiety of painful medical procedures. Pain requires attention, and the more attention diverted leaves fewer signals to the pain receptors in the brain. So, I began to think about my patients. Pain and anxiety are experienced everyday in a pediatric office.  Most kids have a certain degree of fear and anxiety just thinking about getting a vaccine or having blood work done.

I remember my nephew nervously asking me about whether or not he needed any shots at his next check up. I said, ”When is your next visit?” He replied,”In three months!” Typical fear and anxiety only require a patient to hold a parent’s hand, look away, or start a short filibuster by asking questions. Atypical (and not uncommon) fear and anxiety results in patients needing to be held down by parents or staff and can cause post traumatic stress triggered at future visits. It can also result in staff being injured or having an unnecessary needle or blood exposure.

The CHARIOT Program

In my research, I found that VR has just started being used in some children’s hospitals and very few pediatric offices. Most VR use in children’s hospitals are during chemotherapy and pre-op/anesthesia. I reached out to staff at Lucile Packard Children’s Hospital Stanford in California to discuss their CHARIOT program (Childhood Anxiety Reduction through Innovation).  They created their own software but used commercially available VR headsets. I learned how and when they implement it and started using VR in my office with patients that I could identify as “high risk” for anxiety.

VR Being Used at Lee’s Summit Physicians Group

Using my own iPhone, a $30 headset from Toys-R-Us, and several VR apps I downloaded from iTunes, I immediately began to see just how powerful distraction and immersion can be.

LSPG Virtual Reality LSPG Virtual Reality

A 5 year old boy with autism was struggling during the end of his exam. He is non-verbal and had become combative. He still had his kindergarten vaccines left. Sitting on his parent’s lap, we struggled to put the Oculus Go (yes, we upgraded!) headset on him. Once the headset was in place, he instantly became still and started reaching out to grab the manatees during his underwater adventure in an app called Ocean Rift.

Another example? A mother’s jaw dropped when her 8 year old boy made it through blood work without even flinching. Last year he had to be held down by his mother and staff to have blood work done. “This is amazing!” she said.

LSPG Virtual Reality

Currently, our office is using the Oculus Go (VR) headset for patients 5 years of age and older who have a high likelihood of anxiety with a painful procedure. There are approximately 8 different immersion experiences for them to choose from ranging from underwater Ocean Rift, Star Wars Droid Repair, Learning to fly an airplane, to more adolescent experiences like traveling through the body or moving in and out of the International Space Station.

The results over the past 6 months have been impressive, but it doesn’t work for every patient. Some patients have to see what is happening, but most are completely immersed in a dazzling 360 degree world with amazing graphics and sound. We will ask, but if you’re interested in your child using VR at his/her next appointment, feel free to ask your nurse or provider about it.

LSPG Virtual Reality