KALAMAZOO, MI – Borgess has received Gold Plus achievement in Get With The Guidelines®, a quality improvement program helping hospitals ensure patient care that’s consistent with the most up-to-date scientific guidelines from the American Heart Association and American Stroke Association.

To receive this award, Borgess achieved 85 percent or higher adherence to all Get With The Guidelines-Stroke Quality Achievement indicators for two or more consecutive 12-month intervals, as well as realized 75 percent or higher compliance with six of 10 Get With The Guidelines Stroke Quality Measures. Designed to reduce death and disability, and improve the lives of patients, these quality measures include aggressive use of the latest stroke medications, cholesterol-reducing drugs and smoking cessation.

For more on our stroke care difference, visit stroke.borgess.com.

Funded through grants from The Perrigo Company Charitable Foundation and Borgess Health, the screening offers participants the opportunity to learn about their risk for stroke. Health care professionals will be available to talk about warning signs and assess key stroke risk factors, including high blood pressure, diabetes and cigarette smoking.

About 795,000 Americans each year suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds.

Pre-registration for this screening is required. Call (269) 226.8135 or (800) 828.8135.

KALAMAZOO, MI – Thanks to the community support for the 2011 Borgess Tree of Love campaign, hundreds of low-income women without health insurance will receive potentially lifesaving gifts in the New Year—free mammography services.

“Because of the generosity of area residents, we exceeded our goal of $50,000 ($51,001),” said Kim Loftus, CFRE, development officer, Borgess Foundation. “While more women than we expected will be helped by this extraordinary kindness, we encourage those who still wish to contribute to do so. The holidays may be officially behind us, but the need for support of these vital services continues to grow.”

The actual goal was “topped” through a generous donation from Dr. Dean J. Copely, who also served as one of the campaign’s physician champions.

Major sponsors of this year’s campaign included Blue Cross Blue Shield of Michigan; Cole Buick-GMC-Cadillac; Hall Render Killian Heath &Lyman; Kalamazoo Amusement; Miller Johnson, Attorneys and Counselors; Sanford Tolchin, MD; The Surgical Group of Southwest Michigan; The Tyler Little Family Foundation; and Julia and William Van Domelen.

Since 1985, the Borgess Tree of Love campaign has helped countless women receive free mammography services to identify breast cancer. The campaign also provides an opportunity for donors to honor employees, colleagues, family and friends. The names of donors and those receiving this special tribute are listed on the Web site, and honorees receive an acknowledgement card in the mail.

The Borgess Foundation still welcomes tax-deductible donations at treeoflove.borgess.com. Donor forms are also available for mail-in contributions by calling (269) 226.8100. CJ’s Pub (1027 Schuster, Kalamazoo) will also hold its annual breast cancer dart tournament on Saturday, January 28, beginning at 4 p.m. Proceeds will again benefit the Borgess Tree of Love. To learn more, call (269) 343.4577.

Every $8 donation to the Tree of Love campaign helps a woman receive a mammogram, while allowing the donor to honor or remember someone special. Every $80 donation sponsors a mammogram for a woman and allows the donor to honor or remember up to 10 people.

It’s estimated that one in every five women does not have insurance that covers breast cancer detection services, such as mammography. Several studies have shown that mammograms can reduce a woman’s risk of dying of breast cancer.

“The American Cancer Society estimates that nearly 34,000 American men will lose their lives to prostate cancer this year,” said Anthony R. Gauthier, MD, board-certified urologist with Borgess Lee Medical Group. “The good news is that more than 2 million men in the U.S. who have been diagnosed with prostate cancer are still alive today. If prostate cancer is detected early through simple and painless testing, it can often be successfully treated.”

What is a PSA Test?

A PSA test is a painless screening that measures the amount of prostate-specific antigen, a substance released into a man’s blood by the prostate gland. Low amounts of PSA may be found in a healthy man’s blood; however, this substance typically increases as the prostate enlarges with age. PSA may also increase due to inflammation of the prostate gland or prostate cancer.

Dr. Gauthier and Joe Mashni, family nurse practitioner (FNP), Borgess Lee Medical Group, will provide the free prostate cancer screenings. Testing is recommended for men 50 and older. Test results will be confidentially mailed to participants, and if requested, their physicians. To learn more or register for this free screening event, call (269) 783.3053.

Girls names
Lilly
Brook
Ella
Olivia
Sophia 

Boys names 
Cameron
Braydon
Lucas
Jaxson
Aiden

Celiac Disease is an autoimmune disease (abnormal immune response against your own body) caused by an abnormal response to gluten, a protein in wheat and some other grains. Celiac Disease is also known by the names Celiac Sprue and Gluten Sensitive Enteropathy. Celiac Disease occurs in about 1% of the general population.

What causes Celiac Disease?

Celiac Disease is, at least in part, genetically mediated. Almost all people who develop Celiac Disease have either the HLA-DQ2 or the HLA-DQ8 gene or both. Not everyone with the DQ2 or DQ8 gene develops Celiac Disease, but the presence of one of these genes is a prerequisite.

In addition, it is possible that activation of yet another gene is also required to develop Celiac Disease. An alternative theory is that some other triggering event is required such as an infection. Adenovirus and rotavirus have been implicated in some studies.

What are the Symptoms of Celiac Disease?

Some people with Celiac Disease have few or no symptoms. Some people with Celiac Disease only recognize that they have had symptoms after they are treated and in retrospect notice that the symptoms went away.

People with Celiac Disease most commonly notice pain, gas and bloating and diarrhea when they eat gluten, a protein found in wheat, barley and rye. They may have a poor appetite (anorexia). They may also experience constipation at times.

These symptoms are in part due to villous atrophy (The absorbing fingers inside the gut wall are blunted.) and hypoplasia (not fully developed) of the small bowel architecture. This blunting of the villa leads to poor absorption of carbohydrates. Which, in turn, leads to bacterial overgrowth.

Children with Celiac Disease may not grow normally. They may come to medical attention for poor weight gain or short stature or both. Pubertal delays may also manifest themselves.

Because of the malabsorption caused by Celiac Disease various nutritional deficiencies may develop:

• Some people with Celiac Disease may have anemia from iron deficiency.
• Vitamin K deficiency may cause abnormal bleeding.
• Vitamin D and calcium deficiencies may lead to osteopenia or osteoporosis (loss of bone).
• Patients with B-6 deficiency may develop neurologic (nerve) symptoms.

Some may develop a skin rash called dermatitis herpetiformis. It is a raised red rash with clear blisters. It itches and may be confused with poison ivy. It can leave scars. Biopsy of the rash may lead to the diagnosis of Celiac Disease.

Patients with Celiac Disease may develop defective dental enamel. This, in turn, may lead to frequent tooth decay.

Mouth ulcers and lactose intolerance are present in some patients. Liver disease and arthritis also can occur. There is also an increased risk of developing some types of lymphomas and gastrointestinal cancers.

There is an association with hyposplenism (The spleen does not function properly.) that in turn leads to an increase in the infection rate.

There is an increased risk of developing Celiac Disease in patients with:

• Diabetes
• Thyroid disease
• IgA deficiency
• Down Syndrome
• Williams Syndrome
• Turner Syndrome

What are the tests for Celiac Disease?

Blood tests (serology) are commonly used to screen for Celiac Disease as the initial test. These tests look for abnormal antibodies produced in patients with Celiac Disease. These tests must be done before any treatment is begun or the tests may be falsely negative.

Additional blood tests are done in patients who are IgA deficient as the usual screening tests depend on the presence of IgA antibodies. And many patients with Celiac Disease are also IgA deficient.

Blood tests may also reveal the presence of DQ2 and DQ8 genes discussed earlier.

As a confirmatory test, biopsy of the small intestine while the patient is on a diet rich in gluten has been the gold standard. However, as the blood tests become more sensitive, some clinicians feel comfortable diagnosing Celiac Disease without requiring a biopsy. Biopsy may only be requested when the blood tests are equivocal.

Who should be tested?

Patients with the following symptoms, if not otherwise explained, who are on a gluten containing diet:

• Failure to thrive
• Persistent diarrhea
• Chronic constipation, recurrent abdominal pain, or vomiting
• Dental enamel hypoplasia of permanent teeth (symmetric distribution)
• Dermatitis herpetiformis
• Idiopathic (unknown cause) short stature
• Significant pubertal delay
• Iron deficiency anemia not responsive to supplementation

Patients with the following high risk factors:

• Relatives of patients with celiac disease
• Autoimmune thyroiditis
• Type 1 diabetes
• Down syndrome
• Turner syndrome
• Williams syndrome
• Selective IgA deficiency

How is Celiac Disease Treated?

While there is no cure for Celiac Disease, most of the symptoms and consequences of Celiac Disease can be reversed or prevented by strictly following a gluten free diet. This means avoiding all wheat, barley and rye flour. Gluten is used in the production of other foods. Gluten may also contaminate other grains if they are milled in the same facility.

Patients should read food labels carefully. Finding palatable foods that are gluten free has become much easier in recent years. Newly diagnosed patients would do well to arrange for consultation with a certified dietician.

Patients may be advised by their physicians to take extra amounts of vitamins K, B-6 and D, iron, as well as extra calcium.

Patients with Celiac Disease are more prone to certain infections. It is critical that they are up to date in all immunizations, but especially the immunizations that help prevent pneumonia.

Only rarely does Celiac Disease not respond to the treatments outlined above. In such cases steroids and or immunosuppressant agents may be considered.

After six months of successful treatment, the serology should be repeated to look for a decrease in harmful antibodies.

Can Celiac Disease be prevented?

There is some early research to suggest that prolonged breast-feeding with the slow and delayed introduction of gluten into the diet may be helpful for infants at increased risk of Celiac Disease.

Asymptomatic patients whose serology is positive may choose to foloow a gluten free diet.

What should I do if I suspect my child has Celiac Disease or is at risk for Celiac Disease?

You should make an appointment with you health care provider for an extended visit. Do not start your child on a gluten free diet until instructed. Starting your child on a gluten free diet prematurely may interfere with making a clear-cut diagnosis.

Other Helpful Links
www.nlm.nih.gov/medlineplus/celiacdisease.html
www.celiac.org
www.csaceliacs.org
www.cdhnf.org
www.uptodate.com

Eric J. Slosberg, M.D., a Board-Certified pediatrician, is accepting new patients at ProMed Pediatrics in Richland, call (269) 552-2500.

Influenza is a viral infection that causes sudden high fevers, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.  Serious infections may develop following a case of influenza – especially in infants and children with serious underlying health conditions.  A child with asthma or heart problems or an immune problem who contracts influenza can have a severe and complicated illness that may put them in the hospital or worse.  A baby who contracts influenza can have severe health problems.  An influenza infection also has serious health consequences for adults, particularly those who have chronic breathing problems or people who are unfortunately going through chemotherapy. Other high-risk patients are those who have asthma, a weakened immune system, any heart, lung, kidney, blood or liver diseases, diabetes, or are pregnant.

Many people don’t get the flu shot because they are concerned about the feeling they get after the shot.  Mostly people have some soreness at the site of the injection.  If you are in the minority of people who feel different or have mild body aches after the vaccine, that feeling is your immune system “kicking in” and forming protective antibodies to influenza.  A lot of people refer to infections that cause vomiting and diarrhea as “the flu.”  It is not.  The viral infections that affect people’s guts are actually something different from influenza.

Every year, tens of thousands of Americans die from influenza.  Getting a needle stuck in your arm isn’t fun, but it is the least you can do to protect yourself and your loved ones against this serious and possibly life-threatening infection.

A Few Words About Safety

Vaccines are safe and they work. Vaccinating children and young adults may be the most important intervention I do as pediatrician.  There will likely always be controversy surrounding vaccination. However, the vaccine campaign is truly a victim of its own success. It is because vaccines are so effective at preventing illness that we even discuss whether or not they should be given. Because of vaccines, most of us have never seen a child with polio, tetanus, whooping cough, bacterial meningitis or even chickenpox. Because of vaccines, most of us have never known a friend or family member whose child died from one of these diseases.

If you still have doubts about vaccines, keep in mind that thousands of our brightest scientists and physicians have studied the safety and effectiveness of vaccinations for many years.  We are confident in recommending these vaccines and the schedule for when they should be given.

In the end, bad things unfortunately do happen to good people. We should take comfort knowing we have the power to prevent serious or life-threatening illnesses from striking those we love through safe and effective vaccines.

For more on the importance of vaccination, visit:

www.flu.gov

www.cdc.gov

www.whattoexpect.org/news/immunizations

www.vaccinateyourbaby.org

www.aap.org/immunization

www.cdc.gov/vaccines

Thomas R. Akland, DO, FACOP, FAAP is a Board-Certified Pediatrician, the Medical Director for Southwest Michigan Children’s Healthcare Access Program, and is accepting new patients at Borgess Family Medicine in Plainwell, call (269) 552-0100.

• Infants need 9 to 12 hours of sleep during the night and 2 to 5 hours of sleep during daytime hours (naps lasting from 20 minutes to 2 hours).
• Toddlers (1 to 3 years of age) need 12 to 14 hours of sleep over a 24 hour time period, usually a nap after lunch lasting 1 ½  to 3 hours.
• Preschoolers ( 3 to 5 years of age) need 11 to 13 hours of sleep; some need a day time nap and some outgrow the nap at 3 to 4 years old
• School age children (6 to 12 years of age) need 10 to 11 hours of sleep
• Teenagers need about 9 hours of sleep

Signs of sleep deprivation in a child can include:

• Mood.  Sleep deprivation may cause your child to be moody, irritable and cranky. In addition, he/she may have a difficult time regulating moods. Older children may become easily frustrated or be upset more easily. Infants and toddlers may be fussy or have more temper tantrums.
• Behavior. School-aged children who do not get enough sleep are more likely to have behavior problems, such as defiance and hyperactivity. Teenagers who are sleep deprived are more likely to engage in risk taking behaviors, such as drinking and driving fast.
• Cognitive Ability.  Inadequate sleep may result in problems with attention, memory, decision making, reaction time and creativity—all of which are important for school performance. Studies show that teenagers who get less sleep are more apt to get poor grades in school, have more tardiness/absences and fall asleep at school.

Here are some recommendations to help your child get the best sleep, to fall asleep easily, and maintain sleep.

• Sleep schedule. The bed time and wake time should be consistent from day to day, not more than an hour difference from school day to non school day.
• Bedtime routine.  A routine that last 20 to 30 minutes is best. Calm activities, books and reading are best. Avoid activities that require the parent’s presence, like rocking or holding to help the child get to sleep.
• Sleep environment.  Background noises, location, sleep partners, bedding, favorite toys, temperature of the room and lighting can all affect a child’s ability to fall asleep and maintain sleep.
• Sleep only zone.  Remove most toys, games, TVs, computers and video games from the bedroom.
• Caffeine.   Avoid drinks with caffeine after 3 p.m.
• Daytime routines.  Consistent schedules and regular mealtimes and playtimes also help to improve night time routines.
• Exercise.   Daily exercise also helps with initiating and maintaining sleep.
• Naps.  Nap times should be geared to your child’s age and needs. Long naps should be avoided.

Many children have nighttime fears at bedtime and most have these at some age. They are a normal part of development. Children have different fears at different stages of development, for example some young children are afraid of monsters. Young children have difficulty distinguishing the difference between real and imagined.  If your child is having difficulty with nighttime fears, your health care provider can help. Give us a call or come in for a visit.

Sleep or night terrors are common in children. They usually happen 1 to 2 hours after falling asleep and can last for a few minutes to an hour. Children who are having a sleep terror may have their eyes open, usually appear agitated, frightented, some may scream or cry or talk nonsense. Although difficult to watch, the sleep terror for the child is less traumatic than a typical nightmare or bad dream. Most children do not remember a sleep terror the next day.  Sleep terrors are not a sign of a traumatic event or psychological problem. Most children outgrow sleep terrors by adolescence, sleep terrors and sleep walking does often run in families. Stress, a full bladder, fever, illness, irregular sleep schedule, not getting enough sleep, some medications, sleeping in a different or noisy environment can all contribute to sleep terrors.

Contact your health care provider if you child has difficulty falling asleep, snores or experiences unusual awakenings or has sleep problems that are causing disruption during the day.

This blog was written by Genevieve Bastos, CPNP of Richland ProMed Peds. 269 552-2500.  For more information regarding sleep habits, bedtime routines or sleep problems, please call for an appointment.

Resources:  Mindell, JA & Owens JA (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Phildelphia: Lippencott Williams & Wilkins. 

Obesity is an excessive amount of body weight in relation to a person’s height.  In children over two years of age, this can be measured by calculating their Body Mass Index (BMI).  BMI is calculated from the child’s weight and height.  It is a reliable indicator of body fat for most children and adolescents.  BMI should be assessed at every well child exam.  Once the BMI is defined, it can be plotted on a chart from the Centers for Disease Control (CDC), BMI-for-Age Growth Chart for Boys/Girls, to obtain a percentile ranking.  Children and adolescents with a BMI between 85% and 95% are considered overweight.  Those with a BMI greater than 95% are considered obese.

Why is this important?

It is important to monitor BMI because it is the best way to measure obesity on a large scale.  Children with elevated BMI levels are at risk for many health problems including:  asthma, sleep apnea, skin infections, joint pain, hypertension (elevated blood pressure), high cholesterol and type 2 diabetes.  Research has also indicated that obese children have lower self-esteem and self-confidence that has been linked to poor academic performance, fewer friends and depression.  For all these reasons, it is important to try and prevent childhood obesity and identify overweight and obese children quickly so they can begin lifestyle changes to maintain a healthy weight.

How big of a deal is it?

According to the CDC, approximately 17% of children and adolescents age two to 19 years old are obese.  One in three children from low-income families is overweight or obese by their fifth birthday.  Since 1980, obesity among children has almost tripled.

So what can we do?

Here are some easy changes that can be made at home to decrease obesity in your household:

• Eat five fruits or vegetables each day
• One hour of activity daily—does not have to be consecutive
• No more than two hours per day in front of the TV/computer/video games/phone
• Eat a healthy breakfast daily
• Limit pop to one can or glass a week
• Limit juice to one 6-8 oz. glass of 100% juice a day
• Fast food less than one time per week
• Limit sugar sweetened beverages
• Use only low fat dairy products
• Prepare food at home as a family and eat together at the table (without TV)
• Eat a diet rich in calcium and fiber
• Breastfeed exclusively until six months and maintain breastfeeding until 12 months of age

Choose one, two or three of these goals to work on as a family, once those have become routine, start on another goal to create a healthy lifestyle for the entire family.

Here are some frequently asked questions and links to resources:

Can you give me some meal suggestions that are tasty, convenient, and nutritious for my children?

http://www.aap.org/publiced/BR_WhatsToEat.htm

Feeding my child is very difficult. How can I make mealtimes less of a hassle?

http://www.aap.org/publiced/BR_FeedingKidsRight.htm

How do I know if my child is eating enough?

http://www.aap.org/publiced/BR_NutritionABC.htm

Resources:

http://www.aap.org/obesity/

http://www.aap.org/obesity/families_at_home.html?technology=1

This blog is presented by Megan Foley RN, CPNP. Please call Richland ProMed at 552-2500 to schedule an appointment to discuss obesity further with Megan Foley or one of the other providers.

In the U.S., more than 200,000 people every year are hospitalized with flu-related complications, and thousands die. While 90 percent of those who die from influenza are over 65, the flu still poses a serious health threat to kids. From September 2010 through August 2011, there were 115 deaths in children under age 18 due to confirmed influenza. Almost half of those kids were under the age of 5 and had no underlying illnesses or risk factors.

The flu season typically hits our area from November to March (peaking in January and February). The virus is spread mainly through tiny droplets (which become airborne when someone with the flu coughs, sneezes or talks). It’s possible to spread the flu before you know you’re sick. In fact, influenza is contagious one day before symptoms appear until five to seven days after becoming ill. Common symptoms of the flu include:

• Fever (unusually high) and chills
• Headache
• Sore throat
• Cough
• Runny or stuffy nose
• Extreme tiredness
• Nausea and vomiting (more likely in children)

Protection From Infection

Believe it or not, influenza has already been seen in Michigan—so put a flu shot on your to-do list today. The best way to protect yourself and your entire family from infection is to get the proper vaccination. The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6-months-old receives an annual flu vaccination. Getting vaccinated now will allow time for full immunity to develop before the flu season peaks. (Note: There is a small group of people who should not be vaccinated. Talk to your doctor before scheduling a flu shot to make sure you’re not in that group.)

This season’s vaccine protects against three flu strains: two influenza A (H1N1 and H3N2) and a strain of influenza B. There are three types of vaccines available:

• The traditional shot—approved for people 6 months and older. Containing killed viruses, the traditional shot sometimes causes soreness, redness or swelling (where the shot was given) and flu-like symptoms. Remember, these side effects are temporary and mild compared to suffering from a real bout with the flu. When given during pregnancy, the traditional vaccine protects the baby until 6 months of age, when the child can receive the shot.
• The nasal spray—approved for ages 2 to 49-years-old. While the nasal spray contains weakened viruses, it does not cause the flu. Mild and temporary side effects may include runny nose or nasal congestion, cough, fever, headache, muscle aches, abdominal pain and vomiting or diarrhea.
• The intradermal shot—approved for people 18 years and older. The intradermal flu vaccine is a shot that is injected into the skin instead of the muscle. A stronger dose is available for people over 65.

Along with vaccination, following these tips can also help you and those you love stay healthy throughout the flu season:

1. Sing “happy birthday” a lot. Washing your hands frequently with soap and water for at least 20 seconds (about the time it takes to sing “happy birthday”) reduces the spread of germs. 
2. Practice sneezing and coughing etiquette. To avoid spreading germs, cover your nose and mouth with a tissue or shirtsleeve when sneezing or coughing.
3. Keep it clean. Keep kitchen counters, bedside tables, bathroom surfaces and toys clean with a household disinfectant.
4. Schedule a sick day. If it’s at all possible, stay home from work (or school) if you have the flu.
5. You are what you eat. Eat a healthy, well-balanced diet rich in vitamins A, C and E. Foods that can boost the immune system include milk, eggs, citrus fruits, vegetables and nuts.
6. Get your z’s. Without proper sleep, you increase your odds of getting sick. Adults need at least seven hours of sleep per night (children need more).
7. Just relax. Find ways to reduce stress, including exercising, listening to music, practicing yoga, meditating or reading.
8. Kick the smoking habit. Smoking kills the fibers in your nose and lungs that help prevent mucus from clogging these airways. Breathing secondhand smoke is also unhealthy for those around you, particularly children.

About Medication

For the very ill or those at higher risk for complications, medications are available to relieve flu symptoms. Those who should seek treatment include:

• Children under 5 (especially under 2)
• People over 65
• Pregnant women and women who have recently given birth
• People with chronic conditions like asthma, or heart, lung or kidney disease
• People with weakened immune systems (such as those with cancer, diabetes, chronic infections and individuals on continued steroid therapy)
• People under 19-years-old who are on long-term aspirin therapy 

Medications, which work best if started within 48 hours of the start of symptoms, may shorten the time you are sick and can prevent complications. Side effects may include nausea and vomiting, and in children, confusion and abnormal behavior.

Lisa Kanwischer, P.A., is a certified physician assistant at ProMed Pediatrics.  For an appointment or more information, call ProMed Pediatrics in Richland at (269) 552.2500 or the Woodbridge location in Portage at (269)329-0944.

Chronic changes in mood and behavior could be a sign of bipolar disorder. Affecting about 4 percent of the population, bipolar disorder or manic-depression is a brain disorder that causes wide fluctuations in mood. A person with bipolar disorder may have sudden mood swings that vary from excessively happy (manic) to excessively sad (depressed). Thoughts of suicide and attempts at suicide may develop. During manic episodes, patients may become euphoric (intensely excited and happy) for no apparent reason.

Mood Swings

In children, obvious manic and depression mood swings are unusual before puberty. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) with poor focus, inattention, over-activity, impulsivity and fidgetiness may precede the development of mood swings. Often mood shifts in kids are more rapid than they are in adults.

Manic Phase

During the manic phase, children may:

• Exhibit feelings of special powers and superiority
• Be overly optimistic and talk excessively with what is described as “pressured speech”
• Be restless and sleep as little as four hours a night
• Have racing thoughts and laugh inappropriately
• Spend money inappropriately and engage in inappropriate sexual activity (adolescents)
• Have difficulty maintaining relationships with family and friends

Note: Hypomania, a less severe form of mania, can appear just as excessive happiness, making the diagnosis of bipolar disorder more difficult.

Depressed Phase

Episodes of mania or hypomania may be interspersed with episodes of depression. Kids may experience:

• Sadness
• Fatigue or loss of energy
• Anger or irritability
• Guilt and anxiety
• Loneliness
• Suicidal thoughts or actions
• Weight loss or weight gain
• Trouble sleeping or sleeping too much
• Inability to concentrate and make decisions

When compared with the general population, those with bipolar disorder (including children) have a higher risk of abusing alcohol and drugs.

Genetic Link

Bipolar disorder does run in families. During patient evaluation and discussion, health care providers often discover other family members who also suffer from the disorder. While there is no specific diagnostic test for bipolar disorder, there are screening tools available. Typically, the diagnosis is reached by observing and recording the common symptoms associated with the disorder. Genetic testing is not currently offered for the condition, although researchers have begun to identify specific genes linked with bipolar disorder.

Chemical Imbalance

Some scientists believe patients with bipolar disorder have a chemical imbalance in the brain, which can be effectively treated with medications. Bipolar patients also seem to have a higher number of stressful events, as well as grow up in harsher environments during their early lives.

Diagnosis is Difficult, But Key

Diagnosing bipolar disorder isn’t easy. In fact, the correct diagnosis is often delayed or never made. When seen, patients may only show depression or happiness (hypomania). For proper diagnosis, non-mental health issues should be ruled out (e.g., lead intoxication, mononucleosis and thyroid disease). There are also other conditions that can occur at the same time as bipolar disorder, including ADHD, fetal alcohol syndrome and anxiety. Because the treatment prescribed varies by condition, it is vital to make an accurate diagnosis as early as possible.

Treatment

Successfully managing bipolar disorder depends on support from a variety of medical professionals. Primary care providers will often seek consultation with psychologists, psychiatrists, neuro-psychologists and/or neurologists, who may provide mental health education, cognitive behavioral therapy, and individual and family counseling.

Therapy is designed to:

• Reduce exposure to symptom triggers
• Help patients and family members recognize early symptoms
• Reduce/stabilize full-blown mood swings
• Relieve other core symptoms
• Prevent substance abuse

Medications prescribed for bipolar disorder include mood stabilizers and anti-psychotics, such as Risperdal, Abilify, Depakote, Carbamazepine, Zyprexa, Lithium and Geodon. Because side effects and tolerance widely vary from patient to patient, these medications should be closely monitored by experienced health care providers. It is also not uncommon for bipolar patients to require other medications along with mood stabilizers to address ADHD, anxiety or severe depression.

Click here to learn more about bipolar disorder.

Eric J. Slosberg is board certified in adolescent medicine and pediatrics. For an appointment or more information, call ProMed Physicians-Pediatrics in Richland at (269) 552.2500.

In June of this year, the FDA modified its sunscreen labeling regulations. Unless they meet the FDA testing standards for protection against ultraviolet A (UVA) sunlight, sunscreens can no longer be labeled “broad spectrum.”

Protection against UVA is not included in the sun protection factor (SPF) number. While SPF has been the gold standard for conveying the strength of sunscreens, this number only looks at the sunscreen’s protection from UVB rays. However, overwhelming evidence shows that UVA radiation also contributes to early aging of the skin, as well as skin cancers like basal cell and squamous cell carcinoma, and melanoma. Only sunscreens that meet both UVA sun protection standards and have a UVB SPF of 15 or higher can be labeled as “broad spectrum,” and claim they protect against skin cancer and early skin aging.

Combined with these new standards, the FDA has banned the use of terms like “waterproof,” “sweat-proof” and “sunblock,” as sunscreen cannot actually provide these benefits. Instead, “water resistant” or “water resistance” can be used if the duration of the effect (either 40 or 80 minutes) is specified. Because their application differs from that of creams, oils and lotions, spray sunscreen formulations must also now provide additional information. These new regulations and labeling guidelines will begin in 2012 and 2013.

Physicians see these changes as long overdue, as they allow consumers to become better informed when making sunscreen choices. Regardless of the type chosen, it’s important to emphasize that sunscreens are effective for only two to three hours and must be reapplied often. Sunscreens should also be used with other protection measures, including wearing appropriate clothing and hats, limiting outdoor activities during peak hours of UV intensity, restricting activities to shaded areas, and wearing sunglasses.

Prevention Through Protection

Sun-protective practices for infants and children have been endorsed by the American Academy of Pediatrics (AAP) and American Academy of Dermatology (AAD). The skin of infants is thinner and more sensitive to the sun than the skin of older children. To protect your kids (no matter their age) from the sun, follow these recommendations:

• Remember, avoidance is the best way to protect your infant/children from the harmful effects of the sun. For babies under 6 months of age, try to keep them in the shade and out of direct sunlight. If they have to be in the sun, use sunscreens, longer clothing and a hat with a brim. When adequate clothing and shade are unavailable, a sunscreen with an SPF of 15 or higher should be applied to areas of skin (e.g., face, back of hands) of all children, including children younger than 12 months of age.
• Keep in mind, dermatologists recommend sunscreens with an SPF of 30 or higher. This is also the recommendation of the AAP and AAD, even though the FDA hasn’t approved sunscreen use for those under 6 months of age.
• There are no reported harmful side effects from today’s sunscreens. However, it’s a good idea to use sunscreens that don’t irritate the skin and/or eyes. Look for broad-spectrum, unscented brands with ingredients like zinc oxide and titanium dioxide, which tend to be less irritating and ideal for infants.
• Apply sunscreen early and often. You should apply sunscreen to your child 30 minutes before exposure to the sun, and then reapply the sunscreen every few hours. No sunscreen is waterproof, and must be reapplied at least every 90 minutes to two hours, particularly if your child spends a lot of time in the water.
• Protect your child’s lips, nose and eyes by applying a lip coating that contains sunscreen. If the nose (or some other area) has been repeatedly burned during the summer, cover it with zinc oxide or titanium oxide ointment. Protect your child’s eyes from the sun’s rays with good sunglasses.
• If your child has red or blonde hair, fair skin, and/or never tans, he/she is at higher risk for sunburn. These children need to use a sunscreen even for brief exposures and should avoid the sun whenever possible. Keep them out of the sun during the peak hours of 10 a.m. to 3 p.m., when the sun’s rays are the most intense.

Hazy or Bright, The Sun Harms Young and Old

Young or old, everyone is at risk for sunburn and its associated complications. The incidence of skin cancer continues to rise, occurring in younger and younger age groups. Since most skin damage happens in childhood, kids especially need to be protected from the sun’s burning rays. Sun exposure early in life increases the number of moles with genetic mutations (potentially leading to cancer). UV radiation exposure during the first year of life can have especially damaging long-term effects.

Think the sun is only dangerous when it’s bright out? Wrong. The harmful UV rays of the sun are invisible. Because he/she may feel cooler, and therefore, stay outside longer, your child may be exposed to more UV rays on foggy or hazy days. Exposure is also greater at higher altitudes. UV rays reflect off sand, water, snow and other surfaces, so even a big hat or an umbrella doesn’t offer absolute protection.

Relief for Sunburns

No matter how diligent we are about protection, most of us will suffer at least one sunburn during our lifetime. Leaving the skin pink/red, warm and painful, sunburns are typically first-degree burns. Prolonged sun exposure can cause blistering and a second-degree burn. In severe cases, sunburns can cause blistering, fever, chills, headache and a general feeling of illness.

If your child’s burn is minor (i.e., red, warm and painful), you can most likely treat it yourself using the following methods:

• Ibuprofen: Start ibuprofen (Motrin) or acetaminophen (Tylenol) for pain relief as soon as possible. Ibuprofen also treats the swelling from a sunburn. You may continue giving your child Motrin or Tylenol for two days.
• Steroid Cream: Apply 1-percent hydrocortisone cream as soon as possible. Use the cream three times a day for two to three days.
• Cool Baths: Apply cool compresses to the burned area several times a day to reduce pain and burning. To avoid a chill, limit cool baths (for larger sunburns) to 10 minutes. If possible, avoid using soap.
• Extra Fluids: To replace fluids lost and prevent dehydration, offer extra water during the first day of the sunburn.
• Blisters: Do not touch or attempt to treat blisters to prevent infection.
• Antibiotic Ointment: For large, open blisters, apply an antibiotic ointment.

Pain will usually stop after two or three days. Your child’s skin may peel at the site of the burn between day five and seven. If the pain becomes severe, the sunburn looks infected,  or your child develops a fever or becomes ill, call your doctor or seek medical attention.

A Seagull Named Sid

When it enlisted the help of a cartoon seagull named Sid, Australia created an effective public-health campaign. Sid encouraged Aussies to “Slip, Slop, Slap.” The message encouraged people of all ages to slip on a shirt, slop on the sunscreen and slap on a hat to protect themselves from the sun’s harmful rays. Today, the message now includes “Seek Shade” and “Slide on Some ‘Sunnies’” (an Australian term for sunglasses). The Slip, Slop, Slap, Seek, Slide message is a catchy way for you to teach your family how to stay safe from the sun.

Thomas Akland, DO, is a board-certified pediatrician. For an appointment or more information, call ProMed Physicians-Pediatrics in Portage at (269) 329.0944.

Within the first few days of life, many infants tend to be sleepy, and only cry if they need to be fed. As time goes on, a baby’s crying pattern may change or increase. Remember, some amount of crying in babies is normal. Babies may cry if they’re hungry, have a wet or dirty diaper, have a gas bubble, are over-stimulated or over tired, or are too hot or too cold. But what do parents do when it seems like their baby always cries, and it isn’t clear why?

First and foremost, look for an obvious reason for crying—hunger, dirty diapers, tiredness, or too warm or cold. Second, keep in mind that infant crying is normal and you may not find a cause. If you have a baby who is often fussy, you will probably hear the word “colic” at some point.

A Closer Look at Colic

So what is colic? Colic is defined as persistent crying in an otherwise healthy infant.   Occurring around the same time each day, colic usually doesn’t begin until approximately three weeks of age and peaks at about six weeks of age. The most common time for colic is between 6 p.m. and midnight, when parents are already exhausted from a long and busy day.

What causes colic? Believe it or not, the causes are not clearly understood. Some children are just exceptionally sensitive to stimulation, likely related to immaturity of their nervous system, while others are suffering from sensitivity to something in their diets or the diet of their breastfeeding mother. Although rare, excessive crying can sometimes signal a medical problem, such as a hernia or illness. So if you’re concerned about your baby’s crying, do not hesitate to talk to your pediatric provider.

About 20 percent of all babies develop colic, so if you have a fussy or “colicky” baby, you’re not alone. The good news is most babies outgrow colic or excessive crying by three to six months of age. Plus, there are some simple tips that may help you and your baby rest easier.

In his book, The Happiest Baby on the Block, Pediatrician Harvey Karp recommends several techniques that pediatric providers often discuss for colicky babies. Dr. Karp breaks these techniques down into the “5 S’s”: swaddling, side/stomach positioning while awake, shushing, swaying and sucking.

• Swaddling or holding your son or daughter close to you is comforting, because it mimics the closeness the baby felt inside the womb.

• Movement and noise also mimic the environment of the womb. For example, babies often respond well to gentle movement like being carried in an infant carrier, the vibration setting on an infant seat, the swaying of a swing, or even just being held as the parent gently rocks back and forth. White noise, such as the sound of a vacuum, exhaust fan or even a CD of nature/heartbeat sounds, can be comforting, too.

• If you’re nursing, talk to your pediatric provider about things in your diet that might be making your baby more fussy. Common offenders are milk, caffeine, onions, cabbage and tomatoes. If you are feeding your baby formula, talk to your pediatric provider about whether a formula change might be helpful.

• What about alternative therapies? in the April 2011 issue of Pediatrics (published by the American Academy of Pediatrics), an article reviewed the effectiveness of complimentary/alternative therapies for colic, including reflexology, massage, probiotics, sugar water and herbal teas. The authors of the article concluded that more studies should be completed before they would recommend (or not recommend) the use of these therapies.

A Few Words About Postpartum

What happens when baby and mom are both crying? Postpartum emotions can run high. Baby blues are common, and can sometimes make coping with your fussy baby even more challenging.

Always remember: as long as your little one is fed, changed and you’ve made sure nothing is wrong, it is okay to put him/her down in a safe place (e.g., his/her crib) and walk away for a few minutes. Feelings of weepiness or mild sadness can be normal after having a baby, and can be made worse with sleep-deprivation.

While 70 to 80 percent of women suffer from baby blues, 10 percent of the time, these blues can progress into full-blown postpartum depression. If you feel persistently sad and unable to care for yourself or your baby, contact your doctor immediately. ProMed Physicians-Pediatrics is also available to help with resources, so please call us if you’re concerned about your health or the health of your child.

Sandhya Sood-McMillen, MD, is a board-certified pediatrician. For an appointment or more information, call ProMed Physicians-Pediatrics in Portage at (269) 329.0944.

Key triggers for eczema include fabrics (especially wool), foods, alcohol, exposure to dry, cold weather, or very hot, humid conditions that cause sweating. Children with eczema have higher incidences of allergies and asthma. In 30 percent of infants with eczema, certain foods will lead to “flare ups.” Eczema can be mild, itchy, dry and localized or severe and extensive. Severe cases may be accompanied by unrelenting itching, sleepless nights and secondary bacterial infections.

Skin affected by eczema is usually dry and itchy, with red or salmon-colored patches. Known as the “itch that rashes,” eczema is often found on the neck, creases of the elbows and knees, ankles, wrists, and hands. The more a child itches, the worse the rash can become. Substances like perfumes, as well as dyes in lotions, moisturizers, soaps and detergents, can exacerbate the condition. If itching is very severe, open sores and infection can occur.

About Bathing

Keeping the skin clean is an important part of managing eczema. Luke-warm bath water is best. Because it helps remove crusts and irritants, provides pleasure, relieves stress and hydrates the skin, bathing should not be restricted. As an alternative to oral antibiotics and to decrease the possibility of secondary infections, some doctors recommend giving a bleach bath. (Only use one to two teaspoons of bleach in a tubful of water.)   

After bathing, towel dry and apply moisturizers or ointments within minutes. Lubriderm, Nivea, Aveeno, Cetaphil, Eucerin or Vaseline Intensive Care are ideal options. Above all, stick with moisturizers and lotions that are free of dyes and perfumes. If moisturizers aren’t enough, or there are red, dry patches, try applying an ointment (e.g., Vaseline or Aquaphor) twice a day. 

Preventing Infection

• Keep fingernails cut short
• Discourage scratching (it is okay to rub with the pads of the fingers)
• Cover “problem areas” at night
• Use Benadryl or Atarax at night to help prevent itching, which can lead to secondary infections

Medications

• For mild eczema, over-the-counter hydrocortisone or itch-x can be used (available in 1/2 or 1 percent ointments and/or creams). Administer these once or twice a day. Stop when the skin looks clear. If symptoms don’t improve within a week, take your child to his/her primary health care provider for a visit. 
• For severe eczema, a health care provider can prescribe a stronger steroid cream or ointment. Keep in mind: long-term use of stronger steroid creams may cause thinning of the skin. Steroids should be administered in small amounts, as directed by your child’s provider.
• Other medications, such as Protopic or Elidel, may be used to block the inflammatory response caused by eczema. If your child has severe and/or chronic eczema, discuss these drugs with his/her provider.

Allergies

Allergies can make eczema flare up. If your child has seasonal allergies, his/her eczema may be worse during that season. If you notice that foods, clothing or detergents irritate your child’s skin, eliminate them. Common food triggers for eczema include eggs, milk, milk products, soy, peanuts and other nuts, wheat, and chocolate. Environmental irritants include dust, mold, stuffed toys, wool clothing or blankets, pets, feathers, some soaps and perfumes.

To Learn More

Children with severe and/or chronic eczema may benefit from an allergy/dermatology referral. To learn more about managing your child’s eczema, visit:

• www.nationaleczema.org
• www.webmd.com/skin-problems-and-treatments/eczema/default.htm

Genevieve Bastos, MSN, is a certified pediatric nurse practitioner (CPNP). For an appointment or more information, call ProMed Physicians-Pediatrics in Richland at (269) 552.2500.

March has been designated National Colorectal Cancer Awareness Month, for some very good reasons.  Based on statistics from previous years, colon and rectal cancer may cause more than 50,000 deaths in 2011.  Unfortunately, some of these deaths are likely to occur in the Kalamazoo area.

The good news is that the colorectal cancer death rate has been declining for the past 15 years.  This is due to many factors, including increased colorectal screening.  Screening and colonoscopy help identify polyps so that they can be removed before they turn into cancer. 

When colorectal cancer is treated early, it is easier to cure.  Regrettably, all too often the disease still goes undetected because people are afraid and uncomfortable about the screening process, so they do not get tested. The greater Kalamazoo area has been identified as having a significantly lower rate of early detection when compared with national rates.

Fortunately, Borgess makes it easy to be tested.  Free colorectal cancer-screening kits are available from Borgess for area residents who have significant colorectal cancer risk factors.  The test used by Borgess is simple and easy to use. 

As a surgeon who has seen many persons who have been diagnosed early and cured, and others who have been diagnosed too late, I hope you and your loved ones taken advantage of this opportunity if you are at significant risk for colorectal cancer.  Visit colorectal.borgess.com or call (800) 828.8135 or(269) 226.8135 for more information about colorectal screening kits from Borgess for Kalamazoo area residents.