Handling the Back-to-School Epidemics – Common Childhood Illnesses

Getting Ready for Back-to-School Epidemics

This post is not about COVID – there is plenty of information out there about that and I’m happy to talk with people individually about those concerns.  But every year as we start up the school season kids are around kids and kids love to share germs.  So, we usually see an uptick in strep throat, sinus infections, and stomach infections in the first few weeks after school starts up again.  This post is about the common childhood illnesses that seem to pop up when kids get back into their school routines.

Strep throat is usually characterized by a fever (including low-grade – 99.5 and above), swollen lymph nodes in the neck (they feel like little marbles or grapes next to the throat), absence or minimal cough (if the child is coughing a lot, that is usually a viral infection), and most important, white exudate on the back of the throat (this looks like milk or cottage cheese stuck on the tonsils or the back of the mouth).  If there is any exudate, or if all three of the other signs are present, do give us a call and come on in – we can treat this quickly and avoid complications related to strep throat.

On the other hand, if the child has a lot of congestion (either a runny nose or a post nasal-drip) and is coughing, this is usually a virus.  Kids pick up viruses quickly, get sick quickly, and usually get better quickly.  Watch at home if the child has a low grade fever and is otherwise acting pretty normally.  A little bit fussy or complaining is normal.  Lots of fluids is helpful, a humidifier by the bedside at night, and honey for children over the age of 2 helps to sooth the throat and reduce cough.  If the symptoms are lasting more than 3 days or if you are concerned that these aren’t normal symptoms, then let the doctor know.  If you are concerned about these symptoms in relation to COVID, then definitely let the doctor know, so we can arrange for testing.  Otherwise, watch and wait, and if they turn around in a few days then no doctor appointment is needed.  A child that is gradually improving usually does not need to be seen.  If he plateaus or takes a turn for the worse, then we are concerned about a bacterial infection setting up on top of the viral infection, and that is worth a visit.

We are concerned if the fever is above 101 degrees, or if there are muscle aches or generalized body aches.  We are very concerned if the child is lethargic – that is, she just wants to curl up in a ball and not move at all.  Other red flags include not taking in fluids, and not urinating (or if the urine is very dark).  These are signs of a more advanced illness that may require antibiotics.  The best indicator overall of a child’s health is their behaviour.  A child that is acting normally but has a 102 fever is far less concerning than a child with a 100.4 fever but is too tired to move or complain.  If the child is complaining of sharp pain in the ears, or a persisting ear ache, that is also reason to be seen by a physician to check for ear infections.

As for stomach infections – we also are usually not too concerned about nausea, vomiting, and diarrhea that is mild and lasts for less than 48 hours.  Hydrate well, drink Gatorade or Pedialyte to replace the electrolytes that are lost, and usually it will calm down within a couple of days.  Stomach infections in children are almost always caused by viruses and replacing fluids is the most important thing.  I tell frequently tell my patients “I don’t care if you’re eating or not, as long as you’re drinking.”  If the symptoms are severe, painful, or lasting more than 48 hours, then you should come in to be seen.

This is general advice that will hopefully help you decide when it’s safe to watch and wait versus when you should take your child in to be seen.  If there is a concern about COVID then definitely call – children recover very well generally but we are always concerned about contacts with people who may be at greater risk for complications from the illness.

And if you’re not sure about whether or not to call – you think this is a common childhood illness but you’re not sure, please call.  I’d much rather give reassurance early than miss something important.  If you are getting the naggy feeling that this is something more concerning than the common colds and stomach issues kids get, let us know!

Dr. Potter

 

 

Dealing with Depression
Pt. 2 – Discussing Depression with Your Doctor

The first thing a doctor will at your appointment for depression is ask a few questions about your mood and related symptoms – are you sleeping ok, are you eating more or less than normal, or are you not enjoying the thing that you normally would.  Sometimes in a visit for other issues, the doctor will notice if you are not quite yourself and ask how things are going.  Frequently someone will come in to discuss this, and then minimize what they are feeling to the doctor: “I sometimes feel down, but it’s not that bad.”  The doctor will think it’s not a problem and therefore not address it properly.   I have found that when someone brings up a concern like this it is best for me to take it seriously even if the person downplays it.  A few follow up questions will help determine how serious of an issue this is.

If you are not sure whether or not you should bring your feelings up – bring them up.  A few questions from the doctor will help determine if this is a significant issue or something that just needs some time.  Remember that it’s easier to put out a small fire than a big fire. The two-week rule is helpful for this – we all have bad days, but if it seems like a “down day” has lasted more than two weeks, talk to the doctor about it.

The next step is to screen for other things that may appear like depression.  Thyroid disorders can be ruled out with a quick test.  Anemia and electrolyte disorders can also cause you to feel sluggish and not yourself.  We also look for any problems related to alcohol or substance use, including prescription medications, that can cause depression.

Once we determine if there is a true clinical depression present, then we possible causes and appropriate treatment.  Persistent situational depression can respond very well to a good counselor.  Recurrent depression where genetics plays a role tends to respond better to medications to help get the stabilize the brain chemistry.  A combination of treatments can be used if there are multiple factors affecting the depression.

It may take several weeks to respond to treatment.  The medications are not “happy” pills; they are normal pills and we’re not really programmed to notice “normal.”  I often see couples come in to follow up on the medication, and the person taking it will say “I don’t know if it’s working, I don’t really feel different” while the spouse will say “This is night and day from where we were!”  It is important to have clear expectations – successful treatment means you feel more even-keeled, stable, and able to react appropriately to problems as opposed to feeling constantly overwhelmed.

When people do try treatment, and it works for them, they feel better.  They feel like they can be the person they used to be.  It helps them with their relationships at home, and it helps them perform better at work or in school.  Chronic depression is a heavy burden to carry, and treatment lightens the load.  If you think you may have depression that is affecting your ability to function, let us know.  We want to help!

Dealing With Depression – Part 1
Recognizing Depression

“Doctor, I feel tired all the time.  I don’t want to get out of bed.  I feel like I’m making stupid mistakes all the time…  I don’t want to hurt myself, but sometimes I think it wouldn’t be a bad thing if I had never been born.  I feel worthless, which makes me hungry – I feel good when I eat, but then I feel bad about eating…  I don’t like where I am and this is not me.”

Depression can be a subtle feeling that influences some aspects of our lives, or it can be a dramatic feeling that prevents us from enjoying any aspect of our life at all.  I am amazed at how many people don’t realize they are depressed when they come in complaining of “just feeling off.”  I will ask “Do you have any stressors in your life right now?”  “Just the usual.”  “What’s the usual?”  And then they reply with something like “Well, things are really tight financially and that’s causing a lot of friction between my spouse and I.  We have bills to pay and I don’t know if I’ll still have a job tomorrow because they’ve had to downsize a lot of the staff.  I hate my job but can’t afford to leave it.”

The numbers are also astounding – 9% of the population will struggle with severe depression at some point in their lives.  People who are facing stressors, chronically ill, in an unstable environment, or who have a family history of depression are at the highest risk for developing severe depression.  As physicians, when we discuss it in the office with patients, we usually describe it as being on a spectrum, with the genetic element on one end, and the situational element on the other end.  We are all somewhere in the middle, some with a larger genetic component and so needing only a smaller trigger, and others with a smaller genetic component and so needing a larger trigger to become depressed.  Whatever genes we have, we play the hand we’ve been dealt. 

Some people present differently than the norm.  In patients above the age of sixty we often see anger or irritability as the main presenting symptom.   As their bodies stop behaving the way their minds feel, sometimes an edge develops that wasn’t there before. In adolescents it can be challenging to distinguish between normal teenage angst and depression.  Many parents get concerned, but calm themselves down with “it’s just a phase, he’ll grow out of it.”  But the feelings persist, and the teenager is suffering.  Frequently the person feels something is off, but doesn’t know how to put it into words.  Sometimes the person knows they are depressed, but feel they need to power through it.  If these feelings last more than two weeks, or they keep coming back over time, there is assistance that can make a powerful change in the person’s quality of life – and in the quality of life of their loved ones.

If you feel this describes you, and it’s been affecting you for more than two weeks, let us know – we are here to help!

Next Week:  Part 2 – Discussing Depression with Your Doctor.

Recognizing Sleep Apnea

Always Sleepy, Never Rested


Recognizing Sleep Apnea

The problem with sleep apnea is that many people who have it don’t realize they do because, ironically, they are asleep when it happens.  It can cause significant problems with our daily functioning – making us feel unrefreshed in the morning,  fatigued throughout the day, and less able to concentrate and remember things like we should.  It contributes to high blood pressure, heart disease, diabetes, and depression. 

You are at risk for sleep apnea if you snore, have high blood pressure, have a larger neck size, or are overweight.  Men are at slightly more risk than women, but it can affect anyone with the genes for it – it tends to run in families.  Sometimes a couple will come into my office and the spouse will say “at times he will stop breathing for 15 or 20 seconds,  I’ll get concerned, and then he’ll gasp and start breathing normally, but it keeps happening.” 

There are two main types of sleep apnea – obstructive and central.  In obstructive sleep apnea, there is a blockage in the airway that affects our breathing while we sleep.  In central sleep apnea, the brain doesn’t send the signal to the lungs to keep moving air.  In both cases, the body realizes it doesn’t have enough oxygen and sends a panic signal that partially wakes up the person, enough for the brain to send the signal to breathe or for the muscles to tighten up, removing the blockage and causing the “gasp.”  Most of the time you are not conscious of these events at all, but sometimes you may wake up in the middle of the night “for no reason.”  As soon as the person starts to breathe, the body relaxes and falls back into deeper sleep, and the cycle repeats.  The problem is that the person never really gets good, restorative sleep – they are asleep, but it’s a very low quality sleep.  This causes chronic stress on the body and leads to the problems mentioned above.

Fortunately, testing has become much simpler for this condition.  We used to have to send people to a sleep center and have them stay overnight.  Now, most people can be tested at home.  If we see that there is sleep apnea then we begin treatment.  The mainstay of treatment is always diet and exercise – losing weight and toning up the muscles can help reduce sleep apnea and sometimes fix it.  The next step is CPAP – a machine that helps you breathe through the night so you can get deep sleep.  In my experience, about 20% of people who use the machine feel it’s the best thing ever after the first night, 60% of people take a few weeks to get used to it, but eventually notice a real positive benefit, and 20% just can’t stand it.  I strongly recommend sticking with it for at least a month, because once you start to feel it work, the reward makes it much easier to use.  For people who just can’t get used to the breathing machine, there are other options, including a device that holds the airway open through the night or an implant that helps to keep the muscles toned so the airway stays open.

If you feel tired constantly, or if you are in need of a family doctor, don’t hesitate to call – we can help!

Preventing Diabetes Pt. 2 – What To Do

Diabetes may be on your horizon, and you don’t want it to be, so what can be done?  The most important thing about adult onset diabetes is that it is a direct response to having too much sugar in your diet and your body’s response to that sugar. 

Reduce foods high in sugar and starch.  Most people have low hanging fruits in their diets – which is to say – simple changes that will make a big difference.  I worked with a gentleman who had a very high blood sugar when he first came in to see me.  His “low hanging fruit” was fast food and two giant-sized sodas daily.  He started to prepare his food at home and stopped the sodas completely.  Within three months he had a significant drop in his average blood sugars, and we were able to eliminate his medication.  He continued with that lifestyle for several years before his blood sugars started to climb again. 

Proteins, such as meats, beans, and eggs, as well as complex carbohydrates such as vegetables, are great for you.  The foods that are primarily sugar, or easily converted to sugar, are the problem.  This includes white bread, white rice, potatoes, and pasta.  Fruit juice and soda are also problematic, as are cookies, candy, and other sweets.  The takeaway:  Eat more protein, eat less carbs.

Deliberate exercise helps the body regulate itself.  Exercise means challenging the body by either increasing your heart rate or exhausting your muscles for a sustained period of time.  Daily activity, like gardening or moving around at work, is good but is not the same as exercise.  Exercise makes the body more sensitive to insulin so blood sugar is more easily controlled and it triggers the body’s mechanisms for repair and regulation.  If we do not exercise, the body does not get the message to regulate and repair itself, and we develop more health concerns over time. 

Sleep well.  A good night’s rest helps the body reset and prepare for the next day.  Lack of rest causes stress on the body, and that stress can impair the body’s response to insulin, causing the body to need more insulin to get the same job done.  If something is interrupting your sleep or preventing a good night’s rest regularly, talk to your doctor about this because it may be causing more problems than just fatigue.

Reduce stressors.  Just as a lack of sleep puts stress on the body, anything that causes ongoing, chronic stress impairs your body’s ability to take care of itself, and can cause an increase in your blood sugars. Identifying stressors is helpful, and a good tool to start identifying your stressors is to ask:  “If someone else were in my shoes, what would they be stressed about?”

If you are concerned about your diabetes or are worried about a family history of diabetes, we’re here to help.  Our goal is to help you and your loved ones live happy, healthy lives for years to come.  A good, personal relationship with your family doctor will protect you and your family.

Preventing Diabetes Pt. 1

Why it’s a Problem


For each of us, as we grow older we become more aware of health concerns.  Things that used to never hurt now present with daily aches.  Over time those little problems become bigger problems, and soon we realize we don’t want any new problems.  A common question people ask me is “Doctor, my dad has diabetes, his dad had it, too. What can I do to prevent that from happening to me?”  In this article we look at why diabetes is a problem and next week we’ll look at what can be done to prevent it.

First, what is diabetes?  There are two main types – Type I is where our immune system attacks the cells in our body that make insulin.  This usually occurs in children and adolescents.   We need insulin to control our blood sugar.   Type II diabetes, which is far more common, occurs when the body produces insulin but doesn’t react to it as well as it should, so the body releases more and more insulin to get the same job done.  It’s like having a hearing problem and needing to turn up the TV volume louder and louder.  In this situation, our bodies gradually lose the ability to handle sugar properly, and the sugar levels in our blood start to build up.

One problem with high blood sugar is that it causes inflammation in our blood vessels.  Inflamed vessels swell, but because of the strong vessel wall on the outside of the vessel, the vessel swells inwards, reducing the amount of blood that can flow through the tube.  As this swelling occurs, everything downstream from the swelling – nerves, kidneys, muscle cells – receive less nutrition and oxygen, as well as less visits from the repair cells in the blood.  They start losing their function, resulting in neuropathy, kidney disease, blindness, heart disease, and strokes. 

Another Problem with high blood sugar is that, as the body tries to control it, the body has to release large amounts of insulin.  Insulin is a hormone with many side effects, including driving blood sugar into fat cells for storage.  High amounts of insulin cause your body to create more and larger fat cells.  In other words, the more insulin you release, the more weight you gain.  This is not just because of the number of calories you are taking in (although that is also a contributor), but to the body’s response to the type of calories you are taking in.

How to Handle Hay Fever

Over the Counter


It’s that time of year when pollen is in the air!  Trees and plants are growing and blooming, which is beautiful to see, but terrible to experience when you have allergies.  Symptoms can range from itchy, watery eyes to a persistently runny nose, sore throat, and cough.  Some people will have sinus headaches and others will have shortness of breath, wheezing, and asthma-like symptoms—in fact, allergies, asthma, and eczema (a dry, itchy skin rash) are closely related.

There are many good options available over-the-counter to treat allergies.  I do not have a strong preference for brand name medications over their generic counterparts, and generally recommend trying the one that is nicer to the pocketbook first.  I have had a few patients that found the brand name medication did work better for them, and so recommend that if the generic is tried but is not as effective as desired, the brand name medication might be more useful. 

For people who have generalized allergy symptoms, tablets work well because once swallowed the medication is delivered by the blood stream everywhere in the body—to the nose, eyes, and airways, as well as to itchy skin.  Non-sedating antihistamines are the most common.  Claritin (loratidine) has the fewest side effects for most people, but is also the weakest.  Zyrtec (cetirizine) is stronger for most people, but can cause drowsiness in about 10% of people who take it.  Allegra (fexofenadine) is a good compromise—it’s not as sedating as Zyrtec, but also stronger than Claritin.  I generally recommend Claritin for mild allergies, Zyrtec for severe allergies, and Allegra for people who don’t tolerate Zyrtec.

Benadryl (diphenhydramine) is a sedating antihistamine.  It is generally stronger than the medications listed above but is far more likely to cause drowsiness and other side effects such as a persistent “hung-over” kind of fatigue during the day, as well as dry eyes and mouth.  It works well for severe allergies, especially if taken before bed, and is a good option to try when the non-sedating antihistamines don’t work well enough.

For people who have localized symptoms—for example, only a runny nose—there are medications that are effective and have fewer side effects than oral medications.  Flonase and Nasocort are nasal sprays that work best when used consistently for a week or more to treat nasal congestion.  Topical eye drops such as Zyrtec Eye Drops (the generic is ketotifen, which is not the same drug as Zyrtec tablets) work great for allergic conjunctivitis—the red, itchy eyes many people get with their allergies.  Topical Benadryl cream and hydrocortisone cream are good remedies for itchy skin, but should not be used for more than a few days without discussing it with a doctor.

These medications are all good first options in dealing with allergies.  If you find, however, that they are not sufficient for your symptoms, don’t hesitate to call your family doctor to discuss further options.  There are many things a doctor can do for severe allergies, ranging from prescription medications to immunotherapy (which can greatly lessen symptoms, and in many cases cure allergies completely).  If my clinic can be of service to you, give us a call!