Why are our teeth crooked?
April 20, 2020
Spend any time in a pediatric clinic or school setting and you will notice two things: crooked teeth and cavities. Why is this the norm? A new article in this month's Scientific American tackles this question. Peter Ungar, a dental anthropologist and evolutionary biologist, thinks that the issues of today are not the issues of the past. Our ancestral kin did not have similar issues with crowding and cavities. If they did not and we do, why?
Coronavirus Update 8
April 24, 2020
SARS2 virus continues to show us that it is the cause of much morbidity and mortality in a select group that gets infected. However, as initial data sets appeared in Italy, Spain and subsequently NYC with dire risks and awful CFR's, case fatality rates, we now see that this is unlikely to be the true reality or the IFR, infected fatality rate. Let us continue our dispassionate tour through the data as we finally have some reasonable domestic data to peruse.
Covid Prevention for Children
April 24th, 2020
For Children:
Poisonings are on the rise because of excessive exposure to unprotected sanitizers and cleaners. With the increase in hand sanitizer use this year, the United States has seen a massive 36% increase in sanitizer poisoning ingestions and 12% from cleaners. (Time Magazine Article) These are preventable issues that bring us back to the reality that everything is not COVID and there are serious consequences to our behavior. Please keep sanitizers and cleaning products locked up or put up and away from young children who do not know the difference between a chemical and a beverage.
Covid Transmission
April 24th, 2020
In the British Medical Journal we see some data on viral transmission rates. "Results 3497 respiratory, stool, serum, and urine samples were collected from patients after admission and evaluated for SARS-CoV-2 RNA viral load. Infection was confirmed in all patients by testing sputum and saliva samples. RNA was detected in the stool of 55 (59%) patients and in the serum of 39 (41%) patients. The urine sample from one patient was positive for SARS-CoV-2. The median duration of virus in stool
Air Pollution - Asthma
April 24th, 2020
50th anniversary of Earth Day just passed with a whimper as COVID dominates everything. It is unfortunate as the air, the water and the food that we expose ourselves to makes for the delta in disease risk. We all want clean air, water and food. We need to fight for it. We need to press congress and our local leaders to keep us safe from pollution.
Last week (if you missed it - below) we discussed air pollution and disease related to COVID19. I was recently given another interesting article related to asthma and pollution showing massive decreases in hospitalizations and medicine use when sulphur dioxide is reduced in the air from coal burning plants by installing scrubbers. (Toussaint K. 2020)
Toussaint Fast Company Article
Last Weeks Article on PM2.5 pollution and Covid19
A new wrinkle
April 27, 2020
There is a new emerging data set that describes a rare but serious consequence to COVID19 disease, stroke or brain blood vessel clot obstruction. This is a frustratingly bad wrinkle in the continually changing landscape that is COVID. The ages are ranging from as young as 30 to 80 years old. This is a dramatic departure from what we consider a "normal" age predilection for strokes in general.
What is happening in these exceedingly rare but tragically affected individuals? No one knows yet.
Dr. David Katz
April 27th, 2020
Flattening the curve has occurred effectively in most parts of the United States. That is a good thing because we still have serious supply chain issues with protective gear for healthcare workers. I have friends that work for companies that produce the PPE materials and the stories that I am hearing as to the why are frustrating and a clear sign that the supply chain needs to be United States based form here on out. That being said, where do we go from here? We have discussed this on and off over the last few weeks. However, the issue that is arising heavily right now is the economic damage that is occurring to the most vulnerable Americans.
Coronavirus Update 9 (Dispassionate Analysis)
May 1, 2020
It appears that the pandemic is slowing down in most areas of the country. This may be a fact of the changing temperatures, humidity, quarantine events or a combination of everything. The next few months will likely be a trickle of events as some areas open up social movement and economic activity. With the current infection fatality rate at somewhere between 0.2% and 0.5%, the number of cases should be manageable nationally with the caveat that the densely populated inner cities are still the wild card for a resurgence until herd immunity is realized. This fall and winter may be altogether different with a resurgence coinciding with influenza season.
Covid Stories
May 4th, 2020
Do you want to share a story about your families experience with COVID, quarantine or life currently? If you send me your story, I will try and share some of them here.
Dr. M
Whiteboard Analysis
May 4th, 2020
When I decide to try and understand a topic as complex as human immunity, I need to see the pathways in order to understand it all. Above, I present the latest analysis of immunity and lifestyle choices as it relates to COVID. You are welcome to copy this picture and study for yourself.
The highlights are as follows. In order to have a good host response to the virus,
What is the future?
May 4th 2020
Everyone will be different post COVID19. This is probably the most truthful statement that I can make today. History has shown this to be true. Post 9/11, Spanish Flu, WWII, etc... Major stressful events always usher in a new norm. What is the future going to look like? Is it a new normal of social distancing and physical awareness? Is it a return to old habits and business as usual? Are we going to be fearful forever? Are handshakes and hugs gone? Are we mentally, spiritually, financially richer or poorer?
SARS 2 CORONA VIRUS
May 11, 2020
The SARS2 coronavirus may be triggering a version of an uncommon inflammatory condition called Kawasaki's disease in children. Kawasaki's disease is a troublesome vasculitis, inflammation of blood vessels, following a viral illness in young children. It is most often seen in young children aged less than 5 years old, but older children and adults can develop this disorder.
We see a case of Kawasaki's once or twice a decade. The incidence is somewhere around 1 in 8000 children.
TEENS
May 11th, 2020
Tattoos and body piercings have made somewhat of a resurgence in the last decade. They are increasingly glorified by professional athletes and entertainment professionals which has a profound effect on our impressionable teens. While I do not have a problem with an adult choosing to pursue body art, I think we need to be cautious with our younger and mentally unprepared tweens and teens.
Dr. Liszewski looked at a study population of tattooed individuals in the New Orleans area and looked at their regret pattern regarding tattoos. What he found was a decreasing regret percentage with an increasing age.
Poverty and COVID
May 16, 2020
To date the modeling data and infection fatality rate data are minimally useful. Statistically, we have already had more deaths than any seasonal influenza outbreak in recent memory, yet, we do not have a clear understanding of the true infection fatality rate for novel SARS2. Recent models continue to pit the IFR between 0.3 and 1.3, which is definitely worse than the flu. More testing and more analysis should get us closer to the truth as opposed to computer modeling guesswork.
Coronavirus Update 10
COVID Kawasaki's Like Disease Update
May 16th, 2020
SARS2 coronavirus seems to be triggering a very rare inflammat ory disease in children. It is similar to, yet different from, the traditional definition of Kawasaki's disease as reported to date. There have been a rash of cases with three recorded deaths in the New York City Area.
Historically, Kawasaki's disease has been around for decades and is a troublesome vasculitis, inflammation of blood vessels, that follows a viral illness in young children. It is most often seen in very young children aged less than 5 years old, but older children and adults can develop this disorder.
FOR ANYONE THAT MISSED TH WHITEBOARD SESSION. HERE IT IS FOR ONE MORE WEEK.
May 16th, 2020
When I decide to try and understand a topic as complex as human immunity, I need to see the pathways in order to understand it all. Above, I present the latest analysis of immunity and lifestyle choices as it relates to COVID. You are welcome to copy this picture and study for yourself.
The highlights are as follows. In order to have a good host response to the virus, we want a robust T Helper cell type 1(TH1) and Natural Killer cell (NK cell) response in the beginning stages of the infection
SPA Covid Plans revised
May 16th, 2020
Salisbury Pediatric Associates is working very hard to mitigate the risks of Coronavirus illness for patients that need care. We remain open and are performing many telemedicine visits to care for children.
TELEMEDICINE IS NOW AVAILABLE FOR WELL CHILD VISITS FOR MANY INSURANCE COMPANIES AND NC STATE MEDICAID.
Work is the key to all things.
May 19, 2020
For the better part of 2 decades I have been willfully preaching work ethic to all of my teenage patients. The absolute key to success in all things, in my opinion, is work. It is that which is persistent, consistent, plodding, incremental, laborious, dispassionate, self-chosen, time independent work. The theater of the effort is irrelevant. Whether you are working at parenting, medicine, relationships, sport, nutrition and so on, the principles are identical.
I have yet to find a time where persistent, consistent, plodding, incremental, laborious, dispassionate, self-chosen, time independent work doesn't provide for
Quality
May 18th, 2020
Continuing on the work theme, I just finished a fantastic article on the immunology and prevention strategies related to SARS2/COVID written by Dr. Sam Yanuck, DC and colleagues. Sam is a persistent, consistent, plodding, incremental, laborious, dispassionate, self-chosen, time independent worker that has provided for the best outcome and the most happiness for me as I learn the immuno-biology of the SARS2 world.
Obesity and Childhood Antibiotic Use
May 25, 2020
We have known for quite some time now that using antibiotics to treat infectious diseases carries secondary health risks. Medical providers and pediatricians in particular have been pushing antibiotic stewardship programs for the past 20 years primarily to fend of antibiotic resistance and the risk of bacterial infections that are untreatable. Unfortunately, the data keeps emerging that the bigger issue with antibiotic use is really the disruption of the intestinal microbiome's bacterial balance that existed pre antibiotic exposure.