Dear Dad,

                                                                 

  May 16th, 2022   

 

 

Dec 2013

Leave nothing left unsaid.  That is what someone advised me when we realized our time with you is limited.  As angry as I am about all the suffering you have had to endure the last several months, I am grateful that we have had time to share our appreciation and love for you.  Many people do not have that luxury.  

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Section I - An Uncivilized Journey


It is time to put aside the overloaded science side of my brain and open up the underutilized feeling side. It is time to share an experience. It is time to be a little vulnerable. It is just time. For the women readers, this piece may seem foreign at first, but I assure you that it matters to you as much as it does to us because men are part of the family and safety structure for most of us.

 ****MAY 16th, 2022 

What does it mean to go on a journey? Is it to leave home and see a new physical place and return home with a new perspective and memories.

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SARS2, the virus that causes Covid – 19,

 

 May 9th, 2022

The massive update to this theory is finished for now: it is long, complex and interesting!

COVID Pathophysiology

2021/2022 is now known to be an infectious disease with features of a human disease that span the spectrum from asymptomatic to profoundly dysregulated immune system responses leading to both aggressive inflammation and autoimmunity in the moderately to severely affected persons.

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A new and potentially devastating reaction to an adenovirus illness has been found in Alabama and other parts of the world.

May 9th, 2022

 Adenoviral illness is usually a mild to moderate respiratory illness with significant sore throat. This time it appears to be affecting the livers of a subset of children after infection.

From the CDC: All nine children were patients at Children’s of Alabama. These patients were from geographically distinct parts of the state; no epidemiologic links among patients were identified. All patients were immunocompetent with no clinically significant medical comorbidities.
Before admission, among the nine patients, vomiting, diarrhea, and upper respiratory symptoms were reported by seven, six, and three patients,

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Volume 12, Letter 21 Coronavirus Update 61 plus other stuff

 

May 9th, 2022

North Carolina like the rest of the country is still without much Covid related illness although case trend is upward.

Salisbury Pediatrics is Covid testing between a zero and 2% positive rate week by week still. Influenza A is prominent in our practice.

In NC, we are down to 5% of admitted patients needing a ventilator and 10% needing an ICU bed for Covid. Historically low numbers and almost all are unvaccinated.

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InsectsThat time of year again!

 

 May 2nd, 2022

Insect Borne Disease Prevention

Every spring and summer, many children present to the clinic with tick and other insect bites. While most bites are benign, some are not. This week we will discuss the bites and the prevention mechanisms that you can employ to reduce secondary issues.

Ticks are little 8 legged creatures that live on animals in the woods and then grab onto us when we come into contact with a plant or animal that they were waiting or "questing" on for a "sucker" to pass by.

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Section II - Return to Space

May 2nd, 2022

The Documentary Return To Space on Netflix is a definite must watch for all parents and their children. There are a few inappropriate words to be careful of at a few points during stressful Falcon launches, but overall the visuals and storyline are so
inspiring and intriguing.

We all know the genius of Elon Musk, but the story is more about persistence in the face of ridiculous adversity. Every child needs to know that the greatest gifts come from constancy of work, collaborative effort, picking the right team, leading that team and so much more.

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Section I - Death Came Romuald Magryta


May 2nd, 2022

I find that life is sending me many signals around feeling, death and life. Between completing a men's retreat last week, whereby I witnessed many amazing men challenging themselves to be better versions of themselves for their families and the population at large by looking deep inside to work through pain and locked in feelings of all sorts. I have never seen such courage and bravery in person. You could not help but be impacted and mirrored as you witness another work on their life. My work was heavily concentrated on the deaths that occurred throughout my medical career.

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Quick hits non-Covid related

April 25th, 2022

1) Firearms are now killing more young humans than cars. In 2017, there was a cross over point where 8 deaths occurred per 100,000 young persons between 1 and 24 years of age. Since 2019, firearms deaths are now at 10 per 100,000. (Lee et. al. 2022)

These results are two fold in cause in my estimation. Cars are much safer now leading to less deaths despite lots of crashes. Firearms deaths are up because as a society our mental health struggles are real and massively exacerbated by the pandemic.

2) Disinfectants and allergies: From the Journal Occupational Environmental Medicine we see - Disinfectants are widely used in the medical field, particularly recently because of the coronavirus pandemic,

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SARS

April 25th, 2022

The massive update to this theory is finished for now: it is long, complex and interesting!

COVID Pathophysiology 2021/2022

 SARS2, the virus that causes Covid – 19, is now known to be an infectious disease with features of a human disease that span the spectrum from asymptomatic to profoundly dysregulated immune system responses leading to both aggressive inflammation and autoimmunity in the moderately to severely affected persons. It is now very clear that the vast majority of these significantly affected

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Coronavirus Update 60

April 25th, 2022

Omicron now has three strains: newer variant BA.2 makes up 74% of current case volume based on different parts of the country while omicron BA 1.1 is at 6 +% and B 2.12.1 is 19%. Delta and BA 1.1.529 are now gone by competition. Cases are increasing in some cities with little increase in hospital morbidity and mortality. In essence we are still fairing quite well in the new norm.

Little else to report here. (CDC Variants)

I flew this week for the first time without a mask. It was a real feeling of normalcy.

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Volume 12, Letter 19 Coronavirus Update 60 plus other stuff

April 25th, 2022

North Carolina like the rest of the country is still without much Covid related illness. A few cities are starting to see some cases. Philadelphia was mandating masks again. (I can't believe that I just wrote those words). Now apparently they backtracked. Salisbury Pediatrics is Covid testing between a zero and 2% positive rate week by week still. Influenza A is increasing in volume at our practice.

The 7 day moving average of cases for the US in recent weeks remains low at 46,000.

The risk of death is 0.000033 once vaccinated with a two dose series or survived natural infection.

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Screenagers

April 18th, 2022

"What happens when you have an active, involved kid with good grades, who wants to play video games for three straight hours a day, every day? A father came to me with this dilemma. He explained, “My son is in 7th grade, plays on two sports teams and is an overall good kid, but I still think three hours is too much time. When he asks me why, I struggled to come up with a good reason.”

What are some good reasons? There are many, and I thought this would be a great time to share this dad’s question with colleagues who I recently spoke with on a panel at the American Academy of Child and Adolescent Psychiatry.

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Over Scheduled Kids Update

April 18th, 2022

 

- A parent's ultimate goal is to raise a capable, energy filled and happy child into a responsible, honorable and successful (depends on your goal) young adult. Historically in the 60's and 70's, parents mostly just let their children play while focusing on one instrument and random recreational sports or clubs. They were not pushy. There was ample time for family, friends and achievement. This attitude was based primarily on the economic times where middle class jobs were achievable without major educational investments.
Fast forward to today's reality of the over scheduled parent and child.

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Prenatal Vitamins

April 18th, 2022

It always has been an interest of mine as to the why the medical establishment shuns multivitamins for all while absolutely supporting them for pregnancy. ....

Prenatal and Teenage Micronutrients.

Since the early 1990's, the American medical community has recommended prenatal vitamins with folic acid as a supplement for mother's to be prior to and during the first 3 months of pregnancy. The thought was that this synthetic vitamin would be specifically targeting a group of congenital disorders called neural tube defects.

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The massive update to this theory is finished for now: it is long, complex and interesting!!

April 11th, 2022

COVID Pathophysiology 2021/2022

 SARS2, the virus that causes Covid – 19, is now known to be an infectious disease with features of a human disease that span the spectrum from asymptomatic to profoundly dysregulated immune system responses leading to both aggressive inflammation and autoimmunity in the moderately to severely affected persons. It is now very clear that the vast majority of these significantly affected individuals have a high burden of antecedent systemic inflammation in the form of chronic diseases

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Quick hits non Covid

April 11th, 2022

1) Otitis Media or a common ear infection and common childhood pneumonia in children greater than 2 years old should be treated with 5 days of antibiotics based on new data and guidelines. (Williams et. al. 2022)

This has two major downstream benefits. First, the reduced exposure to antibiotics reduces antibiotic resistance in bacteria which is becoming a big problem. Second, the reduced antibiotic exposure helps to reduce damage to the intestinal microbiome that is a known antecedent risk factor for autoimmunity and chronic diseases of inflamm"aging". I highly recommend that everyone adhere to these newer and, in my mind, better guidelines. Less is more folks.

2)Placing ear tympanic membrane ventilation tubes is not necessary if your child is not found to have persistent effusions behind the tympanic membrane when visiting the ENT specialist. This is true even in a child with recurrent ear infections.                          Dr. M

 

 

 

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Volume 12, Letter 17 Coronavirus Update 59 plus other stuff

 April 11th, 2022 

North Carolina like the rest of the country is still without much Covid related illness. A few cities are starting to see some cases. Salisbury Pediatrics is Covid testing between a zero and 2% positive rate week by week. Influenza remains relatively infrequent. All of these stats are the lowest since the pandemic began.

The 7 day moving average of cases for the US in recent weeks has plummeted from the highs of greater than 800,000 to less than 29,000 owing to Omicron's incredible activity and burn rate. Quick up and quick down.

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Stoic Thoughts

April 4th, 2022

"Marcus Aurelius and Nero had remarkably similar early lives. Both were not obvious selections for the throne. Both were told early that supreme power was in their future. Both lost their fathers young. Both were given Stoic teachers—Rusticus to Marcus; Seneca to Nero—and both tutored in philosophy.

So why did Marcus turn out to be Marcus and Nero to be Nero? Was one brilliant and just, the other vicious and unhinged?

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Self Compassion

April 4th, 2022

Is being kind to yourself a route to laziness and weakness or is it a pathway to self growth? This question gets a vigorous workout in the 2017 May edition of Scientific American Mind. In the article, The Self Compassion Solution, written by Marina Krakovsky we find a discussion on the merits of self compassion in modern times with an important look at the potential downside to this behavior.

As the competitive nature of society has increased in recent years, parents around the country are putting lots and lots of pressure on their children to succeed in school and on the sports field.

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