Spring 2012        Newsletter

Early Morning Urgent Care Clinic continues until Memorial Day!
Our walk-in hours from 8-9 AM Monday through Friday in the Foxboro office have been a great addition to our practice.   As always, parents can book a same day sick appointment by calling during business hours. We will continue the walk-in hours until Memorial Day.
Spring Health:
Save Emergency Rooms for Emergencies!
It is true that Emergency Rooms are open 24 hours per day, 7 days per week and are required by law to see all who come in to be seen.  However, in most cases we feel that the best medical care can be provided at your pediatric office where we have ready access to your child’s records and medical history.
At Pediatric Specialists, we have expanded our office hours to provide easy appointment availability.  We have walk-in hours in the Foxboro office from 8AM to 9AM on weekdays during the school year, as well as continuing our evening hours (until 9PM Mon and Thurs in Wrentham and Tues and Wed in Foxboro).  On the weekends and holidays there is pediatric availability either in Foxboro or in our covering office in Norwood.  During the overnight hours when our office is closed it is always possible to reach a nurse or physician by phone and discuss any medical concerns about your child. 
There certainly are some true emergencies which are best treated by calling 911 for an ambulance.  In pediatrics these include:

• Severe difficulty breathing
• Serious allergic reaction
• Prolonged seizure
• Severe trauma or laceration

Lyme Disease
We are again entering the time of year when Lyme Disease and tick bites are more common.  Some experts have said that our recent warm winter has led to an increase in springtime ticks but expect that the same dry warm weather will stifle the survival of young ticks (nymphs) that are most prone to spread disease.  The adult deer ticks that may latch on to people or pets now are responsible for transmitting only about 15 percent of Lyme disease.  It is the younger nymphs that typically transmit illness in May, June, or July. 
The best way to protect against tick bites is to wear long sleeves and pants tucked into socks when walking in grass or woods.  Of course this is not always practical in the summer, so insect repellents containing DEET (20% - 30%) are recommended and also a thorough body check when coming inside including the areas where ticks like to hide such as the armpits, groin, hairline, and behind the ears. 
The best way to remove a tick is to use a tweezer, grab the tick as close to the skin as possible and gently pull it straight out.  If the mouth or other body parts are still there, don’t worry – they will come out on their own. Not all deer ticks carry Lyme disease, and if the tick is removed within 24 hours it is unlikely to transmit Lyme.
In 70 – 80% of cases, the first sign of Lyme disease is a ring-like rash, at the site of the bite.  However, sometimes the rash does not occur.  Other symptoms to look for are fever, fatigue and headache, or joint pain. 
Lyme disease in kids is almost always cured with a simple course of oral antibiotics.  For children 8 years and older a single prophylactic dose of Doxycyline can be given after a tick bite to help prevent Lyme disease.  For more information on Lyme disease and ticks go to: www.cdc.gov/Lyme.

Safety:
Prom Safety
This is a good time of year to address the issue of prom safety.  Prom brings many adult choices for teens, some of which have serious health effects.  Parents of prom-going teens may want to discuss the following issues:

• Tanning is dangerous!  Exclude tanning beds from pre-prom preparations as tanning can cause premature skin aging and skin cancer.  If teens have a strong wish for a tan, there are sunless tanning alternatives that are safe such as lotions or professional spray tans.
• Parents should know the evening’s itinerary and who/whom their teen will be with.  Talk with your teen’s friends’ parents.
• Discuss drugs and alcohol with your teen.  42% of teens who talk with parents regularly about substance abuse will just say no.
• Know your teen’s mode of transportation.  Automobile crashes are the leading cause of death for ages 15-20, and alcohol use and sleep deprivation are certainly major risk factors for car accidents.
• If planning to host an after-prom party, parents should strictly establish guidelines.  Adults can be held criminally or civilly liable for illegal substance abuse in their home, whether they provide it or not.
• Talk with your teen about sexual pressures he or she may face.  Teens can be asked to phone home at some point during the evening, giving them an “out” if they need it.
• Decide with your teen on an appropriate curfew. 
• Let your teen know that if they find themselves in a jam, they will be picked up at anytime, anywhere, no questions asked.

        NUTRITION
Healthy snacks

Homemade Chewy Granola Bars
These are an easy to make snack which kids can make themselves.  No baking required!  The recipe is easy to vary as long as the proportions are kept constant (can substitute maple syrup for honey, peanut butter for almond butter, and use any dried fruit or nuts on hand).

½ cup almond or peanut butter
½ cup honey
1 cup crispy brown rice cereal
1 cup low sugar granola
½ cup almonds or peanuts, chopped
½ cup dried apricots, chopped
¼ tsp salt
Cooking spray

Put almond butter and honey in small saucepan over medium heat for 2-3 minutes until melted together, whisk to combine.

Combine rice cereal, granola, almonds, apricots and salt in bowl and add almond butter and honey mixture.  Stir well to combine.

Grease 7-8 inch square baking dish with cooking spray and line with plastic wrap.  Spread granola mixture in pan, pressing down gently, and cover with more plastic wrap; refrigerate until set, at least one hour.  Once set, peel off plastic and cut into bars.

Dried Apple Slices
2 apples (Fuji, Gala, or Honeycrisp)
½ tsp cinnamon
Preheat oven to 225.  Slice apples as thinly as possible (1/8 inch or thinner, use mandolin if you have one)
Arrange slices in single layer on 2 baking sheets lined with parchment paper.  Sprinkle with cinnamon. Bake 1.5 hours, turn slices over and bake 1.5 hours longer or until completely dry and crisp (they won’t crisp more after cooling).  Let cool.  Store in airtight container up to one week.

Peanut Butter Pinwheels
Spread creamy or chunky peanut butter and a little bit of honey, maple syrup, or sliced banana on a whole grain tortilla (available in the refrigerator or deli section of most grocers). Sprinkle with granola, roll up the tortilla, then slice it into bite-size pinwheels.
Frozen Fruit Snacks
Frozen berries can be served right from the freezer or warmed briefly in the microwave and topped with a little coconut or granola.
 Freeze the following bites for a fast and frosty treat: grapes, pineapple chunks, peach slices, apricot slices, banana slices, apple slices, cantaloupe balls, watermelon chunks, peas, zucchini slices, cucumber slices, or orange wedges. 
Cereal Mix
4 cups Multigrain Cheerios
1 cup chopped peanuts
1 cup raisins or chopped dried prunes or apricots
1 cup sunflower seeds
1 cup chopped pretzels
Shake in Ziploc bag until mixed – makes 8 servings.

Ask the Doctor

Question: My college aged son has admitted to using a hookah, and insists that it’s safer than cigarette smoking.  Is this true?
Answer: Hookahs are not safe!  They are a type of water pipe used to smoke a blend of tobacco, molasses, and fruit.  A 2008 study of college students in 8 universities found that more than 40% had smoked a hookah at least once.
Often young adults believe that the sweet, aromatic, and fruity hookah smoke which is filtered through water is less harmful than cigarette smoke.  In fact, since many hookah sessions last up to one hour with smokers typically taking long, deep breaths, the smoke inhaled can equal 100 cigarettes or more, according to a study by the World Health Organization.  This study also found that the water in hookahs filters out less than 5% of the nicotine.  Also, hookah smoke contains tar, heavy metals, and other cancer-causing chemicals and the tobacco in hookahs is heated with charcoal which can lead to dangerously high levels of carbon monoxide even for those who are in hookah bars but not smoking. 
Several studies have linked hookah use to lung, oral, and bladder cancer, as well as clogged arteries heart disease, and adverse effects during pregnancy.  Since hookahs are generally smoked communally, the hoses passed from one smoker to the next can spread tuberculosis, herpes, and other infections. 
With increased recognition of the dangers of hookah smoking, some colleges have expanded their anti-smoking policy to include hookah use and several state legislatures are taking action to ban or limit hookah bars or include a ban on hookah under existing indoor smoking laws.
Question:  If I have expired medicines at home, can I flush them down the toilet?
Answer: Generally no!  Scientists have become more concerned in recent years about pharmaceutical agents finding their way into public water supplies. 
Most medicines do not “go bad” after their expiration date but will lose potency over time.  Medicines should be stored in a cool, dry, dark place (not a humid cabinet in the bathroom). 
Most medicines can be disposed of in normal trash containers.  The medication should be taken out of it’s original packaging and mixed with an inedible substance such as coffee grounds or kitty litter to prevent young children or pets from being accidentally exposed to the medicine.
Unused or expired liquid antibiotic suspensions can be poured into a Ziploc bag and then thrown away, and should not be flushed down the toilet. 
There are a few medications that should be flushed down the toilet including: Daytrana patches, Oxycontin, Percocet, and other opioid products.  Controlled substances often come with proper disposal information on the printed patient information. 
Some pharmacies also have programs for taking back and disposing of unused medication.
Question: I’ve heard that the Gardasil or HPV vaccine is now recommended for boys.  Why do boys need the vaccine?