Alternative (Medicine?)

In an age of acceptance and tolerance, it is not really politically correct to trash alternative medicine. Is it alternative? Yes. Is it medicine? Not in my definition. For the practitioners that cannot take a stand, this approach is often termed Complimentary Medicine. As a complimentary part of traditional medicine, alternative approaches may have promise, but as a stand-alone therapy, they routinely fail.

This message rang sadly and true for Microsoft evangelist and Blogger savant, Robert Scoble. Mr. Scoble's mother recently died. His mother was an alternative medicine disciple.

If you think the age of the Snake Oil salesman is gone, you better look around. True, they are no longer preaching from the back of a wagon claiming that the man with them is over 150 years old, thanks to this wonderful Elixir of Life.

The Snake Oil salesman now uses health food stores, television, and most of all, the Internet, to hock their wares to a wider and more gullible audience than ever before. The approach is absolutely the same: amazing discoveries that doctors do not want you to know, wild and wonderful claims of cure, credible-appearing testimonials, and all for this low, low price of whatever. Many back up their claims of miraculous results with quasi-scientific research taken out of context, huge studies that involve up to three people, and money-back guarantees.

How can you lose? Well, you can lose your life.

If I have to see that penis enlargement ad or that stuff to get rid of belly-fat one more time, I am going to scream. This is exactly what was going on more than 100 years ago and is still going on today. Sure, they don't call it Dr. Kilmer's Kidney, Liver, and Swamp Root, Kickapoo Indian Sagwa, or Dr. Pierce's Golden Medical Discovery anymore, but the message is the same. In the mid-19th century and early 20th century, patent medicines were BIG business. They are even a bigger business now, but the sales approach is a bit slicker.

My first colleague, a wonderful and kind physician, loved this type of voodoo medicine. At his insistence, I once attended an Orthomolecular (whatever the hell that is) Medicine conference in Los Angeles. In attendance, were hundreds of chiropractors, homeopaths, naturopaths, osteopaths, physicians, and one very confused PA.

He wanted to open my biased eyes to the world of holistic and alternative medicine. He was not just a physician, but a businessman, and this was the road to prosperity. "Patients eat this stuff up. They love it", he said.

I sat through lecture after lecture of some of the most bizarre subjects ever: Detoxifying patients using coffee enemas. Treating arterial plaque using celation therapy. Laetril for cancer management. Aura therapy. Manipulation. Aural (ear) acupuncture. The exhibit areas were filled with expensive devices that would impress any paying patient. Since most insurance companies will not pay for unproven treatments, a big machine would convince patients to open up their wallets.

He bought one of those machines called a Heidelberg Gastric Analysis. Patients would swallow a small radio transmitter ($75) that would record and transmit the pH (acid levels) of the stomach to a belt-like antenna worn around the waist. Since stomach acid is an important step for digestion, and essential nutrients may not be absorbed unless this acid is "balanced", this $8000 machine would tell us if the patient had enough gastric acid. Duh! By the way, the capsule can be retrieved and used again (by the same patient) if you attached a string to it and pulled it back out of your stomach.

This man was my mentor and trusted friend, but this stuff was pure, unadulterated baloney. He learned to accept that I would not be a convert to pseudo-medicine, and eventually, we parted professional ways. We remained close friends until his death. I helped clean out his house and dispose of THOUSANDS (Yes, thousands) of bottles of vitamins, minerals, trace elements, herbs, and unidentifiable nostrums. He even had thousands of dollars worth of human growth hormones that he injected several times daily in an effort to prolong his aging life.

We have some of the most advanced medical technology in the world and true medical miracles happen every day. So, why do people migrate to Charlatans and quacks?

Traditional medicine has created a void. It is in this vacuum that alternative medicine has found a firm niche. This void is the fine art of caring.

When a patient is diagnosed with a life-threatening cancer, they are frightened and lost. They are quickly referred from their primary care doctor to an oncologist where they are bombarded with radiation and filled with toxic chemotherapeutic agents that make them feel even sicker and more depressed. Their hair falls out. They lose weight. They look and feel terrible. There must be another way, so friends and relatives try to help.

"Go see my chiropractor. He cured my mother of cancer when all of the doctors just gave up on her." "You can still get laetrile in Mexico." "These drugs are doing more harm that good. You should try alternative medicine." Out of fear and frustrations, patient after patient will try just about anything to save their lives, even to the point of completely abandoning proven treatments.

Seriously-ill people are in need of CARE. Zapping them with radiation and pumping IVs full of drugs into them is NOT care. Without the human side, a void in care is created. They want someone to hold their hands, acknowledge their fears, and give them hope.

This is where alternative practitioners often have the upper hand over traditional medicine. They DO care about their clients. They hold their hands...touch them...massage them...CARE for them. It is this profound and powerful element of human kindness that draws patients to alternative approaches. The only gap here is that many alternative treatments are scientifically unproven and/or downright worthless. Time and time again, people choose Alternative Medicine, only to return when it is too late.

Medical providers must be better salesmen. Unless you can convince a person to embrace your therapy or treatment, they will not remain under your care.

We need to bring CARE back into patient care, hold more hands, offer more hugs, and spend more time. When your patient's clock is ticking downward, it behooves all practitioners to spend the time to find out what makes them tick.

We are all going to die someday, and patients do have the right to chose how they do it. Medical providers have the ongoing responsibility and obligation to honestly and realistically reveal our path. Unless we involve our patients in this most-important journey, they are likely to take a road unproven.

Resources: National Center for Complimentary and Alternative Medicine

Related Topics: Be Smart About Integrative Medicine, The Heart Speaks: Are You Listening?

BRATS

Working in pediatrics is one of the most rewarding professions. Children are absolutely wonderful, fascinating, funny, and loving....most of the time. Today, a two-year old got the best of me and nailed me square in the 'nads. I have an ice pack in my lap as I write. This little guy was strong and very determined not to have his ears examined.

Typically, I will do a lap exam on children that are frightened, or in this case, combative. A parent will usually help restrain the more resistant, keeping those little hands from ripping off my glasses and pulling out my eyes.

Ninety-nine percent of children cooperate with a routine ear examination. I hand them the otoscope and ask them to hold it for me -- a quasi-risking act, since our fiberoptic otoscopes cost a few hundred dollars. He wouldn't play this game as he screamed protests from under one of the examining room chairs. I usually tell them that I need to check the ears for birds. Once I have their attention on this improbable infestation, I carefully examine their ears by making tiny, little chirping, bird-sounds, much to their delight and puzzlement.

Not only does this little game hold their close attention while I take time to examine their ears, it also tells me that they can hear. Not this guy... There was nothing we could do to convince him to cooperate. I was just pleased that he didn't flip ME the bird.

So, Mom fished him out from under the chair and the arms and legs began to madly wave in perfect unison with this cries of protest. We laid him down in Mom's lap, she held his hands, and I had the legs...more or less.

I can usually pin the legs while I examine his ears, but this little Houdini quickly escaped, and with a carefully-executed karate move, he drove that bare foot home, connecting with one of my boys.

Immediate waves of nausea resulted as I repositioned myself, determined to complete my exam. Besides, I had one good testicle left. And, wouldn't you know it, BOTH ear canals were filled with wax -- the scourge of otologist everywhere. It seems that the level of uncooperativeness is directly proportional to the amount of earwax.

With Master Miyagi lovingly restrained now, I was able to remove the earwax using my trusty cerumen loop so that I could see if he had an ear infection or not. He did not. I took a few extra moments to search his scalp for a 666.

Mom apologized for my inadvertent injuries and I limped quietly to my office.

I had another 18-month old female version later in the day, and it wasn't even a full moon...just a Monday. Again, she was not going to go down easy. I had both parents this time, and I stay clear of those feet.

As she screamed and danced in place, frustrated that she quickly lost the battle of the otoscope, I calmly reached into my goody cabinet and took out a sugar-free lollipop. Her bug-eyed grimace instantly changed to a smile of delight, as she ran to me. I picked her up, she gave me a big hug, and I gave her the lollipop. What a Drama-Mama!

BRATS, an acronym for Behaviorally-Resistant and Tantrums (I made that up, but it fits) compose a significant part of our practice.

I am not sure if brats are created, or they are born that way. Some parents are completely oblivious to the misbehavior of their children.

About ten years ago, I was working a 12-hour shift in the local urgent care center. I went in to examine an 8- year old boy who was as yellow as a canary; most likely Hepatitis A, the most common form of hepatitis.

Hepatitis A is transmitted by the fecal-oral route, a rather disgusting thought. As I was examining his jaundiced eyes, I told him that he was going to need a blood test. Without missing a beat, he spit directly in my face, another great way to transmit hepatitis.

Fortunately, I am well-immunized, but the assault caught me completely off-guard. The mother, witnessing this act of aggression, simply said, "Honey, don't spit in his face."

My only chance for retribution was a hope that that blood test may really hurt. As a matter of fact, I ordered a blood test for the mother, too!

Related Topics: Top 10 Parenting Pitfalls, Kids Often Depress Parents

I Hate Mosquitoes!

Sometimes, I think that I am a human mosquito magnet. I could be in crowd of a thousand people, and I would be the only one that is getting bit.

I worked out in the yard today, and I was bitten so many times that it is even difficult to write this Blog while scratching my welts. I use some top-of-the-line, jungle-quality DEET, but somehow, the mosquitoes find the one spot that I missed. I wear bland-colored, long sleeve shirts, long pants, socks, and a hat. I don't wear deodorant or cologne when I am working outside. I have an impenetrable beard and wear glasses.

I sound pretty, huh? They still get me...fleas and ants, too. I must excrete some powerful insect-attracting pheromones.

I read that mosquitoes bite people if they eat bananas, so I have given up my favorite, potassium-laden fruit. I take a multiple vitamin that is high in vitamin B, thought to be distasteful to mosquitoes.

I bought one of those electronic mosquito repellents that emit a high-pitched whine; and I have even worn TWO of them. It didn't help.

I have used Avon Skin So Soft, another purported repellent, but alas, this was not helpful (My skin did get soft, however, making it even more desirable for my biting nemeses). So far, my best defense is to just wait until the land and then slap ‘em to death.

Since I also have tinnitus, I think I always hear them buzzing around me. My neighbors, seeing this constant waving and slapping, must think I have a serious mental disorder. One pair of breeding mosquitoes can have up to 3,000 offspring, so I take pleasure in knowing that each mother mosquito that I kill (only the females bite), I take out a thousand or so of the kids.

Several years ago, we were visiting some friends in northern Minnesota, the home of some of the biggest, meanest mosquitoes on Earth. Since we were sleeping out near the lake, I planned on using some industrial strength DEET.

I completely covered my body (so I thought), and the next day, I had multiple bites on my eyelids! Short of having several trained bats sitting on my shoulder at all times, I am at a loss to find a solution. As a matter of fact, I built a bat house in order to encourage these voracious mosquito eaters.

Mosquitoes also bite more during a full moon. I don't like to go outside during a full moon because of my bats. I am not sure one isn't going to turn into Dracula. If mosquitoes love my blood, I am sure going to attract Dracula.

I have scoured the area for standing water (none), and I do use mosquito chemicals in the fountains. The most logical source of these pests may be a small lake located less than a mile away.

According to mosquito experts, these insects can travel this far...especially if they smell ME. Mosquitoes are attracted to heat, lactic acid, and exhaled carbon dioxide, but there is nothing I can do about that. They would probably bite me if I was dead.

Mosquitoes are the most dangerous insect in the world. They kill more people than any other creature on this planet.

Mosquito-borne illness, such as malaria kills millions of people every year, mostly in Africa. Mosquitoes cause encephalitis, including West Nile. They carry yellow fever, dengue fever, and even heart worm that could hurt my dogs. Both of my Shelties take heart worm preventatives. Mosquitoes do not carry HIV.

As soon as the weather in this area hits a consistent 100 degrees and the mosquito population wanes, I will need to stay in the house early in the morning and at about 4 PM, the time they seem to start tracking me down. Fortunately, California is usually dry. Mosquitoes bite more in humid weather.

For the twelve or thirteen bites that I have right now, I am rubbing in some hydrocortisone cream and taking an antihistamine for the itching. And yes, I am strategically scratching them from time to time. It just feels good.

I am not a big fan of bug-zappers since they seem to catch more beneficial insects than mosquitoes. I do have two of them (different types) that I have tried. The only thing that I have not tried is those thousand dollar commercial mosquito machines that hook to a propane tank. Mosquitos dislike citronella (we have a lot of those things), but so do I.

Although I know that DEET is safe, I still don't like the smell. DEET is the most effective mosquito repellent out there, and you can even use it on children over the age of two months. Consumer Reports listed some of the best ones in an issue earlier this year. I bought the ones that were highly recommended, so I will let you know.

I seemed to be getting a headache. Damn, I bet it is encephalitis!

Related Topics:

Links to Information about Mosquito and Mosquito-Borne Disease

• Mosquito Control
• Mosquitoes and West Nile Virus
• West Nile Virus Home page
• Malaria and Mosquitoes
• DEET and children


• WebMD Editor Cherie Berkley's first-hand account of malaria's devastating toll in Africa

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Technorati Tags: mosquito, mosquito bite, DEET, mosquito repellent, west nile, malaria

Sexual Exploitation of Children

I have had some challenging jobs in my three-decade medical career, but one job in particular ranks high on the stress-o-meter. For several years, I worked part-time as a pediatric sexual abuse examiner.

Our on-call medical team would be summoned by law enforcement to provide the proper forensic examinations in the emergency room when children have been sexually assaulted or raped. Each examination would take up to two to three hours and would involve the collection of numerous specimens for DNA analysis and photographic evidence. I performed about a hundred of these intense examinations on children from three months to adolescents, and it never got easy, as you might imagine. If the perpetrator was ever caught and prosecuted, I would have to defend my examination findings in a court of law.

A few weeks ago, a friend of ours discovered that her 13 year old daughter was being groomed by a child molester on a popular (unnamed by choice) Internet site used by teens and children. The parents were horrified when the read the sexually-explicit postings by their "innocent" little girl and a man named "Death".

I shudder to think what might have happened if she and this criminal would have met. Recently, Dateline NBC has been doing a series of sting operations on Internet child molesters. As the school vacation time approaches, our pediatric sexual assault team saw an increase in calls for examinations. Bored teens are left alone at home; and younger children are often left in the care of others.

Adolescents are not stupid, but they certainly do a lot of stupid things. A repeating summer scenario was the 13 to 15 year old girl involved with an over-18 (in some cases, over 30) year old man. The girls would typically lie about their age (and many looked mature-enough to pull it off) and they would strike up a relationship with these men.

Even if they revealed their true age, it probably would not make any difference to these child sexual predators. Soon, alcohol or drugs will be offered. Somewhat later, these girls would be facing a serious situation that no girl or woman should ever face. They may be staring into the face of a rapist.

Many of these sexual assaults are never reported to law enforcement. The young girls are terrified to reveal what happened. They worry about sexually transmitted diseases or pregnancy. They worry what their parents might say. And, they worry that it was their fault. The girls that do reveal the sexual assault and involve law enforcement must undergo an evidentiary examination. Someday, they may have to face their perpetrator in court.

Parents are supposed to protect their children. I remember a case of a 13 year old mentally-challenged girl who attended a Special Education Program in our country. During a school program about inappropriate sexual conduct, she mentioned that her father did those things all of the time.

School officials called law enforcement; law enforcement interviewed the child and she was transferred to the emergency room. The ER called me at 1 AM to perform the evidentiary examination. By this time, Lisa (not her real name) had clammed up and was no longer admitting to being molested. She was cooperative for the examination which included a pregnancy test. The test was positive.

When I informed the mother of this finding, she said, "Damn, he told me he had stopped doing it." She grabbed the little girl by the arm and said they were going home. I informed her that I was placing this child in protective custody. She was not going home to the perpetrator on my watch. A struggle ensued, security was called, and even some misdirected people in the waiting room tried to beat me up.

I did not let go of that child until Mom was in handcuffs. She hugged and cried on my shoulder as the police searched her for weapons. When the police pulled out some crack cocaine, the little girl wailed even louder. God, I hate this job, but someone has to do it.

Another evening, I was called to examine a six month old baby girl and her three-year old sister. Their prostitute mother had left them in the expert care of a homeless man that lived in the garage. Another child in the apartment complex had looked through the window and witnessed this animal sexually assaulting both children. The police were called and he was actually caught in the act. The children were sent to the ER so that I could examine them.

The baby was sleeping, and the three year old was very happy to see me. I offered my hand and she jumped on my lap and hugged me, head lice and all. She said she was hungry. I took the necessary mouth swabs, but before starting the genital examination, I ordered some food from the hospital kitchen for her. When the food arrived, she devoured it. She tore into one of the two chicken legs like nothing I had ever seen. She downed the milk, ate the apple, and inhaled the granola bar.

As I collected the trash, I notice only one chicken bone. Where was the other? This little three year old had hid it in her jacket, saving it for her six month old sister. "Why are you crying?" she asked. Six hours later, I had completed the forensic examinations on these two little innocent children and went home.

The evidence that I collected put this child rapist in prison for life.

I am sorry, I can't write about this anymore. Next time I'll write something happier.

Parents, protect your children.

Related Topics: Pros and Cons For Kids' Internet Use, How to Protect Yourself Against Crime, Sexual Abuse: Support Group

Technorati Tags: sexual abuse, child abuse, internet exploitation

Ear and Other Piercings

Body modifications, like ear piercings, have been going on for thousands of years. When the first Neanderthal put a bone in the ear and received some grunts of enthusiasm from his tribal friends, the trend likely began.

I pierced my daughter's ear when she was just two, much to the horror of her grandmother who felt that piercings made girls look "cheap". My daughter was certainly not cheap, and she sure looked cute in those little earrings.

Little did I know, twenty years later, I would be looking at my daughter with pierced eyebrows, nose, lips, belly-buttons, and tongue (and perhaps piercings in areas that Dads never see). She even worked for several years as a piercer.

I once visited her at the tattoo place and was absolutely horrified at the place people get pierced. I saw their catalogue of piercings: the penis (various locations), scrotum, nipples, the labia, the clitoral hood, etc. You name it, and someone will put a hole and some jewelry in it.

Piercings are done without local anesthesia as part of the experience. Screaming, apparently, is frowned upon. Since I am not a big fan of intentional pain, it never entered my mind to have a pierced anything. I will leave this world with the same number of natural holes that I had when I was born, and without jewels or chains hanging from anything.

Behind the confidential door of the examining rooms, I have seen many, many piercings; just about everything in the catalogue. A medical provider quickly learns to be non-judgmental in these situations. On the outside you either ignore it, or you might say, "Oh, I see you have a pierced _______."

Inside, you are saying, "Oh my God! She has a pierced ______!"

Most piercings done in reputable establishments are done under sterile conditions. Since hepatitis B, HIV, and other blood-borne diseases are a definite risk, this is nice to know.

The human skin, unfortunately, cannot be adequately sterilized, so infections are quite common until the piercings heal. Minor infections in the earlobe are easily treated; infections in the ear cartilage are more problematic. Unless ear cartilage infections are properly and promptly treated, the person could end up with a deformed, cauliflower ear.

Keloids, or hypertrophic scars, can also occur. Keloids are another thing that can permanently deform the outer ear. At least once or twice a month, I am fishing out an infected and embedded ear post in a child's ear.

I see a lot of nipple piercings in both men and women. Surprisingly, these do not get infected very often. Tongue piercings, painful as they are to have inserted, rarely get infected since they are constantly washed by protective saliva. The nasal mucosa is not the cleanest place on our body. Subsequently, nasal piercings get infections. Umbilical piercings take several months to heal, so infections are much more common in this area. Lastly, you take the most risk with genital piercings.

My daughter is thirty years old now, more mature, and has gone back to just having pierced ears again. Whew!

By the way, the picture is NOT my daughter.

Related Topics: Tattoo Trends: It's Not Just Sailors, ADA Dental Channel: Oral Piercing

Technorati Tags: piercing, jewelry, tattoo, body art

Doctoring Mothers

My mother was our doctor. She had absolutely no training, and I must say that she was not very good at it. Dangerous, in fact. Her pharmacopedia consisted of two medications: iodine and mercurochrome, both of which burned like hell.

She would pour these red concoctions into my gaping wounds with righteous and perverse pleasure. She seemed to enjoy seeing me writhe in pain as she chastised me about playing in the creek. My physical wounds were then dressed in a clean rag. Any emotional wounds were not acknowledged. I would limp off to play in the creek again.

My mother is 86 years old now and suffering from severe dementia. Her dementia has progressed quite rapidly over the last year. She does not know who I am, or how much I would like to doctor her now. Unfortunately, not even mercurochrome will not cure her aging and confused mind.

My older brother is her main caregiver, making sure that she is safe, clean, and well-fed. She is provided medications to lower her cholesterol and maintain her blood pressure to prevent additional cerebrovascular accidents (strokes). Her years of cigarette smoking have indeed been contributory to her current state of health. At least she doesn't smoke anymore.

Although her body has remained surprisingly healthy, we suspect that she will die soon--not a pleasant thought as Mother's Day approaches. We have pledged that her life transition will be peaceful and compassionate. Medical science cannot fix our mother.

Sadly, my mother was not a mother that hugged her children. We were clothed, fed, and housed; perhaps the only way that she could show love. Although my mother's lack of overt love and compassion was due in part to her own damaged childhood, she did manage to produce sons that do hug their children...and their mother.

My only daughter informed me two weeks ago that she would soon be a mother for the first time. It was my surprise birthday gift from her. A few days later, she saw this new, little beating heart by ultrasound and anticipated the soul within.

A few days after that joyful event, my daughter had a sudden miscarriage. Nature had determined that this pregnancy could not continue, for whatever reason. This is a primitive mechanism that has protected the human race since the Dawn of Mankind, but that doesn't make it any easier to comprehend when it happens.

As a medical provider, we have held the hands of our patients for years who have had the rug of motherhood pulled out from under them, reassuring them that most women who miscarry will eventually carry a baby to term. Intellectually, my daughter knows this as well.

But, as Mother's Day approaches, I am having a hard time holding back the tears. As her father, I feel so empty and sad, but there is no way that I can fully comprehend my daughter's disappointment of this life interrupted. My daughter is strong and independent and I know she will be fine, both physically and emotionally. My daughter is already a wonderful mother--inside, where it counts. She will most definitely hug her children.

My wife started getting calls this week from our children (all adults now, more or less) asking her what she wanted for Mother's Day. They don't realize that what she wants, she already has. Children...and, grandchildren, and the opportunity to love and hug them.

Mother's Day is really more than just flowers or the obligatory breakfast or dinner. It is a celebration for the person that gave them life. Sure, we fathers had an important role in the parenthood process, but we would be fools to try and compare our contribution to that of a mother.

Every day is Mother's Day. We only celebrate it once a year.

Related Topics: Dana Buchman on Learning Disabilities and Labeling Children, Mother Knows Best

Technorati Tags: mothers day, miscarriage, dementia, parenting

Airplane Ears

As the summer travel season approaches, people will be heading to the airport for destinations unknown, especially since it is too expensive to drive anywhere now. Most air travelers will not have problems with their ears when the cabin is automatically pressurized on take-off or depressurized on landings, but some will. It happened to me.

I suspect I had a cold. No big deal, since I get my share of upper respiratory infections dealing with sick people every day. Although I have become more of a white-knuckle traveler since 9/11, the flight from Washington, DC, to Detroit was surprisingly smooth. I was sitting in the worst seat in the plane -- last row; no window, over the noisy engine, and by the bathroom. Henry Kissinger once said that there are only two reasons to sit in the back of the plane by the bathroom: either you have diarrhea, or you enjoy talking to others that do. I was sitting with an elderly woman who remained seated the entire flight, so I am guessing the Kissinger theory did not apply.

For some unknown reason, the plane suddenly descended on the approach to Detroit. Of course, I am thinking this is an evasive maneuver to avoid a mid-air collision, or the pilot couldn't find the airport until the last minute. The plane rapidly dove a few thousand feet and I thought my ears would explode. The little old lady sitting next to me must have noticed my extreme discomfort, profuse sweating, and grimace on my face. She reached over and held my hand, lovingly stroked my arm and said, "Don't worry, honey...everything will be just fine." She then proceeded to share a few of her near-death experiences during air travel. I must say it took my mind off of the excruciating ear pain. My ear remained painful and stuffy for the next four days.

I am sure that everyone has noticed that some babies cry as the plane is landing. Although they have no verbal ability to tell us, they are most likely crying because of ear pressure. Not only is crying an indication of pain, crying is also therapeutic. Crying, like swallowing, will help open the eustachian tubes and relieve middle ear pressure. I do not recommend that adults cry and scream during plane flights. It worries the other travelers.

The eustachian tubes are tiny ventilation and drainage tubes that run from the middle ear space (the area on the other side of your eardrum) to the back of your throat. The primary function of the e-tubes is to make sure the pressure in the middle ear is the same as the outside atmosphere. Rapid changes in barometric pressure that can be experienced during take-off and landings can cause ear pain (otalgia) if the eustachian tubes are not functioning well. In children, the e-tubes are very tiny. In adults, the eustachian tubes are often compromised if you have a cold, allergies, or other types of inflammation in the nose, ears, or throat. People who smoke can have throat inflammation that can cause the eustachian tubes to malfunction. Of course, when your ears are painful it is a bit too late to worry about the cause.

There are a few things you can do BEFORE you fly:

Adults

If you have a cold or allergy problem, talk to your doctor about prescribing or recommending some medications that may help prevent "airplane ears". These include oral or short-acting nasal decongestants, antihistamines, or prescription nasal steroids sprays. Since many of these medications have side effects or problems for people with high blood pressure, heart disease, pregnancy, thyroid disease, etc., you should NOT self-prescribe (or treat others for that matter) without first consulting your medical provider.

Yawning and swallowing will open the eustachian tubes. Many seasoned travelers chew gum, suck on mints or candy, or slowly drink water during take-off or landings.

"Popping your ears": If nothing has worked to prevent the ear pain, you may need to unblock your ears by this pressure equalization maneuver -- Pinch your nose and close your mouth. Try to direct the air to the back of your throat and then gently blow (not too hard!) to increase the pressure, directing the air up the eustachian tube. If you hear or feel a "pop" your ears should "open". This maneuver may need to be repeated throughout your descent.

A special type of ear pressure-regulating earplug (EarPlanes) available at pharmacies or the airport convenience stores may be worth trying during ascent and descent.

Infants and Children

Like adults, infants with ear infections should not fly. If possible, the trip should be postponed for a few days to give the antibiotic a chance to work.

With the permission of your medical provider, infant decongestant nasal sprays can be safely used for children over the age of two. It is used about one hour before flying (or one hour before landing). For children younger than age two, certain oral decongestants (like pseudoephedrine) can be used. Saline (salt water) nasal sprays may also be helpful in the dry air of an airplane.

During landing (and even take-off), babies should be encouraged to either breast or bottle-feed to encourage swallowing. Since babies are safer strapped in their car seats, using a bottle would be best. Pacifiers are not a substitute, since they do not encourage beneficial swallowing. Older children can sip from a cup or juice box.

If the ear pain does not go away relatively soon after landing, your medical provider should be consulted. It is not unusual for infants and young children to develop middle ear infections after a recent plane flight.

Related Topics: Dr. Moser's FAQ for Airplane Ears, Traveling with Kids: A Survival Guide

Technorati Tags: air travel, ear problems, airplanes

It's Wheezin' Season

In a general pediatric practice, the fall and winter season is a nonstop dance of infectious diseases: colds, ear infections, pneumonia, and influenza. The onset of warmer weather coincides with a decrease in these illnesses, and a well-deserved break in the number of patients I see per day. Not this year...

Because spring in Northern California was delayed due to one of the wettest years on record, we made a jump in one week from infectious diseases to children with allergy. Earlier in the week, the runny noses started. The waiting room was filled with raccoon-eyed toddlers doing the "allergic salute". The allergic salute is a characteristic upward hand wipe of an itchy, runny nose. The raccoon eyes are also called "allergic shiners" - a bluish discoloration around the itchy, tearing eyes due to constant rubbing. Children have an itchy flair-up of eczema (atopic dermatitis). And, of course, the distinct sound of wheezing. When a person has itchy eyes, runny / itchy nose, AND audible wheezing, it has to be an allergic disorder.

All that wheezes is not necessarily asthma. Even simple viral infections (colds) can cause wheezing. An inhaled foreign body (not uncommon in children) can do it. Pneumonia and RSV (Respiratory Syncytial Virus) can do it. As a matter of fact, if you had a child that had RSV in infancy, this child has an increased risk of developing asthma.

Allergies and asthma runs in families, it is not unusual to see BOTH the child and the parent snorting, sneezing, and sniffing in perfect harmony. If one parent has asthma, the child has a 20% chance of getting it. If both parents have asthma, then the child has more than a 60% chance of having it. Asthma is more common in boys than girls until age ten, then it equals out.

Environment plays a huge role, since people can literally be allergic to anything. Asthma is much more common in industrialized areas. Some people just have seasonal symptoms, mostly in the spring. The unfortunate people have allergic symptoms and asthma all year long. Asthma is not something to sneeze about. Uncontrolled, it can be a very serious and life-threatening condition. Despite our armada of effective asthma drugs, the death rate of asthma among children rose 30% from 1980 to 1987 and continues to rise.

Welcome to Wheezin' Season. Wheezing is often described as a musical lung sound - a high-pitched squeak heard loudest during expiration, caused by the narrowed airways in the lower respiratory tract. The air goes in; but it can't easily get out. The body begins to compensate by increasing the respiratory rate in order to maintain adequate oxygen levels. Breathing is supposed to be effortless, but when a person wheezes, the body must work harder. Simple breathing becomes an exhaustive effort.

Although many areas claim to be the Allergy Capitol of the World, I think Sacramento Valley is definitely a top contender. The heavy rains caused everything to bloom at once. Pollen complete covers my car at work and you can see billions of particles floating in the air from the headlights. When I watched the news in the morning, the daily pollen count put trees at the top of the list. I knew it would be a busy day at the clinic. Fourteen hours and a half-dozen kids on nebulizers and one hospital admission later, I was right.

During the Wheezin' Season, children (and parents) frequently miss school and work. The ERs are crowded and there is often a shortage of hospital beds in some areas. People carry their inhalers, take steroids, and avoid all outdoor activities during the high pollen times.

I have always considered myself a medication minimalist, but when you treat asthma, you need a pharmaceutical armada and it is a medical art to fine-tune these needed drugs. It is not unusual to have people taking six or more different medications to control their asthma. Asthma treatment is very individualized. These are just two of the many drug types that are used:

Bronchodilators: Relaxes and expands the air passageways. Fast-acting beta-agonists, such as albuterol (Proventil, Ventolin), are considered "rescue drugs" and are often used by asthmatics that have infrequent or exercise-induced symptoms. People with asthma who are frequently using their inhalers are NOT IN CONTROL.

Antiinflammatory agents: Reduces airway inflammation. Steroids are the mainstay of asthma management, but people hate hearing the word "steroid", and think Barry Bonds or thick-forehead body-builders. Allergies and asthma cause profound inflammation, and steroids are often the best medication to manage it. There are many different types and strengths, and can be taken orally, by injection, by hand-held inhaler, or by nebulizer. Like most drug, steroids do have potential side-effects so it is vitally important for everyone to educate themselves about their asthma medications.

People do not become dependent on asthma medications. They are not like narcotics. Daily asthma medications are very important and may keep you out of the ER or hospital. Never take your asthma for granted. Always be prepared. Your GOAL is CONTROL.

Related Topics: Asthma Action Plan, WebMD Video: Suffering Seasonal Allergies?

Technorati Tags: allergy, asthma

My Best Birthday Gift: Oh, Baby!

I have been told that I am a difficult man when it comes to birthday gifts. As I mentioned in my Birthday Blog, I am not a big fan of celebrating the day I was born since it is just another reminder that the clock is ticking. Of course, I should just be grateful that I have a clock that ticks at all.

This was really one of my BEST birthdays. The weather was wonderful and we ate outside. With the exception of some mosquitos that were also eating, the atmosphere was perfect. Good food. A warm, starlit evening with frogs peeping and family gathered around the table. Four of the five kids came, including three of the grandchildren. My youngest son is in San Diego and could not make it.

After the traditional singing of Happy Birthday (including a variation sung only by former employees of a local Mexican Restaurant -- three of the kids worked there during high school), I blew out eleven candles (each one counted as five years). Now, the gifts: A gift certificate for a book store (nice), Curb Your Enthusiasm DVD set (one of my favorite shows), a promissory note for two days of yard work (much needed), a custom-made copper fountain, and one mysterious little box presented by my only daughter (age 30).

I held the little box for a few minutes and noticed how light it was. I opened it slowly and found a tiny scroll inside - a note. What could this be? Slowly, I unwound the note and read the words that made this the best birthday ever. "Happy Birthday, Daddy. Your daughter is 9 weeks pregnant." Words cannot express my joy. My daughter is going to have a baby in December. Next year at this time, I will have another little grandchild sitting on my lap. Now that is a birthday gift!

Related Topics: Aging Well May Mean Mind Over Matter, Healthy Aging

Technorati Tags: birthdays, grandchildren, aging