Halloween: The Devil's Holiday or Just Plain Fun?

Halloween in the late 1950s was definitely one of my favorite holidays. We would trick or treat in our small town for three or four days! There would be a parade down the main street of town, and we were allowed to wear our costumes to school for a day. We would collect tons of candy treats and eat it as we ran from house to house. Some people would give us apples. We threw those away, along with boxes of raisins and other healthy snacks, like popcorn. We were after candy, Man!

For the people who would turn out all of their lights, pretending they were not home, we would dish out our bag of tricks, usually throwing dried corn kernels at the windows, or soaping them up. Yes, we would smash a few Jack-O-Lanterns, too. As we grew older, we were not particularly interested in the candy, but we sure loved those tricks. Pushing over outhouses was particular favorite.

The highlight of any evening of mischief was always having dogs or angry geezer chase us. I vividly remember running full speed through a dark backyard only to be nearly strangled by a low-hanging clothes line. Once, I hit a crotch-high tree stump during a quick escape. If we were caught (rarely), we would most likely be sentenced to washing those soaped-up windows or standing up the outhouse. Fairchance, Pennsylvania only had one policeman and he was usually home protecting his own property. We all knew where he lived.

Halloween in 2006 is a bit different. Every year, stories surface about razor blades buried in apples (Remember, we threw those away...not because of the fear of razor blades, but because they were heavy, usually bruised or rotten, and besides, everyone had an apple tree in their yard), or tales of needles stuck in your Milky Way.

One of my former clinics used to x-ray bags of candy for free. Any sicko that would try and harm a child needs to be put away for a long, long time. To this day, parents are reluctant to allow their children to accept candy from unfamiliar houses. As a parent of five, I personally inspected all of the collected goodies before the kids good eat it. I was always high suspicious of those little Baby Ruth bars (my favorite), so I took those.

I now live in a very rural area. With the exception of our grandchildren, we do not see children trick or treating. However, five years ago, we lived in a nice, upscale neighborhood that attracted kids like flies. Our first Halloween there, we counted over 300 kids. We even ran out of candy, and had to shell out handfuls of pennies that I kept in huge jar. A quick trip to the grocery store found the candy shelves empty, except for those little boxes of raisins. I picked most of them off of our lawn the next morning, before I hosed the toilet paper out of the trees.

In a pediatric clinic, we are well-decorated for Halloween with spider webs, skeletons, ghosts, and pumpkins scattered about. The kids love it. The staff will dress up on Halloween, including a few of the doctors. A few years ago, Dr. Grattendick, dressed as a six-foot four bunny walked in to perform an adolescent sports physical. The surprised teen inquired if he was the doctor. "You bet", he answered. "That's just great", he responded.

Listen, it isn't easy doing a hernia check with bunny mitten, you know. I really should dress up myself, but I always have this fear of wearing a gory mask with huge ears and one eye hanging out, only to enter the exam room and face a parent with one eye and big ears!

For weeks, I have been asking the kids what they are going to be for Halloween. The little girls like to be fairies, princesses, or Dora the Explorer. The boys still like Spiderman, the Hulk, or Bob the Builder. One young man last week, told me he was going as a booger. Apparently, there is a booger suit you can buy at the local costume store. Working with snotty nose kids all day, I tend to have a booger suit of my own at the end of the day.

Some families do not celebrate Halloween for religious reasons because it is the Witch's holiday or Satan's Day. Whatever. While all families have the right to raise their children as they see fit, I don't see that Halloween in its purest, innocent form is harming little children. The vast majority of them are only interested in the fun of dressing up and eating their fill of candy for one day of the year. They are not going to cross over into the Dark Side where candy surely would melt.

There is a local church that has an alternative called Trunk and Treat. Children dress up in more religiously-correct, non-evil costumes and go from car to car in the large church parking lot collecting goodies from the participating parishioners. There are also Harvest Festivals that permit tasteful costumes, without abandoning the true fun of dressing up.

I am really looking forward to working today. I love examining princesses and pirates. They have ears, too. As a matter of fact, I should only charge the pirates two dollars for the visit. A buck an ear (get it?).

Here are a few tips for a Safe Halloween:

1. Help your children choose more tasteful costumes. Some are just over the edge.


2. Adults must accompany and supervise all children. Stand in the back, but be there to watch and protect your children.


3. If you are going to be trick or treating in the dark, avoid the black costumes. Children tend to dart from house to house and do not notice cars.


4. When dark, kids should carry a flashlight, glow-stick, or flashing lights.


5. Only trick or treat in your own neighborhood or accept goodies from people you know or trust.


6. Many malls have daytime trick or treating from store to store. This is much safer for the younger crowd.


7. It is fun to be frightened a bit during Halloween, but you may have to reassure the little ones, especially at bedtime. Or, plan on sleeping with the Hulk that night.


8. Forget the tricks. Leave the toilet paper at home. Don't throw eggs and cause damage.


9. Inspect ALL goodies in that bag before children dig in. Collect all of the Baby Ruth's and send them to me c/o WebMD.


10. Don't allow them to eat the entire bag in wild, sugar frenzy. Dole it gradually and try not to eat too much of their stuff!

Related Topics: Kids in the Kitchen for Halloween, Trick or Treat, or Cavities?

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Smoke Gets in My Eyes

Fires kill thousands of people every year and untold millions (if not billions) of dollars in property damage. Although some forest fires are caused by from lightening strikes, many are the direct result of senseless, human acts. When our five children were young, we hired not one, but two baby-sitters to care for them in our home during the summer. It required two people to keep them out of trouble. One day, as we drove up to our home at the time (located in a nice residential neighborhood), we saw smoke billowing from the backyard.

Rushing through the door, my wife rushed past the two baby-sitters watching their soap operas, to the backyard where three of our boys were burning down the playhouse. Just last month, I could barely see the beautiful green hills because of smoke. My eyes were red and irritated and I was coughing off and on for days.

Every year in California, we experience some extreme dry weather. Everything is dry...the trees...the undergrowth, but yet some idiot will light a campfire or throw out a lit cigarette. We live at the top of a wooded hill surrounded by some inaccessible terrain filled with dry trees and undergrowth. Although I have taken great steps to clear the area around my home, I am constantly on edge about fires.

At this moment, thousands of acres are burning in California. A few thousand firefighters are risking their lives on the ground; aerial tankers are flying over our house. People have been evacuated from their homes to Red Cross shelters, filling their vehicles with beloved pets and precious family heirlooms. Many have horses and other livestock that must be relocated. The fire in Palm Springs was started by an arsonist.

During the fire in my area last month, I saw the medical results of this smoke-laden air. Children (and adults) experiencing exacerbations of their asthma, sore throats, runny noses, and red, irritated eyes. We can prescribe the medications needed to help control those symptoms, but other than staying in your home, closing the windows, and monitoring the news; there is really nothing that can be done about that smoke. Although smoke certainly causes respiratory difficulties, it is the threat of a fire that concerns me the most.

We have a neighbor (of sorts) that occasionally camps out on his vacant, wooded lot directly adjacent to our property. Over the weekend, this moron had another open fire. Not only did he have a campfire, but he had about a half-dozen torches (for light and mosquitoes) lighting up the wooded area.

Last year, he built a 48-square foot "weekend cabin" that reminds me of the one built by Ted Kaczynski - the now incarcerated Unibomber. We have told Ted (not his name, but this is what we call him) repeatedly NOT to have any open flames this time of year, but he exercises his right as a property owner to "have a campfire for cooking and warmth".

When he is there, the neighbors do not sleep as well. One of my neighbors predicted that someday he will burn down the hill. As a matter of fact, last winter (during the rainy season), he had a huge burn pile of downed trees and other debris that sent flames thirty feet into the air. He left that pile to burn and smolder, unattended, for a week.

This is why we are very concerned about his judgment, and his lack of consideration for his neighbors - those of us who actually live here; in real homes. Yes, smoke gets in my eyes, but it is these careless, selfish acts that really burn my butt! We called the Department of Forestry to check on the regulations, and they insisted on making a visit to him. He was not happy when the fire truck clamored up his dirt road.

On my thirty-minute commute to work every week, I often see burning or recently burned areas along the freeway, usually caused by a cigarette tossed from a car window. Since we only live a mile from the edge of this busy interstate highway, I wonder when a discarded cigarette or other careless act will destroy our home while we are at work? It would only take a few minutes for a life of memories to go up in flames.

Working in pediatrics, I see the first-hand the results of children and matches, from little finger burns that I treat in my office, to the serious, life-threatening burns that scar children and families for life.

My heart goes out to all of those families that are being evacuated at the moment, and to the brave firefighters who lost their lives yesterday and are risking their own lives to save others. Five years ago, hundreds of firefighters lost their lives when planes hit the Twin Towers. While our local fire does not compare in magnitude to this tragedy that shook the world, it still makes my eyes red and tearful. Maybe it is not just the smoke.

So today, take a few minutes and review WebMD's Fire Safety Measures. It could save your life.

Related Topics: First Aid and Emergencies, Inside an Arsonist's Mind

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Why Do Vaccines Cost So Much?

When I was in kindergarten, vaccines were apparently free, or at least I never saw any money exchanged when we received them at school. Granted, we lived in a poor area of Appalachia, but I assume that the Public Health Service was responsible. We would line up in mass as the school nurse (my neighbor) would give us shots, one after another. We all winced in pain...some cried, some tried to run off. We didn't mind the sugar cube (oral polio vaccine), but we sure didn't like those school shots, even if the price was right. The costs of vaccines were kept low to increase the widest possible use. Some were federally subsidized, and of course the federal government was the largest customer. Vaccines were definitely cost-effective, since those preventable diseases cost untold billions in direct medical costs alone.

Many of the childhood illnesses that are not prevented were commonplace in the 1950s. We received most of our antibodies the good 'ol fashion way -- we got the diseases. I remember getting measles (AKA, the "big measles", the "red measles"), mumps, and whooping cough. Everyone got chicken pox. My cousin, Danny, developed polio and nearly died. Unless you travel beyond the borders of the United States into Mexico and Central or South America, you are unlikely to see most of these illnesses today.

Everything goes up in price, but vaccines have climbed astronomically in cost to the consumer or insurance company. Twenty years ago, the full array of childhood vaccines used to cost about $84. Now, those same vaccines, along with the increasing number of newer vaccines costs, about $1,200 or more -- a 14-fold increase. Since the cost of medical care and hospitalization has also skyrocketed, vaccines are still a good deal. This year, we added RotaShield for the infants and Gardasil for the young girls -- they are not cheap. Gardasil alone will cost someone about $360 for the series.

There used to be about two dozen companies producing vaccines. We are now down to five major players that account for 80% of the vaccine market. Perhaps we should call them the Vaccine Cartel, since the free-market allows them to set their own fees. In the overall scope of revenue, vaccines still account for only a few percent of pharmaceutical company profits. The sale of drugs is still the cash cow.

Vaccines are inherently safe, but when rare adverse events happen, some people head for an attorney. However, winning a suit against a large pharmaceutical company is not that simple. The cost of liability may be an underlying factor in the cost of vaccines, but it is a small one, since companies are aided by liability protection enacted by Congress. Manufacturing costs have also increased over the last twenty years, but biotechnology has made vaccine production even easier. Actual production and marketing costs do not drive this market -- we do, by our desire to prevent more and more diseases. When you see lines forming to get the annual influenza vaccine, you know you have a good product.

Many years ago, I worked part-time at a busy urgent care center. Wanting to drive up business, the doctor-owner decided to give away free flu shots to the first one hundred people one fateful Saturday. As I looked for a place to park, I saw a line stretching the entire length of the shopping center. We opened the doors at 9 a.m. and the rush began. Angry senior citizens loudly complained about the wait and lack of seating. Tempers flared when it was determined that we were not giving the shots fast enough. By noon, we narrowly avoided a riot when we ran out of those one hundred free doses. At that time, the going price for a flu shot was about ten dollars.

For the last two years, there seemed to be a suspicious shortage of flu vaccine. Last year, millions of doses were contaminated and had to be destroyed. The year before, it was a manufacturing shortage. Personally, I look at these shortages the same way I perceive gasoline shortages. Shortages increased demand. We start giving flu vaccines at the end of the month and, already, people are clamoring for early appointments; perhaps expecting another unforeseen shortage. We ordered 3,000 influenza doses. Oh, by the way, we also have a shortage of a popular meningitis vaccine. I am confident that the supply will eventually increase, along with a corresponding increase in price.

Vaccines are a modern success story and more miracles are on the horizon. We have only seen the tip of this biotechnological iceberg. Can we afford them? Can we afford NOT to have them? I suspect that I will be standing in an angry line some day trying to get my Alzheimer's Vaccine.

Related Topics: Treating Disease with Vaccines, Are Vaccines Safe for Your Child?

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Limitations of Medical Science

There are definite limits of medical science. Unfortunately, not all human conditions and afflictions can be adequately diagnosed even after exhaustive tests and studies, or sadly, effectively cured or treated. Medical providers live with that reality every day and so do our patients. When specialists and diagnostic studies have not revealed a cause to your symptoms, it does not mean you do not have a problem. It just means that no one has been able to find it...thus far. These events are as frustrating to your medical provider as they are to you.

Medical providers are trained as "fixers". There is nothing more rewarding in medicine than to have a patient come up to you in a grocery store, give you a hug, and say, "It worked. Thank you so much. I feel wonderful again."

Although I am pleased that my medical intervention did the trick, I often have little clue as to (a) who that patient was, or (b) what I did. Maybe the person just got better on their own, and I was just the last one who intervened. Like most medical providers, I will gladly take credit for the cure. I see a lot of patients and I do not remember them all, but I sure like to hear about sucess stories.

When patients cannot be adequately diagnosed, it is the responsibility of the treating medical provider to refer you to someone else more qualified. You would be surprised how frequently this does not happen. Patients will be told to "just live with it", or to wait months or even a year to "see if it will just go away". Surprisingly, a large number of people accept this and simply give up without a second opinion. As talented and skilled as your medical provider might be, he/she is only one brain. Medicine is much too complex to rely on just one provider...one opinion. Medical collaboration is the key. Two medical heads are definitely better than one. A team of medical heads would be even better, although it could reach a point of diminishing return...like having several chefs in the kitchen preparing just one meal.

Before throwing in the diagnostic towel for a difficult-to-diagnose or treat condition, I recommend that people consider a high-level diagnostic assessment at a large, university-based medical center. The collaborative and technological resources of these large research and teaching institutions are often better equipped to deal with complex medical challenges. Logistically and/or financially, I know this may be very difficult.

Life was never intended to be fair and bad things happen to good people. Peter, a very good PA friend of mine, died of pancreatic cancer a few years ago. Not being a fool, he knew that pancreatic cancer is a usually a death sentence, but he did not give up. He endured chemotherapy and radiation until his hair fell out and his body wasted away. He endured terrible pain despite the strongest pain medications available. He even spent thousands of his own hard-earned dollars trying experimental drugs and therapies, both in the U.S. and Europe. In the end, the pancreatic cancer won. Medical science, again, met a formidable foe. I wish that Peter did not have to die. I miss him, even though I still haven't forgiven him for once dragging me off to an Amway meeting. One of Peter's sons recently wrote to me when he found my Blog. He simply thanked me for being a friend to his Dad.

Helen developed metastatic breast cancer about 20 years ago, long before bone marrow transplants were commonplace. Her insurance company considered it "experimental" and refused to pay a dime. Helen knew it was her last and only chance to survive. While the insurance company did have an appeals process, the process was so cumbersome that she would surely die before a claim resolution was made, so she fought. They sold their home and paid the several hundred thousand dollars for the recommended therapy, including a bone marrow transplant. Helen was cured of her cancer and later successfully sued the insurance company for full reimbursement. She is alive today, albeit minus her breasts, and living life to the fullest.

Donations for medical research are not fair, either. We donate umpteen millions of dollars in this country for breast cancer research, but very little money trickles into such areas as pancreatic cancer research. Breasts certainly have more public appeal than an ugly, 'ol pancreas, but shouldn't some of this research money be shared? Now don't take me wrong, we have had more friends and relatives battle breast cancer than pancreatic cancer. They are both indiscriminate killers.

Medical science has come a long, long way, even in my own lifetime. Medical miracles happen every day, and more are on the horizon. But, in spite of those advances, medical science will always have limitations. We will not live forever and it is unlikely that Walt Disney's unfrozen body will some day open up a theme park on Mars. Like most people, I lament the painful failures of medicine, often without truly appreciating those very obvious limitations, and the dedication of those who do not give up...patients AND medical providers.

Related Topics: Integrative Medicine: A Patient's View, Advances in Diagnosing Breast Cancer

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Amish School Shootings

In 1790, three Moser brothers boarded a ship to Philadelphia. Like many German immigrants, they left their home country to find religious freedom and take advantage of the free land in Pennsylvania offered to these adventurous homesteaders.

My ancestors were not considered Amish or Mennonite, but you wouldn't know it by looking at the old photographs. My great-great-great-grandfather, with his full neck beard and black hat would have fit in perfectly in an Amish community.

Growing up in Pennsylvania, we lived side by side with the mysterious Amish and other similar German religious sects. More recently, we lived near an Amish community in mid-Michigan. The Amish kept to themselves. We were the Outsiders. We bought their delicious pies, their beautiful furniture, and quilts. My grandmother and mother were expert quilters as well, but their work was nothing like the unbelievable quilts made by the Amish.

In the hustle and bustle of modern life, it is heartening to see their characteristic black buggies parked in front of the grocery store. The Amish are quiet, respectful, friendly, and admirable people who strive to live as they did centuries ago.

The very last place that anyone would have expected a violent school shooting would be a one-room Amish schoolhouse. As the news reports poured in over the last few days, I was stunned. Along with Columbine and the more recent Colorado school shootings, this most recent, senseless tragedy struck an especially painful chord. My heart goes out to the families of those innocent children (including the family of the murderer). While the pious Amish can forgive this sick perpetrator for the murders of their children, we non-Amish are not as forgiving.

Crimes involving harm to children seem to be more frequent. No longer can parents trust that their children are safe when they are in school. In my own clinic, I see more and more parents choosing to home-school their children. I am beginning to understand at least one of the reasons: safety.

Growing up in Appalachia, my biggest school-related fear was the teachers. Corporal punishment was permitted, and I must say that I was on the business end of a wooden paddle or razor strap on at least three occasions: Once for skipping school in first grade; once in third grade for walking along the railroad track on my shortcut home; and last in 7th grade for being a smart-aleck.

Of course, we had our walking-to-school and playground bullies, too. I would name them in this Blog, but I still live in fear that they would somehow find me, assuming they are not currently in prison. Basically, we got in more trouble during the idle summer months, than ever in school. In school, we had order and unquestionable obedience. In school, we were safe. There were more guns in our town than cars, but the idea that someone would take children hostage and shoot them execution-style was not even in wild imagination.

Urban schools now have armed security guards and metal detectors. Children are forced to carry their books in heavy backpacks because the lockers are gone – too easy to hide weapons and drugs. Schools are becoming citadels. Crimes even come from inside the school. Teachers are having sex with students (and vice versa).

A recently-hired, ex-con janitor raped and killed a young girl in one of our local high schools where my wife and I provided annual sports physicals. About ten years ago, I took care of a young girl that was pushed out of a moving car and then shot twice in the head by her softball coach when she threatened to reveal their sexual relationship. She miraculously survived, but like the Amish school murderer, the coach conveniently killed himself.

I am rarely short of answers on the WebMD boards or this Blog, but I don't have any answers or solutions for this disturbing trend of school violence. Yes, life is filled with inherent risks. And, yes, life was never intended to be fair. But, where is life's fairness when little Amish girls are killed in the presumed safety of their bucolic classroom?

God help us.

Related Topics: Bullying Increasing: First Boys, Now Girls, How Adults Can Help Stop Bullying

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Ear Infections in Children - Count to THREE; wait and see

When I turned on the news this morning, there were stories on two major stations about the "new" philosophy about NOT treating middle ear infections in children. This is not really new information, but maybe it will catch on this time. For decades, European physicians have not treated middle ear infections as aggressively and as early as we do in the U.S. Many European physicians wait a WEEK before writing that prescription for amoxicillin.

The nature course of untreated middle ear infections in generally-healthy children is that most, nearly ALL, will get better...on their own...without antibiotics...in a few days. So, why do most medical providers treat 'em all?

Some medical providers even treat children with antibiotics who MAY get an ear infection, but currently only has a cold. There seems to be a universal belief among medical providers that patients expect antibiotics and leave unsatisfied and upset if they don't get them. While this may be true for some patients; it is far from a universal assumption. The 2004 Otitis Media Guidelines by the American Academy of Pediatrics states that for initial, non-severe otitis media, withholding antibiotics is an option. Duh! Not treating has always been an option.

A study of patient satisfaction with their medical visit (Hamm, Journal of Family Practice 1996; 43-55), it was determined that satisfaction was predicted by two factors: (1) Time spent by the medical provider explaining the illness, and (2) the patient's understanding of the treatment choice. Satisfaction was NOT predicted by whether they received antibiotics or not.

Parents with a screaming child are not that enthusiastic about withholding antibiotics. It is going to take some extra appointment TIME for the medical provider to explain the rationale for not treating some of these infections, and to convince parents that this is the right way to go.

It is only when medical providers begin to treat patients as equals and encourage them to become partners in their own and family's care, will we get a handle on the astronomical use of antibiotics -- antibiotics for a medical condition that has been proven, beyond a shadow of a doubt, to be self-limiting in most cases.

Universal changes in medical philosophy rarely happen suddenly. That, too, takes time. Whether the American medical community can jump from the current indiscriminate use of antibiotics to waiting a week, like our European counterparts, is questionable. But, we can compromise. How about waiting three days before treating healthy children with an uncomplicated middle ear infection? Give our ancient and remarkable immune system a chance to work! Count to three; wait and see.

Efforts to reduce antibiotic use will have many benefits. First, it will reduce the cost of medical care. Second, it will reduce the creation of community "super-bugs" -- microorganisms that have rapidly become resistant or even immune to antibiotics. And, lastly, initially withholding antibiotics will help strengthen our immune systems. Immune systems only improve by overcoming a biological challenge.

It is has been said that what doesn't kill us will make us stronger. While we never want children dying or developing complications from middle ear infections again, the "watch and wait" method makes excellent biological sense. Human beings have been naturally fighting pathological microorganisms as long as we have shared this planet -- millions of years. Antibiotics have only been around since the late 1930s.

These watch and wait guidelines are not intended for every child. Babies under 3-6 months of age should be treated early, as well as children who are immunocompromised or have other serious heath issues. However, for the vast majority of kids, it is perfectly safe and reasonable to take a deep breath and count to three (days).

Remember that pain should always be addressed while you are waiting those three days to see if antibiotics are going to be needed. The relief of pain is really the child's primary goal, Withholding antibiotics does not mean you should withhold the treatment of pain. Ear infections hurt!

While acetaminophen (Tylenol) and ibuprofen (Motrin) may be all that is needed for most children, some ear pain may require a bit more. A codeine-containing prescription for a few days can be used. There are also benzocaine-containing ear drops that the medical provider can prescribe that are helpful. Finally, make sure that your children have been immunized against pneumococcal disease - a common cause of middle ear infections. Get the Prevnar vaccine.

Something has to be done, folks. Like global warming, we are already paying the economic and biological price of our frequent antibiotic use. Next time that your medical provider whips out that prescription pad, ask if it would be reasonable to wait a few days before starting an antibiotic. Your doctor may be pleasantly surprised, but I suspect he/she will be willing to work with you on this "new" concept.

Related Topics: Slime Behind Chronic Ear Infections?, Drug-Resistant Staph a Growing Concern

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