Life Lessons from Dr. Moser

Lesson 1: When you need help moving, your friends and family have other plans.

My adult daughter needed some help moving to a new apartment. Her father (me) just happens to own a truck and trailer. I offered to help as long as she could line up some of her buff brothers and their friends to carry the big stuff. One brother (who also has a truck) was out. He had knee surgery for a meniscus tear earlier in the week. The injury occurred from coaching Little League baseball (don't ask). Two other brothers live out of town. And the last brother suspiciously wouldn't answer his cell phone.

Of course, her new apartment is on the second floor requiring a tricky navigation of wooden steps, turns, and other hazards. My daughter did find two friends to help on day one, but day two was all my wife and me. There is nothing I love to do more than lug a big couch, heavy shelves, and mattresses up a few flights of stairs.

My daughter has agreed to provide a home for my parrot, Dorian. Dorian is an African Grey and is about 30 years old. Besides myself, my daughter is really the only person that can handle her. Dorian was a male (presumably) for nearly 16 years, until he/she decided to start laying eggs on a regular basis. Of course, she does not have a mate (other than me), so the eggs are just for practice. Dorian does not like my wife, or cats. I have both, so she is going to live with my daughter, at least for now.

Lesson 2: When someone hits your vehicle, they develop memory loss.

I had an interesting weekend, highlighted by being involved in a four car accident on the freeway. I not exactly sure what went on behind me, but there was a lot of screeching of tires and swerving, quickly followed by the thud of a large object hitting the side of my trailer. This, of course, caused a little butt-tightening fish-tailing, but I was able to control it and pull to the side.

A young boy stopped behind me. He said that he didn't remember hitting my car, but the paint on my trailer did match the paint on his passenger side door and I did have a bit of his green paint on my trailer - an odd coincidence. And I thought I had a short-term memory! As much as I can piece together based on witnesses who stopped, two other vehicles tried to occupy the same lane, causing them to hit each other, and so forth. I was just an innocent bystander, traveling along minding my own business. Now, I will need to get my trailer fixed...

Lesson 3: Heavy books should be packed in little boxes.

Several of my daughter's heavily-packed boxes contained books. One cardboard box must have weighed three thousand pounds (perhaps, I exaggerate). Some smaller boxes seemed to contain helium balloons or cotton. Being the only male in the Sunday moving crew, I was assigned the heavy boxes, of course. So, instead of lugging a huge box of books up the stairs, risking a hernia, I had to repack the boxes at the bottom of the stairs, or carry up a stack at a time.

Lesson 4: Turkeys do not respect landscaping.

Large amounts of bark have been appearing in my lawn along the edges of the planters. I rake it back, but the next day it appears again. This weekend, I caught the culprits - a family of wild turkeys; Mom and her seven juvenile (delinquent) turkeyettes. My dog happily chased them away, but they simply walked back in a few minutes and continued their ongoing destruction of my landscaping. I don't mind them eating the bugs, but I do mind the excavation. This morning, the devastation was even worse.

Ever since we seriously reduced the family of coyotes living on our hill, we have been up to our butts in turkeys. When the coyotes finished eating the turkeys and rabbits, they ate my favorite cat, George. It is just one ecological disaster after another in the Sierra Foothills.

I guess I could lay out some feed and fatten them up for Thanksgiving. The last time I killed and ate a wild turkey was when I was a high school teenager in Pennsylvania. It tasted pretty bad; very stringy - certainly not as good as those hormone-injected and artificially-fattened store birds.

I spent some time on the Internet researching turkey repellents; and yes, there are such things. I have not decided if I am going to spend the money and buy one though. Maybe I will see if I can get the coyotes to come back.

Lesson 5: If you don't want to tramp in dog poop, walk in the grass.

I take a lot of pride in my lawns. They are green and lush and I water them regularly when our irrigation system is functioning. We have two dogs and about three acres for them to roam and poop wherever and whenever they want - sort of a Poop Heaven. Do they poop in the lawn like most dogs? No, they poop in the sidewalk; right in the middle where a human walks. Perhaps they do not want to be eaten by a rogue coyote during their morning constitution; or perhaps they do not want to get grass on their feet. Regardless of the reason, my sandals seemed to have some sort of poop magnet.

Lesson 6: You can't spend $20 at Costco.

I needed a box of copy paper. It was cheaper at Costco than the local stationary store, so I stopped on the way home. I ended up spending over $200 on stuff that I really didn't need, and they didn't even have the proper copy paper. I had to buy it at the local stationary store.

Lesson 7: Always look in the mirror before you leave the house.

I wake up about 5:30 AM, partly due to the dogs and partly due to my own bladder. I tend to have plenty of time to have a leisurely cup of coffee, watch the news, take a shower, and get dressed for work. I have never been late for work in my life. This morning (Monday), I was a mile from home when I noticed that I had not dried or combed my hair after my shower. It had that same, spiky look when you towel dry it. I had to go back home and finish my grooming. I still made it to work on time and did not spend the day looking like a derelict.

Life truly is a on-going series of lessons.

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Dealing with Swimmer's Ear - Even If You Don't Swim

Summertime is the season for swimmer's ear, medically known as otitis externa (OE). Basically, OE is a skin infection that just happens to be in the ear canal. Ninety percent of the time, the opportunistic organism that causes OE is a bacterial. About 10% of the time, it is fungal.

The ear canal is a warm, dark, most tunnel about 2.5 cm long, lined with sebaceous (oil) and ceruminous (wax) glands. A healthy ear canal is lined with a thin layer of acidic wax, protecting this sensitive skin from water and moisture, as well as inhibiting bacterial and fungal growth. The shape and angle of the ear canal allows for natural drainage of excess wax and debris. When these natural, protective measures fail, otitis externa can result.

In the summer months, people love to swim. Combined with the warmer (wax-melting) temperatures, moist perspiration, and excess water exposure, it doesn't take long for this protective wax coating to be depleted. Showers and bathing can also be factors. Year-round, we often have another underlying culprit - the frequent use of cotton-tipped applicators (Q-tips), or other instruments (paper clips, bobby pins, fingernails, etc.). If you happen to have a dry, itchy skin condition like eczema (atopic dermatitis) or psoriasis, this can occur in the ear canal as well.

Because the ear canal is rich in sensory nerves, OE is considered one of the more painful ear conditions. It can come on slow over a week or so, often starting as an annoying itch; or it can come on painfully fast with profound pain, swelling, or even drainage from the ear canal. It can become so painful, in fact, that people often cannot even touch their ears. OE is one of the many causes of ear pain that does not require an otoscope to diagnose.

The classic MIDDLE EAR infection, common in children, does not cause pain when the outer ear is moved or the tragus (the little flap of skin directly in front of the ear canal opening) is compressed. More often than never, if it hurts to move the outer ear or push on the tragus, you most likely have OE.

OE can be somewhat challenging to diagnose and treat. If the ear canal is painful and swollen, it can be nearly impossible for your medical provider to completely examine your ear. If there is considerable swelling, getting those eardrops in will also be a challenge. In severe cases, medical providers often insert little wicks made of compressed seaweed. These wicks gradually and painlessly expand and allow the penetration of antibiotic and antibiotic/steroid eardrops. It is rarely necessary to take oral antibiotics for OE, but some practitioners still give them anyway.

There are many different types of eardrops; some containing just an antibiotic and others containing a combination of an antibiotic (or two) plus a steroid. Why steroids? First, they are not the "bad steroids", so don't expect muscles to grow and foreheads to widen. These safe, topical steroids are used to help reduce the often-severe swelling and inflammation so that the topical antibiotics can do their job.

I am constantly puzzled why these eardrops are so darn expensive. Some of the older ones that we use have been around for decades. They should be dirt-cheap, but they are not. The newer ones, like Floxin or Ciprodex, can retail for nearly a hundred dollars, sometimes more. And, people complain about the price of gasoline! If eardrops sold be the gallon, they would be cost over ten thousand dollars. Of course, no one really needs a gallon of this stuff.

OE eardrops should always be instilled at body temperature. Why? The ear is extremely sensitive to temperature. If you put ice cold drops (some people mistakenly put these eardrops in the refrigerator) or even room temperature drops of anything in the ear, you could experience a caloric response. Your eyes will rapidly twitch from side to side (nystagmus), and you may get profoundly dizzy and nauseated; could even vomit. So, warm up those drops up in your hand or under your arm before putting them in your ear.

Do earplugs help? Sometimes; basically anything that keeps the water out of the ear canal may help. The trick is keeping the earplugs in place unless you are also wearing a bathing cap - not a fashion statement that kids are fond of making. Children, in particular, tend to lose earplugs relatively fast; so if you do use them, but the cheaper wax or silicon ones. Kids will also scream louder during water play when they using ear plugs and parents find it more difficult to yell at them for doing something wrong. For this reason, I rarely recommend them routinely, unless the child has surgical tubes in place.

Part of reason why earwax is so protective against infection is that it is acidic. Bacteria and fungus does not do well in an acidic environment. So what can we do to make sure the ear canal is more acidic? The answer is in your kitchen cabinets - vinegar. If you are particularly prone to getting OE, a 50/50 solution of white vinegar (acetic acid) and water is a cheap and very effective preventative. Just instill a few drops (at body temperature!) of this solution after swimming or showering will help prevent OE. Many of the over-the-counter swimmer's ear drops are primarily acetic acid mixed with rubbing alcohol.

Alcohol-based eardrops are safe as long as you do not have tubes, a ruptured eardrum, or a break in the skin lining. If you do, expect that those drops are going to burn...burn a lot! For this reason, I tend to prefer the homemade vinegar-only eardrops over products containing alcohol.

A final word about fungus: About 10% of OE will be fungal; often yeast. Unless properly diagnosed, fungal infections can last a long time and be an itching nightmare. Guess what? Many fungal infections in the ear canal will respond to the vinegar (acetic acid) solution. Some will require anti-fungal therapy, however, so it is important to consult your medical provider when home and/or prescription medications seem to be failing.

Now, go swimming and have a good time.

Related Topics:

• Q-Tips - Weapons of Ear Destruction?
• Ear Canal Problems: Swimmer's Ear

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Dolphin Encounters - Therapeutic or Not?

As a child, I watched a show called Flipper. It was about a bottle-nose dolphin that lived in Florida and apparently had a PhD in psychology. Each week, Flipper would happily save someone's life or solve some puzzling criminal investigation. He would follow his triumphs with a happy dance and that voice of his. I once saw a cartoon that showed Flipper removing his outer skin (there was a zipper in the back), only to reveal that Lassie was inside. Lassie was always getting Timmy out of a well; his Flipper persona could have just dove in and saved him.

I would read stories about clandestine military dolphins trained to detect underwater explosives and help recover accidentally-dropped hydrogen bombs. I would go to Sea World and see captive dolphins jumping through flaming hoops (something they often encounter in the wild, apparently), playing beach ball, or catching thrown rings. Their reward was a few dead fish, a clean tank, and top-notch veterinarian care.

I think that dolphins are fascinating creatures and I am glad that we share our world with them. I am also pleased that humans have not developed a taste for bottle-nose dolphins and eat them. Of course, bottle-nose dolphins do not eat us, either - a nice trade-off in my opinion.

About 15 years ago, I was in Florida for a medical conference with several of my professional colleagues. They decided to head to the Florida Keys and swim with the dolphins. A group of entrepreneurial people had made an inlet to the ocean and lured some wild dolphins into some swimming pool-like pens. According to the trainers, the dolphins were free to come and go as they pleased, but many simply chose to hang around and eat the free fish. In exchange for these handouts, the dolphins would have to tolerate paying people bobbing around in their pool.

This dolphin research facility also allows for developmentally-disabled children, especially those with autism, to have these therapeutic encounters for free.

We arrived at the Dolphin Encounter, paid our fee, and entered the water. There were about four "wild" dolphins swimming around. We were told to stick our heads underwater and make dolphin noises. Dolphins are apparently tricked in to believing our very strange, underwater whistles, shouts, and clicks were somehow other dolphins.

The dolphins were swimming around looking at us. Once they determined that we were not packing fish, they would swim on. One particularly amorous dolphin took a liking to a young woman in a bikini. He would not leave her alone, perhaps attempting to have a little inter-species love making (Once you go human, you don't go back). A bit intimidated by this unwelcome attention, she left the water. So, instead of a sleek, thin young woman to cuddle-up with, the dolphins were left with a handful of hairy men treading water, and a few ample women bobbing around like manatees. They were not impressed. During my hour in the murky, dolphin-poop pool, I was only able to briefly touch one as he (she?) went quickly by. I guess that was worth eighty bucks at that time.

Photo Credit: Rod Moser

For the last two years, we have been driving about 1500 miles south to Loreto, Baja Mexico. Kayaking or boating in the clear waters of the Sea of Cortez is a real dolphin experience. It is not unusual to see hundreds of dolphins playing in the boat's wake, or feeding on the abundance of fish in this area. Loreto Bay is a protected marine sanctuary, so it is prohibited to chase or molest any marine mammals.

Knowing from past experiences that dolphins do not like hairy men, I did not attempt to enter the water with them. They were free to jump up and enter mine, but that was as close as I was going to get. I got this one in the air trying to have his "human encounter". I wonder how much he paid?

The Mexican people love dolphins and consider them lucky. Of course, feeding dolphins also help locate fish for the fisherman. The dolphins do not seem to mind sharing their fish.

Photo Credit: Rod Moser

My teenage granddaughter wants to be a marine biologist , so for her birthday, my wife and I arranged a dolphin encounter for her at Six Flags Marine World in Vallejo, CA. For about two hundred dollars, she could actually enter the training tank, one on one with an instructor/trainer, and commune with those fascinating mammals. It was an overcast, rainy day; a bit cold to be plunging into a tank of sea water in my opinion. She ended up being the only person who showed up for the Dolphin Encounter that day. After a brief class and some instruction, she donned her wet suit and headed to the tank. There were two or three dolphins waiting for her. She stood on an underwater platform with a dolphin trainer and had the time of her life.

Apparently, the animal rights activists are not happy about these encounters and other dolphin encounters that have appeared all over the world, including Disney World. They consider any dolphin encounters a type of animal abuse. Capturing dolphins in the wild and forcing them to swim with humans is not a good idea, but for dolphins born in captivity, this appears to be fun (and therapeutic) for them, too. The picture is my granddaughter, Shelby, communing with a dolphin. Doesn't seem a bit abusive to me at all. I thought the two hundred bucks was a bit abusive, but I was assured that part of this money goes toward ongoing dolphin research, and of course, the care and feeding of them.

Being in California, these dolphins appeared to have a much better disposition then those delinquent ones in Florida. (Of course, the ones in Florida were wild.) She could freely touch and hug them and the dolphins did not seem to consider it harassment (or even foreplay). These were "nice" dolphins; mellow in fact. This behavior was certainly due to their constant socialization with humans.

Personally, I wouldn't mind trying to swim with the dolphins again. Maybe these California dolphins will be a bit more tolerant of a hairy man; maybe even like them. On second thought, I think I will just take pictures of them from the dry land.

If I were somehow reincarnated as a dolphin, I would prefer to be one of those Mexican ones frolicking free in the Sea of Cortez. However, I wouldn't mind retiring at Six Flags. Just kick back, eat some fish, and play with the kids.

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Creating a Time Capsule

Photo Credit: Rod Moser

Lucas was born twenty-one years ago, the son of one of my best friends. As a gift to the family, my wife and I decided to create a time capsule in a big PVC pipe; one to be opened on his 21st birthday. Since this first capsule, we have created them for all of our grandchildren, and I have launched a few hundred with my patients. I tell all new parents about creating time capsules.

So, what has changed in the last 21 years?
January, 1987: the Dow Jones closed for the first time over 2000.
February, 1987: The Unabomber was up to his antics.
In April that year, Mike Schmidt joined the 500 Home Run club.
Iran and Iraq were fighting each other; and there was the Iran-Contra Affair going on in Washington

Much has changed in the Smiley family since Lucas was born. For instance, they now have two grandchildren. One of the sons, Judson, could not be present for the picture. Some things have not changed in 21 years - Lucas is still living at home, but in a bigger bed.

Photo Credit: Rod Moser

What we put in Lucas' time capsule (some of the things):

• A nice bottle of wine to celebrate


• A pack of condoms


• Firecrackers (for the celebration, of course)


• Party hats, balloons, etc.


• We picked out an outfit for Lucas to wear on this 21st birthday: a pair of surfer shorts and a t-shirt with the California Raisins ("I heard it through the grapevine"). I even included the receipt and encouraged him to try and return it (21 years later) if it didn’t fit! But it did fit - see photo.


• A collection of magazines published the month of his birth, including a Playboy.*


• A video of shows that were on television, including the news and a lot of commercials. The video also had precious interviews by his older brothers, aged 5 and 7.
• Birthday cards: Written 21 years ago.


• An autographed blow-up dog (with signatures of everyone)


• Stamps


• Mementos: Collectible baseball cards, two antique medical bottles (from me), Canadian money (now worth more)


• A funky, cheap digital watch (it had stopped)
• Stickers and Disney memorabilia


• A Baby's First Christmas Hallmark ornament

Photo Credit: Rod Moser

*Strangely, we included a Sports Illustrated magazine that had a vicious-looking pit bull on the cover. For the last ten years or so, they own a near identical dog (not vicious, of course) now. See photo.

Every Time Capsule should be unique to the person or family. For our grandchildren, they included some of the following; some are suggestions:

• Clothes - we really spent time predicting sizes and tried to pick contemporary styles of the day; the more-weird, the better, like a bathing suit. Sports clothing items are a plus. Include some interesting underwear if you want, or one of Dad's shirts or Mom's bra!


• As many magazines, newspapers, etc. from the day or month of the birth as we can stuff into the box (fits well on the top).


• An expensive, collectible Barbie doll or Star War or GI Joe figures


• McDonald give-away toys from those Happy Meals


• Collectible comic books
• Small, interesting toys, trinkets, and (little) stuffed animals


• Sports memorabilia, like a signed baseball


• Birthday cards from grandparents and great-grandparents who may not be present when the capsule is opened 21 years in the future


• Hand-written, stamped, and sealed letters and life-stories from relatives (especially the grandparents and great-grandparents)
• Collectible coin sets


• Future predictions (We made a list of 20 questions for people to fill out, trying to guess the weight, height, occupation, etc. of the child at age 21).


• Stock certificate (Yes, that worked out)


• Jewelry from grandparents, etc.


• Other family heirlooms


• Local tourist collectibles like banners, flags, post-cards, etc.


• Video tapes (DVDs or CDs), pictures, and a few baby items.


• A "packing list", including an explanation of some of the more confusing items. Delete this list from your computer files, so you will be surprised.

Don't leave any room in the time capsule box - stuff it!

What you should NOT include:

• Don't use a PVC pipe! Too small and too difficult to open.


• Wine – not only did the sealed time capsule not protect the wine, it leaked on some of the other stuff. Perhaps, anything in liquid is not a good idea


• Things that a heat sensitive; stuff that could melt. Balloons and other latex items, like condoms, are not reliable and should only be included for the humor element.


• Things not sealed in proper protective packaging. You don't want a Mickey Mantle rookie card getting ruined.


• Anything edible


• Large amounts of money – you don’t want the kids breaking in to it.


• Anything that you might need in the next 21 years.

How to get started: Buy a big, opaque-plastic file box or other suitable container that can be permanently sealed. Don't get them too big or they will become annoying over the next 21 years moving them around; or too small that you cannot include everything that is collected. Buy a big tube of silicon to seal the box. Write the date this capsule will be opened, who owns it, etc. with a permanent marker. Have a safe, cool place to store it, like a bedroom closet. Start collecting some things BEFORE the baby is born, or at least shortly thereafter. It would be great to have letters and cards mailed and postmarked on the day of the birth. You can seal the box anytime, but it must be sealed by the first birthday.

Photo Credit: Rod Moser

In 21 years, you can invite people that contributed to the time capsule for the Grand Opening party or get-together. Some items will have significantly increased in value; others will have questionable significance. The personal letters may need to be read in private, especially letters from relatives or family members that are no longer with us. Technology rapidly changes - make sure to retain a device to play any electronic items (We had to hold back a VCR player).

You are preparing for a celebration in the future. Let your mind go wild and have fun.

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Diagnosis by Photograph? It's NOT Worth A Thousand Words

It is rare that a medical condition can be diagnosed solely by a photograph. Without the corresponding medical history and other detailed information about the person, a picture is not worth those proverbial "thousand words". The medical magazines must plenty of photographs to test the diagnostic acumen of clinicians, but these are often accompanied by a long medical explanation, and have at least two or three diagnostic considerations (clinical possibilities).

I love my new digital camera. I had always prided myself as being a good medical photographer using my collection of 35mm lens, but my digital one trumps them all. Lighting is always a consideration when doing medical photography. The best medical pictures use a circular flash the surrounds the lens; eliminating much of the shadows that accompany a flash located above the lens. The light has to be perfect to get a perfect picture. I have been taking medical photographs for over three decades but I would never expect another clinician to be able to consult on a case with me, based solely on a photograph.

Clinicians who practice in very remote areas, often use high-resolution photographs or videos for medical consultation. The military has been experimenting with this for years. Live feeds can be sent across the world to specialists for consultative advice. There are even cases where doctors have remotely operated on patients by telemetry and robotics. Who really knows where this technology will end, but don't expect to find this equipment in your local computer store.

On the WebMD Ear, Nose, and Throat message board, I am getting an increasing number of links to photographs that the posters would like me to view. This is not really helpful. In most cases, the photographs are of poor quality (sorry, but we clinicians are picky), and do not reveal the three dimensional view that we really need. A photograph is not even close to seeing the actual picture. I know that people are just trying to be helpful and thorough, but photographs are not really helpful.

Making a diagnosis is much more than visual. For instance, when I look in the throat at some inflamed tonsils, I don't just take a quick glance; I examine the throat. I look around that tonsil from all sides, I smell the breath (mostly inadvertently), I look at the surrounding tissue above and below that tonsil; I look at the teeth and gums, the sides of the mouth, and I feel the neck carefully for suspicious lymph nodes or lumps. I can look for rashes, feel the skin for fever, and listen to the heart for murmurs that may accompany strep throats. If the person is a smoker, I take that exam up another notch, adding cancer to my diagnostic considerations. I can perform certain diagnostic studies, like a rapid strep, culture, blood count, or mono test. And, I can see and talk to the patient. The medical history is the probably the most important part of any medical encounter.

When someone posts a brief posting and even a picture on WebMD hoping to get both a diagnosis and a treatment plan, it is not happen. A diagnosis is not made this way. Not only are WebMD health experts prohibited from diagnosing someone; how in the world are we going to treat them? Yes, we give suggestions/advice; many times pointing the person in the right direction. We can make suggestions on what they can do to help symptoms, such as pain. However, this is not a true, medical encounter and should never be viewed as such.

Everyone is taking digital photos now. I sutured a child the other day in the clinic, and the mother clicked away on her cell phone. Sometimes, a teen patient will take pictures of me doing a surgical procedure on them. Some medical providers absolutely forbid this practice; I really don't care. However, I would hate for those photographs and videos to appear on You Tube or shared on medical web sites from someone seeking a "second opinion".

"Look at this mole. Do you think it is cancer? Should it be biopsied or removed?"

In recent months, I had one person attempt to post dozens of pictures, including microscopic slides of something he removed from a part of his body, asking for my opinion. People request to send x-rays and MRIs, and well as complete medical records. A few years ago, I looked at a few of those photos, but not anymore. Sometimes, that is way too much information, if you know what I mean.

I run the ENT board. I really feel sorry for someone addressing questions about hemorrhoids or sexually-transmitted diseases. Can you imagine those pictures being posted? Don't get me wrong; photographs can be helpful in some cases, but usually not in the context of providing an educational service on WebMD member boards.

On the Boards, I do miss not looking at the face asking the question. Is she crying? Is she young or old? Is she a she? During a medical encounter, I watch the eyes more than any other part of the body. The eyes are truly the window to the medical soul, and reveal so much about a person. No offense to the visually impaired who have adjusted to a life without seeing those eyes. In my clinic, I will try not to converse with anyone wearing sunglasses (unless they are blind or prescription ones). I want to see those eyes, those reactive emotions, even if they have a sore toe.

The Internet is progressing rapidly, but it will always have its limitations. With advanced telemetry, it will be possible to monitor and even accurately diagnose patients from remote areas, and perhaps, even perform certain endoscopic surgeries. This will never be like having a live, breathing, talking, complaining, crying, moving patient in the room with you. The art and practice of medicine requires that you reach out and hold a hand, or even give a hug to a grieving patient. A robotic arm is not going to do that. A two-dimensional picture, often out of focus and frozen in time, will never be a substitute for seeing something "first-hand".

Want to see how easy it is? What would be your diagnosis for these three pictures? These are some EASY ones. If you do well, I will post give you some more difficult ones. Post your guesses and I will post the answers in about a week.

Picture A: What is this rash on my son's legs?

Picture B: My daughter has a fever, rash, and sore throat. What is it? Is it serious?

Picture C: What is this skin lesion on my son's upper arm?

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Technorati Tags: diagnosis, rash, medical photographs, health and wellness

Photo credit: Rod Moser, PA