Halloween - The Good, Bad, and the Scary

Kevin Dooley / CC BY 2.0

Children love Halloween; or most likely, they love to dress up and pretend they are super heroes, rock stars, cheerleaders, or monsters. Too bad that Halloween is only once a year, and too bad that Halloween has such an evil reputation as being a day that opens the gateway to Hell. Seeing happy little children dressed as fairies or Darth Vader is not the same Halloween it was two thousand years ago.

Ancient people (and even modern people today) believe in spirits - good ones, and bad ones. When I am seeing a traditional Hmong family in the clinic, they are unusually quiet. They do not want to draw attention to themselves by the evil spirits that lurk around medical offices. Actually, I have seen them myself, cleverly disguised as inspectors renewing one of our many accreditations. The Hmong and many other people in third-world nations do not believe in germs as a cause of disease; they believe that evil spirits are responsible. Since it is becoming more and more difficult treating certain drug-resistant diseases now, I am inclined to start believing it myself.

Two thousand years ago, the Celts, a much admired group by the tattooed crowd, believed that October 31st - the last day of their year - was a day when ghosts came back for a visit, and the dead comingled with the living. The Celts would dress in masks and costumes to scare them away, and leave offerings of food (the "treats") to appease them. However, if you are already dead and just making an annual visit, I don't really understand the point. Come on...they're already dead. What can happen? I wonder if adult Celts ate the primitive Baby Ruths and Milky Ways out of their kid's stash, as is our tradition now? I heard that archeologist have found some wrappers, including one intact 2000 year old Snicker that was missed. It is still edible.

After the Romans invaded Ireland and England, Halloween begin to change. The Romans didn't really like Celts dancing around in goat pants and stuff. Then came the Christians, who put the damper on this annual holiday by making November 1st All Saints Day; thus making October 31st All Hallow's Eve, or as we know and mispronounce it, Halloween. Hallow means "Saint". All Hallow's Eve became a religious holiday. The Celts were not pleased, so they invented Irish dancing and whiskey. I made that last part up, but I love to start Internet rumors.

The good part of Halloween is the fun that children have dressing up. They love going door-to-door getting candy (for their parents). Competing neck and neck with Christmas and their birthday, Halloween is often their favorite. Why do some people hate it?

The bad part of Halloween has got to be those poor choices for costumes. Being in the medical profession and having done my time in the emergency rooms, I don't really care too much for eyeball hanging out, knives stuck in ears (worse than Q-tips!), or blood dripping down from severed limbs. I keep trying to bandage them, or at least put on some gloves to keep from getting fake blood-borne pathogens. That is the scary part for us. For the younger crowd, these costume choices are equally as terrifying. Let the teenagers wear them at parties that only have teenagers, but let's not go door to door scaring the crap out of the little ones (and their parents).

Halloween can bring out the ultimate essence of poor taste, like a transvestite Obama or a Nazi cheerleader. No one, and I repeat, no one, should be wearing costumes that are offensive or in poor taste. The medical assistant who works with my wife is from Moldova, and is offended by anything related to Halloween, even pumpkins. Since my wife loves to decorate her office for Halloween, she is slowly (very slowly) learning to tolerate this American tradition.

Spiderman, Superman, and the Transformers tend to be popular in my office for the boys. The girls still love being ballerinas, divas, or one of the Disney heroines, like Ariel or Pocahontas, although Native Americans or mermaids may be insulted. Witches and ghosts are okay; I am not particularly fond of vampires, although I did like Twilight. I can vividly remember as a child, sleeping in my hot, humid attic room with the window closed, so that Dracula would not come in. I would avoid walking through the woods at night, too. The Wolfman, if you are curious.

A local mega-church goes half-way and has a Harvest Festival. For the safety of the children, they organize an annual "Trunk and Treat." Cars are parked all around the periphery of their large lot; the children go from car to car in their costumes, getting candy and treats from the trunks of their cars. I think this is a great idea and a wonderful compromise. They are prohibited from being witches, vampires, or axe-murderers, as they should.

It is time to re-invent Halloween, not abandon it because a few inflexible people may be offended because of some issues and associations 2000 years ago. Halloween is fun if you set some reasonable perimeters and join in.

Danielle Closs / CC BY-ND 2.0

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Antibiotics for Middle Ear Infections - Love 'Em or Leave 'Em

Antibiotics have only been in the medical arsenal for about 75 years, starting with sulfa drugs in the 1930s and penicillin in the 1940s. There are now dozens of different and more potent antibiotics, but very few new ones are patented. Since their discovery, antibiotics have saved umpteen millions of lives, and still do everyday. However, antibiotics have been heavily used and abused from their debut. Slowly but surely, they are become less and less effective.

As a child, our local, small town GP used to give injections of penicillin for just about any reason, it seemed. If you had a sore throat or tonsillitis, you got a shot of penicillin. If you had a fever for unknown reasons, you got a shot of penicillin. If you were uncooperative in his office, fearing that you will get a shot of penicillin, you got a shot of penicillin. He was such a shot-doctor, that kids would not even go to his door for Halloween.

In the U.S. as in many other countries, antibiotics are controlled by medical prescriptions. However, in places like Mexico, you can simply walk into a pharmacy and buy them - assuming they are "real ones" and not fake, counterfeit substitutes. With a Canadian doctor's prescription, you can easily buy large quantities in Canada. It is not uncommon for Americans to smuggle antibiotics in huge amounts across the borders, primarily for personal use, or share among friends. Some people have literally become Amoxiholics!

Antibiotics are only used to treat susceptible bacterial infections. They are completely ineffective against viruses - the main cause of most diseases. If they are self-administered indiscriminately for viral illness, not only will they be ineffective, they can make things worse. Sub-therapeutic doses of antibiotics help create resistant strains - the dreaded Superbugs. Primitive microorganisms can rapidly adapt to most antibiotics, even when given appropriately. There are bacterial strains out there that are completely resistant to EVERY known antibiotic. You really don't want an infection from these guys.

One of the major reasons antibiotics are prescribed for children is for the treatment of otitis media - the middle ear infection. Surprisingly, the vast majority of middle ear infections in children will resolve spontaneously in a few days, WITHOUT antibiotics. So, why do clinicians keep giving them and parents keep demanding them? That is the billion dollar question. Controlled, scientific studies in the U.S. and Europe have proven time and again, that antibiotics are only needed for the treatment of otitis media in very young children with immature immune systems, immunocompromised children (children with diabetes, cancer, etc.), or in children that are very toxic-appearing. These are the children who are very ill, in extreme pain, and not fighting off their infections naturally.


In Europe, children with otitis media are not routinely treated with antibiotics for at least the first week. That does not mean they are not treated in other ways for these painful afflictions. Children are routinely given pain medications - usually more than just acetaminophen or ibuprofen - to make them more comfortable while Nature orchestrates the cure. In the U.S., the typical care involves the early use of antibiotics, even in cases where the child does not even have signs of middle ear infection, and mild pain medications.

Over 90% of European children get better, on their own, with just pain medications, and tend to have fewer recurrent middle ear infections and need for surgical tubes. The U.S. kids tend to get better, too, but with potent and expensive antibiotics on board that more and more clinicians feel are unnecessary. Old treatment habits are hard to break.

I had a posting on the Ear, Nose, and Throat message board recently by a person inquiring about the proper dose of amoxicillin for her two children. She felt that the doctor's dosage was way too high, and that she would prefer to give half-doses. I really wanted to tell her that antibiotics are not really needed at all in most cases; but of course I knew nothing about her children and cannot blindly tell her not to use them. I assume that her children were properly examined, and probably treated with the appropriate dosage of amoxicillin. For most clinicians, treating otitis media is really routine stuff. However, most clinicians have not jumped on the "no antibiotic" bandwagon.

When amoxicillin first came out, maybe twenty years ago, it was dirt-cheap - only a few dollars for a standard, ten-day course. Children were treated, based on body weight, at about 20-30 mg/kg per day, in three divided doses. Amoxicillin virtually replaced ampicillin - an antibiotic that had some nasty gastrointestinal side-effects (like explosive diarrhea) and had to be given four times per day, a dosage nightmare for busy parents. The bubble-gum flavored amoxicillin even tasted better. For nearly a decade this dosage seemed to work great. Later, studies started to show that amoxicillin can be given twice a day, even more convenient for busy parents, and for as little as five days instead of ten.

My wife and I used to teach an all-day pediatric class for child care providers. I remember putting my lunch in their refrigerator, only to be shocked by the dozens and dozens of bottles of amoxicillin, all lined up for the various kids.

As the years progressed, everyone started using amoxicillin (a lot), still the drug of choice for otitis media. Unfortunately, amoxicillin started to fail as resistant strains took over. Many clinicians would abandon using it after the first-failure, until studies showed that a higher dose was more effective. Now, the standard dosage for amoxicillin (in children) is 60-80 mg /kg - more than twice the original dosage.

There are now about two dozen different antibiotics that can be used for pediatric middle ear infections. Every day in my clinic, I encounter the otitis media frequent flyers, usually on their way to the surgery center for tubes. There is a better way, but it is going to take a partnership of parent and medical provider to change the way we treat these kids. We need to trust that our immune systems have protected us long before the advent of antibiotics, and will continue to do so, IF we give them a chance.

Parents can help by not insisting on antibiotics, especially when clearly told that the child does not have a middle ear infection at the moment. Sure, they may get one tomorrow or over the weekend, or while you are at Disneyland, but that never justifies giving antibiotics prematurely.

Medical providers need to stand their ground and resist antibiotic solicitation from worried parents. Instead of medication, a healthy dose of EDUCATION needs to be administered. Parents who have children with frequent ear infections need to have a home otoscope, and learn how to use it. Medical providers have an obligation to cooperate with these novice otoscope-users, and encourage, not discourage their use. Parents should choose a medical provider that allows for this type of participatory care.

I still feel that antibiotics are miracle drugs, but the real miracle is to know when and how to use them. The bugs are getting smarter, and we need to be smart, too - always staying one step ahead.

Related Topics:

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• Living Better Newsletter - Wellness news to keep you healthy and strong!

Do Kids Need Pack Animals?

Photo: M.Lubinski / CC BY-SA 2.0

Now that school has started again, I expect to be seeing my share of backpack-related back pain again. Obviously, the weights of those packs vary from child to child, but I have weighed many backpacks in my office and found some to top twenty pounds. That is two, ten-pound sacks of potatoes! Another observation has been - the smaller the child, the heavier the backpack. I don't really understand this.

Why are packs so heavy? First, books are heavy and kids often have to lug around ALL of their books to every class. Unlike my school days, many schools have completely eliminated lockers. Why? Apparently kids were hiding contraband in those lockers, such as illegal drugs or weapons. The only things we would find in our lockers two generations ago were ancient lunches, snacks, smelly gym clothes, and of course, the occasional Nerd. In those days, schools had the right to open our lockers anytime that they wanted without fear of the ACLU coming down on the school for violating civil rights or privacy laws. I didn't think we were entitled to any privacy in public schools.

If kids wanted to hide contraband, they can hide a lot of scary stuff into those huge backpacks they are carrying around every day.

Why don't they have wheeled backpacks? They do, but none of the kids will use them because wheeled backpacks are not cool... not cool at all. If they tried using them, they would most likely be stuffed into one of those unused, empty lockers, and permanently labeled as a nerd. It is also not cool to use both straps, like a camping backpack. Kids are expected to use just one strap, hanging on one shoulder. Backs do not like this type of imbalance.

Adolescents get injured in sports all of the time, injuring limbs and backs. Unless they are paralyzed, they want to continue to play football or do cheerleading anyway. Regardless of their injuries, they always ask for a note (see my blog post about notes) for PE. Teen rationale dictates that it is okay to play football with an injury, but not square dance in PE.

I have a solution to bring this on-going back problem to light. Since service animals, such as Seeing Eye Dogs, are protected by the Americans with Disabilities Act, I think I am going to start recommending pack animals to kids with recurrent back pain who must carry heavy loads all day long. I can just see it now; kids walking the halls with miniature donkeys, mules, llamas, or St. Bernard dogs. They can tie up outside the classrooms, or to their desks. They will be novelties at first, but soon, the schools will get used to seeing of animal poop on the floor, llama spit on the walls, and of course, the omnipresent barking and braying. I am really, really tempted to start writing prescriptions for service (pack) animals. Schools won't give our kids some lockers, so let's see if they build some stables.

Heavy backpacks are not the only things responsible for adolescent back pain. Teens tend to have the worst posture ever - the slouch in their chairs, and sit with their backs humped over like Quasimodo. The kids in sports tend to be very active, but a large percentage of teens just come home, raid the fridge, and then plop onto the couch, or more likely, slouch in a chair to play hours of computer games. Inactive, after-school, latchkey kids tend to get fat, and of course, get into mischief.

Several of my patients with back pain have bed issues. For some, there are still sleeping on swayed mattress, handed down from older siblings. Many of the six-foot plus adolescents sleep with their legs hanging over the end of their toddler beds.

I have back problems myself, but mine was not due to lugging around a back pack. I do carry a brief case that could be lighter. My briefcase weighs considerably less than my wife's purse, which incidentally, looks a lot like a backpack without the sleeping bag. I would love to dump out a woman's purse someday, just as an experiment. Once a year, I do make my wife dump out her purse so I can get the hundred or so receipts jammed in there so I can do the taxes. I once found a receipt that was four years old!

I was always told to never look inside a woman's purse. When I was older, I just assumed it was so that curious boys would not find a tampon and think it was dynamite. When my wife goes into a dressing room on those (very) rare occasions that I am with her when she shops, I usually have to sit in the man chair with the other guys and hold her purse. The men sort of nod at each other, but none of us are digging around trying to see what is so heavy in there, perhaps expecting an anvil.

Women with children get very adept at carrying heavy loads - a heavy purse and a diaper bag hanging on one shoulder, balanced out with a huge, squirming toddler on the other arm. I am often amazed in my clinic, when I lift up one of those "big ones" onto the exam table, how deceptive their weight can be. Even some of the "little ones" are dense as lead. Maybe I am just getting weaker. At the end of the day, my back is starting to hurt. I don't know how these Moms do it. I have a hidden rule: if I see a baby with more than two chins and no neck, I let the Mom pick them up.

My old college roomate, Robert, was planning a six-month long backpacking trip to Tahiti, Fiji, New Zealand, and Australia (must be nice). I had to watch him everyday, packing and unpacking his backpack, trying to make room for both summer and winter clothes and balance his load. He actually used my postage scale to actually weigh socks! After about a hundred packings and unpackings, he finally was satisfied. He was in the shower the morning of his departure; his carefully weighed and balanced backpack sat by the door. As I went out to get the morning newspaper, my evil eye spotted a loose brick sitting next to a garden wall. Smiling, I picked up the brick, and rushed into the house. I quickly unpacked his backpack, pulled out his down jacket in the bottom (for the winter in New Zealand), and carefully hid this five pound red brick. I finished repacking his bag as I heard the shower stop.

Over the next several months, I anxiously awaited those postcards from exotic places; and pictures of his lazy butt sitting on the beach in Fiji. I would smile when I would see that backpack sitting under a swaying palm tree. Then one day, my long-awaited postcard arrived.

"You SOB! I found that brick!" I had attached a note asking that he please deliver this brick to New Zealand for me.

So, somewhere in the South Island of New Zealand, perhaps along a rural road, sits a lonely, red brick. I should have put two bricks in there. Maybe next time.

Related Topics:

• Ear, Nose & Throat Message Board with Rod Moser, PA, PhD
• Living Better Newsletter - Wellness news to keep you healthy and strong!