Healthy isn?t something you are or aren?t. It?s a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It?s a balance between living well and taking care, and you can start right where you are.
A blog by Christina Elston
Healthy isn't something you are or aren't. It's a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It's a balance between living well and taking care, and you can start right where you are.


Archive for the ‘Just Ask’ Category

Just Ask: When Should a Boy’s Foreskin Detach?

Tuesday, June 21st, 2011

Courtney writes: My son is 7 and not circumcised. At a recent checkup his doctor seemed pretty alarmed because his foreskin hadn’t yet detached. She prescribed a steroid cream to help dissolve the connecting skin, but the pharmacist’s warnings (Don’t use too much!) have us spooked. And some Internet research suggests the foreskin could normally detach on its own as late as age 10. What should we do?

I took your question to Robert Adler, M.D., Senior Vice Chair of pediatrics at Children’s Hospital Los Angeles. Here’s what he had to say:

dr-adlerAlthough it is true that the foreskin can detach later in childhood, the older that the child is the less likely it is to happen spontaneously. Although the retraction of the foreskin is important for hygiene; as long as the child is not experiencing any problem, I would not recommend or encourage any forceful mechanical attempt to force the foreskin back. Watchful waiting is the best course, but a trial of steroid crèmes would pose no harm to your child.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it!

Ask An Expert: Not Quite 20/20?

Thursday, March 31st, 2011

Steve asks: My 10-year-old daughter was told by our optometrist that she needs glasses for her near-sightedness, and because she’s been that way for a while the best they can do is get her to 20/40 for now. Is this the doctor’s way of making me feel guilty about not getting annual eye exams or is there a logic to progressively bringing her vision with glasses to 20/20?

Health-E responds: We took your question to Mark S. Borchert, M.D., head of The Vision Center at Children’s Hospital Los Angeles. He was kind enough to answer. But first, a little vocabulary:

  • Myopia/Near-sightedness: Vision is clear up-close but blurred at a distance.
  • Astigmatism: Focus problems caused by the cornea, the clear, front part of your eye.
  • Diopter: A measure of the corrective lens needed for proper vision.

Now on with Dr. Borchert’s answer …

borchert_markTen-year-olds with pure myopia (mild to moderate near-sightedness without significant astigmatism) in both eyes can almost always be fully corrected to 20/20 with the first pair of glasses. High myopia (more than 6 diopters) in both eyes that has been present for years may not be fully correctable to 20/20 but should still receive the full power in their glasses as the vision might gradually improve to 20/20 with this prescription. Other potential causes should be sought for vision that cannot be corrected to 20/20 in a 10-year-old who does not meet these criteria. In such cases consultation with a pediatric ophthalmologist is recommended.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it!

Just Ask: A Cold From Nasal Flu Vaccine?

Thursday, December 23rd, 2010

Beth Writes:

My 12-year-old daughter had the nasal flu vaccine a few weeks ago. A week later she developed a bad nose cold (no fever) and is still not fully recovered. I’m not sure if it’s related, but wanted to ask if this is possible. Most importantly, I want to know if there are any known long-term consequences of having the nasal vaccine. I’m hoping we made the right decision to have the nasal vaccine instead of the injection.

Health-E Responds:

nasal-fluI took your question to James Cherry, M.D., a professor of pediatric infectious diseases who works with Mattel Children’s Hospital at UCLA. Asked if your daughter’s cold could have been related to the nasal flu vaccine, he responded, “Almost certainly not.” Some people do experience symptoms after having the nasal flu vaccine, but Cherry says these come on right away. Since your daughter’s cold didn’t come along until a week after she received the vaccine, “Unfortunately, she was exposed to somebody with a cold and she caught it,” Cherry says.

No long-term side-effects have been documented from the nasal flu vaccine. Cherry does point out that young children seem get a slightly better immune boost from the nasal vaccine, while adults do better with the injection. Your daughter being right in the middle, both should be fine.

He also says the flu vaccine, in either form, is well worth getting. “You have roughly 35,000 deaths a year from flu, and a large number of those are preventable through the vaccine.”

Jill Hoffman, M.D., acting head of the Division of Infectious Diseases at Children’s Hospital Los Angeles also chimed in with this response:

I cannot answer this question specifically as it relates to your child, but I can tell you from my experience and expertise that the most common side effects are stuffy nose and mild scratchy throat occurring up to a few days after receipt of the FluMist nasal vaccine. Since cold viruses are very common, especially this time of year, it is possible that your daughter was coincidentally incubating a cold virus at the time of the vaccine, which then manifested itself a week later. The vaccine is very safe when given to normal children and adults (2-50 years old) and no long-term side effects have been documented, except for protection from influenza for a year! You cannot get influenza from the vaccine.

The vaccine is NOT recommended for :

  • People less than 2 years of age
  • People 50 years of age and over
  • People with a medical condition that places them at high risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system.
  • Children <5 years old with a history of recurrent wheezing
  • Children or adolescents receiving aspirin
  • People with a history of Guillain–Barré Syndrome that occurred after receiving influenza vaccine
  • Pregnant women
  • People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components.

If you have further questions about your daughter, I would discuss these with your pediatrician and consult the Centers for Disease Control website (www.CDC.gov). 

Got a question about your family’s health? Click here, and we’ll find an expert to answer it!

Just Ask: What To Do With a November Garden?

Tuesday, November 9th, 2010

Carolyn Asks: We enjoyed our summer vegetable garden, but those plants are done. Now what?

Health-E Answers:

kathy-kellogg-johnsonI took your question to Kathy Kellogg Johnson, a Southern California Native and Chief Sustainability Officer at Kellogg Garden Products, her third-generation family business. Visit them at www.kellogggarden.com. Here’s what she had to say:

If your garden is really ugly in November, congratulations. That’s just what it is supposed to look like. Here’s what to do to bring back beauty – and make it produce more food.

First, clean up. Clear out those old zucchini and tomato plants, which are no longer producing.   The crispy plants that are bearing seeds may just be your next crop.  Experiment with saving seeds in wax paper.

Next, add soil amendment. This will help moderate the temperature around your root zone, keeping it cooler in summer and warmer in winter and creating a happy atmosphere underneath the soil for roots.  Adding an organic amendment will restore what your plants took away from the soil.

This time of year you can plant root crops (onions, carrots, beets, potatoes, radishes), ever-bearing strawberries, sugar peas and any kind of lettuce. To have fresh lettuce all year, plant a new set of plants about every four weeks. Now’s the time to add beautiful EDIBLE flowers to your salads.  Try nasturtiums, pansies, or violas to top your greens.

Once you’ve planted, amended the soil, add organic fertilizer, and be sure to mulch. Spreading ground bark or other mulch about 1  - 2” thick over the “naked soil” between plants can reduce water loss by 70%. And because veggies are heavy feeders, fertilize every 3 – 4 weeks  with an organic fertilizer.

If you run into trouble or have questions, visit your local nursery for help. Even if you don’t buy anything, they are usually happy to offer advice for free.

 Got a question about your family’s health? Click here, and we’ll find an expert to answer it! 

 

Just Ask: Flattening That Tummy?

Wednesday, August 4th, 2010

Carrie writes: I had a C-section several years ago, and just can’t seem to get rid of that little bulge that lives just above my scar. Are there any exercises I can do to flatten it out?

Health-e responds: I took your question to awesome fitness expert Jill Brown, who I met a few weeks ago at The Grove. Here’s what she had to say:

 

Jill Brown demonstrates one possible plank position.

Jill Brown demonstrates one possible plank position.

 

First I would have a professional (perhaps your OBGYN) ascertain whether that “little bulge” is a pocket of fat or if it’s something underlying like scar tissue.

If it’s fat, then there’s good and bad news. The bad news first: There’s no way to spot reduce. That means there’s no way to remove a pocket of fat from an area of your choosing through diet or exercise (plastic surgery exists for that reason of course). To burn off extra body fat you have to be sure that you’re doing plenty of good cardiovascular exercise (weight training is included in this if it’s in the form of a circuit), in conjunction with a proper diet. That said, there are some exercises that specifically target that lower belly pooch and can firm up the area of the lower abdomen.

Perform various types of plank exercises daily (on the elbows and/or with straight arms). Try holding for a minimum of 20 seconds to a minute, squeezing the belly button in toward the spine until you feel your abs twitching a little (this means they’re fatiguing and will get stronger the more you do it). Do your planks around three to six times most days of the week and remember these tips:

  • Keep the tailbone tucked by gently squeezing the cheeks of the buttocks and be very sure not to let the lower back and the space between the shoulder blades sag.
  • Keep the neck extended and in neutral. If you were standing upright, this would be the natural position of your head – not drooping.
  • You will feel your abdominals working the hardest if you keep your elbows directly under your shoulders.

The other surefire method for belly flattening is Pilates. There are plenty of great DVDs, classes at your local gym or personal trainers who can teach you how to engage the TVA muscle (transversus abdominus). This muscle works like a girdle to literally hold your guts in! And, it’s a primary focus in all Pilates training. People who do lots of crunches don’t necessarily engage this muscle and it is key to keeping the abdominals flat and sexy! Added bonus: doing both planks and exercises for the TVA are also great strengtheners for the lower back.

Just Ask: Cleaning a Skinned Knee?

Friday, July 2nd, 2010

Cora writes: “Even with helmets and safety gear, my scooter-happy daughter gets the occasional scrape or road rash. What’s the proper way to clean and bandage the wound?”

Health-E Responds …

alan-nagerAlan Nager, M.D., Director of Emergency & Transport Medicine at Childrens Hospital Los Angeles, was kind enough to offer this advice …

Clean the wound with warm soapy water, using a washcloth, every day. In between, apply a small amount of polysporin/bacitracin and cover the wound with a bandaid. The bandaid should be changed and the medication should be reapplied every day in order to keep the injured area clean. The injured site should also be inspected for redness or pus (signs of infection). If signs of infection do occur, the child should be seen by a physician, as oral antibiotics may be needed.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it! 

Just Ask: Alternatives For Treating Allergies?

Friday, April 16th, 2010

tissueTerri writes: “My son always has a runny nose. I have been to an  allergist and he said that he has pollen allergies. I am not too thrilled about having him on allergy meds all the time. Besides pollens, are there foods that can cause this runny nose? Any alternative ways of eliminating this problem?”

Health-E Responds: I took your question to the wonderful folks at Childrens Hospital Los Angeles, where pediatric allergist Ron Ferdman, M.D., provided this answer …

In general, foods are not a common cause of a chronically runny nose. Most food allergic reactions include skin rashes and gastrointestinal symptoms. Foods can cause respiratory symptoms, but they usually occur immediately after eating the food, and don’t cause a chronic runny nose.

Almost all the time, nasal allergies are due to airborne or inhalation allergens. Examples include plant pollens, dust mites, mold spores and animal dander. Grass pollen allergies are one of the most common causes.

In terms of treatment, the best treatment for any allergy is to eliminate, or at least minimize contact with, whatever is causing your allergies. Unfortunately, this is hard with pollens, especially in Los Angeles. Here the grass is green for most of the year – which means it is growing and producing pollen. Our grass season is longer than other areas of the country that have “real” seasons. You can protect the air inside your home by closing windows so the grass pollens don’t blow inside – especially during pollen seasons and times. You can run an air filter to filter out any pollens that enter your home. You can minimize unnecessary outdoor exposures by not hanging wet clothes outside to dry (the pollens stick to the wet clothes) and avoiding gardening or cultivation.

However, you can’t stay indoors forever – and you eventually have to go outside where you will be exposed to pollens.

To control symptoms due to exposures to allergens that can not be eliminated, there are two basic options: allergy medicines and allergy shots.

I understand parents’ hesitation to use daily medications, but fortunately, most allergy medications are very safe, even when used long-term, such as for years, and even when used in very young children. Most have essentially no serious side effects, and the side effects that do occur are usually mild and temporary. You would need to check with your doctor regarding the potential side effects of your particular medication.

Allergy shots (more accurately called “specific allergen immunotherapy”) are another possible treatment. With allergy shots, patients are given increasing concentrated injections (via a very, very small needle) of purified extracts of the allergens to which they are allergic, in this case grass pollens. The unique advantage of allergy shots is that over time the patient actually becomes desensitized – that is, their allergies become milder and can even disappear altogether. When effective, many people can decrease or even stop their medications, and can sometimes have years or even a lifetime without allergies. Allergy shots are effective for many inhalants (pollens, dust mites, animal dander) and for insect venom (bee sting) allergies. While generally very effective and safe, allergy shots require a large commitment from families/patients because they require frequent visits to the doctor’s office for injections, especially in beginning of treatment, and the total duration of treatment is usually between 3-5 years.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it! 

Just Ask: Tooth-Grinding Toddlers?

Wednesday, March 24th, 2010

Terresa asks: My 2-year-old daughter has been grinding her teeth at night. It sounds awful. Is it doing any harm?

toothHealth-E Responds: I took your question to Kathy Shafagh, D.D.S., a dentist practicing at 1st Choice Dental in North Hollywood. Here’s her answer …

Actually my own son does the same thing. Usually the high-strung kids or very sensitive kids do this. It will cause some leveling of the back teeth chewing surfaces. In some cases it may affect the incisors. However, it is not of any major consequence and it is not an indication that this will continue into adulthood. Six-month checkups need to be done to make sure that dentin (the second layer of the tooth, after enamel) is not exposed, as that may increase the chance of cavities.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it! 

 

Just Ask: Kids and Bladders

Tuesday, September 8th, 2009

Sandy asks: I have a 9-year-old who just never wants to empty her bladder. I know this puts her at risk for bladder infections. What should I do?

Health-E responds: We took your question to pediatrician Jim Sears, M.D., member of the renowned Sears medical family, and co-host of “The Doctors” television show. Here’s what he had to say …

jim_plexi_045-r2-finoutChildren (especially girls) who tend to hold their urine for too long tend to have a hard time fully emptying their bladder. This is because the bladder gets stretched out – much like an overfilled balloon – and won’t fully contract during urination, leaving a small amount of residual urine in the bladder and increasing the risk of infection. The best way to “re-train” the bladder to fully contract is to keep it from getting over-stretched. By having the child urinate every TWO hours, the bladder will never get over-full and will regain it’s “elasticity.” This can sometimes take many weeks. At home, set the oven timer for two hours so your child knows when it’s time to go. At school, talk to theteachers, and have your child go to the bathroom during snack and lunch breaks. Even if your child says she doesn’t need to go, just sitting on the toilet (or standing at the urinal for boys) will usually cause the urination “instincts” to kick in.

Got a question about your family’s health? Click here, and we’ll find an expert to answer it! 

Just Ask – Toddler Constipation

Monday, June 22nd, 2009

questionDionna Watson writes:

My son Christopher who is 26 months stays constipated. We give him prune juice on a regular basis. In fact, we give him prune juice even when he drinks milk. I try to give him a variety of foods … but lets be real, he only likes certain veggies, fruits, and snacks.

However, I do promote whole grains in our home. Likewise, I need advice on how we can help him to feel comfortable when he goes poop so that he will use the potty. He uses the potty every morning and only urinates but will not do a bowel movement because he holds his buttocks together so he can’t let it out.

We really would like advice on how to deal with this because its not only hurting our son but hurting us as parents.

 

Health-E responds …

For help with your question, I called on pediatrician Tanya Remer Altmann, M.D., bestselling author and Southern California mom. Here’s what she had to say:

drtanyaConstipation is common in toddlers and can cause endless problems. If his stool is hard, he won’t want to go in the potty because it hurts. He’ll hold onto his stool, making it larger, harder, and more painful, and potty training will not be successful. Back off on the potty training for a while while you treat his constipation. After a few weeks of having soft stools, he’ll forget that it hurt and you can reintroduce the potty when he is ready.

So, how do you treat the constipation? There are 5 fruits and 4 juices that are natural laxatives.

Fruits: prunes, plums, cherries, apricots, and grapes

Juices: prune, apple, apricot nectar and pear nectar

Prunes and prune juice work best.  Many toddlers love eating a few “giant raisins” a day. You can also increase the amount of prune juice you give him. If he doesn’t like the taste, mix it with milk (kids like it) or apple juice. Some toddlers just don’t drink enough fluids in general so add an extra glass of water a day to help push things through. Vegetables have natural fiber to help keep kids (and adults) regular so be sure to include a few servings a day in your family’s diet. If you make pancakes, waffles or oatmeal, add extra oat bran to the mix. Make sure that all breads, cereals and grains that you buy have at least 3 grams of fiber per serving. Read the labels and you’ll be surprised at how many good tasting options are available. If dietary changes aren’t helping your son have at least 1 soft stool a day, talk to your pediatrician. She may recommend an over the counter medication to help soften the stools.

Good luck!

Dr. Tanya

Visit Dr. Tanya online at www.drtanya.com. And for more great children’s health advice from this doctor-mom, check out her latest book, Mommy Calls.