How to clean your kid’s ears (and yours) without Q-tips.

Jack Murphy (not his real name) was famous in my house growing up.  He sat in the back of my brother’s class in elementary school.  At that point in my life, what he did was the most disgusting thing I had ever heard of.  So, naturally, it was also the funnest thing I had ever heard of.

My dad coined the term “chips and dip.”  When no one was looking, or so he thought, Jack would go to work.  He would start rooting around in his ear until he found the perfect piece of earwax.  Quietly, subtly, Jack then slid that finger into his nose.  Careful not to lose control of the wax, he proceeded to dig around until he found what he was looking for.   A smile would cross his face as he looked down to see a piece of earwax (the chip) topped by a bugger (the dip) sitting on his finger.

What do you do with chips and dip?  You eat it.  And, that is exactly what Jack did.  As an adult, I vomit in my mouth a little when I think about it.  As a kid, it was the funniest thing that had ever happened.  To this day, if you talk about Jack’s “chip and dip” my brother and I will still have a little chuckle

Surely, there is a better way to clean out earwax.


Earlier this week, we posted why you shouldn’t clean your kid’s ears (or yours) with Q-tips.  How to clean them then?

First, we need to discuss the two different types of earwax.  The type your kid has is determined by his or her genes.  The approach to cleaning ears differs slightly depending on the type of wax your kid has.

  1.  Wet, sticky earwax.  Often dark in color, 98% of people of European descent have wet, sticky earwax.
  2.  Dry, flaky earwax.  This wax is often white.  A majority of people of eastern Asian decent and almost everyone of Korean decent have dry, flaky wax.  People with dry wax also lack a certain chemical in their sweat that odor-causing bacteria feed on.  Therefore, those lucky few have less body odor and many don’t even need to use deodorant.

 

So, what works to remove earwax?

It should be clear that you should not put anything in your ear if you may have an infection, perforation, or recent surgery.

Cerumenolytics are medications used break up cerumen (earwax).  First, lets say that cerumenolytics work.  They have been proven to be more effective at removing earwax than doing nothing at all.  This may seem obvious, but it important to establish that these meds do work.

Now, which one to use?  Basically, all of them work.  The three most common being mineral oil, hydrogen peroxide, and liquid docusate sodium.  9 clinical studies were reviewed and showed that all of the tested cerumenolytics worked.  There was no difference in how well each of these meds worked.  In fact, even water and salt water were shown to have a similar effect as the meds.

One caveat though. If your child has dry, flaky earwax, you should avoid medications that cause excessive dryness, specifically, hydrogen peroxide.  If the ear canal becomes too dry, then the ear may produce even more earwax.  Your child’s earwax should be removed with mineral oil or liquid docusate sodium.

It’s hard to say how often your kid should receive these medicines.  It may be helpful to ask your doctor.  Some kids need a drop every day.  Some need a drop every once and a while.  Others, none at all.  It all depends on how much earwax your child makes and if the earwax is blocking up their ear canal.

 

Lastly, do no use ear candles. What in the world is an ear candle, you may ask.   It’s a hallow candle that is burned over the ear.  The thought is that the burning candle creates negative pressure, which helps to draw the wax out of the ear canal.  It doesn’t work.  The candles do not produce negative pressure.  No earwax is removed.  There are multiple reports of hot ear wax dropping into the ear canal causing ear injuries though.  Just don’t do it.

So, to recap:  1) Ask your doctor if it would be helpful to remove your kid’s earwax.  2) Don’t burn a candle over your ear. 3) Consider yourself lucky if you have dry earwax and less body odor.

And no chips and dip.

-Jeff

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3 reasons why you shouldn’t use Q-tips to clean your ears.


A buddy in college once told me, “If a hypocrite gives you advice, the fact that they are a hypocrite does not make the advice any less true.”  Today, I will be that hypocrite.  In full disclosure, I use Q-tips to clean my ears.  So does Stephanie. And yes, we even clean our kids ears with them occasionally.  I’m asking you to ignore my hypocrisy and hear why you shouldn’t use them in your ears (or your kid’s).

In my house, we call all cotton swabs Q-tips, even though Q-tip is only one brand.  So, I will call them Q-tips here too.

 

First, a brief history.

Betty White was a spokeswoman for Q-tips in the early 1980s.

In 1923, Leo Gerstenzang, a Polish immigrant to the U.S., observed his wife wrapping cotton around a toothpick.  Supposedly, she was planning on cleaning out their son’s ears.  When he saw this, a light bulb went off, and the Q-tip was born.  Actually, at first Gerstenzang named them Baby Gays, but he changed the name several years later to Q-tips.  The Q stands for “quality.” 

Originally, the Q-tip was marketed as a way to clean out ears, among other things.  However, in the 1970s, a warning first appeared on the box that the Q-tips should not be inserted into the ear canal.  Instead, they were to be used to apply ointments, remove make-up, clean small objects, and for crafting.

Isn’t it strange?  By far, the most common use of Q-tips is to clean earwax out of ears.  The product itself, though, has warned consumers against this use for over 40 years.  Is there any other product that is used primarily for the purpose that the makers explicitly warn against?  Obviously, the warning isn’t much of a deterrent.


So, why the warning?  Q-tip use in the ears can cause several problems, including:

  1. Eardrum Perforation

So, this complication rarely happens.  Not many people clean their ears with enough force to rupture the eardrum.  However, perforation has been reported in cases of accidental trauma with a Q-tip.  For example, if someone’s arm is hit while they are cleaning their ears, the Q-tip can be thrust down the ear canal, injuring the ear drum.  One case report tells of a woman who had cleaned her ear and forgot to remove the Q-tip.  She went to bed and laid down on the side containing the Q-tip, causing it to be jammed into her ear canal.  Ouch.  And yes, this really happened.

 

2.  Cerumen impaction

Cerumen is the medical term for earwax. Cerumen impaction results when earwax builds up to the point where it blocks the ear canal and puts pressure on the eardrum.  Cerumen impaction can be uncomfortable and can affect hearing in that ear.  Most often, the impaction is the result of previous attempts to remove ear wax.  While using a Q-tip, the wax is inadvertently pushed further into the ear canal.  Over time, this can accumulate and block the ear canal.  In one study, 75% of all cases of cerumen impaction were related to the use of Q-tips.  As a side note, the study also showed that cerumen impaction from Q-tips was more common in the left ear rather than the right.  Not sure why this is the case.  Maybe our left hands are less coordinated at removing the wax?

 

3.  Otitis externa

This one is the biggie.  Otitis externa is often referred to as “swimmer’s ear” and should not be confused with otitis media.   Otitis externa is an infection of the ear canal, outside of the ear drum.  Otitis media is a “typical ear infection,” which affects the ear behind the ear drum.  Most people refer to otitis media when talking about ear infections.  Otitis externa is the most common problem resulting from using Q-tips in the ear.

Maybe the name for otitis externa should be changed from “swimmer’s ear” to “Q-tip ear.”  Q-tip usage in the ear was found to cause 70% of all cases of otitis externa.  Swimming was a factor in less than half of that amount.  The theory is that putting Q-tips in the ear causes small scratches and irritation, providing an opening for infection to enter.

The bottom line is that Q-tips can cause a number of problems in ears.  Avoid using them in yours (and your kid’s).  I’ll try to do the same….maybe.

 

Look out for a follow-up to this topic.  If we can’t use Q-tips, how are we supposed to clean our ears?  We’ll look into it.

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-Jeff

 

Home remedies don’t always work.

Home remedies are used every day, all across the globe. Some work well, others don’t.  Some make us feel better, others make things worse. Here are two that did not quite turn out as well as planned:

 

Vinegar breath.

Sometimes great ideas don’t turn out so great.

It was my sophomore year of college.  I spent the summer working as a waiter at a local microbrewery, Hops.  On this particular workday, I wasn’t feeling so well.  My stomach had been upset and hurting all day.  Was I getting an ulcer?  As the day progressed, it seemed to worsen.  Just as the dinner rush started, I became fed up.  I had to do something.  I am a smart enough guy, right?  I can figure this out.

Let’s see, the stomach is full of acid.  If I have an ulcer, maybe that means I have too much acid?  Having just finished my Chemistry final a few weeks before, I knew the answer.  I needed to neutralize the acid with a base.  How about vinegar?  Brilliant!  I was quite proud of myself.

Grabbing red wine vinegar from the salad station, I poured about four ounces into a cup.  After adding an equal amount of water, I chugged.  It was not pleasant, but it did go down.  I had just cured my pain with my own ingenuity and some rudimentary chemistry knowledge.  Great job Jeff!

A few minutes later, I greeted a table of customers, a family of four.  While taking their drink orders,  suddenly, unexpectedly, a belch flew from my lips.  The mother’s eyes widened as an overwhelmingly fetid odor of vinegar permeated the air.

Lady, don’t give me that look.  I didn’t have any more warning than you did.

What to say in a moment like this?  Did I explain myself?  Apologize?  Nope.  Sure didn’t.  I’m not that smooth.  I just pretended like it didn’t happen.   They didn’t say anything, and neither did I.  Can’t say I got a great tip though. I don’t blame them.

My night was just beginning.  I burped for hours, each burp reeking of vinegar.  Although, I did get better at hiding it from my other tables.

Oh, and it didn’t even help my stomach.  When I got over the embarrassment, I think that my pain had worsened a little.  I never tried the vinegar solution again.

 

Vicks Vapor Tea.

An elderly lady came into the ER with a cough and cold.  She had been sick for about a week, and she was quite irritable.  Honestly, she was a crotchety old lady. Nothing she had done at home helped her feel any better.  Earlier in the week, her friend had recommended Vicks VapoRub, promising it would clear her congestion.  It didn’t.

“I even got Vicks VapoRub.  It doesn’t work, and I hate that stuff.”

That was a strange way to describe Vicks VapoRub.  “What do you mean?  Why do you hate it?”

“Well Doc, at first, it’s all nice and minty.  Then, it starts feeling funny and begins to burn a bit.  The damn thing tastes awful.”

“Ma’am, what do you mean it tastes awful?  Are you eating it?”

“Of course I’m not eating it.  I’m not an idiot…. I drink it.  I drop a spoon full into some hot water, add a little lemon, and drink it, like tea.  But, you can’t make me use it anymore.  I’m done with that stuff.”

Yum.  Menthol mouth.  No thanks.

We had a long conversation about how to use the Vick’s.  It needs to be rubbed on your chest, not swallowed.  I’m pretty sure that she just chucked it when she got home.

 

-Jeff

As always, Identifying information about patients and providers were changed to protect their identity.

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5 Home Remedies for the Stomach Flu; the Clinical Evidence.

Gastroenteritis, aka the “stomach flu” or the “stomach bug” is characterized by nausea, vomiting and diarrhea.  It’s a nasty thing and can run rampant throughout the household.

Some people go to their doctor or to the ER.  Other’s try “grandma’s home remedy,” often with varying success.  Because home remedies are not studied often, we don’t know if they are helpful, ineffective, or if they cause harm.  History is riddled with “home remedies” that turned out to be bad ideas.  Some of my favorites include:

  1.  In ancient Egypt, dead mice were mashed and mixed with other ingredients. This paste was placed in the mouth to treat toothaches. 
  2. Mercury, not known to be poisonous, was used to treat syphilis and in ancient China it was believed that imbibing Mercury could results in immortality.
  3. Heroin.  Ok, so, not a home remedy, but it was originally marketed as a non-addictive cough suppressant for kids.

Not all home remedies are safe and effective.  What about home remedies for vomiting?  Is there any clinical evidence to support at-home treatments?

 

 

1) Ginger

Ginger is the most extensively studied home remedy for vomiting, although the studies are not specific to the stomach flu. Instead, they focus on morning sickness in pregnancy, vomiting from chemotherapy, and seasickness. 

The results:  Three studies were performed on pregnant women with morning sickness. Two of the three showed ginger to be more effective than placebo. Another three studies showed ginger to be effective in improving nausea and vomiting in patients on chemotherapy and in those suffering from seasickness.

The verdict: Thumbs up. It cannot be decisively concluded that ginger will improve symptoms associated with the stomach flu.  However, significant evidence does show ginger to be effective in improving nausea and vomiting from other causes.

 

2) Aromatherapy of Essential Oils: Lavender and Peppermint

Two studies tested aroma therapy with essential oils. Both showed positive results.

The results:

Aromatherapy with a mixture of essential oils, including Lavender and Peppermint was studied in pregnant women.  Although, vomiting symptoms did improve, those effects were not noticed until the 3rd day of therapy.

-When studied alone, peppermint  decreased the intensity and number of vomiting episodes in the first 24 hours of chemotherapy.

The Verdict: Thumbs up. (kind of) Although effective, some questions remain as to how long it takes for the symptoms to improve.  Most vomiting from the stomach bug will resolve in the first 24-48 hours.

 

3) Aromatherapy by Mint oil (apparently, this is different than peppermint oil)

Pregnant women were treated by aroma therapy with mint oil.

The results:  No improvement was shown in this study over placebo.

The Verdict: Thumbs down. No evidence to say it works.

 

 

4) Cinnamon

I was not able to find any clinical studies on humans using cinnamon for nausea and vomiting. One study did look at vomiting in chicks (baby chickens).

The results:  The chicks were given medicine to make them vomit.  Some were treated with cinnamon to help with the vomiting.  In chicks, cinnamon was found to decrease the frequency of vomiting.

The Verdict: Unclear. Works in chicks. Further studies are needed to determine if it is effective in humans.

 

5) Accupressure/Pressure Bands

Accupressure bands were compared to placebo in chemotherapy patients.

The results:  The bands reduced nausea on the first day of the study but not for the rest of the study (days 2-5). Even though the participants reported feeling less nausea, they still vomited the same amount.

The Verdict: I lean towards a Thumbs down. While the evidence shows improved nausea symptoms on day 1,  no improvement  was apparent on days 2-5.  However, the frequency of vomiting didn’t change on any day of the study.  Sounds fishy to me, like maybe placebo effect.   My guess is that the participants with the wristbands expected them to help, so they reported less nausea. However, when they kept vomiting, they stopped believing it provided any benefit.  Just a guess; but I don’t believe in them.

No matter if you go to the doctor and get a prescription or you try home remedies, the best thing you can do is to try to keep hydrated, rest, and wash your hands. Good luck.

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-Jeff

 

 

 

 

Gun shy at the urinal. It’s clinically proven.

Walking into an empty bathroom is a glorious feeling.  Empty urinals as far as the eye can see.  Which one to choose?  Invariably, just as we settle down settle on one, paradise is lost.  “That guy” comes in.  You know who he is.  He is the one who ignores all of the empty urinals and sets up shop next to you.  Why..  Why did this have to happen to me?  Great, now I am going to be here forever.

Don’t be that guy.  That guy is annoying.


Believe it or not, researches conducted a study in the 1970s to see if personal space affects how men urinate. It was performed in two parts; a pilot study followed by a full length study.

 

The Pilot Study:

This gets the award for the creepiest study I’ve ever heard of. So, a guy hung out in a college’s men’s bathroom. He pretended to be “grooming” but instead was spying on the guys at the urinals.   Random men would come into the bathroom, not knowing they were part of the study. The researcher would listen for a fly to unzip and take out his stopwatch. He would measure the time it took the student to initiate flow of urine and how long before he finished peeing. These values were recorded along with his proximity to other users at the urinals.  The results were promising, so they pressed on to the full length clinical study.

 

The Complete Study:

Similar to the pilot but in a little more depth. This time, the participants were aware that they were being studied. 60 participants were studied urinating by an observer in the bathroom.

Ok, I lied about the Pilot Study being the creepiest. This one gets the cake. Apparently, it was difficult to hear when the flow of urine would hit the urinal. So, the observers stood in the stall next to the urinals.  They rigged up a periscope that ran below the stall to the legs of the participant.  Through the periscope, they were able to visualize the urine flow into the urinal.  Maybe it makes for a more accurate measurement, but the periscope definitely upped the creep factor.  Hey, it was the 70s, right?

 

Three different situations were studied:

1) Another man stood at the urinal right beside the participant

2) With one empty urinal between the two men

3) The participant was alone at the urinals

 

Results:

The researchers found two statistically significant results from this study:

1) The men were slower at initiating urine flow while someone stood close by. When alone, they began peeing the quickest (4.9 seconds).  The slowest times came with another person at the adjacent urinal  (8.4 seconds). With one empty urinal between the men, the times were between the others (6.2 seconds).

2) The closer the participants were to each other, the less time they actually had a flow of urine. The solo participant urinated for 24.6 seconds. The participant separated by one urinal peed for 23.4 seconds. The participant standing closest finished in 17.4 seconds.

The closer someone was standing to the participant, the longer it took for him to start urinating and the less time he actually spent urinating.

Researchers concluded that this study supported the “arousal model.”   When a person’s personal space is violated, they become aroused (not sexually) and uncomfortable. The degree of “arousal” seems proportional to the amount of personal space violated. They postulated that once a man is pressured by the social stressors of having his personal space violated, he has difficulty relaxing the external ureteral sphincter. He can’t urinate until that sphincter has relaxed.

This study was performed among college students. If it was done a geriatrics club, who knows how long those times would have been?

The take home point is; Don’t stand right next to me at the urinal. It’s clinically proved to decrease performance  Besides, it’s just weird.

 

-Jeff

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The difference between a heart attack and heart failure?

James, a 22 year old man, was admitted for a heart attack after using cocaine.  I met him while rounding with the cardiology team.  Our interaction with James was frustraing but not entirely uncommon.  He had likely caused permanent damage to his heart, yet, he didn’t seem to care.  No matter how we tried to impress upon him the need to stop using cocaine, our pleas were falling on deaf ears. He sat back in bed, avoided eye contact, and flipped through the TV channels. His only response was a sarcastic scoff. His distain for us was palpable.

We gave up. Our efforts were fruitless.  The cardiologist began to listen to James’s heart and teach the students.  With his back to the patient, the cardiologist made an off-hand remark about hearing a very mild murmur (likely no big deal).

At this, the patient sat up and said “Hey Doc, what’s that?”

He explained, “Well, a murmur is when we hear a small amount of blood flowing back through a valve in your heart. It makes a noise, and we can hear it.”

Wide-eyed, the patient stammered “Doc, I’ve got blood flowing the wrong way? Oh no. I’ve gotta quit doing cocaine.”

Ummm…yes.  We left it at that.  Obviously, he didn’t have a strong grasp of how the heart works.  Whatever gets him to stop using.  I think that the ends justify the means on this one.


News came out recent reporting the deaths of celebrities Carrie Fisher and George Michael, who both apparently died of heart problems.  These deaths have brought up questions about heart issues.  What is a heart attack?  Is it the same thing as heart failure?  We will try simplify these terms and the function of the heart.


Your house has two major systems, the plumbing and electrical systems.  Your heart has similar systems.  The “plumbing” of the heart includes the blood vessels that bring oxygen and nutrients to the heart muscle itself, giving the heart muscle the energy to beat. The plumbing does not control the speed at which the heart beats.   This responsibility falls to the electrical system, made of fibers that run inside the heart muscle itself. The fibers send an electrical message telling the heart to beat, how fast to beat, and hopefully to beat in a fluid motion.

 

So, what is a heart attack?

A heart attack, or myocardial infarction, is a problem with the “plumbing” of the heart. During a heart attack, a blood vessels going to the heart itself is blocked, usually by plaque (I’m looking at you pizza and cheeseburgers). Usually, a small piece of plaque breaks off the inside of a blood vessel and blocks (partially or totally) a blood vessel to the heart. Since the blood vessel is blocked, blood cannot reach the heart muscle. Without oxygen, the heart muscle there begins to die. When someone comes to the hospital suffering a heart attack, the goal is to open up this blocked blood vessel to the heart as soon as possible.

 

What is a heart arrhythmia?

The “electrical system” of the heart is responsible for sending an electrical message down the muscle of the heart. It is tells the heart to 1) beat in the correct order and 2) beat at the correct speed.

It is important for the heart to beat efficiently. Think of a tube of toothpaste. If I squeeze from the back of the tube and move forwards, most of the toothpaste will leave the tube. If I squeeze the opposite way, not as much will leave. It’s the same with the heart. The electrical signal tells the heart to pump from the top of the heart down to the bottom, resulting in a more efficient beat.

The electrical system also controls the rate. Our hearts normally beat between 60-100 beats per minute. However, if we go running, it needs to beat faster. The electrical system helps increase our heart rate to meet our body’s demand.

An arrhythmia, or irregular heart beat, can take many forms. It is the result of a problem with the electrical system.  Arrhythmias can range from a benign irregularity to one that will result in sudden death.

 

What about heart failure?

Envision your kitchen sink. If you cut the faucet on, the water should quickly flow down the drain and out of your house. Just this morning, I was doing the dishes after breakfast. Egg shells, lemon rinds, and oatmeal began to clog up the outflow drain. Water stopped draining easily and began to back up into the sink.

The heart works similarly. Blood constantly enters the heart from the body and is pumped out again.  If the heart has difficulty pumping blood out properly, it too begins to back up.   This is what is called heart failure, where the heart is unable to pump out the amount of blood needed. Two major reasons for this is include:

1) the heart is having difficulty pumping out because of some force. These forces can include high blood pressure and heart valves that aren’t working properly.

2) The heart muscle isn’t squeezing as strongly as it should.

Two problems can result from heart failure. First, the heart has trouble pumping blood and oxygen out of the heart to the organs that need it. Second, the heart cannot pump blood out of the heart well enough, resulting in fluid backing up. Fluid will build up in the legs or even in the lungs (making it difficult for the person to breathe).

 

What is cardiac arrest?

According to the American Heart Association, cardiac arrest is defined as “the abrupt loss of heart function.” Meaning, the heart stops functioning in a way to compatible with life.   Cardiac arrest can be the result of a fatal arrhythmia (a problem with the electrical system), a heart that cannot pump enough blood to the body to sustain life (either the heart is took weak or there is not enough blood in the body), and complete standstill of the heart.  Cardiac arrest can be the result of a heart attack, arrhythmia, or heart failure, among other things.

None of this compares to the horror of having blood that flows the wrong way though.  Beware!

 

-Jeff

As usual, the patient’s identifying information was changed to protect their identity.

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In honor of Hanukkah…

A trauma surgeon once told me “trauma is not a random disease.” As med student, I wasn’t quite sure what he meant. It didn’t take long in the trauma bay to figure it out. Sure, bad things can happen to anyone, but certain segments of the population are more likely to get hurt than others. Miscreants get shot. Drunkards fall. Young people wreck cars. Very few white haired grandmas end up on the trauma service.

In my life, I have only seen facial swastika tattoos twice. Both were trauma patients.

Dr. Trotter has practiced trauma surgery for over 35 years. You name it; he’s seen it. Gunshots. Stabbings. Car accidents. Hangings. Farm accidents. He could write a book.  No, volumes of books. On this particular day, I was rounding with him in the trauma ICU. It’s important to know that Dr. Trotter is Jewish.   We had just left the room of a white male with a large swastikas tattooed between his eyebrows when Dr. Trotter told me this story.

Several years ago, Dr. Trotter was on call one evening. A man involved in a bad car accident was flown in by helicoptor. He had sustained multiple abdominal injuries and needed to be rushed to the operating room. And yes, this patient had a large swastika tattooed onto his forehead. Dr. Trotter and the anesthesiologist rushed upstairs to meet him in the OR. The anesthesiologist had just pushed the sedative medicine to induce general anesthesia. The patient’s eyes became glossy as he was drifting towards unconsciousness. Dr. Trotter walked over to the patient and bent over. With his lips almost touching the patient’s ear, he whispered, “By the way, your doctor is a Jew.”

The patient’s eyes shot open, his head jumped off the bed, and a protest formed on his lips when suddenly his eyes went glossy and his mouth shut.  The unsaid words still on the tip of his tongue.

I can’t say if the patient remembered what was said, but I doubt that he did. What is clear is that the Jewish doctor saved that man’s life, irregardless of the patient’s prejudice.  And, he would do the same every time. The patient made a full recovery and was discharged from the hospital the next week.

Chag Chanukah Sameach, Happy Hanukkah.

As always, details about the providers and patients were changed to protect their identities.

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-Jeff

Prevent the spread of the stomach bug in your home.

The Continental is a good local restaurant. Delicious food. Fun atmosphere. But, I won’t go there again anytime soon. During my last two visits, I had a daughter vomit all over me. Don’t get me wrong; it is not the restaurant’s fault. It wasn’t food poisoning. Each time, we unknowingly brought the stomach bug with us.

My eldest daughter was looking “a little punky” (as a pediatrician would describe it) when we brought her in for her 3 year old check-up. The doctor’s office is close to the Continental, so why not enjoy a good lunch afterwards? We didn’t even make it to our table. I approached the hostess stand with my daughter in my arms when things suddenly went south.   Upon entering the restaurant, I heard a wretching sound just in time to see vomit fall to the floor at my feet. Instinctively (I am not sure why this was my instinct, but what can I say), I turned my daughter in my arms so that she would vomit straight onto me. Yeah, good decision dad. Within seconds my shirt was drenched, soaked from my neck to waist. We didn’t stay to eat.  I can’t say that drive home was pleasant.

The second story is similar. It was my younger daughter this time. It had taken us nearly a year to venture back out to the Continental, still scarred by our previous visit. Things were going swimmingly until we finished our meal. My daughter hadn’t eaten much for lunch, which is not normal for her. After paying, we walked outside.   Disaster strikes again. This time, I had no warning.  No instinct took over. She just vomited all over me. Again, it was a fun ride home. On the bright side, I have gotten pretty good at taking off a wet shirt without smearing vomit on my face.  We have had to learn how to keep the rest of the family from getting the GI bug as well.


So, when the stomach bug strikes, what is our next big fear? Who is going to get it next?  One kid with it is bad enough. The whole household vomiting is a disaster. So, when the puking and diarrhea begins, what can we do to prevent its spread?

 

A little background

The Norovirus.

Gastroenteritis (vomiting and diarrhea) has many causes., we will focus on the stomach bug (infectious gastroenteritis), specifically, Norovirus. It is a nasty virus that has gained notoriety by wreaking havoc on cruise ships. It is a common infection and the average American will be infected with Norovirus 5 times in their life. Most people are exposed in the winter months, between November and April. Tis the season!

Symptoms begin between 12-48 hours after exposure to the virus and they last between 24-72 hours. Symptoms consist of nausea, vomiting, diarrhea, and occasionally is accompanied by low-grade fevers, body aches, and headaches.

 

How is Norovirus spread?

This is pretty gross when you think about it. You can only get Norovirus gastroenteritis by ingesting tiny particles of the Norovirus virus.   It is excreted in vomit and stools. That means that you need to ingest microscopic particles of other people’s vomit or diarrhea to get sick. Pretty gross, huh? The person with the stomach bug becomes contagious as soon as he or she begins having vomiting or diarrhea. Here is the kicker; people can shed Norovirus in their stools for as long two weeks after their symptoms start. That means that they can still be contagious for a week and a half after they are feeling better. Meaning, when they are back at school, work, or playing with their otherwise healthy brothers and sisters.

 

Someone in your house has the GI bug. How can you prevent its spread?

1) Wash, wash, wash your hands (and everyone else’s in your house). After you use the toilet, after you change a diaper, before you eat or prepare food, and any other time you think about it.. Seriously, this is the best thing you can do to prevent its spread. Hand sanitizer is ok, but it doesn’t compare to simple soap and water.

Vomiting Larry in action.

2) Sanitize everything. A group of researchers made a machine to simulate human vomiting. They affectionately named it “vomiting Larry.” What they found is that small particles of vomit can travel up to 10 feet. If these particles land on hard surfaces, they can live as long as a few weeks.

Since the particles can travel 10 feet, you also need to disinfect an area with a radius of 10 feet after you or your family member vomits. My daughters have a habit of vomiting right in the middle of the bathroom, never in the toilet or sink. So, the entire bathroom needs to be disinfected. That means, the ground, the counters, toilets, doorknobs, faucets, etc. I have never thought about it before today, but that probably means the toothbrushes need to be disposed of if they are on the counter. Who bleaches a toothbrush? Plus, we put those in our mouth. Gross.

When you can, bleach everything. Bleach works better than other household cleaners and disinfectants. However, not all surfaces can be bleached.   The North Carolina Department of Health gives recommendations for cleaning and disinfecting your home from the Norovirus on various surfaces. You can see those here.

3) Wash all of the exposed clothes and linens. Try not to shake them as it could potentially spread the virus.  Crank that washing machine up to the strongest setting your clothes will tolerate.

4) Don’t eat or drink after someone who has the stomach bug. Seems obvious right?

5) Don’t prepare food while infected. It looks like you might get yourself out of dinner duty for a few weeks if you get sick.

6) What about probiotics? According to the American Academy of Family Physicians (AAFP), taking probiotics with the stomach bug can reduce the duration of diarrhea by one day. No word on taking them to prevent transmission if exposed to someone already infected.

7) What about antidiarrheal medicine? The AAFP recommends against their use in kids because it may “delay the elimination of the infectious agents” (virus or bacteria) in the stool.

If someone in your family gets the GI bug this year, hopefully you can contain it before your entire family gets sick. Remember, keep hydrated and see your doctor if you need to.

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-Jeff

 

Don’t eat the mistletoe. A review of holiday poisonings.

My mom walked into the living room to see my older brother, then two years old, with a snow globe up to his face, gulping its contents. He had been busy playing with the globe, and my mom hadn’t noticed that he had removed the plug from the underside. By the time she snatched it from his hands, most of the liquid it contained was gone. Although not normally one to worry, this one got her. What in the world was in that liquid? What did my son just drink? She frantically called the pediatrician and was relieved by his reassurance. He told her that the globes were filled with glycerin and that my brother would be fine. Whew, what a relief. Although I don’t remember this incident, it still comes up every now and then when my mom sees a snow globe. I’m not sure if this happened, but I would like to think that at least his diaper was filled with shimmery, glittery silver poo; a little Christmas present for my mom.


The journal of Emergency Medicine just published an article entitled “Holiday Poisonings” in their December issue this year. I wanted to highlight some interesting poisonings from this article.

 

Poinsettia

It is widely believed that the poinsettia plant is extremely poisonous. I was surprised to learn that this is false. The poinsettia is non-toxic or only mildly so. An urban legend from 1919 told of the reported death of a 4-year-old boy after eating poinsettia leaves. This belief still persists 100 years later, long after we forgot the urban legend that perpetuated it.

The truth is that poinsettia ingestion will only cause some nausea and vomiting. Interestingly, the sap does seem to have some cross-reactivity to latex. So, if you are allergic to latex, you can get some skin irritation if you touch the sap of the plant.  If your skin gets irritated after touching the poinsettia, wash it thoroughly with soap and water.

 

Mistletoe

Mistletoe contains two different toxins, phoratoxin and viscotoxin. Although a handful of people receive treatment for mistletoe poisonings each year, most of their symptoms are mild. Commonly, they present with nausea and vomiting within a few hours of the ingestion.

However, more significant side effects are possible. These cases are much more likely in people who have a concentrated exposure to mistletoe, as in tea brewed from mistletoe. This can result in a low heart rate, kidney failure, liver failure, and death.

My guess is that a lot more people have gotten sick kissing under the mistletoe than eating it. Still, stay away from the tea.

 

Tinsel

Tinsel was fist made in the early 1600s in Germany. Initially, it was made of silver and was only available to the wealthy. Eventually, manufacturers started making it out of copper and aluminum. However, during WWI, these metals were scarce, so these metals were replaced with lead. It wasn’t until the 1970s that the FDA realized that lead was poisonous. So, because of the risk of lead poisoning, tinsel has since been made of plastic. Still though, don’t eat it.

 

Snow Globes

Most snow globes are filled with either water or a mixture of water and ethylene glycol (the same stuff in antifreeze). Ethylene glycol is added to prevent freezing during shipping. Ethylene glycol is a highly deadly toxin and should be totally avoided. However, the concentration of ethylene glycol in snow globes is usually so small as to not cause symptoms if swallowed.   If symptoms (drowsiness, difficulty breathing) do occur, the poison center should contacted immediately.

 

 

Artificial snow

Most “fake snow” consists of a polymer called sodium polyacrylate as well as the aerosol component in the can. Exposure to the aerosol can cause difficulty breathing in patients with pre-existing lung diseases, such as asthma or COPD.

Sodium polyacrylate can cause significant damage if exposed to the eyes. When it contacts the water on the eye, it absorbs the water and forms an expanding gel. This gel adheres to the surface of the eye. Significant eye trauma has been reported, sometimes requiring multiple surgeries to correct.


So, enjoy the holidays.  Merry Christmas.  And, don’t eat the decorations.

 

-Jeff

 

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What is the dose of Tylenol or Ibuprofen? 3rd of 3 in series.

It was 2pm. I walked downstairs, having just awoken from sleep after the last of several night shifts in a row. The kids were acting nuts and Stephanie looked a little frazzled. As I walked into the kitchen, I noticed a few red splotches on the kitchen ceiling. I asked, “What are those red spots on the ceiling? Is that spaghetti sauce?” I envisioned a pot sitting on the stove too long that bubbled over? Maybe?

“No, that’s Tylenol.”

“Tylenol? How is that possible? Those are 9 ft. ceilings.”

“Don’t ask.”

It seemed wise not to ask then. Those spots are still there now, right above the sink. I still am not exactly sure how they got there. It seems like a sore subject.

It turns out that we are not the only people who have trouble using syringes. In this 3rd of 3 posts in a  series about the issues we have dosing over-the-counter medicines, we will discuss the difficulty we have using the syringes themselves.


Over the last few weeks, we have established that over half of all kids get the wrong dose of Tylenol or Ibuprofen, leading to poorer symptom control and possible toxic effects.

The first problem, discussed in the 1st of this series, is related to how we figure out the dose of medicine to give our kids.

The second, discussed in the 2nd of this series, has to do with what dosing device we use to draw up the medicine.

Today, we will look at the third major problem:

We stink at using measuring devices. This problem was honestly a shocker to me.

Even though the syringe is the most accurate way to measure medicine, we still have great difficulty with it. In one clinical study, parents were asked to draw up a certain amount of medicine in a syringe, i.e. please draw up 5mL of medicine into the syringe. How many parents were able to do this correctly?

I would have guessed 75%. It seems pretty simple. Just draw up the medicine to the 5mL mark. No big deal, right? But unfortunately, I was wrong. Only 35% of parents could draw up a correct dose using a syringe. If the person performing the study demonstrated how to draw up the correct amount of medicine in the syringe and marked the correct dose on the syringe with a marker or pen, then 100% of parents were able to draw up the correct amount of medicine. Many parents need to be physically shown how to use a syringe to use it correctly. I couldn’t believe it.

This problem does not have an easy fix. Is it possible to teach the millions of parents of young children how to use a syringe? That is a difficult task. Maybe our doctors and pharmacists need to actually get a marker and mark the patient’s exact dose on the syringe.  It’s at least good to know that this problem exists.


Take Home Points (from all three blogs in the series):

•Over-the-counter medicines are safe and effective if given in the recommended dose, but we often screw this up.

•The next time your pediatrician tells you the dose of Tylenol or Ibuprofen for your child, write it in Sharpie on the medicine bottle itself. Write the day’s date and the dose for each child. When your child gets sick, figuring out the dose will be a cinch.

•Never use kitchen spoons. These are incredibly inaccurate. Only use dosing cups or syringes.

•Consider asking your doctor or pharmacist to mark the syringe at the volume of medicine your child would need.

If ever you are unsure of how much medicine your child needs, contact your doctor or pharmacist. It’s the safest thing to do.

-Jeff

 

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