Probiotics can be used to treat diarrhea in kids.


Runners diarrhea, known as the “runner’s trots,” occurs when long distance runners feel a sudden urge to have a bowel movement in the middle of their run. Although the cause isn’t clear, it is thought to be due to either decreased blood flow to the gut during extreme exercise or as a result of repetitive mechanical trauma. Most famously, Paula Radcliffe experienced this phenomenon en route to winning the 2005 London marathon. In full view of a packed crown and streaming live on TV, Paula Radcliffe stopped mid-race and relieved herself on the side of the road. It brings a whole new meaning to the term the runs.

Hippocrates, the Father of Medicine, coined the term diarrhea. It is derived from the Greek words dia, meaning through, and rhein, to flow. So, diarrhea literally means “to flow through.” Aptly named. Nice work Hippocrates.

Our questions today though is, “Are probiotics useful in the treatment of diarrhea in kids?”  First, let’s define probiotics.  They are microorganisms, bacteria and yeast that, “when administered in adequate amounts, confer a health benefit on the host.” We will look at two different settings in which probiotics can by used by children, first in the treatment of the “stomach bug” and second in the prevention of diarrhea from antibiotic use.


Treatment of the “stomach bug”

The European Society for Pediatric Gastroenterology, Heptaology and Nutrition (ESPGHAN) reviewed a collection of clinical trials which studied probiotic usage in the treatment of acute gastroenteritis (the stomach bug). The ESPGHAN recommended the use of probiotics in the treatment of children with gastroenteritis. They deemed that the benefits gained outweigh the risks of consuming live micororganisms. The reported benefits include:

1) Probiotics have been shown to decrease the duration of diarrheal illness by one day.

2) Probiotics usage decreases the chances that a diarrheal illness will last  4 days or more.

More than 25 probiotic species were studied. However, only Lactobacillus rhamnosus GG and Saccharomyces boulardii were recommended. The remaining species were not found to both safe and effective.


Prevention of diarrhea from antibiotic use

The ESPGHAN also reviewed the literature concerning probiotic use concomitantly with antibiotics to prevent antibiotic associated diarrhea. Probiotic use was shown to decrease diarrhea from antibiotics by 52%. Once again, only Lactobacillus rhamnosus GG and Saccharomyces boulardii were shown to be effective. The remaining species need to be studied further.


Lastly, all probiotics contain live organisms. They should not be given to kids whose immune systems don’t work well unless instructed by their doctor.

An article from Infectious Diseases in Children was heavily referenced for this post.  You can read it here.

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“Double Down” Donnie and the errant rectal exam.

I didn’t know Donnie very well. As a medical student, he was rotating through the ER. He seemed like a nice enough guy, but he didn’t really stand out during his rotation. That is, until the day he earned his nickname, “Double Down” Donnie.

Nearing the end of a busy day, I worked to wrap things up and discharge my patients. Donnie and I had seen a patient together that we suspected may have prostatitis, an infection of the prostate. Donnie needed to perform a rectal exam to palpate the prostate.

I went to speak with another patient. We would reconvene and discuss his findings after the exam. While speaking with my patient, I heard a few screams down the hall; nothing out of the ordinary in the ER.  Surely if I was needed, a nurse would find me.

Shortly afterwards, Donnie and I met at our work station.  He began describing the exam.  Immediately,  I had the vague feeling that something wasn’t right. Time slowed. His words became drawn out. While describing the rectal exam, he lifted his right hand into the air and moved it back and forth, as if feeling a prostate. My eyes were drawn to his hands. Something was definitely. What was it? Slowly, Donnie’s index and middle finger moved in a slow arc, demonstrating how he had felt the prostate. It looked like he was petting the head of a small pet with gentle back and forth motions. Then suddenly, it hit me. Oh no!

“Donnie! How many fingers did you use during the rectal exam?”

Taken aback, he replied “Two fingers, just like for the pelvic exam, right?”

“No, Donnie, no. We only use one finger for the rectal exam, not two. One finger!”

Realization dawned on his face. “Oh. Man. No wonder he screamed so much.”

And, that is how he became known as “Double Down Donnie.”


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As always, the names and identifying information were changed to protect the privacy of the people in the story.  Ain’t nobody want their friends and family to know they are “Double Down” Donnie.

Tips to reduce the risk of SIDS

Is there anything more terrifying than bringing a baby home from the hospital? I can’t even find my wallet for days at a time. How am I now expected to ensure this tiny human will survive? I can vividly remember watching the baby monitor, eyes straining on the four-inch screen, looking for the rise and fall of our daughter’s chest just to ensure that she was still breathing.  I would hold my breath unit I was lightheaded.  Each breath would distort my vision a little bit but I needed to be sure that she was still breathing.  When I finally saw her chest move I would suck in air in loud gasps.  Don’t worry, Stephanie knew that I was weird long before we had kids together.  She was sitting there holding her breath with me.  The real dilemma came when the monitor had been bumped and was no long pointed on her. Did we dare risk waking her to go into her room to fix the monitor? We eventually would go in her room, and yes, she did wake up almost every time.

By the time we got to our third child, we were a bit less irrational. However, SIDS (Sudden Infant Death Syndrome) is still a real, although rare, threat. The American Academy of Pediatrics update their SIDS guidelines in 2016. Here are a few highlights:


1) The infant should always be placed flat on their back each time they go to sleep until they are 1 year of age. No side sleeping. Honestly, they may be more spitty and their acid reflux might be worse, disturbing any long stretches of sleep that you hope for as a parent. However, upon initiation of the “Back to sleep” campaign in 1994, the U.S. SIDS rate declined by 50%.

2) The infant should sleep on a firm, flat surface. Soft mattresses, pillows, blankets, wedges, crib liners, and anything else in the crib besides a fitted sheet increase the risk of suffocation and should be removed.

3) Breastfeeding is recommended because it is associated with a decrease risk of SIDS. Ideally, babies should be breastfed for at least 6 months.

4) The child should sleep in the parents room but on a separate sleeping surface for the first year of life? Wait, what? The first year? Our eldest only stayed in our room for 5 weeks. Whoops. No word on how a year of having baby in your room will affect your “marital bliss.”

5) Consider using a pacifier for sleep. Pacifier use has been shown to decrease the risk of SIDS. The exact mechanism is not clear. No need to re-insert the pacifier if it falls out during sleep.

6) Avoid smoke exposure, drugs, and alcohol during pregnancy and after birth. I mean…duh. Don’t get high and try to take care of your kid.

7) Keep it cool baby. Avoid overheating your child at night. Dress baby with no more than 1 extra layer of clothes than an adult would wear.   No specific room temperatures were given, but avoid overheating your house.


8) Don’t use cardiorespiratory monitors to reduce the risk of SIDS. They have not been shown to decrease the incidence of SIDS. Pretty sure mom and dad don’t sleep well with all of the false alarms though.

9) Tummy time is good. Supervised time for baby to be awake on their belly helps to prevent the baby from getting a flat head and to help increase muscle development to meet milestones of development.


The full AAP guidelines can be viewed here.


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Hand sanitizer is less effective and tastes worse than hand washing.

The nurse asked me to speak with Ms. Johnson again, whose room I had just left. Apparently, she wasn’t happy that she was about to be discharged. She wanted to be admitted to the hospital overnight for her urinary tract infection. As soon as I entered the room, she exclaimed, “I just tried to kill myself.”

Me: “What? Here in your room? What did you do?”

Ms. Johnson: “I got a handful of the hand sanitizer,” nodding to the metal canister on the wall behind me,” and I ate it. Then, I got another handful, and I ate that too.   I want to kill myself because you won’t admit me to the hospital.”

After calling psychiatry and asking a tech to stay with her to ensure her safety, what did I do?  I did what any other self-respecting ER physician would do. I got the hand sanitizer off the wall from her room and brought it back to my desk.  I was curious, so I gave it a try.  Bad decision. It was worse than I would have imagined. It would probably make the list as one of the top five most foul things I have ever had in my mouth (remember, I have previously blogged about vomit and eye boogers in my mouth).  Ms. Johnson had eaten the sanitizer foam in her room.  I’m sure that the hand gel doesn’t taste good, but I am confident that the foam was even worse.  The taste was so synthetic, it is difficult to describe.  My best attempt to to say that it tastes like a mixture of plastic, gasoline, and ammonia.  Like I said, it was nasty and the taste lasted all night.  The only recognizable ingredient on the bottle was propane.

What did I do next? Naturally, I convinced my scribe (a college aged kid who helps me write my charts) to try it too. She liked it about as much as I did.  And of course, she tried to get the rest of scribes working that night to try it too.

So, what’s the deal with hand sanitizer? We’ll go over its benefits and shortcomings:


The Good:

Hand sanitizer works well on most types of bacteria and viruses. It may even decrease the amount of some types of bacteria on skin even better than soap and water. Hand sanitizer use has been shown to:


1) Prevent the spread of the “stomach bug” illness in homes. (although, it does not work as well as hand washing)

2) Decrease school absenteeism in elementary schools.

3) Reduce illness in college dorms.

Lastly, hand sanitizers are more convenient and are generally not as drying. If you work in a job that calls for repeated hand washing, it is less likely to cause dry, cracked hands.


The Bad:

Hand sanitizer has some limitations.  Here are a few:


1) Washing with soap and water is more effective at removing germs in most circumstances.

2) Alcohol based hand sanitizer needs to contain at least 60% alcohol to be effective.  Hand sanitizers with less alcohol are not as effective at killing germs.  Even if it smells pretty and flowery, ditch the sanitizer if it doesn’t have enough alcohol.

3) Sanitizer may not work well if your hands are dirty and greasy.

4) Sanitizer does not work well on all germs, most notably norovirus, which causes a nasty form of the stomach flu. If someone has vomiting or diarrhea in your house, rely on hand washing instead of hand sanitizer. The sanitizer is not as effective at killing or removing the virus. Also, hand sanitizer may not work as well on certain strands of influenza.

5) It tastes nasty. Seriously, don’t eat it. It could be really bad for you.

In conclusion, wash your hands with water when possible. If you can’t wash, then hand sanitizer is the next best thing.

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You want a TV doctor if your heart stops.

The year was 1995. Braveheart topped the box office. People Magazine named Brad Pitt the Sexiest Man alive. The Macerana went viral. Dr. Green, on NBC’s hit show, ER, was America’s doctor. And boy, was he good; much better than a real-life doctor, infact. Here is a clip of his prowess:

Dr. Green only needs 15 seconds to get his pulseless patient, Mr. Gasner, back. After he became unresponsive and pulseless, CPR was initiated. Dr. Green called out for an “amp of epi.” Luckily for Mr. Gasner, his doctor is a miracle worker.  After 8 modest chest compressions and some gentle coaxing “Come on. Come on back,” Mr. Gasner suddenly awakens with a “Waahh.” Dr. Green got him back before Mr. Gasner could even receive that epi. Dr. Green doesn’t need epi. He is that good.

As it turns out, most TV doctors are better than the doctors in real life. If I ever suffer cardiac arrest and am brought to an ER, I hope that they page the TV doctor. Their success rates are amazing.

In the 90s, the New England Journal of Medicine published the survival rates after cardiac arrest from three popular TV shows (ER, Chicago Hope, and Rescue 911).  The short-term survival rate (the patient’s heart was restarted) was an amazing 75%. The long-term survival (the patient was discharged alive from the hospital) was 67%.

In 2015, a second study evaluated if TV doctors are still as good as they were in the 90s. The researchers published survival rates from Grey’s Anatomy and House.  These doctors were pretty darn good as well. The short-term survival rate was 70%. Only 16% of the survivors died before discharge.

So, how does this stack up against survival rates in the real world? Not so good.

The American Heart Association reports the survivability to hospital discharge (the same as “long term survival”) after cardiac arrest.  These patients were divided into “in hospital” (they coded while in the hospital) and “out-of-hospital” (the code started before they reached the hospital) cardiac arrest.  In 2016, the survival rate of in-hospital cardiac arrest was 24.8%. Out-of-hospital cardiac arrest survival rates were a mere 12%. Much worse than the 67% TV survival rate.

Many factors affect the likelihood of survival after cardiac arrest.   Maybe the greatest factor affecting survival is location.  Some cities have better survival rates than others. At a rate close to 20%, Seattle has the highest survival rate for out-of-hospital arrests. Detroit fairs much poorer with a survival rate of only 3%. Many factors contribute to these differences in survivability, including:

  1. EMS training. Urban areas tend to have better trained EMS personnel and more paramedics.
  2. Physical layout. One of the important factors affecting survival is how long it takes EMS to reach the patient and then how long it takes to transport them to the hospital. The longer it takes, the less likely the patient will survive. So, it follows that rural areas are associated with longer travel times and poorer outcomes.
  3. The health of the population. The Southern states of the U.S. have higher obesity rates and poorer cardiac arrest survival. These factors are likely related.

However, there is one place where one has a much greater chance of surviving an out-of-hospital cardiac arrest. Where, might you ask? A casino. Preferably in Los Vegas, where the survival rate is an astounding 70%. Take that Dr. Green.

Why so high in a casino in Vegas? Two factors: 1) Cameras are everywhere. Time = survivability. So, when a person is witnessed going down, EMS can be dispatched almost immediately. Personnel from the casino can also be sent immediately to initiate CPR. 2) AEDs (automatic external defibrillators) are all over the place as well. Often workers can start chest compressions and use the AED even before the rescue squad has reached the patient.

One last thing about cardiac arrests.  No matter the location, bystander CPR is vital for survivability. Basic CPR should be a skill that all adults possess. Bystander CPR more than doubles the chance of survival. It a simple skill that may just save your loved one’s life.

If you want, you can sign up for a CPR class through the American Red Cross or the American Heart Association.  Maybe we can get Dr. Green to teach it.  He only needed to do 8 compressions to save his patient.

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Why the flu vaccine often fails.

I had forgotten my wallet at home. So, Stephanie drove us to our friend’s daughter’s birthday party.  I am not a good passenger.  Despite a few harrowing moments, we arrived at the party safely.

Having stopped in a no-parking zone. I hopped out to get the girls out of the back. As I placed them on the sidewalk, I said “Don’t worry girls, Daddy will drive next time. Daddy is the better driver.”

Well, that was a stupid thing to say.  I just hoped that I didn’t get in an accident on the way to work the next days.  I didn’t have to wait that long.  I began backing out, thinking of the words I had just uttered, when suddenly…..WHAM.  I had backed into a tree.

Great job Jeff. It’s amazing how quickly I can put my foot in my mouth.

So, it is with great reservation that I share this fact; I have never had the flu. Despite seeing hundreds of friends, family members, and patients with the flu, I’ve gotten lucky. I would like to think that this is because of my incredible hand washing skills and the fact that I get my flu shot every year. But, this is probably not true.

You see, our flu shots stink. Sometimes the flu shots stink a little bit, other times, they stink a lot. Last year, it was 47% effective. Sounds pretty crappy, right? Well, this was actually a good year. The year before, the flu shot was 10% effective. So, why is the it so bad? We’ll cover a few of the reasons:


1) The flu vaccine is selected almost a year before the flu arrives.

The World Health Organization plays a guessing game the year before. They try to pick the flu strains that they believe are the most likely to circulate in the Northern Hemisphere the next year. Sometimes, they guess well. Other times, they don’t. If they guess wrong, the flu vaccine won’t be as effective.


2) The flu virus mutates.

The flu vaccine targets a protein on the surface of the virus, called hemagglutinin. However, this protein mutates frequently. When it mutates, the vaccine is not as effective.


3) The nasal spray vaccine hasn’t been effective recently.

This year, the CDC did not recommended using the nasal spray vaccine (FluMist) because it was not effective at preventing the flu each of the last three years. While the cause is not clearly known, it has been postulated that FluMist does not cause enough of an immune response from the recipient to provide protection.


4) Repeated vaccinations may not work as well.

Healthcare workers, children, and the elderly are strongly encouraged to receive the flu vaccine each year. One study showed that immunizations in consecutive years may decrease the effectiveness of the flu vaccine. It is not entirely clear why this happens. A person who received the flu vaccine the year before may not be able to mount as vigorous of an immune response because they already have some remaining antibodies from the previous year’s vaccine.


5) The protection from the flu vaccine may not last long enough.

I, along with many health care workers, am required to receive the flu vaccine before the flu hits. This year, I had to get vaccinated before October 1st.  The flu vaccine package insert says that immunity will last one year.  However, some suggest the protection may only last 92-100 days (or a little over 3 months). If the latter is correct, then an immunization in early fall would be obsolete now.


6) Not enough people get vaccinated.

Vaccines provide “herd immunity.” The more people who are vaccinated, the more protection the vaccine provides for the population at large. The CDC reports that only 40% of people in the U.S. are vaccinated against the flu. If 5% more of the population was vaccinated, an additional 500,000 cases of the flu and 6,000 hospitalizations due to the flu could be prevented.


Just to be clear, we are supporters of the flu vaccine, especially in children, pregnant women, the elderly, and people with chronic diseases. Last year, it prevented an estimated 5 million cases of the flu, 2.5 million medical visits, and 71,000 hospitalizations.  The current flu vaccine is not great, but it is definitely better than not receiving it at all.


The future of the vaccine:

flu virus

Work is being done to improve the vaccine. One area of cutting edge research is to develop a “universal influenza vaccine.” Instead of targeting the rapidly mutating protein, hemagglutinin, researchers are aiming to develop a vaccine against the “stalk” that holds the hemagglutinin.  This part of the virus is thought to mutate at a much slower rate. The universal vaccine could provide between 20 years to a lifetime of immunity. The bad news is this vaccine is at least 10-15 years away.

In the mean time, get your flu vaccine (even though it stinks) and wash your hands!


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This post heavily relied upon an interesting article in Infectious Diseases in Children from January 2017 entitled “Influenza vaccine desperately needs improvement.”

Are there any medical benefits to eating the placenta?

After 14 hours of grueling labor, our son had finally arrived.  He slept silently on Stephanie’s chest.  We were all exhausted (ok, so she did more of the heavy lifting, but I was still tired).

So, when the nurse asked “Did you have any plans for the placenta?,” I was impressed that Stephanie had the energy to quip, “I have some great recipes I have been dying to try.”  Her tone was obviously sarcastic.

One of the ladies in the room spoke up, “I dehydrated and encapsulated my placenta.  It works great for postpartum depression.”

The comment was a little surprising, slightly awkward, and definitely too much information.  But hey, whatever.  To each her own.  It got me thinking about placentas though. I decided to delve a little deeper.

Most animals on earth eat their placenta, or “afterbirth.”  However, with the exception of very few cultures, the practice of placentophagy (eating the placenta) among humans is exceedingly rare.  The practice is becoming increasingly common in one people group, though, namely affluent, educated, white, American women.

Why are women consuming their placenta?  Proponents of placentophagy purport the follow benefits:


1)  To stabilize the mood and treat postpartum depression. This is thought to be due to the hormones present in the placenta, particularly estrogen.

Verdict:  Inconclusive


2) To Increase milk production of the mother. Once again, thought to be related to the consumption of hormones from the palcenta.

Verdict:  Inconclusive


3) To Decrease bleeding after delivery. Oxytocin, which helps to contract the uterus, is present in the placenta. If the mother consumes more oxytocin, the thought is that her uterus will contract more = less bleeding.

Verdict: Inconclusive

These first three claims have been studied but the results are inconclusive.  While oxytocin and estrogen are present in the placenta, it is not clear if ingesting the amount in the placenta has any measureable affect on the mother’s mood, mild production or bleeding after delivery.


4) To Enhance recovery. This is thought to be secondary to the consumption of iron from the placenta. More iron equals more hemoglobin, which means less anemia and more energy.

Verdict:  False. The placenta has not been proven to decrease anemia.

Although the placenta does contain iron, it is not enough to cause any significant improvement in iron studies of the mother. Therefore, it does not improve the mother’s anemia.


5) To Decreased pain after delivery.

Verdict:  Inconclusive but promising.


This claim has the most promise thus far.  Although it has yet to be substantiated in humans, it has been proven in rats.  The rat placenta contains a chemical (called Placental Opioid-Enhancing Factor, or POEF), which helps decrease pain sensation in rats.  In one study, the rats were fed rat placenta.  I am not going to go into how one can tell a rat is on pain or not, but apparently it’s termed a “tail flick test.”  Anyways, the POEF seems to work on the same part of the brain as narcotics (like percocet or heroin), and helps to decrease pain perception in rats.  While it has been proven in rats, more studies are needed to see if the human placenta has similar effects.


In the end, many questions remain about the benefits of consuming the placenta. If you are feeling hungry, here are some recipes for placenta. The placenta smoothie seems particularly enticing. There is nothing like drinkable uncooked placenta.

The verdict may still be out on its benefits, but I’m pretty sure I’ll pass.


If you follow pop culture, you can read here why Kim Kardashian eats her own placenta.

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My first “welcome to the ER” moment.

It didn’t take long for me to realize that I don’t have the luxury of believing my patients all of the time.  In fact, I learned this lesson the very first day I worked in an ER.

It was a decade ago now.  I was a fourth year medical student and was considering a career in emergency medicine.  This was my first “welcome to the ER” moment.

I went to see a 25-year-old man.  We’ll call him Jack.  Jack had come to the ER because he was considering suicide.  I entered his room, closed the door, and sat down beside Jack.  To be honest, this interaction really affected me.  My heart felt broken that this man, similar in age to me, was considering killing himself.  Jack told me that his life was stressful and that he and his girlfriend were on a break.  Jack couldn’t take it any more and wanted to kill himself.

It broke my heart.  I pulled my chair up beside him, placed my hand on his shoulder, and promised him that we would take care of him.  I told Jack how glad I was that he had come into the ER today instead of trying to hurt himself.  Almost in tears, I left the room.

I hadn’t walked five steps when a police officer grabbed my arm and spoked in a hurried whisper.  “Is Jack going to be discharged now?  When is he going to be sent home?”

“Gosh, I don’t know. I’m a student. I don’t make that decision….Why?”

“We have been trying to find this guy for a long time.  One of my partners saw him walk through the ER, so he called for back-up.”

It was then that I noticed the five or six other officers placed strategically around the ER.  Each was close to Jack’s room but could not be seen by Jack’s bed.

The officer continued, “You see, Jack is a murderer.  He is the suspect in several different homicides.  We just found out where he has been staying when he suddenly turned up here.”

“You let me go into his room and shut the door believing that he is a mass murderer?” I was in shock.

As it turns out, Jack wasn’t really suicidal at all. Apparently, he had gotten word that the police knew where he was staying.  Jack had come to the ER hoping to be admitted to the psych ward.  He thought that if he came in voluntarily, he would be able to leave suddenly and escape from the police again.   This was his get out of jail plan.

Lesson learned. While, I shouldn’t believe that every patient is lying to me, I won’t be completely surprised when I found out that they are.



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As always, all identifying information was changed to protect the patient’s identity.


Cracking your knuckles is good for you…maybe?

Maybe not.

Years of hard work as a plumber, farmer, and refurbishing tools left my grandfather’s hands calloused and incredibly strong.  They were vice grips, and he knew it.  With a coy grin, he would try to find any excuse to shake my hand.  I’m no dummy.  I wouldn’t touch those things.  On the rare occasion when I let my guard drop and absentmindedly offered my hand, I would soon regret my negligence.  Does it mean I’m a wimp that at 20-years-old I couldn’t shake my 90-year-old grandfather’s hand due to the pain?  It hurt, okay.

Meanwhile, at an early age, I had developed into a knuckle cracker.  It is so satisfying to feel that “pop.”  Whenever my grandmother heard it, she would put on a scowl and say “Don’t do that, Jeff.  You’ll give yourself arthritis.”  I have to admit it though, I had an ulterior motive.  For some reason, I had convinced myself that cracking my knuckles would make my knuckles big.  And, of course, bigger knuckles meant stronger hands, right?  I was on my way to making my own vice grips.

It didn’t work.  If my grandfather were still alive today, he would still crush me.  But, I have been cracking my knuckles for the last 30 years.  What is going to happen now?  Will I get arthritis?  And, why do my fingers feel better and less stiff after I crack them?


What causes the sound when we crack our knuckles?

The truth is, we don’t know.  Many theories have been proposed, but two seem most likely.  Both describe gas bubbles that form in the joint fluid.  The first theory says the sound we hear when cracking our knuckles comes from air bubbles in the joint fluid that burst open.  The second theory states that the sound is caused from sudden pressure changes in the joint.  This pressure change causes gas bubbles to be formed, making the sound.  The exact cause is still up for debate.


Does it cause arthritis?

Dr. Unger seems like a happy fellow.

No.  Booyah Grandma!

Dr. Donald Unger is a pioneer in knuckle cracking and self control.  He is a physician and for the last 60 years has been cracking the knuckles in his left hand every day.  He never cracked the knuckles in his right hand.  And, 60 years later, he had no more arthritis in his right hand than his left.

Several clinical trials have confirmed similar findings.  Prolonged and regular knuckle cracking does not increase your chance of developing arthritis.  One study from 1990 did show that regular knuckle crackers are more likely to develop hand swelling and decreased hand strength.  However, these results have not been duplicated and their validity has been questioned.


Does knuckle cracking provide any benefits?

Besides feeling awesome?  Possibly.  Knuckle cracking causes joints to become more relaxed and increases the range of motion of that joint.  This is likely why your fingers feel less stiff after you crack your knuckles.  No word though if this flexibility is just a short term benefit or if it persists.

So, crack away, and don’t shake my hand too hard.  Please.


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3 tips to reduce your child’s eczema and dry winter skin

  1. My daughter has this little patch of eczema at her wrist that gets worse when the weather is cold. When I remember to apply moisturizer and steroid cream, it goes away. However, if I don’t actively monitor it during the winter months, it comes back, and often with a vengeance. With the arrival of the baby, I have slacked off a bit. Yesterday after bath time, I noticed it was quite red and irritated. She even cried a little bit when I touched it. #momfail #mommyguilt

Once the heat is turned on at home, the humidity is taken out of the air. Most heating systems suck out the moisture and pump out dry, hot air.  Low humidity levels wreak havoc on our skin. The face, hands and feet are the most commonly affected.

So how can we protect our little one’s skin?

  1.  Moisturize.

This seems like the most obvious answer, but it’s important to time it right and use the right moisturizer. Moisturizer restores hydration to the skin. The optimal time to put it on is immediately following a bath or shower when the skin is toweled off but still mildly damp. The best moisturizers “seal in” moisture/water before it evaporates. Ointments such as Vaseline or Aquaphor are completely oil-based and are the best for extremely dry skin. Creams such as Cetaphil are a mix of oil and water and don’t have as “sticky” of a feel. Lotions have more water as a base than creams. They should be used preventively rather than reactively. So quick re-cap: for rough, itchy dry skin, an ointment is the best. For daily prevention, use a lotion or cream.


2. Don’t further irritate the skin.

We want to protect our skin barrier. Hot water irritates the skin. Certain soaps can also be irritating such as the traditional Irish Spring and Dial soaps. Interestingly enough, we buy Irish Spring in bulk from Costco because my husband likes that it dries out his skin (I’m not sure why he likes this, but he does). This is not what we use for the kiddos. Dove and Cetaphil are much more gentle on the skin.


  1. Add back the humidity.

Something about a humidifier just seems soothing to me. I love the sound and feel of the cool mist. Humidifiers essentially add water vapor back into the air and can help dry skin. However, like with anything, there can be too much of a good thing. If the air is too humid, mold and mildew can result. Also, it’s important to keep your humidifier clean as it is pumping small particles of water in to the air you breathe.  Mold in humidifier = mold being pumped into the air.  Gross.  You can find tips for cleaning your humidifier here.


So there you have it, winter skin care in a nutshell.

Anyone else counting down the days of winter? I love playing with my kids in the snow (not driving in it!) and Christmas, but I don’t love cold weather and the increased amount of sickness that winter brings, especially with my little guy (now 7 weeks old).



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